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Stigmatization of the
Mentally Ill


Jessica Lewis

Saint Anselm College

Psychology Department of Saint Anselm College


Acknowledgments
Abstract
Introduction
Background Information
Conclusion
References

Key Words: Deviant behavior, mental disorder/illness, stigma, victimization, violence


Acknowledgments

    First and foremost I would like to thank everyone who has guided me through this arduous process.  I would not have been able to complete it successfully without all of your support.  I would like to thank Professor Troisi for his encouragement and guidance.  You were able to challenge my writing skills and organizational techniques.  I would not have been nearly as proud of this work without your constant critiques and supervision.  Next I would like to thank my parents for making me smile and being able to handle my stress and mood swings.  Without your constant support and love I would not be the person who I am, and I would not have been able to appreciate the simple things in life.  Lastly, I would like to thank all of my friends and roommates.  You were the ones who had to deal with my constant bouts of “insanity” and remind me that “everything would be ok.”  Without your encouragement and support I would never have been able to cope with the daily hassles and stresses that tended to overwhelm me.  Thank you all so very much.


Abstract

    Stigma against the mentally ill has many negative effects.  This literature review supports the stance that the mentally ill are not as violent as society perceives them to be.  The harmful effects that are a consequence of the stigma are thoroughly acknowledged and believed to be a detriment to society.  Many significant aspects of this topic are evaluated which aid in the awareness and misconceptions of mental illness and stigma. 

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Introduction

    There is a consistent pattern of stereotypes that repeatedly accompany the diagnoses of various mental illnesses.  These stigmas have the ability to decrease the self confidence of a person and reduce the self-esteem of someone who suffers from an illness.  Link et al. (2001), for example, addressed how stigma can negatively affect a person who suffers from a mental illness, and that the reactions from others initially influence the self esteem of the person.  Throughout time people who have been diagnosed as mentally ill have been treated differently and have constantly been viewed as “ignorant”, “dangerous” and “unintelligent.”  The media has been an aid to these stereotypes by constantly reinforcing and influencing the labels that people have bestowed to the mentally handicapped.  Hollywood has often made the distinct mistake of adhering to the beliefs and ideas that everyone who is mentally challenged is “crazy”, and will violently lash out and assault an innocent person (Teplin, 1985).  The public has been raised with the media making these negative assumptions that have become accepted as factual by most people.  The fear that society has towards the mentally ill and the crimes that are committed renders the determined attitude that they should be punished harshly regardless of their disorder (Lohman, 1997).  Society desires to see justice implemented rather than support the beneficial treatment that could be applied to the mentally ill. 
    A prevalent thought that constantly possess the minds of the general public is that most people who have a mental handicap are violent and at a high risk to commit serious crimes.  Although it has been presented that many perpetrators have been diagnosed as mentally ill; other factors must be acknowledged for the reasons why these people have committed violent crimes (Wiener, 1999).  People will repeatedly assume that those who commit atrocious crimes must be mentally unstable; however, society does not consider the other factors that may have motivated the violent incident.  The concept of a mentally ill person harming another human being has been instilled into many people’s minds, thus causing people with a mental illness to receive discriminatory reactions by the public. These negative reactions have caused a majority of the mentally ill to view themselves as more different than they are.  Numerous psychologists, psychiatrists, criminologists and sociologists have repeatedly researched the study of mentally ill offenders.  The one question that desires an answer is, “Why do most people fear those who are mentally ill, even if they have proven themselves to be nonviolent?”  Hodgins and Lalonde (1999) reported that numerous studies that have been conducted support the hypothesis that the mentally ill population is equally as likely as the general population to commit criminal acts.  It has been asserted numerous times that only a small number of crimes are attributable to the mentally ill and that it is the clinician’s responsibility in identifying the people who pose a threat to society (Clark, 2002).  Society has the popular conviction that offenders commit crimes as a result of their mental illness; however there are numerous other variables that need to be taken into consideration when identifying the motives.  If these other factors are not recognized, society will continue to brand people with mental limitations as future felons.
    There are many topics that are addressed in relation to stigma and the mentally ill.  The general stigmas that are associated with the mentally ill and the effects that stigma can have on this population is very important when examining this subject.  The various ways that the law enforcement handles situations involving the mentally disordered and their rate of reconviction after release from prison is very interesting when considering the bias and discrimination that is frequently displayed towards this population.  Society often is concerned with the disorders that are associated with violence in association with the “early/late” theory of violence.  An intriguing aspect of stigma that has been researched numerous times is the cultural and racial differences that affect the mentally ill.  Victimization of the mentally ill is a topic rarely recognized because most of society underestimates its occurrence.  People would rather focus on the violence that the mentally ill enact rather than the harassment that occurs to them.  The causes of violence and the general victims of assault have increased the interest of researchers throughout the years.  There are many misconceptions that are associated with this topic which needs to be clarified so that society will not fear being attacked by someone who is mentally handicapped.  One last topic that intrigues and initiates awareness are the children and mothers who commit violent acts, especially murder.  These acts draw the most attention because of the rarity and unacceptable motives that are perceived with them.  The topics mentioned are reviewed thoroughly and the data for these studies support the concept that the mentally ill are not as violent as many perceive. 

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Background Information:


