As CNN evacuated its newsroom and investigators launched a search for clues as to who may have mailed explosive devices to Hillary Clinton, George Soros, John Brennan and others, we should take time to reflect on the reality that one in five Americans struggle with mental illness.

There is no question that the political climate in the Trump era has become overheated. Political leaders few of us could imagine going out on such a precarious limb a few years ago are tacitly, if not explicitly, calling supporters to confront, if not mob, opponents. Fear that a tipping point is upon us has largely been downplayed and dismissed by mainstream media — that is, until pipe bombs bound for public figures made headlines Wednesday, October 24, 2018.

What is increasingly lost upon us in these troubled times is the reality that a percentage of Americans who are exposed to incendiary rhetoric on the part of pundits, politicians and social media may act upon it — to disastrous ends.

If mere words are indeed capable of setting off deadly consequences, the question must be asked why political discourse in this country is increasingly over the top?

Perhaps the recklessness with which pundits, politicians, social media users — and even journalists — feel entitled to speak owes some of its success to a modern-day taboo. Whether in the wake of a mass shooting or a bomb scare, underscoring a link between mental illness and violence is verboten.

“The American Psychological Association reports that only 7.5% of crimes are directly related to symptoms of mental illness. Poverty, substance abuse, unemployment, and homelessness are among the other reasons why people commit violent acts,” writes Amy Morin in “The 5 Most Common Misconceptions About Mental Illness”.

While it can and should be said that most people who suffer from a psychiatric problem do not commit violent crimes, the other way to frame the question is to ask what percentage of people who commit violent crimes suffer from a mental illness?

One in 25 Americans suffers from a serious mental disorder. The National Institute of Mental Health defines a serious mental illness as a mental, behavioral or emotional disorder that limits one or more major life activities. In any given year, mental disorders afflict ~44 million adults of which  ~11 million battle severe illness.

Should even ~10 percent of ~11 million seriously ill people be at risk of crossing criminal lines, an estimated one million individuals may be triggered by personal, political, economic or social factors.

That possibility should give us pause.

Anti-stigma messaging has been a staple of mental health advocacy for years. After all, the vast majority of mental illness suffers hold down jobs and lead productive lives. Mental health advocates — for good reason — do not want to see the mentally ill suffer employment and housing discrimination, among other ills. This is not only understandable — it is a noble effort. There is, nonetheless, a flip side to every issue, which merits a broader discussion.

Substance abuse and homelessness correlate to poor mental health. A person with untreated mental illness may “self medicate”, hence they will present as an addict when, in fact, mental illness is a precipitating risk factor. Among the impoverished, similarly, a percentage may be unemployed thanks to the fact that mental illness is a leading cause of disability.

If, in fact, mental illness and criminal violence overlap, one might expect to see mental disorders over-represented among the incarcerated. However, with only a fraction of mental illness suffers in treatment, it follows that the rate at which prison populations suffer mental illness may be underestimated. As an example, frequently-cited estimates unwittingly imply prison populations, at a mental illness rate of ~20 percent, are no more likely to contend with mental illness than the general population. The reality, however, is that individuals who suffer psychiatric disorders such as schizophrenia and bipolar disorder are ten times more likely to be in jail or prison than a hospital bed.

Efforts to do away with stigmas about mental illness are laudable. But when people are led to believe by mental health advocates that mental illness is essentially a victim-less affliction — meaning they principally serve to harm the lives of sufferers — it may have the unintended consequence of causing fewer to seek treatment.

Perhaps the mental health community would be better served to help the public correlate untreated mental illness to the afflictions we tend, as a society, to compartmentalize: poverty, substance abuse, homelessness and incarceration.

As an example of why a broader and more cohesive advocacy effort is overdue, consider the homeless population — an astounding 58,000 in Los Angeles County, alone. Mounting frustration exists among California residents in the face of sprawling homeless encampments and the public health threats that go hand-in-hand with squalor. Protest demonstrations have arisen when public officials attempt to relocate the homeless to temporary shelters in the midst of suburban Orange County and beyond. From Los Angeles to Denver, crimes against the homeless are on the rise.

Prevailing wisdom among too many Americans holds that homelessness is the product of little more than character deficits such as laziness. This view, in turn, makes it possible to dehumanize the homeless. In the minds of too many, homeless people bring misfortune upon themselves because they are unmotivated and irresponsible. Public sentiment of this kind has allowed homeless individuals in California and elsewhere to not only to become criminal targets, but to proliferate in number thanks to a blind-eye mentality that undermines the will to craft and support effective public policy solutions.

What if we shifted public perception by more frankly characterizing homelessness as a risk linked to physical and mental disabilities?

The case can be made that mental health advocacy groups that de-emphasize the correlation between mental illness and crime, poverty, substance abuse and homelessness enable the public to minimize the devastating impacts of untreated mental illness in this country.

Though well-intended, anti-stigma messaging may have the paradoxical impact of enabling individuals with mental health challenges to struggle with their illnesses alone. This is, perhaps, most damaging to children — one in five of which are impacted by mental health challenges. Do we want parents to succumb to the powerful forces of denial — to assume that a “mood problem” has little bearing on a child’s risk of substance abuse, school dropout or delinquency?

Perhaps it is time to consider the possibility that anti-stigma messaging may undermine the efforts of prison reformers, substance treatment organizations and homeless advocates to raise awareness about the interconnections between social ills. Failure to highlight these connections, in turn, may be a reason why taxpayer-funded support for efforts to treat these scourges as the health and disability issues they frequently are is lacking. Put another way, public policy objectives aimed at improving access to mental health services ultimately suffer when psychiatric disorders are portrayed in a manner that unwittingly divorces them from their wide-ranging, real-world impacts.

While stigmas are widely appreciated as an added burden on the mentally ill, far less appreciated are the unintended consequences of anti-stigma efforts. Decades of anti-stigma messaging appears to have played a supporting role in dulling our collective awareness of the risks that accompany unchecked hyperbole. Adults who once knew better than to pursue vendettas in the public sphere have not only lashed out on social media and cable news but have allowed their hostility to invade formerly unthinkable settings such as funerals, fundraisers and restaurants.

A coarsening of public discourse betrays a lack of awareness for how words and actions may influence unstable individuals to take an already divided-America to new lows. 

When celebrities, politicians, pundits and media gatekeepers pull out all the stops to perpetuate an accusatory, histrionic climate, they fail to appreciate that America — indeed the world! — is listening. Taboo or not, political protests, mass shootings in recent years and bomb threats must serve to remind us that not all who listen and watch the daily spectacle that is social media — and partisan politics at large — are of sound mind. That is why the rest of us must come to grips with our collective and individual responsibility to act the part of rational, reasonable and self-controlled adults.

The public figures Americans turn to to bring us news, entertainment and leadership must set an example of civility and class even if — and especially if! — the man at the top hasn’t lived up to his obligation to do the same.

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Resources

Stigma and Violence: Isn’t it Time to Connect the Dots? | MPRC

Sometimes Mental-Illness Destigmatization can Backfire | The Cut