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Painted Brain | Schizophrenia, Violence And Aggression
We're bridging communities and changing the conversation about mental illness using arts and media.
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  • April 7, 2014

Schizophrenia, Violence and Aggression

In the minds of many people, schizophrenia is inextricably linked to violent behavior. Published studies do not exactly bear this out. The picture is far more complicated than one might suppose, and a broader perspective brings additional elements into view that call for a shift in focus.

Such a broad and comprehensive overview of the subject by Heidi J. Wehring and William T. Carpenter was published in 2011 by the Oxford Journals’ Schizophrenia Bulletin. It is concise, fact-filled, and contains much food for thought. First of all, while asserting that schizophrenics are fourteen times more likely to be the victims of a violent crime rather than the perpetrators, the authors acknowledge the possibility that many post-1990 studies on schizophrenia have very-likely underestimated violent behavior in schizophrenics in a well-intentioned attempt to de-stigmatize the condition.

According to Wehring and Carpenter, “Schizophrenia is a heterogeneous clinical syndrome and individuals with this disorder will vary extensively on variables related to violent action.” Violence and aggression in schizophrenics have also been found to arise from different causes, and to manifest themselves to varying degrees, if at all. It follows logically that while some schizophrenics exhibit aggressive and violent behavior, it is very difficult to predict, stating that, “clinicians consider many contributory factors in evaluating a patient for risk of becoming violent, including personality traits, history of violent acts, paranoid beliefs, content of auditory hallucinations, substance abuse, impulsivity, suicidal acts, agitation, excitement, social circumstances, and age and sex. Prediction of a singular violent event is very challenging.”

Most clinical evidence demonstrates that while a low-stress environment reduces the incidence of aggressive and violent behavior among schizophrenics, it is often difficult to provide one, especially in a street or institutional setting. The use of anti-psychotic medication has been more helpful. Second-generation anti-psychotics, such as clozapine, olanzapine and risperidone, have been shown to be more effective at reducing the behavior in violent individuals, while long-acting injections address the problem of  non-adherence to oral medication. At this time, however, long-acting injections are not yet widely used.

The most thought-provoking conclusion of the study suggests that the study of the psychopathology of violence and aggression might move forward faster if it were studied separately, rather than drawing inferences from studies which focus specifically on schizophrenia. To quote Wehring and Carpenter, “The pace of acquiring new knowledge may be increased by identifying a hostility/aggression/impulsivity/violence domain of psychopathology for specific study at each level of the human organization. Instead of drawing inferences from the general study of schizophrenia, investigators may explicitly target this domain. Questions to be addressed may include what genes are associated with the domain, and what molecules, cells, and neural circuits may be addressed in subjects selected according to the domain of pathology, perhaps cutting across diagnostic boundaries…”

Refreshingly, they go on to suggest that there may exist more than one means to address violent and aggressive behavior:

“Pharmaceutical science needs to ascertain which preclinical screening models can predict an anti-hostility effect in humans. Novel targets may be identified from genomic studies relating to the defining components of the hostility/aggression domain. The field of psychosocial therapeutics is in the best position to determine the most effective ways to help family members or other caretakers minimize stress and develop strategies for coping with potential violence. For patients where violence is associated with thought content, special procedures with cognitive behavioral therapy (CBT) may be developed.”

 Billy Bang Douglas is a singer and freelance writer/editor from New York City where he was member of the editorial research staff of Newsweek magazine for five years. After two years singing and recording in London, he relocated to LA in 1990, and as a singer/songwriter, he toured the US, Canada, UK, and Japan. A recovering heroin addict with seven years clean & sober, he is currently an experiential counselor at Bel Air Treatment by Evolve as well as the editor-in-chief of Painted Brain’s online newspaper, Painted Brain News. He lives in Los Angeles with his wife, Naomi, the Painted Brain artist-in-residence known as Bugk23609.

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