Virginia Tech Tragedy Sharpens Focus on Relationship Between Violence and Mental Illness

Paul Ballas Health Guide
  • The April 16th shooting at Virginia Tech which led to over 30 students and faculty killed was the worst of its kind in U.S. history.  There has been much discussion about the mental state of the shooter, Seung Hui Cho, particularly his evaluation and psychiatric hospitalization for imminent danger to himself.  Several psychiatrists have suggested that he had symptoms consistent with a form of schizophrenia, noting his isolation and unusual behavior weeks prior to the attack.  

    What I would like to point out from the beginning is that in the absence of actual medical records or a face-to-face interview, it is difficult to determine what psychiatric disorder Seung Hui Cho was suffering from.  Clearly he was a disturbed young man, though I would hesitate to diagnose him with any psychiatric illness at this point without additional information.  In light of these recent events, I felt it would be appropriate to discuss several aspects of violence and schizophrenia in this blog.  
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    Most published studies do confirm that there is a relationship between schizophrenia and violence.  The risk tends to be higher in acute psychosis, and is much higher if the person has an active substance abuse problem.  Now what this relationship actually means gets a little complicated.  First of all, violence is defined in very different ways in different studies.  Is violence a premeditated act of assault, or is it an impulsive lashing out at the first person they meet?  Is it a handgun crime, or pushing a staff member?  Sometimes threats are included in the definition of violence.  In fact, it’s very tough to find two studies that define violence in the same way.  

    The fact remains that many studies using many different definitions still show that there is an association between the risk of violent behavior and the diagnosis of schizophrenia.  Despite this increased risk, schizophrenia accounts for only a small amount of violence in society.  In fact, research shows that less than 10% of violent crime in society is attributed to people with schizophrenia.  

    Compared to other risk factors like young age and male gender, the risk of violence due to the diagnosis of schizophrenia is quite small.  This is a key point; research over the past 25 years has shown increased relative risk of violence in people with schizophrenia, but the absolute risk of people with schizophrenia committing acts of violence is quite small.  

    Mental illness has a long history of being stigmatized by society, particularly prior to the age of effective medications, and it is unfortunate that psychiatric disorders often come to public light when there is a tragedy like the recent one in Virginia.  Much of the violence in our society has a lot more to do with other, non-psychiatric factors, such as economics,  criminal activities, etc.  How our society treats people with severe mental illness has a lot to do with these issues.  My next blog will discuss how the interface between psychiatric services and the criminal justice system can impact a community as a whole.  
Published On: April 30, 2007