Violence and Mental Health

red fist against blue background

 © 2015 Bill Eddy, LCSW, Esq. We live in an age of overlap between legal and mental health problems. It is frequently said that there are more people with mental health needs in our legal systems than in our mental health systems. Recent news events have emphasized mass shootings by those with mental health problems, workplace conflicts which become violent and police encounters with the mentally ill – which sometimes end in the death of the mentally ill person or the police. In family court cases, workplace disputes and community conflicts, mental illness is frequently cited as a major factor in incidents of violence. Yet despite all of this talk about mental health problems, there seems to be little discussion of what mental illness really is. In reality, there are many different types of mental illness, some more dangerous than others, and some more identifiable than others. This article attempts to give a brief overview of some of the basic mental disorders in terms of general violence risk and why everyone needs to understand these problems better – and to support efforts for more professional training and more services for those with mental health needs. The following information is drawn from my general knowledge as a therapist and family lawyer, and from the manual of mental disorders used by mental health professionals: Diagnostic and Statistical Manual of Mental Disorders, fifth edition (2013), published by the American Psychiatric Association – commonly known as the DSM-5. You should not attempt to diagnose someone based on this information, but rather seek the assistance of a licensed mental health professional for evaluation and treatment. Depression Depression has a wide range, from situational temporary depression such as over the loss of a close friend or relative, to mild chronic depression, to major depression. The DSM-5 says that approximately 7% of the population will suffer from major depressive disorder in any given year, which means that they have depressed mood most of the day, almost every day. This includes feeling sad, hopeless and discouraged. Fatigue and insomnia are common. In children and men, this may take the form of irritability rather than sadness – yet still be depression. Some people have suicidal thoughts with depression, while others do not. Depression mostly drains the energy from the person, but some become energized as they are coming out of a depression and take action to harm themselves. Men, more than women, have agitated depressions which may give them energy for self-destructive acts. In rare cases, they will harm others while ending their lives, such as in a murder-suicide. However, I personally believe that the people who do this also have a personality disorder (see below). In general, depression alone appears to make one less likely to hurt others, rather than more likely. Depression is a fairly treatable disorder, with medications, counseling or both. Anxiety Anxiety is generally characterized by extra caution or avoidance of perceived threatening situations. Anxiety also has a wide range of intensity. More severe forms include social anxiety disorder, which the DSM-5 says occurs in any given year for about 7% of the adult population, generalized anxiety disorder for about 3% of the population and panic disorder for 2-3% of adults. These tend to cause an overall decreased sense of well-being, sometimes to the point of dropping out of school, losing a job, avoiding dating and over-compensating with drugs and alcohol. Generally, they are more afraid of confronting others rather than acting out aggressively. Anxiety disorders are also fairly treatable with therapy, medications or both. Bipolar Disorder Bipolar disorders take several forms, which are each described in the DSM-5 and add up to about 2% of adults. They appear to be more genetic – a biologically-based chemical imbalance – and cause the person to have manic episodes (for a week or longer) when they are extra energized most of the day, don’t sleep much, are extra talkative, distractible and enthusiastically engaged in activities that may hurt them in long run (sexual indiscretions, over-spending, etc.); followed by depressive episodes (two weeks or more after a manic episode), when they demonstrate the sadness, hopelessness and reduced energy described above for people who suffer depression. While people with bipolar disorder are sometimes known for their wild behavior, during the manic episode there is also an increased risk for violence. On the other hand, their suicide risk to themselves is much higher than the general population and the DSM-5 states “bipolar disorder may account for one-quarter of all completed suicides.” Medications are the basic treatment approach for the bipolar disorders, because they appear to be primarily a bio-chemical problem. Schizophrenia This disorder is poorly understood by most people, because it is so rare. Only about 1% of the population has this disorder, which is marked by psychotic symptoms, such as hallucinations (hearing voices that aren’t there) and delusions (seeing people or having beliefs that are not based in reality). While this disorder is often mentioned with mass shootings, people with schizophrenia are generally no more violent than the average population and that was my experience working with them in psychiatric hospitals. When we hear about someone with schizophrenia being involved in a mass shooting, I believe that it is because they also had a personality disorder (see below), not because of the schizophrenia. However, in very rare cases they may have “command hallucinations” which order them to kill someone. Schizophrenia is often what people think of when they think of mental illness. Substance Use Disorders Alcoholism and other chemical addictions are a common problem in the United States. They are characterized by denial that there is a problem and continued use even when the substance causes increasing problems in relationships, employment, finances, health and other areas of one’s life. The DSM-5 states that alcohol use disorder occurs in about 8.5% of the adult population in any given year. Adding in all the other substance use disorders, including addiction to prescribed medications, there may be as many as 15%

Excerpted from Bill’s New Book: The Future of Family Court

© 2012 By Bill Eddy, LCSW, Esq. Disorders in the Court THIS BOOK IS DESIGNED FOR family court judicial officers, although I realize it may be read by other professionals and individuals involved in family court themselves. It’s written from my perspective as a family lawyer and mental health professional, and as a trainer of judges in managing high-conflict people in court. I am not a judge and I do not presume to know how to do the difficult work judges do day in and day out. Yet I have represented clients in family courts for 15 years and I have heard many of the concerns of judges in my seminars and private conversations. The emphasis of this book is to apply lessons learned from the field of mental health to the family court system, especially in regard to working with parents with personality disorders or traits. Prior to my legal career, I was a therapist working with children and their parents in psychiatric hospitals and outpatient clinics. This background has given me a different perspective on today’s families in family court. Yet my emphasis here is on what individual judges can do, rather than recommending sweeping changes in the court system or creating new players in the decision-making process. Bill Eddy is a lawyer, therapist, and mediator. He is the co-founder and Training Director of the High Conflict Institute, a training and consultation firm that trains professionals to deal with high conflict people and situations. He is the author of several books and methods for handling high conflict personalities and high conflict disputes with the most difficult people.