What plane crashes can teach us about violence in mental illness

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Yes o — I'm still on this mental illness and violence matter! Honestly, I thought I'd just do a post on it, but each post so far has produced responses that necessitate another. (This will be the last for now, although I'm sure I'll have to come back to it.)

This post started as the answer to a comment:

What do you say to people who refer to the cases in the U.S. where someone with a known history of mental illness picks up a gun and shoots people at random at a mall or school?

It's a valid question, to be sure, but what if the question itself is wrong? What if the very fact that we connect mental illness and mass shootings is already a misconception? I find most people give me blank stares when I say that, so I need to explain.

Mental illness-related violence is really small.

I've explained this in a earlier post, but here are a few more stats.

  • Yes, people with mental illness can get violent — contributing to a grand total of 3-5% of violence. Yes, it's that small. [ctt title="How much violence do you think is due to mental illness? Only 3-5%!" tweet=""How much violence d'you think is due to mental illness? Only 3-5%!" via @DocAyomide #RISEAboveIt" coverup="tAlwV"]
  • That figure, small as it might seem, is still smaller than violence from people under the influence of alcohol and drugs, who're 7 times more likely to be violent.
  • TV doesn't reflect this small proportion though: 60% of people with mental illness on US primetime are shown involved in crime or violence. (I've previously complained about M-Net's Tinsel.)
  • I've said before that people with mental illness are more likely to suffer violence than be violent. Add to that the increased risk of suicide from having mental illness (it's present in up to 90% of suicides), and that deaths by suicide surpass deaths by murders (and that includes mass shootings).

If we reduced all violence due to mental illness, we would reduce violence by only 3-5 percent

But you might wonder, if there's really so little violence from people with mental illness, why does it feel like such a lot? Am I saying the feeling is without basis?

No, I'm not. It's hard to ignore your feelings, anyway, especially when they're really strong. But in this case, the feelings have a basis, just not necessarily in fact.

Here's a video, for instance, illustrating how the feelings we have about violence and mental illness are way off the mark from reality.

http://www.youtube.com/watch?v=xxK8FO66Hg0

To better understand the issue here, let's look at aeroplanes.

Let's think about aeroplanes for a bit: are they really dangerous?

If you're like me, you probably know many people who're nervous about flying — understandable, given recent events like the Malaysian Airlines incidents and closer home, the Dana crash. In fact I know someone who insisted, after the Dana one, on going as far as Abuja by road.

But aeroplanes remain by far the safest means of travel. For instance, consider that:

  • Crashes occur less than once in every 2 million flights!
  • No other form of transport is as investigated as air travel.
  • There are about 100,000 flights per day, every day.
  • In 2013, there were 210 fatalities out of 3 billion — that's about 1 in 15 million!
  • A bunch of stats about flying.
  • 27 more (playful) reasons why flying is still safe: including, that death by falling out of bed is more likely!

Long story short, planes are about the safest form of transport (not counting walking)!

If you've ever tried to argue with someone who's nervous about flying, though, you'd know none of those stats is convincing. So maybe instead of more stats, let's try to understand why the fear.

Three reasons:

  1. The media medium. The media plays crashes up far more. A plane crash is in the news for days, sometimes months. The car accidents that happen every single day, however, don't make the news, precisely because they are so common. (Car accidents only make news when they're exceptional: like involving lots of people or a major personality.) CNN's coverage of MH370 contributed to crash-related conspiracy theories, and what this article from International Business Times describes as, “wall-to-wall cable coverage [which has become] part of a wider trend over the last 30 years: A far greater amount of reporting on far fewer accidents and deaths.” (Emphases mine.) Also see this article: Aircraft accident rates at historic low despite high-profile plane crashes. All of this contributes to something called the availability heuristic: the more you hear about something, the more frequent it seems to you.
  2. The familiarity factor. What feels familiar generally feels safer, or at least less likely to get out of control. A couple of ways this plays out:
    • Cars feel way safer than planes because you're either driving or know who is. And even when you don't, the mere fact that you yourself can probably drive makes it feel less freaky. With a plane you can't even see the pilot.
    • We tend to feel more confident of our ability to escape a car crash. (Never mind that the chances of this happening are lower than one imagines, as anyone who's ever experienced a real crash can tell you.) Planes, on the other hand, are all those miles up in the air with no land in sight. (Actually, studies suggest survival rates of up to 90% — I know, I know, that's from outside Nigeria. Still, I bet you didn't think it was nearly that high.)
  3. The experience example. This is probably the most powerful reason of all: having personally experienced a plane crash, either as a survivor (unlikely as that is), or as one who has lost a loved one to a crash. If such a person were never to fly again, it would be perfectly understandable. But powerful as that is, it doesn't make flying less safe — but it does make it less appealing to that particular person.