General Stigma Concerning the Mentally Ill

    There are numerous stigmas associated with being mentally ill.  There is a tendency for people to be wary and cautious when directly interacting with someone believed to be “unstable.”  The ignorance and naiveté of society has increased the fear of being assaulted by a mentally ill individual.  However, numerous studies that have been implemented support society needs to learn more about the mentally ill and understand that the myths posses are untrue.
    The general public perspective about mentally ill persons is that they are dangerous human beings with a desire to harm others.  Stuart and Arboleda-Florez (2001) chose to elaborate on this notion by developing a study that analyzed the views that society has about the mentally ill.  They study included 1,151 randomly selected inmates who were interviewed and diagnosed by a panel of psychiatrists.  Subjects diagnosed with antisocial personality disorder were asked to complete the Psychopathic Checklist.  This survey was given to ensure that a high ratio of axis II disorders would not be acquired.  Only the participants who received an extremely high score on the survey were clinically diagnosed with antisocial personality disorder.  The results indicated that severe substance abuse was prevalent when half of the violent crimes were committed, and that the prevalence of psychotic disorders accounted for less than 1 percent of the offenses committed by participants in the sample (Stuart & Arboleda-Florez, 2001).  It was suggested that the violent crimes committed by this selected population contributed to one in every ten acts of violence as a result of an interaction between substance abuse and mental illness.  Thus it is rare for a person to commit a deviant act solely because of a disorder.  This particular study supports the claim that society possesses a negative stigma towards the mentally ill and that the fear possessed is greatly exaggerated.  The research supports the concept that the risk of being assaulted by a mentally impaired person is low and that they are not primary contributors to the crime that encompasses the world.  Stuart and Arboleda-Florez (2001) were able to explain that civilians are not the main targets for the mentally ill who commit crimes, but rather close family members are more likely to be victimized.  Thus, it has been speculated that the media is responsible for instilling these common fears against the mentally challenged into society (Buckley, 2003).  The media often broadcasts and amplifies the crimes that are committed by the mentally ill.
    Many people have the tendency to believe that the mentally ill are responsible for much of the violence that plagues society.  The association between crime and mental illness has always been a vivid image in the general public’s minds, yet studies have been conducted which do not support this illustration.  Teplin (1985) reviewed studies implemented in the past which support the claim that mentally ill patients have an elevated risk of being arrested, and the patients who were previous offenders had a much higher risk of being rearrested.  There was a lower risk for the general public to be arrested than for the mentally ill.  It was asserted that the incredible increase of arrests were the result of the large numbers of mentally ill offenders who were being admitted into hospitals.  Teplin (1985) speculated that mentally ill people are more likely to be arrested than the general public because of the bias possessed by officers.  If a non-mentally disordered person was committing the same crime he may be reprimanded rather than apprehended.  Thus, the mentally ill are considered to be more deviant because of their observable symptoms.  It has been concluded through previous studies that patients who were hospitalized prior to the incident usually return to the hospital instead of being detained in prison (Teplin, 1985).  People who reside in state hospitals are usually lower class citizens.  This fact correlates with the supported relationship between lower social class and crime.  Teplin (1985) conducted a study that required six people to observe the mentally ill in specified police sectors of a city.  The sectors ranged from extreme poverty to affluent, with each observer recording the interactions among the police and residents of these districts.  This naturalistic experiment permitted the observers to employ a symptoms checklist of the various mental disorders.  This experiment prohibited the use of clinical interviews and accurate diagnoses, so the check list was greatly depended upon.  A second validity test was utilized to distinguish between people who were severely mentally ill and those who were not.  Prior to the study Teplin (1985) randomly selected 61 prisoners who were diagnosed with a mental illness through observation and the criteria described in the Diagnostic Interview Schedule.  Teplin (1985) observed this population for 5-10 minutes and then conducted a short interview with the subject where a diagnosis was provided using the DIS.  By comparing the results of the observation and the interview there appeared to be high correlation between the two sets of data.  Teplin (1985) believed that this valid measure would be applicable in the present study.  Observers were only allowed to make a list of the interactions that occurred between citizens and police officers; however it was critical that the interaction involved more than three verbal exchanges.  It was estimated that 1,072 encounters occurred with 2,122 citizens being coded and monitored.  The rate of a mentally ill person encountering a police officer was relatively rare.  Only four percent of the subjects were coded as severely mentally ill.  They were more likely to be suspected of a deviant act and less likely to be divulging an act of victimization.  It was revealed that the general public and the mentally ill will commit similar crimes as opposed to the belief that the mentally ill are more violent.  The concept of the mentally ill being more violent than the average citizen was not supported in regard to this study, however many fear this population because of the portrayal by the media (Teplin, 1985).  The mentally ill must reside in the communities and interact with their neighbors, yet one should not be overly cautious during an interaction.  The support and aid from police officers in the precinct allow the mentally ill to confide in them and view them as a peer.  Thus, the mentally ill are not considered to be more dangerous than the average citizen.  

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Effect of Stigma on the Mentally Ill

Stigma can cause profound impairment to the mentally ill.  The feelings of shame and embarrassment that accompany this population are indescribable.  Many are constantly discriminated against and held responsible for the development of their illness.  It is very important for this population to understand that they did not cause their suffering, and that there are people willing to support them through this difficult time.
    The negative effect that stigma have on a person’s self-esteem is disheartening and tragic.  People with a mental illness begin to feel inferior and worthless because of the negative image portrayed by society.  Link et al. (2001) was very interested in evaluating this specific subject.  Link et al. (2001) was aware of the damaging influence stigma can have on a person’s confidence and wanted to ascertain how much of this deterioration was the result of harmful stereotypes.  Link et al. (2001) described certain actions that can negatively affect a person, such as being rejected from a job opportunity after disclosing about an illness.  This discrimination is common among people who are diagnosed as mentally unstable and they often find it extremely difficult to be hired for a company.  By evaluating the research that was reviewed prior to this study, Link et al. (2001) assessed how the media and social relations influence the way one thinks about mental illness.  It is most likely exhibited in a negative manner when the apparent symptoms are portrayed rather than the core qualities of a person.  Thus, society has been conditioned to fear and be cautious when interacting with someone identified as being mentally disordered.  The person with the illness realizes these false beliefs, yet lives in constant fear that he will be rejected and isolated from society because of the impairment.  The fear of rejection and discrimination is more common among those who have been hospitalized for a serious illness, as opposed to the people who are diagnosed with a mild disorder.  Link et al. (2001) described the association between self-esteem and stigma as the self being responsible for interpreting and responding to society’s reaction to stigma.  The study consisted of 88 randomly selected people involved in a clubhouse program.  Each member was assigned to a group that provided a program which taught people various ways to cope with stigmas, or a group that did not provide a program.  The most prevalent diagnosis in the sample was schizophrenia, with rates of bipolar and non-affective psychotic disorder closely following.  The stigma intervention course was given after a six-month assessment.  Link et al. (2001) used Rosenberg’s Scale to measure self-esteem, and each participant was asked to answer each question with a: “strongly agree”, “agree”, “disagree”, or “strongly disagree.”  The perception of stigma was analyzed with an instrument that allowed each subject to rate his feelings on certain beliefs and statements that the public perceives as true about the mentally ill.  This instrument allowed the researcher to understand how strongly the participants assumed that the general public would discriminate or treat them differently because of the disorder (Link et al., 2001).  The results of the study revealed that a majority of the subjects had a high level of self-esteem, and that a significantly small number of participants possess low self-esteem.  Results indicated that the subjects believe that the psychiatric patients would receive the most discriminatory reactions by society; and that people with a mental illness find it easier and less intimidating to befriend another person with a disorder.  The strong belief possessed by the subjects is that the psychiatric patients will receive the most negative stereotypes and will be rejected the most by society.  Thus, the results supported the idea that stigma is an influential factor in deciphering the level of confidence of a mentally disordered person.  Stigma can be apparent in different forms, so it is very important for advocates to identify each type to enact the proper mediation.  Stigma can be detrimental to someone who is mentally ill and this issue is should not be ignored.

