Study Reveals Public Perceptions of Dangerousness and Mental Illness

A recent study published in Health Affairs journal’s “Violence and Health” issue found that just under half of the US population fears random mass shootings and terrorist attacks. Public responses to these concerns have become habitual, especially in popular culture, which ignites the debate of mental illness patients needing treatment versus stronger gun policies.¹

Investigators Bernice A. Pescosolido, Bianca Manago, and John Monahan analyzed 2 decades of the American public’s view of dangerousness with various mental health disorders. Three National Stigma Studies (in 1996, 2006, and 2018) were compared to understand how Americans interpreted mental illness, and what they did to resolve their own mental health issues.¹

The researchers intended to evaluate the public stigma about the mental health system. Using a vignette strategy, the National Stigma Study described behaviors to participants that met Diagnostic and Statistical Manual of Mental Health Disorders criteria for specific disorders. Symptoms of depression, schizophrenia, alcohol dependence, and a control condition of “daily troubles,” or having day-to-day problems, were used to describe the vignette characters. These characters were also defined by sex, race and ethnicity, and education, as each respondent was randomly assigned 1 vignette by an interviewer.¹

Results showed that there was a greater public concern about the danger posed by a person with mental illness to self, compared to the danger of others. However, the public perception of the likelihood of people with mental illness being violent towards others was high, according to their findings. The rates were much lower when respondents rated a vignette character with major depression or “daily troubles.”¹

The most apparent result was in the public support of schizophrenia, with 40-60% of respondents supporting all forms of legal forced treatment for this character type. Meanwhile, there was a rise in support for all forms of coerced treatment in 2018; close to 20% pushed for medication and hospitalization, and just over 15% for seeing a physician.¹

Support for coercive physician treatment and hospitalization was more likely among respondents who assessed people’s potential dangerousness as more severe than among those who have viewed it as less severe. Dangerousness to the public was also perceived more in respondents who have less than a college education and were a younger age.¹

Psychiatrists and the mental health system are often held accountable, as they are expected to have the proper tools to identify people as potential mass shooters, even if the individual has no prior history of violence. This becomes troublesome, as psychiatric expertise gets misaligned with legal duty in most scenarios, the investigators noted.¹

In conclusion, the researchers felt that “it is critical to continue to monitor cultural attitudes, beliefs, and predispositions that link mental illness to violent behavior.” The most recent example of this is Todd Phillip’s 2019 film interpretation of Marvel’s Joker. The film had received mixed reviews from critics across the nation, even before the film was officially released on October 4 in theaters. Many claim the film is “incel-friendly” and “dangerous,” as it follows the story of Gotham City’s Arthur Fleck, a mentally ill man who loses his grip on reality and becomes the Joker.^1,2

The public has become outspoken on the film’s plotline, specifically family and friends of the Aurora shooting victims. In a letter written to Warner Brothers studio, the group said the character development from loner to villain “gives them pause,” while urging the film studio to support building “safer communities with fewer guns”.³

References

• Pescosolido BA, Manago B, Monahan J. Evolving public views on the likelihood of violence from people with mental illness: stigma and its consequences. Health Affairs. 2019; 38(10): 1735-1743. doi: 10.1377/hlthaff.2019.00702.
• Happy now? Everyone is talking about ‘Joker’. Associated Press website. https://www.apnews.com/f2eb430a7c5b4b4eb366c82547738cfd. Published September 30, 2019. Accessed October 3, 2019.
• ‘Joker’ is already the most controversial movie of Oscar season. Thrillist website. https://www.thrillist.com/entertainment/nation/joker-movie-controversy-explained. Published October 2, 2019. Accessed October 3, 2019.