In the aftermath of the horrifying killing spree at Sandy Hook Elementary School in Newtown, many have sought — some in an attempt to steer the discourse away from considerations of the need for stricter gun control measures — to cast the tragedy as a shocking revelation of this country's failure to provide adequate mental health care for all of its citizens.
There is indeed a vast unmet need for mental health treatment in the United States, but this is by no means shocking or a revelation. It is not even news.
Thanks to large-scale studies such as the Epidemiological Catchment Area program (administered in the early 1980s) and the National Comorbidity Survey (originally conducted in the early 1990s, with a replication in the early 2000s), those in the field of mental health have known for decades that less than a third of Americans meeting diagnostic criteria for a mental disorder receive treatment. We should all be glad that this tragic gap in our health care system is receiving attention. However, responding to a mass murder by invoking the need for more widespread mental health services is likely to be counterproductive.
There can be no doubt that something is seriously wrong with any person capable of carrying out a shooting spree that kills dozens of innocent people, most of whom are young children. The vast majority of people with mental disorders, however, are not violent, and only a minuscule percentage of violence in the U.S. is attributable to psychiatric illness, as data from the Epidemiological Catchment Area program have shown.
In fact, even the presence of a serious mental illness is not independently predictive of violent behavior, according to more recent findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Research has demonstrated that people with mental disorders are actually much more likely than the average person to be the victims of violence.
Why then, despite these facts, is the immediate reaction of many Americans upon learning of a tragic massacre to raise the issue of the need for more widespread mental health screening and intervention? The answer, at least in part, seems to be that perceptions of dangerousness and violent tendencies are a deeply ingrained part of the stigma that accompanies mental illness — a stigma that adds tremendously to the immense burden endured by people with psychiatric disorders.
Media reports that geneticists have been brought into the Newtown case to study the shooter's DNA for clues about his psychiatric status are unlikely to help matters. Recent psychological research has shown rather consistently that genetic and otherwise biological conceptualizations of psychopathology are associated with stigmatizing attitudes toward the mentally ill. Although conventional wisdom often holds that treating mental illness as a "disease like any other" — caused by biological abnormalities — should improve attitudes, studies have actually linked viewing mental disorders as brain defects or genetic aberrations to the perception of mentally ill people as dangerous, incurable and deserving of social rejection.
Linking mental illness to violence and casting people with psychiatric disorders as menacing threats to society — which many have done, implicitly or explicitly, in the wake of the Newtown tragedy — serves only to exacerbate the pervasive stigmatization of mental illness. We do not even know if the Sandy Hook shooter did suffer from a mental disorder or what role psychopathology might have played in the massacre. But we do know that embarrassment stemming from the stigma of mental illness can deter people who need treatment from seeking it.
If we truly want mental health services to reach a greater proportion of those who need them, then, we can start by challenging the association that exists in the public imagination between mental illness and horrific acts of violence.
Matthew S. Lebowitz, 26, is a doctoral student in the department of psychology at Yale University.
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