Political Violence and Mental Health

kkkGiven the fact that the alleged murderer of Jo Cox has been charged, it is important that any discussion of the surrounding issues is contextualized by the requirements of the criminal justice system. There is guidance on reporting restrictions and contempt of court provided by the Crown Prosecution Service here.

But if we step outside this immediate British context, to consider another “lone wolf”, Omar Mateen, who committed the appalling slaughter at the Pulse night club in Orlando, then there are contested accounts in the mainstream media whether his motivation was the political expression of jihadi terrorism, or due to poor mental health. According to CBS:

The suspect had been married to Sitora Yusufiy for several months before divorcing in 2011, Milton reports.

“He was mentally unstable and mentally ill,” Yusufiy told reporters in Boulder, Colorado. Although records show the couple didn’t divorce for two years after the marriage, Yusiufiy said she was actually only with Mateen for four months because he was abusive. She said he would not let her speak to her family and that family members had to come and literally pull her out of his arms.

Yusufiy said she was “devastated, shocked, started shaking and crying” when she heard about the shooting, but she attributed the violence to his mental illness, not any alliance with terrorist groups.

It is surprising the speed with which commentators take as good coin the mental health assessments of non-professionals with a link to the alleged perpetrators, and this betrays “common-sense” misconceptions about mental health. Of course crimes are committed by individuals, and the mental health of those individuals needs to be professionally assessed, but as an article by three practicising mental health professionals, Maryam Hosseini, Christina Girgis and Faiza Khan-Pastula, recently argued in connection with reporting of Omar Mateen.

Lately, the term mental illness has come up a lot when we talk about mass shootings. For many, words such as “bipolar” have become almost synonymous with violent and unpredictable. It’s human to look for reasons, to find any cause that could explain senseless or atrocious acts. But blaming “mental illness” is a dangerous precedent that moves the conversation in the wrong direction.

The fact is, we cannot know yet why Mateen took his disastrous course; the reasons are likely complex, and we are in no position to hazard a guess, much less diagnose from afar.… As psychiatrists, it scares us whenever we read the words bipolar in relation to mass shootings. It increases the stigma against an already vulnerable population without addressing any attributable cause.

… Mental illness is a broad term, one that can mean a lot of things to a lot of people. It doesn’t really help us understand a person’s state of mind, and it does not always correlate to an actual psychiatric diagnosis.

The term “bipolar” has become a colloquialism. It has come to mean someone who is irritable, has frequent mood swings, outbursts of rage, lacks restraint. … But that’s not bipolar disorder. Bipolar disorder is not outbursts of anger. In fact, when someone has daily mood swings from minute to minute with trivial triggers, bipolar disorder is a pretty unlikely diagnosis.

Bipolar disorder occurs in 2.6% of the population, according to the National Institutes of Mental Health, and is characterized by distinct episodes of depression, distinct episodes of mania or hypomania, and distinct episodes of normal mood, or euthymia. It is not a set of pervasive characteristics that a person displays daily throughout his or her life. It is an illness, separate and distinct from the person, which has no bearing on his or her character and is not related to personality traits. This is an important distinction to make, particularly when we look at risk factors for violence. … In fact, most times what the public calls bipolar disorder or generalizes to be “mental illness” could actually qualify as antisocial personality disorder or some variant. Those people know the difference between right and wrong and may feel no remorse for their actions.

Jessica Rosenberg, from Long Island University, argues in a persuasive paper on “Mass shootings and Mental Health Policy” that popular debate linking high profile incidents of violence with poor mental health has had a prejudicial effect, not only increasing the stigma attending mental health, but also leading to some changes in public health policy that have been ill considered, enacted as they were in the highly politically and emotionally charged aftermath of violent events which may not have even been associated with actual mental illness.

Let us be clear, the connection between violence and mental health is a complex one, but most violence is not attributable to poor mental health:

Research suggests that demographic and economic factors, such as being young, male, and of lower socioeconomic status, are the major determinants of violence (Stuart, 2003). Although teasing out a causal connection between mental illness and violence is difficult, a large body of research shows that violence by people with serious mental illness, such as schizophrenia or bipolar disorder, is rare and accounts for approximately only 4 – 5% of violent acts (American Psychiatric Association, 1994; Appelbaum & Swanson, 2010; Fazel & Grann, 2006; Monahan et al., 2001). Moreover, when people with mental illness are violent, it is almost always interpersonal (87%), typically occurs in the home, and the targets are usually family and/or friends. In contrast, the vast majority of violent acts are associated with crime, not mental illness (Stuart, 2003). Persons with mental illness are far more likely to be victims, rather than perpetrators, of violence (Hiday, 1995; U.S. Department of Health & Human Services [HHS], 1999).

