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The beauty of the summer weather in France has contrasted with the headlines of appalling violence from various European cities, most notably Nice. Nice has hosted the ECNP Workshop for many years now and it was painful to think how staff at the Boscolo Hotel (about 100 metres from the Boulevard des Anglais) will likely have been affected by the worst of the summer’s violence.
Did mental illness contribute to the incidents this summer? Press reports have sown their usual crop of confusion. Mental illness is a risk factor for violent offending. There has been a well-meaning attempt in recent years to down play the association, in the hope of reducing stigma. However, any psychiatrist who looks after psychotic patients worries about it a lot. Well-controlled studies from Sweden’s databases have shown that a schizophrenia diagnosis per se indeed has little impact on the risk of violence compared with sibling controls. However co-morbid alcohol or drug use disorder, which is common, almost doubles this risk.
It would therefore be surprising if mentally ill individuals were not over-represented in the ranks of individuals bent on terrorism. However, few (about 5%) of the people who commit violence are mentally ill; this percentage is less in young people, higher in older people. Draconian measures specifically aimed at the mentally ill could accordingly have little impact at a population level, although appropriate medical treatment reduces the probability of violence by about 50%.
To take a longer-term perspective, despite current perceptions, we appear to live in increasingly pacific times. Stephen Pinker’s book 'The Better Angels of Our Nature: Why Violence Has Declined' highlights the law, commerce, female values, literacy/education and what he calls the escalator of reason for data showing longterm downward trends in the frequency of violence. His argument is not popular with the extreme left but the facts appear pretty convincing to me whatever the explanation. Anyway, if you have time left for a summer read, it offers grounds for a kind of optimism, which we may need in the coming years.
Guy Goodwin
ECNP President
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