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Law Enforcement and the Mentally Ill

    Many studies have been conducted that support the likelihood of a mentally disordered person being arrested.  The rates of arrests for this population are disproportionately higher than for the general public.  Many researchers attribute these high ratios to the negative stigma related to the mentally ill and violence.  If symptoms of a disorder are observable, the law enforcement will generally arrest a mentally ill person and detain him for longer periods of time.
    An important issue that is often discussed when addressing the issue of stigmatization is the various ways that law enforcement manages people with a mental handicap.  Ashford (1988) was determined to test how the law treated and judged repeat offenders who were diagnosed with a mental illness.  Ashford (1988) hypothesized that mentally ill criminals were more likely than non-mentally disordered criminals to be imprisoned for minor crimes.  Ashford (1988) randomly selected groups of inmates from the Maricopa County Jail System and reviewed their case histories and criminal records.  It is relevant to recognize that this particular prison has a correctional psychiatric unit that has been acknowledged and approved by the American Psychiatric Association.  Ashford (1988) described how the division provides various treatment services to this deviant population.  These include a crisis intervention component, an outpatient component, an in-patient component and a treatment component.  Each inmate was categorized by their mental illness and whether they were recidivists.  The study indicated that mentally ill offenders were more likely to engage in minor acts of crime.  The results of the study support the claim that repeat criminals who suffer from a mental illness committed more minor crimes and were more likely to be charged with these violations than non-mentally ill recidivists.  The findings displayed a statistical significance among the mentally ill and non-mentally offender in regard to violence.  It is more likely for a mentally ill recidivist to commit an act of theft rather than an aggressive act.  This supports the idea that mentally ill people are not as violent as society would like to believe.  It is important to acknowledge that mentally ill recidivists may be required to participate in different programs and seminars before being released into the community (Ashford, 1988).  With the aid of directors and administrators of these various curriculums, other institutes should be established that would help rehabilitate and counsel the mentally ill recidivists.  This would solve several problems plaguing the mentally ill because many of them do not have the proper support and guidance from family members or their community. 


Rates of Reconviction after Release from Prison

    There have been few studies that examine the mentally ill after they have been discharged from prison, and the different ways that detainment has affected them.  The desire to learn about the ways law enforcement copes with situations involving the mentally ill has become increasingly more appealing.  Researchers find it interesting to evaluate and report the well being of mentally ill offenders once they have been released from custody. 
    Certain stigma believes that people who suffer from a disorder will continue to commit acts of crime once released from prison or an institution.  Steels et al. (1998) reviewed the lives of mentally ill and psychotic offenders after they had been released from prison.  Archival evidence revealed that people diagnosed with schizophrenia have a more positive occupational and psychiatric adjustment to life, as opposed to those diagnosed with antisocial personalities who thrive in familial and residential environments.  One of the most interesting findings among people with psychotic disorder is their likelihood to be convicted of another crime after release from an institution.  The study consisted of 184 subjects who were released from prison with a restriction order.  There were 75 men and 20 women psychotic disordered subjects, and 70 men and 19 women diagnosed as mentally ill.  Restriction classifies anyone who is considered to be dangerous to society and is monitored regularly by clinicians and law officials.  The measure used for this study was a follow-up questionnaire which rated employment and relationship status.  Files were reviewed to gain knowledge about the past convictions, diagnoses and mortality rates.  Results specified that men and women with PD were younger than the MI subjects when first admitted into an institution.  The PD women had a longer history of hospitalization than the women with a mental illness.  People with a psychotic disorder were more likely to have committed a past offense, and a majority of men with PD had served previous time in prison.  Attempted murder and homicide were the most common crimes for men with a mental illness, while PD men were more prone to crimes of sexuality and violence.  However, women with PD were more likely to have committed crimes of arson while women with a mental disorder were prone to acts of homicide or attempted murder.  Mortality differed between the two groups as well, for more people with a mental illness died after release from prison than those with psychotic disorder.  Steels et al. (1998) hypothesized that this factor was a result of the difference in ages and adaptability between the two groups.  The mentally ill tended to be older and were expected to commit suicide more frequently.  Results indicated that that people with a psychotic disorder were more likely to commit more offenses and be convicted of more charges than the group with a mental illness.  In relation to forming and acquiring adequate relationships and occupations, results revealed that men with PD were much more successful than the men with a mental illness.  However, only five men in the PD group reported not committing any crime within this time period.  The study was able to support the original hypothesis that people with a psychotic disorder were likely to adapt more successfully to social situations, yet were more prone to re-conviction than those diagnosed with a mental illness.  A person suffering with a mental illness is more likely to have a difficult time adjusting to the world in terms of social relationships.  The mentally ill person will need more treatment and support during his release into the community.  The mentally ill can do little to aid and increase their lack of social functioning, but the psychotic disordered subjects can deter from their deviant behavior by controlling their impulses and aggression (Steels et al., 1998).  The theory of restriction may not be as successful as previously thought because it did not prevent PD subjects from recommitting offenses.  Thus, there is an observable comparison that can be derived between people with psychotic disorders and people with a mental illness.  It is important for people in law enforcement to understand and acknowledge these differences when interacting with this population, especially when someone is released from prison.       