As a caveat to that, there is a linkage between co-occurring psychiatric disorders and substance abuse, but the psychoactive effect of certain substances, primarily cocaine, methamphetamine, and alcohol, is considered to contribute to violence even in those without underlying mental health issues. The social problem here is substance abuse, not mental health.

Consultant Clinical Psychologist, Dr Elie Godsi, who has worked with a large number of perpetrators of violence, including at Rampton Maximum Secure Hospital, argues in his excellent book “Violence in Society: Reality Behind Violent Crime” that even some of those who commit heinous acts and find themselves in secure hospitals may in fact have been abnormally socialized so that the extreme violence was to them a rational response to situations as they perceived them, rather than being due to an underlying organic or biological illness. In some such cases therefore violence may be the result of an extreme social problem rather than an issue of individual psychopathology.

As Godsi argues:

We are living within a cultural frameworks that predominantly distort and obscure the reality of violence in society. The unquestioned belief in medical and scientific explanations, allied to a general culture in which genetics and biology are given massive prominence over environmental explanations, all adds up to a society that continues to exist in ignorance and collective denial.

The alacrity with which some, including liberals and those on the left, leap to an assumed link between political violence and mental health, including the uncritical acceptance of “common-sense” attribution of poor mental health by non-professionals, can be prejudicial against acknowledging that political violence can be a deliberate act. As Randall Law, a historian specializing in the study of terrorism, states:

Individuals or groups choose to commit terrorist acts as part of a process or rational and conscious decision making within particular political and cultural contexts. Thus terrorism is not, as it is often colloquially described, a kind of madness …. Terrorism is a communicative act intended to influence the behavior of one or more audiences.

The cultural presumption that Godsi refers to, of seeking genetic or biological explanations, chimes with the legacy “deep” theories of mental health, which were really quite poor science as they were based upon unfalsifiable propositions that can never be adequately tested, including narrative case studies, testimonials and clinical anecdotes. There is discussion of this by Lilliston and Shepherd in their article “New Religious Movements and Mental Health”. These deep theories continue to have a disproportionate hold on popular understanding of mental health, although they are now relatively marginal among clinical professionals.

For example, for Freud and his followers in the psychoanalytic school, good mental health is characterized by normal adjustment to the constraints of social norms, so that a well-adjusted person has “normative personal and sexual relationships,is a productive worker in a satisfying job, values most highly a normative family life, embraces the standard civic values and virtues and makes some contribution to the maintenance of those larger societal values”.

Other “deep” theories with a more “humanistic” perspective, for example, those of Carl Rogers, view humans as transcending their animal nature and having a need to pursue self-actualisation and a creative quest for understanding. Yet this still defines psychopathology in terms of social conformity, of deviation from an expected norm.

If good mental health is judged by the absence of behaviours which we assume should be evidence of psychopathology, then we end up with an unfalsifiable proposition that a person who acts crazy is crazy.

In the context of political terrorism, then we need to understand the degree to which the vulnerability landscape has shifted, to include so called “leaderless resistance”. The concept was made clear by Louis Beam, former Grand Dragon of the Texas Ku Klux Klan, who in 1983 called upon “like minded individuals to form independent cells that … … commit acts of terrorism without coordination from above”. The so-called “lone wolf” terrorists, who act either alone or in concert with a few close confederates, but who feel connected to a larger community through publications, both printed or on-line, and through interactions with a network of possibly geographically dispersed co-thinkers.

It is perhaps useful to characterize the supporters of modern Jihadism as a Cult or Sect though a particularly malign one; and it is a small stretch from that to seeing the parallels with the networks of white nationalist extremists. I offer this as a proposition worthy of consideration, rather than a firm conclusion, but there is a body of research that may be useful in evaluating this aspect of the terrorist threat,

The reason this is worth considering is that a corrective to the common-sense idea that someone who believes or acts differently may be crazy is consideration that they may be judging themselves against values and social expectations that are different from the mainstream, but are normative for their own subculture.

