Paranoid Schizophrenia and Violence

by Jack Fowler

Over the weekend, E. Fuller Torrey and Mona Charen posted about the Aurora massacre and a murderer who is by all counts severely disturbed. As Publisher, and also as the Chairman of the American Mental Health Foundation, I read them with great interest. My AMHF colleague, William van Ornum, our Director of Research and a professor of psychology at Marist College, shared his thoughts on something Mona wrote, which I in turn share here.

“So a system for checking in on those with paranoid schizophrenia and other serious mental illnesses would be ideal.”

A complicated assertion.

On the one hand, only an extremely tiny percentage of persons with paranoid schizophrenia make the news for violence.

The vast majority of those with paranoid schizophrenia suffer from their delusions and hallucinations and don’t act out. They are more fearful than fear-inspiring. And it is true that paranoid schizophrenia is often the most successfully treated as medications target the so-called “positive symptoms” of schizophrenia — delusions and hallucinations. (The “negative symptoms” include social withdrawal, eccentricity…the meds do not help these deficits.)

Torrey’s book, Surviving Schizophrenia, notes the positive prognosis for many with paranoid schizophrenia. They may have one episode, and never another, or they may have intermittent episodes requiring hospitalization that is successful in getting them on the right dosage of medication. When I worked on an inpatient unit, it was amazing to see how successfully some episodes of paranoid schizophrenia could be treated.

So we have to be careful here. But yes, “paranoid schizophrenia” does yield violent persons.

I think one of the best ideas is to educate the judiciary. Many times family members, physicians, etc. approach for a court order for commitment that is denied. When this occurs for ideological reasons that overlook/deny a history of documented threats/violent acting out, a great disservice is done to patient, family, and public.

Perhaps all justices who deal with these matters should read E. Fuller Torrey’s books. Surviving Schizophrenia is a gem. Also, at AMHF, we have provided information on Torrey, particularly related to “Kendra’s Law” (involuntary treatment) in New York State.

Professor van Ornum may also be found writing on NRO’s Right Field sports blog: The huge Chicago Cubs fan reported from Cooperstown this weekend on Ron Santo’s induction into the Hall of Fame.