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Common Disorders Associated with Violence

    Although it has been previously stated that many individuals who commit non-violent offenses have a diagnosis of more than one disorder, the most common pair is psychotic disorder accompanied by substance abuse (Munetz et al., 2001).  With this being the most prevalent combination many psychologists and psychiatrists have chosen to research this topic in association with the dramatic increase of mentally disordered people becoming incarcerated.  These topics have been reviewed in conjunction with the decrease of people institutionalized.
    There have been numerous studies and researches conducted that examine which mental illnesses generally afflict an offender.  The three most prevalent disorders are antisocial personality, schizophrenia and substance abuse.  Dietz (1992) described various cases of mentally ill people who were the perpetrators of unique crimes.  In the first occurrence, Dietz (1992) explained in great depth the reasons for people with psychotic symptoms to submit to the demands of their illness.  Dietz (1992) claimed that people who suffer from delusions, especially persecutory delusions, will perform deviant acts to protect themselves from the perceived harm.  They will assail before the “Devil” has an opportunity to attack and execute them.  Dietz (1992) continued to illustrate how people who suffer from hallucinations tend to perpetrate crimes of violence, although these are less frequent.  With these symptoms in mind it is relevant to understand that people inflicted with these psychotic characteristics can be accepted and labeled as insane (Dietz, 1992).  In the second scenario expressed, Dietz assessed that a primary reason people harm others is to indulge in specific uncontrollable desires.  The article defends the idea that a mental illness does not impair a person’s judgment, but rather it motivates the person to indulge in these unacceptable pleasures.  Someone who is constantly being bothered by irrational urges and is unable to control these inner yearnings will resort to the most radical stress relieving activities.  Dietz (1992) realizes that there is a discrepancy concerning how much control offenders possess over their actions.  The article speculates as to whether a person commits the deviant act to suppress the inappropriate desires, or if the desires are able to dominate the individual.  One of the last instances discussed is the influence that personality disorder has on crime.  Dietz (1992) believes that personality disorders are strongly correlated with crime if they are accompanied by other disorders, such as substance abuse or depression.  The environmental conditions that surround a person have strongly been linked to the development of antisocial personality disorder, which enables a person to possess a low level of fear arousal.  Dietz (1992) continued to give examples of other personality disorders and the crimes that are most often linked to them such as: the paranoid personality and the likelihood of committing hate crimes with the use of eclectic warlike weapons, the narcissistic personality is most likely to be associated with credit fraud, and the possibility that the histrionic personality will frequently accuse innocent people of sexual crimes and theft.  The article provides the average civilian with insight into the inner minds of a mentally ill offender and the reasons for the mentally handicapped to commit crimes.  It has been suggested that people who suffer from psychotic symptoms can be regarded as “insane”, yet it is rare for criminals to be assumed this label if they have been diagnosed with a personality disorder, or if they act on “uncontrollable” impulses.
    The concept of someone intentionally harming another human being for their own pleasure appalls most of society.  Some of the most feared crimes consist of sexual assault and sadistic rituals.  Holt et al. (1999) proposed a strong correlation between sadism/psychopathy and sexually/violent offenders.  The research supported the theory that half of all psychopaths reacted and motivated by a sadomasochism response (Holt et al., 1999).  The hypothesis was primarily interested in discovering if there was an underlying sadistic motivation between psychotic sexual and violent offenders.  This was compared to the population of men who had committed the same crimes but were classified as non-psychotic.  Holt et al. (1999) hypothesized that there would be significantly higher sadistic scores for the psychopaths than for the non-psychopathic offenders.  Holt et al. (1999) chose one hundred random files from a prison in California, but only forty-one of the prisoners were able to participate due to various reasons.  The participants were grouped as being violent or sexually abusive, depending on the nature of the crimes they had committed.  Each subject was interviewed and coded for psychopathy.  After a thorough review of each file which included, psychological evaluations, social histories and clinical interviews, it was assessed whether sadism had influenced the individual.  Results from the study illustrated that there was no difference between people who perform sexually violent acts and those people who commit violent offenses.  The assumption that there would be an interaction between the type of felony and the different levels of psychopathy was not supported.  However, the study was able to support the findings that there is a positive correlation between psychopathy and the various stages of sadomasochism.  This was shown to be significant across all measures besides sexual sadism.    A confounding variable of the study was the limited number of participants in the study and its potential for displaying the possible relationships that could exist between variables.  However the study was able to support past research that sadism is an associated characteristic of psychopathy and that, “Psychopaths relate to others on the basis of power and dominance, rather than affection” (Holt, 1999, p.31).  .  Holt et al. (1999) believes that more research should be conducted in this field of research.

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"Early/Late" Start Theory of Violence