As with plane crashes, so also (in a sense) with mental illness

These three factors also apply in mental illness. Not exactly, of course, since you really can't compare machine accidents with human illnesses. But I think the comparison illustrates the points I'm trying to make.

  1. The media medium. The media plays up mental illness like crazy — pun intended! And this happens on many levels. Like I said earlier, people with mental illness in TV shows and movies tend to be portrayed as unreasonable and violent. Then when there is real violence related to mental illness, it not only makes the news in a big way, it often stays there long. The availability heuristic kicks in again. But the everyday violence from otherwise non-mentally ill people doesn't make the news, because, you know, it's simply too common to be newsworthy. (Yes, media houses really can't report everything, but they can report more responsibly. See this page for tips on better reporting.)
  2. The familiarity factor. Also, the unfamiliarity of mental illness admittedly makes it more scary. The truth is it's easier for someone like me to be less scared of people with mental illness because I see them everyday; it doesn't feel as way-out to me as it might to most people. So again, it's understandable that there's fear. But it's also important to understand that this fear is rooted more in emotions than reality. The fact that mental illness is unfamiliar doesn't, generally speaking, make people who have it more dangerous than those who don't.
  3. The experience example. It's a very serious issue to have personally experienced violence related to mental illness. I must tread carefully here, because personal experience goes deep. I'll just say three things.
    • One, if you've personally experienced violence from someone with mental illness, the truth is, you're one of a very few people. Most people who have suffered violence received it at the hands of people without mental illness. (Chances are also that it was a close family member. Unprovoked stranger violence in mental illness is pretty uncommon.)
    • Two, I mean violence, not aggressiveness. It's easy to misinterpret certain behaviours from people with mental illness as being aggressive. Sometimes it's disinhibition that isn't necessarily with aggressive intent. But then it may escalate into aggression when it is interpreted and reacted to that way.
    • Three, generalising from personal experience with mental illness-related violence is sort of like someone who's had negative relationship experiences with women concluding that all women are evil. Both men and women would disagree.

So what about when there is actually violence?

Violence does happen in mental illness after all. I'm not trying to pretend that it doesn't. The reason I've emphasised the reduced likelihood is because most people already believe the rates are high. But it's not like it doesn't happen.

The good thing is, it doesn't happen anyhow. Violence in mental illness has certain characteristics. (Generally speaking, that is. There will be exceptions, but that's just the point: they are exceptions.)

  • It is generally not random. The fear of random violence is one of the biggest fears about people with mental illness. The good thing is this fear is largely unlikely to become real. (That said, violence in general, whether in mental illness or not, is not easily predictable.)
  • Violence in mental illness doesn't occur in most mental disorders. And even in the severe mental illnesses where violence is more common, it's often because the person is not undergoing adequate treatment.
  • Another major factor behind violence in mental illness is drug and alcohol abuse. In fact, like I've said before, in the absence of drug and alcohol abuse, people with mental illness are no more violent than anyone else.
  • Which raises another point: violence is human. Anyone can be violent. People with mental illness just tend to get reported more and have their violence more publicised.
  • More often than you might imagine, this violence is actually provoked. And by provocation, I mean with the intent to. I've seen instances where people were actually "looking for the person's trouble" (as we say here in Naija), but they won't tell you that when they come to report it. (I'm not including when the provocation is unintended.)
  • Most violence in mental illness is often directed at close family members or other loved ones — for the simple reason that they're the ones usually at hand, and that's where provocation is most likely to come from. And I can't say this enough: at the end of the day, people with mental illness actually have more to fear from those who don't, than vice versa.

Now, if that isn't the most tragic part of the entire business, I don't know what is.

I'll leave you with this video. (Warning: mild language — of the sarcastic variety, that is!) :-)

https://www.youtube.com/watch?v=HNsiHaGmdno