Opponents of psychiatry use 3 main strategies when discussing schizophrenia and other forms of psychotic illness: deny it, romanticize it, or trivialize it. Thus, a recent “white paper” by the British Psychological Society (“Understanding Psychosis and Schizophrenia”) blandly declared, “Many of us hear voices occasionally, or have fears or beliefs that those around us do not share.”1 This shallow trivialization does scant justice to the nightmarish reality of psychosis, which is vividly detailed by Deborah Danner, a 66-year-old woman with self- described schizophrenia, who was shot to death in October by a New York City policeman.
The New York Times’ release of Ms. Danner’s eerily prescient 2012 essay, “Living With Schizophrenia,” gives the lie to the misleading narratives of antipsychiatry.2
In her essay, Ms. Danner described schizophrenia as “a curse,” with the only saving grace being “. . . it’s not a fatal disease.” (That’s true, although the rate of suicide among persons with schizophrenia is about 10 times that of the general population.3) For Ms. Danner, as for millions who suffer with schizophrenia and related disorders, her illness is like having “. . . the proverbial ‘Sword of Damocles’. . .” hanging over one’s head. She recounted memories of “roaming the streets of New York in the wee hours of the morning” with the intention of finding “. . . a public place to kill myself . . . .”
Ms. Danner lamented the lack of mental health training among police, and the plight of both incarcerated and homeless persons with severe mental illness. And far from regarding mental illness as a “myth,” Ms. Danner rightly noted, “Mental illness is just that, an illness, a treatable illness and most of the public needs to be educated about that fact.” Instead, many in the general public (including some of Ms. Danner’s employers) regard persons with schizophrenia as terribly dangerous or violent, leading to unwarranted discrimination.
To be sure, untreated psychotic illness, especially if complicated by substance abuse, does substantially increase the risk of violence toward oneself or others.4 However, schizophrenia by itself is only weakly associated with perpetration of violence, and when adequately treated, poses a very low risk of violence toward others.4 And, fortunately, suicide risk in schizophrenia can be significantly reduced with antipsychotic medication.5
Unfortunately, in the public perception, “. . . there remains a focus on violence perpetration [by those with mental illness] to the neglect of victimization” within this vulnerable population.6 Yet when personality disorder and comorbid substance abuse are taken out of the equation, persons with mental illness who live in the community are more likely to be victims than perpetrators of violence, at rates of victimization several times higher than that in the general population.6
Ms. Danner observed that “. . . generally speaking, those who don’t suffer [with mental illness] believe the worst of those of us who do. We’re treated with suspicion as liars . . . .” This is not surprising. The notion that people with schizophrenia are “liars” was actually propounded by one of psychiatry’s most famous critics, the late Dr. Thomas Szasz—who declared that mental illness is merely “a myth” or a “metaphorical” illness. But in his 1996 book, The Meaning of Mind, Szasz went even further, writing:
I believe viewing the schizophrenic as a liar would advance our understanding of schizophrenia. What does he lie about? Principally about his own anxieties, bewilderments, confusions, deficiencies and self-deception.7
1. Cooke A (Ed). Understanding Psychosis and Schizophrenia. The British Psychological Society. http://www.bps.org.uk/networks-and-communities/member-microsite/division-clinical-psychology/understanding-psychosis-and-schizophrenia. Accessed November 7, 2016.
2. Danner D. Living With Schizophrenia. January 28, 2019. Posted by The New York Times, October 19, 2016. http://www.nytimes.com/interactive/2016/10/19/nyregion/document-Living-With-Schizophrenia-by-Deborah-Danner.html. Accessed November 7, 2016.
3. Baxter D, Appleby L. Case register study of suicide risk in mental disorders.
Br J Psychiatry. 1999;175:322-326.
4. Are People with Serious Mental Illness Who Are Not Being Treated
Dangerous? Treatment Advocacy Center. March 2014. http://www.treatmentadvocacycenter.org/storage/documents/violent-behavior-backgrounder.pdf. Accessed November 7, 2016.
5. Haukka J, Tiihonen J, Härkänen T, et al. Association between medication and risk of suicide, attempted suicide and death in nationwide cohort of suicidal patients with schizophrenia. Pharmacoepidemiol Drug Saf. 2008;17:686-96.
6. Desmarais SL, Van Dorn RA, Johnson KL, et al. Community violence perpetration and victimization among adults with mental illness. Am J Public Health. 2014;104:2342-2349.
7. Szasz TS: The Meaning of Mind: Language, Morality, and Neuroscience. Santa Barbara, CA: Praeger; 1996.
8. Bakhshi K, Chance SA. The neuropathology of schizophrenia: A selective review of past studies and emerging themes in brain structure and cytoarchitecture. Neuroscience. 2015;303:82-102.
9. Woo TU. Neurobiology of schizophrenia onset. Curr Top Behav Neurosci. 2014;16:267-295.
10. Iritani S. What happens in the brain of schizophrenia patients? An investigation from the viewpoint of neuropathology. Nagoya J Med Sci. 2013;75:11-28.
11. Johnson A, Candisky C. Mental-health system overwhelmed, underfunded. Columbus Dispatch. May 26, 2013. http://www.dispatch.com/content/stories/local/2013/05/26/overwhelmed-underfunded.html. Accessed November 7, 2016.
12. Earley P. Foreword. In: Miller D, Hanson A. Committed. The Battle Over Involuntary Psychiatric Care. Baltimore: Johns Hopkins University Press; 2016.