    The positive correlation between schizophrenia and violence has been a significant topic for many researchers throughout the years.  Many people have speculated whether the stigma has been over exaggerated, and if this negative attitude that has encompassed society can be waned with adequate care.  The “early/late” start theory suggests that people with a disorder will either become violent early in life, such as childhood, or later in life as a result of the disorder.  The “early” starters are assumed to have had conduct disorder which results in a history of oppositional behavior.  The “late” starters react negatively to an incident that occurs because of their disorder and do not have a history of being hostile.   
    There have been numerous assumptions regarding the differences between people with schizophrenia who commit crimes early in life, as opposed to those who become deviant years later.  Tengstrom et al. (2001) performed a study that evaluated this concept.  The research gathered claimed that adults who were diagnosed with a severe mental disorder committed more crimes and acts of violence than people who did not develop a disorder (Tengstrom, 2001).  It has been examined through archival research that people who suffer from schizophrenia are more likely to commit crimes but not necessarily violent ones.  This would discard the belief that is presumed by society that people with schizophrenia are dangerous citizens who intentionally harm innocent people.  There has been a strong connection between the risk of substance abuse and schizophrenia leading to more violence and crime, which creates a more aggressive environment for the person suffering from these illnesses.  The researchers hypothesized that there are two groups of people, the “early” and “late” starters, which would explain an association between the disorder and the offenses committed.  The “early” starters began acting deviant in adolescence before there were any apparent symptoms, while the “late” starters began acting offensively once the symptoms had become prominent.  It was hypothesized that men are more prone to be “early” starters and for women to be “late” starters.  The research claimed that the “early” starters have been diagnosed with substance abuse, tend to be inflicted with psychotic symptoms and are convicted of more crimes.  The study consisted of 272 men in Sweden who had been evaluated using a pretrial psychiatric assessment after being accused of initiating a violent act.  Archival research had been implemented to aid the researchers in their understanding of the “early/late” starter hypothesis.  Files were coded, reevaluations of the diagnoses of the subjects were achieved and the term “violence” was redefined to connect this study with past analyses.  The article explained that violent crimes included murder/manslaughter, assault and unlawful threats.  Forceful crimes were described as murder/manslaughter, assault, rape and armed robbery (Tengstrom et al., 2001).  The results of the test illustrated that there was a difference in criminal patterns between the two groups of offenders.  It was assessed that the “early” starters had been convicted of more violent crimes and that they had been hospitalized 2 years prior to the hospitalization of the “late” starters.  It had been revealed that one of the most significant similarities was the troubling childhood of most of the subjects, but results displayed that the “early” starters had a harsher time which clarified some of the reasons why deviant acts were committed at a younger age.  It was disclosed that most of the subjects had been removed from their homes at a young age, yet reasons differed between the groups.  Deviant behavior was the most significant reason why the “early” starters were removed from their families, while the “late” starters were removed because of poor academia and cognitive issues.  The study presented the researchers with a glimpse of new treatment programs that must be established to treat these men suffering with schizophrenia, substance abuse, antisocial behavior, conduct, insufficient life and social abilities (Tengstrom et al., 2001).  Thus, the effects of the study were able to support the hypothesis and research in the past because there is a difference between the two groups of offenders.  Although there were a few similarities between the two, the differences were able to assist the researchers in the convictions that there are major differences between “early” and “late” start offenders.

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Stigma of Mental Illness across Culture and Race

    Researchers can acquire much knowledge when culture and race are intensely studied and evaluated.  The cultural and racial differences that encompass society allow many to understand how stigma can universally affect people.  The influence that stigma possesses over certain nations can be more detrimental than ever imagined.  By employing the different attitudes and behaviors of diverse countries effective processes can be created that will permit society to learn and understand the discrimination that is inflicted upon this population.
    One of the most appealing topics to researchers is the stigma and cultural differences that affect the mentally ill.  Xie (2000) chose to study the Japanese population in regards to the gender differences of mentally ill offenders.  The study consisted of 2,094 mentally disordered criminals residing in Tokyo.  The subjects were assessed and grouped into three different categories according to the crime they had committed.  Only the most serious crime was considered if participants had been arrested for numerous charges.  The three categories were: crimes against persons, crimes against property and other crimes.  The “other crimes” category included traffic violations and possession of illegal substances.  Each offender was also diagnosed and assigned into separate divisions of mental illness.  These groups consisted of psychoses, major depression, substance abuse and other mental illnesses.  The results indicated that mentally disordered males were less likely to commit crimes against other people, as compared to the population of non-mentally disordered offenders.  In regard to the assault of an individual, males were more likely to attack a stranger in comparison to the women who would assault a family member.  There was a significant difference among the suicide attempts for females and males.  The females had a higher occurrence of suicide attempts preceding a homicide than the males (Xie, 2000).  Results indicated that the women in the sample were more prone to depressive disorders, had a small substance abuse problem, attacked more family members and tried to commit suicide more frequently as opposed to the men in the study.  Women were less likely to have had a previous criminal record before their offense.  The most common diagnosis for the entire sample was acute psychosis.  The men in the sample tended to have a higher deficiency in prognosis because they came from a less supportive and financially unstable upbringing.  A majority of the participants were considered to be Not Criminally Responsible, which accounted for an enormous women participant population.  This high ratio occurred because the diagnosis of antisocial personality disorder is not considered to be an adequate excuse for the reason crimes are committed.  Many men were excluded from this particular study which resulted in confounding variables.  Domestic violence is not acknowledged in the Japanese culture, which means that women are forced to remain with their husbands in order to maintain the family’s pride and dignity.  The wives of these abusive men remain silent in order to preserve their name.  One of the most interesting findings was that Japanese women kill their children more frequently than any other culture.  A child is considered to be part of the woman, when she attempts to kill herself she also kills her child so that part of her will not continue to live.  She kills the child to ensure that no part of her is left behind to flourish (Xie, 2000).  One last prevalent difference between Japan and other countries is the disgrace associated with mental illness.  Many families keep their relatives secretly locked away because of the harsh stigma that accompany the minds of Japanese society.  It is only when the illness causes a serious consequence that the disordered family member receives the proper intervention and assessment.  There needs to be many studies conducted to evaluate the differences in gender among the mentally ill.  This will allow for a much stronger correlation to be observed and accountable.   There should be other culture differences measured so people from other nations can compare and contrast the stigma and aspects of other societies. 
    Another aspect of mental health that has fascinated many is the effect certain stigmas and illnesses have on minorities.  There has only been a small amount of research completed that examines this issue.  Ford (2002) conducted a study that correlated the relationship between violence and trauma among African American women.  The study was interested in observing the welfare of women diagnosed with a severe mental illness and their reactions to traumatic events.  It has been estimated that about fifty percent of women diagnosed with dual disorders have been subjected to a traumatic experience.  The archival research conducted prior to the study revealed that the environments and living situations of African American women enable them to be more likely to experience traumatic events.  These women having been exposed to a traumatic event are more susceptible to develop a negative psychosis.  One of the most common disorders linked to traumatic events is Post-Traumatic Stress Disorder, which normally develops in women who have been sexually assaulted or violently raped.  The symptoms of PTSD appear almost immediately after exposure to the traumatic instance.  Ford (2002) performed the study employing patients from an outpatient clinic in western Pennsylvania.  Fifty-five African American women were chosen to participate in the study, with each having received mental health care for at least two months.  The subjects were interviewed over an 8-month time span and a review of their files was assessed to obtain the correct information regarding their illness.  The Post-Traumatic Diagnostic Scale was used to measure the rate of violence and trauma each woman had experienced.  The Medical Outcomes Survey was utilized to measure the well being and functioning of each individual.  Results indicated that on average, the women had experienced about three traumatic events in their lifetime.  The struggles with various mental illnesses were the consequences of these experiences.  It was presumed that the mental illnesses moderately interacted with everyday life; however they did not appear to have a poor level of functioning.  The general well being of the women appeared to decline as exposure to traumatic events intensified.  This would suggest that exposure to certain traumatic events would be extremely harmful to the victim in numerous ways.  There are a larger number of women who are extremely vulnerable to victimization because of their mental illness.  They are perceived as weaker and less likely to report an act of assault.  The act of violence that is perpetrated against these women permits their illness to become more critical and create problems in their daily functioning.  

