Research Article: Facing Up to Unpalatable Evidence for the Sake of Our Patients

Date Published: August 18, 2009

Publisher: Public Library of Science

Author(s): Paul E. Mullen

Abstract: Paul Mullen discusses Seena Fazel and colleagues’ paper on the association between violent behavior and having been diagnosed with a schizophrenic disorder, and its implications for care of these individuals.

Partial Text: The paper of Seena Fazel and colleagues published in this week’s PLoS Medicine[1] provides the most extensive and sophisticated analysis to date of the available data on the association between violent behaviour and having been diagnosed with a schizophrenic disorder. The possible association between schizophrenia and violence remains a contentious issue in mental health. This question is particularly emotive for those, like myself, who started their psychiatric careers at a time when massive asylums still dominated the landscape of mental health care, or the lack of care, and the struggle for civil rights for the compulsorily detained was just beginning. Those working for reform confronted the necessity of calming the exaggerated fears of the general population about the violent tendencies of the mad. Equally it was essential to overcome similar, though more politely articulated prejudices among those who controlled public mental health services, including most of our older colleagues. The question of an association was in those days as much a political as a scientific question, and it was in the guise of scientists that we answered politically [2]–[4]. The efforts to minimise, or if possible explain away, the apparent association between schizophrenia and violence was remarkably effective, and up to a point beneficial to patients. Several generations of mental health professionals were taught there was no association, patient advocacy groups gratefully accepted the new wisdom, and even journalists and politicians became somewhat more constrained in evoking the fear of the murderous mad.



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