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Op-Ed: Personal Safety and Listening to the Right Voices

As an indicator of violent behavior, mental illness is no more of a factor than is liking football.

If you were concerned about your personal safety, whom would you rather sit next to on the bus? Someone with schizophrenia who sometimes hears voices, or a football fan whose team just lost the championship? The correct answer is: we don’t have enough information, because neither schizophrenia nor liking football makes someone a safety threat.

The fact is that those in treatment for schizophrenia or any other brain disorder are no more likely to commit a violent act than anyone treated for heart disease, cancer, diabetes, or acne. They are no more dangerous than anyone else, according to the MacArthur study on violence and mental illness published in 2001.

In fact, not only are they no more dangerous, they are more likely to be the victims of violence. So when we hear anyone proposing a national registry for those with mental illness, we should all just cringe.

Of course, when it comes to personal safety, we should always be careful, and consider all the risk factors for violence. But mental illness is not one of them. So, what are the risk factors that make someone more likely to become violent?

According to numerous studies on violence, the single greatest risk factor associated with future violence is past violent behavior. But what constitutes a past violent act?

Is it arrest for assault? How about violence where no one was arrested? There have been lots of street fights and bar fights, as well as brawls at soccer matches and fraternity parties, husbands abusing wives, parents abusing children, and children bullying other children -- where no one was ever arrested.

Among these offenders, there are those where violence was a youthful indiscretion, and who are not at all violent now, and others who are always at risk of violence.

But even those prone to violence were innocent children once. What caused them to change into violent adults? Most probably, they were exposed to one or more risk factors, but with greater frequency and greater intensity than the rest of us.

I say "more than the rest of us" because we have all been exposed to these risk factors to one degree or another, and to that extent, we are all at risk of becoming violent, under certain circumstances and certain stresses.

So, in addition to past violent acts, we should be aware of the other risk factors, and there are a lot of them: alcohol and drug consumption, poor tolerance for stress, high emotional distress, being victimized, being bullied, social rejection, familial distress or conflict, financial problems, poor parenting, school failure, associating with violent people, among numerous others.

At Greater Trenton Behavioral HealthCare, where we monitor for safety on a daily basis, our focus is on risk factors, not on whether mental illness is present. When there is a safety problem, substance use and past violence are typically involved.

Alcohol consumption -- at football games, soccer games, and pretty much anywhere that people gather -- increases the risk of violence by a huge margin. So, back to who’s sitting next to me on the bus, I’d be more concerned about an intoxicated football fan, and what negative voices might be at work in him, especially if his team lost.

But, we all have negative voices -- even when our team does not lose, and even when we are not intoxicated. And we have all been exposed to one or more risk factors, so the question for all of us is: when we hear our negative voices, which ones do we listen to? Which ones do we screen out as odd? And, which ones do we act on?

An even more important question is whether among these negative voices, is there at least one voice that is even-tempered enough to tell us when we need to settle down, and look at things a little differently.

Listening to this voice of discernment inside us is an important part of good mental hygiene. Learning how to listen better is what mental health counseling is all about. It helps us better manage our stresses, so that stress-based, negative thinking does not drown out this voice of discernment.

But counseling is only one way to cultivate this voice. Clean living, good friends, exercise, prayer and meditation, or taking a lap around the block when needed, all work just fine. But for those of us struggling with one or more risk factors, it doesn’t hurt to get a little coaching from a mental health counselor from time to time.

So next time you hear anyone scapegoating someone with mental illness because he’s upset about all the violence around us, just know that he may also be dealing with some risk factors that have been triggered. So stand clear until he takes a jog around the block or gets a little coaching. You never know.

John Monahan is the president and CEO of Greater Trenton Behavioral HealthCare. He is also a board member of the New Jersey Association of Mental Health and Addiction Agencies, and chairs its Safety Committee. To review the results of the MacArthur study, please consult Monahan, J. & Steadman, H. (editors), Rethinking Risk Assessment, The MacArthur Study of Mental Disorder & Violence.

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