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Victimization of the Mentally Ill

Many people underestimate the amount of abuse that is directed towards the mentally ill.  It is common for people to believe that the mentally ill are more likely to victimize than be victimized.  The mentally ill feel intimidated and threatened by law officials when they disclose a personal attack.  They fear being judged and blamed for their assault, which would produce a lower level of self confidence.  This timidity results in many cases of abuse being unreported and not acknowledged by the victim.  The victims often believe that they had instigated their assault and that they deserve the abuse because of their mental impairment.
    One of the major misconceptions among the general public is that mentally ill people are always the offender and never the victim.  There have been numerous studies that evaluate the belief that mentally ill people are never victimized.  Many people are astonished to learn that victimization among the mentally ill is frequent.  Marley and Buila (2001) became involved in a study that measured the assault of a person who was mentally disordered.  Research conducted prior to the study concluded that people diagnosed with schizophrenia are most likely to be assaulted by civilians.  It is common for the mentally ill to remain quiet after a violation has occurred because they fear that no one will believe them.  They fear that law officials will assume they are lying or hallucinating.  There has been research conducted that corresponds with the belief that mentally ill people are violent.  This only supports the idea that aggressive people have a long history of being violent.  If a person is going to assault someone it would be a common happening and not a random incident.  Marley and Buila (2001) were interested in reviewing the victimization of those suffering from schizophrenia, bipolar and schizoaffective disorders.  The National Alliance for the Mentally Ill and the National Alliance for Research on Schizophrenia and Affective Disorders were contacted, and with their help Marley and Buila (2001) were able to survey 265 individuals.  The survey contained three parts.  The first part was concerned with personal information about the individual and the disorder, the second consisted of assessing whether the subject had been a victim and the third was interested in their most traumatic assault.  The findings of the study explained that women were more likely to have been the victims of sexual attacks, while men were more prone to have experienced robberies or muggings.  Over half of the population surveyed revealed that they had known the offender of their traumatic attack.  Most of the women in the study reported rape to be the crime that they feared the most, while men reported being the most wary of violent assault.  The most traumatic experience was reported to have occurred to women numerous times, while the incident only occurred once to men.  The study concluded that there is a higher ratio of female victims because of their perceived vulnerability.  Many people depict mentally ill women as being weak and highly dependent on others.  They are assaulted more frequently because they are believed to be more passive and desire affection.  This rationalization accounts for many of their assailants to conclude that women will do anything for the attention and love that is absent from their lives.  It was revealed that the more severe the disorder the higher the likelihood that the violent incident will occur.  The most disheartening fact is that most of the abuse that occurred was perpetrated by a relative or a family friend.  This disintegrates the trust and support that is needed during these hard times.  There is a constant need for services and care that family members need to provide.  Society needs to be aware of the harmful issues that many mentally ill people endure, especially the ones that can cause permanent damage to the self-confidence of a person (Marley & Buila, 2001).  Services need to be provided for the victims of these atrocious acts so they know that they need to report any acts of personal harm.  Law officials need to become conscious to the truth that majorities of mentally ill people are assaulted and that they need help and support to overcome these traumas.

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Causes of Violence and Its Victims