It is worth considering that groups like the English Defence League and Britain First both provide a mutual support network, and also popularize the idea that political, and if necessary violent, action can reconfigure society towards their own conception of it.

On the left we are accustomed to the energy with which left groups respond to mass strikes or political crises, hoping that this will lead to a breakthrough, and their very orthogonality to the modalities of mainstream politics can mean that they are dynamic and effective at mobilizing popular campaigns. It would be easy to see how a popular campaign by mainstream politicians based upon opposition to immigration could excite far right extremists, and increase their motivation towards demonstrative violence, for which they have been planning for and fantasizing about for years.

The work of Dr Marc Gallanter, of the American Psychiatric Association’s Committee on Psychiatry and Religion suggests that, perhaps contrary to expectation, mental health within members of Cults is actually better than that of the general population. Lilliston and Shepherd suggest some reasons why that may be the case, that membership of a tight-knit, counter-cultural group may be associated with a more clearly evaluated value system, and will foster a belief in their own self-efficacy, that is, they may be confident that their actions are leading to the results that they want to see. Both of these are associated with good coping mechanisms, and therefore associated with a good model of adaptive functioning when confronted with “stressors”, which is indicative of good mental health.

The truth about violent white supremacist groups is that they are not “crazy”, but they are dangerous. These are people who fundamentally oppose the tolerant values of our society, and are prepared to use violence to achieve what they want. We need to be very clear that this is a problem of politics, and not of mental health.

An expanded version of this article appears at Socialist Unity

  1. I didn’t follow

    If good mental health is judged by the absence of behaviours which we assume should be evidence of psychopathology, then we end up with an unfalsifiable proposition that a person who acts crazy is crazy.

    If ‘well-coordinated’ is judged by the absence of behavours that we take to be clumsy that does not result in an unfalsifiable proposition that clumsy is clumsy.

    It seems to me that the problem in the above quoted statement lies in the word “assume”. If “assume should be” is replaced by “that we have good grounds for taking as” then the circularity disappears.

  2. Violence is always and in every example the continuation of politics by other means. It is politics not mental illness that drives violence but of course the mentally ill are more vulnerable to being turned into the violent instrument of somebody else’s politics.

  3. It’s very difficult to draw the line between mental illness and political violence, but I do think there must be something of both in an act of violence perpetrated against other human beings who hold different political views to the one who kill them. What is certain is that mentally unstable people who are not well informed can easily be manipulated by others who incite them to kill. I should think psychiatry expertise is required in this.

  4. Not massively easy to follow, a bit too much of the “I’m very clever aren’t I?” in the article to be honest.

    But if my instinct is right that Andy’s saying: “Don’t make ‘mental-health’ excuses for the murdering Nazi filth who committed last week’s foul atrocity,” then he’s absolutely right – spot on.

  5. An underlying issue is the connection between believing crazy things and actually being individually crazy. That’s difficult because most people have crazy beliefs or one sort or another. One question is the degree of individual commitment to those beliefs and that has to be related to the surrounding social attitude to them.

    Thus it is is generally okay to believe that Jesus was born of a virgin miraculously impregnated by God because believing such things is “normal”. It is not therefore likely to generate a dysfunction between the believer and the surrounding society. But when the beliefs in question are not generally regarded as acceptable or normal then a frictional edge is added and it becomes a question of how far the believer is prepared to take that. If they are prepared to go a long way without rational justification then there comes a point at which crazy beliefs end up generating individual craziness.

    And let’s not say it is just a phenomenon of right-wing politics. The left has its share of crazies who are prepared to do violent things to pursue their nutty beliefs. Let’s consider the problem in the round and not just pin it on people at the opposite end of the political spectrum.

  6. Apart from the EdL have never suggested using violence, I might point out that even Jeremy corbyn described the violence of reclaim the streets rioting as self defence

  7. The first thug to make it respectable to approach Labour politicians in a hyper aggressive manner was John Mann. He looked a bit mentally ill when he got up in Livingstone’s face.

    • So Corbyn calling Hezbollah friends, militant beating people up, the arson at wapping, Jeremys mates the IRA weren’t violent thugs?

        • I’m not justifying it at all, just saying that Mann wasn’t the first labour thug