The misconception of the causes of violence and who are most likely to be victimized is prevalent among society.  Many fear that random strangers will be accosted and that violence will erupt with no plausible cause.   The limited number of crimes that are related to the mentally ill have intrigued and stupefied society.  The universal theory that mentally ill people greatly contribute to the crime in society, has relied upon the escalated rates of arrest and the detainment of the mentally ill to inflate the actual number of crimes that are committed by this population.  There are many components that contribute to the aggressiveness in a person.  Thus every factor is not a result of the mental disorder, for many people have a predisposition to be more hostile than others. 
    It has been supported numerous times that substance abuse, in accordance with a major mental disorder, is a high indicator of aggression.  Hiday et al. (2001) conducted a study that assessed the causal factors which resulted in the violence among the mentally ill.  The archival researches displayed numerous causes for aggression.  Hiday et al. (2001) believed that the offender’s victimization produced a violent effect in that particular individual.  The elevated vulnerability of being victimized by others can be an influential factor in explaining the predisposed violence of some people.  A predisposition to be hostile in accordance with a substance abuse problem is another variable that could motivate one to be violent.  Poverty appeared to be a contributor to the onset of aggression, regardless if a mental illness was present or not in the individual.  The constant observance to the acts of violence in impoverished neighborhoods can function as a model for people who witness it on a daily basis, some of these people may not be well educated and they may not understand that violent behavior is socially unacceptable.  The study consisted of 331 severely mentally disordered participants who were unwillingly admitted into a hospital.  The subjects provided the researchers with answer to the questionnaire concerning victimization and their committed violent offenses.  Interviews were held to assess the severity and the development of the illness.  This also included their functioning capability.  The results revealed that only a quarter of the sample had experienced victimization within the last four months.  About half of the sample had been involved in a physical struggle or had threatened to harm another individual.  A majority of the sample who were coded as aggressive had not caused injury to anyone and had not utilized a weapon during the assault.  An alarming concept that needs to be addressed by mental health professionals is that a majority of sexual assaults that occur to the mentally ill are never reported to law officials.  Many fear that they will be blamed for their abuse.  There is an underreporting within the general population but it is even more unnoticed in the mental health field (Hiday et al., 2001).  Results have supported the theory that personal victimization will increase the likelihood of the victim becoming violent, and the rate of violence appears to decrease with age.  Thus a young, victimized, mentally ill person is more likely to commit a violent crime as opposed to an older, victimized, mentally ill person.  Another variable that could influence the aggressiveness of a person are the history of violent acts.  If a person has a tendency to be hostile there is a higher risk that he may act violently in the future.  The victims of violent acts are most likely family members, friends or acquaintances.  Constant tension and enduring conflicts between a mentally ill individual and a relative can increase the risk of violence, especially if there is a history of aggression.   The hypothesis that violence is a consequence of victimization has been supported and many people now attribute this cause to one of the many motivators of aggression.
    There are many issues that are addressed concerning the victims who are assaulted by the mentally ill.  Much of the research conducted and many beliefs of the public, suppose that innocent bystanders are constantly in danger and are most likely to experience the wrath of the mentally ill.  Johnston and Taylor (2003) were determined to learn more about the victims of the mentally disordered.  By reviewing research completed in the past, Johnston and Taylor (2003) were able to identify that 75% of crimes committed against another person were performed against someone that the offender knew.  It is highly unlikely for a stranger to be singled out when an attack is going to be committed.  It is relevant to declare that crimes executed by the mentally ill contribute to only a small amount of the overall violence of society.  Most of the violence carried out does not result in permanent injury to the victim.  The participants in the study were 975 men and women who resided in a high security hospital in England.  They had been admitted to the hospital because they were repeat offenders and perceived as dangerous towards other people.  Johnston and Taylor (2003) were able to obtain the clinical files of the mentally ill from the hospital, as well as the files that contained their criminal history and interviews administered while in the institution.  Using the data collected, the researchers were able to diagnose the offenders and claim that schizophrenia and other delusional disorders were predominantly manifested in the subjects.  The researchers accounted for the characteristics of the victim accosted.  The categories consisted of an intimate, acquaintance, authority figure, stranger or no victim detail.  It was ascertained that most of the victims had been female.  Males were more likely to assault strangers as opposed to women who frequently assaulted acquaintances.  Results specified that the two largest reasons for the assault were feelings of jealousy and sexual motives.  A startling fact was that people diagnosed with mental retardation were more susceptible to victimize an acquaintance, while the personality disordered offenders’ frequently accosted strangers.  There were a significant number of offenses in relation to substance abuse that resulted with aggression in the victim, offender or both.  In support of the other studies conducted, it is important to assert that the offenders did have a history of violence before being committed to the hospital.  This does not support the belief that a mentally ill person will randomly become violent and accost anyone who threatens them.  Homicide was more prominent between the intimate and acquaintances, while sexual assaults were the most frequent crimes committed against strangers.  It was affirmed that the offenders who committed homicide were more likely not to have a history of violence, which made the researchers desire to learn the motives of the murder.  Offenders who have familial support tend to have a more positive prognosis, for this motivates the patient to surpass this stage in life and overcome the aggression (Johnston and Taylor, 2003).  It is suggested that if tension is among relatives, and if the mentally disordered person has a history of violent behavior, it would be beneficial if the pair was separated.  This would grant the person the ability to overcome the hostile feelings, and it could prevent an irrational act from occurring. 

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Juvenile Murderers

    One of the most disheartening and disturbing group of people in the world are the aggressive children who murder an individual.  Many stigmas affect these children which often results in their deviant behavior.  If a child hears that he is “worthless” and “deviant”, he will most likely conform himself to these stereotypes.  Many people ignore the concept of young children committing acts of homicide; for they would rather have the child imprisoned instead of receive treatment.
    Myers and Scott (1998) conducted a study that evaluated the psychotic and conduct disorder symptoms of adolescents who have committed murder.  Through their research prior to the test Myers and Scott (1998) ascertained that hostile and aggressive youths have witnessed more acts of violence, have a genetic predisposition for developing certain disorders, have a higher rate of abuse and are more neurologically imbalanced than the non-aggressive population.  Children are more prone to violence if they regularly observe close family relatives interact with gang members.  They are at a higher risk if there is a low educational level within the household.  It has been estimated in the previous research that the number of children who suffer from psychotic symptoms is rare, and that a majority of the youngsters who commit murder are not responding to hallucinations or delusions.  The main purpose of the study was to evaluate two groups of adolescents who had been diagnosed with conduct disorder, but who varied in intensity and degree of violence.  The study consisted of 18 male adolescents who were diagnosed with conduct disorder, with a majority displaying symptoms of schizophrenia during their initial evaluation.  The control group contained 15 boys who had been detained in a hospital for the past two years.  This particular group was also diagnosed with conduct disorder, but was seeking treatment for their aggressive behavior.  The procedure for the study included diagnostic interviews, clinical interviews with physicians and parents and a review of medical, school and criminal records of the participants.  Results indicated that 89% of the homicidal adolescents had experienced psychotic symptoms, but only four had a history of delusions and hallucinations.  Every subject in the study was diagnosed with conduct disorder, with a majority of the two groups being concurrently diagnosed with substance abuse.  There were no significant differences revealed between the two groups in regard to history of abuse/family violence and medical history.  Both groups appeared to have learning disabilities, which resulted in academic difficulties.  The analysis was able to support the concept that there is a major difference among juvenile homicide offenders and the non-homicidal juveniles.  Paranoid ideation appeared to be a main factor when evaluating these two populations and it was revealed that the non-homicidal group had never been involved in counseling.  There is no precise explanation as to the reasons these youths are more susceptible to psychotic symptoms, yet the effects of environmental stressors could be assessed (Myers & Scott, 1998).  One of the most essential findings was that the control group had a higher ratio of depression, but the juvenile murderers possessed more psychotic symptoms.  This discovery displays how affective disorders were not responsible for the psychotic symptoms in the youths, which frequently form the basis for symptoms.  This study was able to display how there are a large number of adolescents in society who need the help of mental professionals.  They are not given the support and the means to obtain the aid which is needed.  It is very important for the public to understand that these offenses could have been prevented, yet they lack the encouragement and the resources that will teach them how to control their hostility and aggressive tendencies.  It has been suggested that aggression accompanied by a mental illness, abuse and a chemical imbalance result in violence.  These factors accounts for many crimes that have been committed by juveniles suffering from psychotic symptoms. 
    Stereotypes against people who murder are some of the most common beliefs shared among people.  Society repeatedly has labeled people who kill as “deranged psychopathic maniacs” who constantly desire to take another human life (Ewing, 2001).  The murdering of a family member, especially a parent, is one of the rarest crimes that can occur.  The concept of a child killing someone who was responsible for their birth ultimately bewilders many and causes some to wonder what had motivated this tragic crime.  Ewing (2001) described parricide and how it appears to be one of the most explainable offenses.  It has been estimated that adolescents are the most likely candidates to murder their parents, but numerous studies suggest that the ages of those offenders can vary.  A prevalent risk factor associated with parricide is the rate and severity of abuse inflicted on a child.  A child will be motivated to kill a parent if he is continuously   abused and cannot suppress his anger.  Ewing (2001) reviewed other factors that can result in the killing of a parent such as, familial patterns of violence, a child’s inability to cope with stress, alcohol abuse in the home and the child’s failed attempts to seek help and be removed from the house.  A child who kills an abusive parent may offer a feeling of reprieve to the other family members, and may experience pride for defending himself.  A common motivation for a child to kill a parent is if another member of the family, especially a mother, desires the death of an abusive relative.  A majority of children who murder their fathers act to appease their mother and to protect her from future harm.  Emotional disturbance is the primary mental illness that is diagnosed to those who commit parricide, yet a majority of the youths are not seriously ill.  Most do not suffer from psychotic symptoms or antisocial personality disorder, but many of the children cannot escape the hell that surrounds them.  The limited numbers of youths identified as being mentally ill are not diagnosed until after the killing, and rarely a history of mental illness existed prior to the act.  The most common reason for murder is if the child has been a victim of severe child abuse and has repressed his shameful thoughts.  Occasionally a child will murder his parents for economic reasons, but these instances are rare and usually occur among an older cohort.  This group consists of people with antisocial personality disorder who have been abused.  Ewing (2001) describes step-parents are at the greatest risk of parricide because of the potential conflicts that can arise between the adult and child.  The abusive parent is a prime target for many children.  The risk of parricide is increased if the death of a parent appears to be beneficial to more than one family member (Ewing, 2001).  There have been limited studies conducted on this topic.  Society would benefit by understanding and realizing the motives for parricide.  There is never an excuse for murder, unless an innocent life is threatened and the perpetrator is killed out of self defense. 

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Mothers Who Murder

The stigmas that affect mentally ill mothers who kill are universally the most harmful and the most widely held.  People immediately assume that a woman is “deranged” and is not suitable to be a mother.  The reaction of society is universal and many believe that the mother should lose her life if she takes the life of a child.  However, not all of the mothers who commit murder are insane and a majority of them are excellent parents.  The stresses that accompany one’s life, especially someone who is mentally ill, may trigger a negative response.  Thus, it is the researcher’s responsibility to assess the various motives and influences that cause a mother to kill.
    The media has a tendency to over-publicize the murders committed by mothers.  The concept of a mother taking the life of a child horrifies and angers a majority of the public.  Dobson and Sales (2000) recorded how the English court system is more lenient towards mothers who murder as opposed to fathers.  Fathers have reportedly been executed and sentenced to life in prison, while mothers are more likely to be admitted to a hospital and ordered to serve less time in penitentiary.  Many people throughout the world assume that mothers who commit infanticide are mentally disturbed, and that fathers who commit the same crime are just deviant and “evil.”  Dobson and Sales (2000) reviewed a study that evaluated the motives of mothers who murdered their children.  Most of the mothers had been diagnosed with psychosis or severe depression.  The mothers had committed neonaticide or filicide.  Neonaticide is described as the killing of an infant within the first 24-hours of its birth, while filicide is defined as the killing of an infant after the first postnatal day.  Most of the infants, who were born within a 24-hour period, were unwanted by their mothers.  Over half of the infants who were more than a day old, were killed to save them from potential harm or suffering.  A quarter of the sample indicated that the mothers had been deemed psychotic at the time of the murder, with most of them suffering from delusions and hallucinations.  There was a significant difference between the mothers diagnosed and treated prior to their criminal act.  A majority of the filicide women had been treated and hospitalized for their disorder, as opposed to only a limited number who had not been diagnosed and considered psychotic prior to their detainment.  Many of the women feared rejection from immediate relatives, and denied that they had been bearing a child.  The reason abortion was not considered was because most of them did not believe that they were pregnant until the birth of the child (Dobson & Sales, 2000).  The filicide women believed that the only way to “save” their child was to sacrifice them and allow God to take care of them.  Many of the women were mentally ill and sought treatment in the past for their symptoms.  Dobson and Sales (2000) revealed that motivation and influence to commit this crime is correlated with a difficult childbirth.  The predicament with blaming childbirth as a major cause for the murders is that a majority of the general public may begin to believe that anyone is at risk for this deviant behavior.  Childbirth is not solely linked to murder, but it can act in association with other variables and predispositions that increase the vulnerability of these women.  The differences between postpartum blues, postpartum depression, and postpartum psychosis are described to differentiate between them.  The most common form is postpartum blues, which consists of crying, anxiety and mood fluctuations.  Postpartum blues lasts for less than 2 weeks and there are reasons to acknowledge the rarity of this disorder resulting in murder.  A woman diagnosed with postpartum depression is displaying the similar symptoms apparent in severe depression.  Someone suffering from postpartum depression will most likely cope with the various symptoms for months before beginning to feel “good” again.  There is contradicting evidence that explains whether the depression is developed because of childbirth, or if they are more exaggerated as a result of the labor (Dobson & Sales, 2000).  The rarest and most severe disorder developed from childbirth is postpartum psychosis.  Women diagnosed with this disorder suffer from delusions and hallucinations.  Psychosis can be maintained for over a year after the child’s birth, which leads many researchers to assume that many filicide deaths which occur after a year can be associated with this disorder.  The archival research implemented by Dobson and Sales (2000) revealed that postpartum blues could not be considered a motive for a child’s death.  Childbirth should not be thought as a traumatic experience which causes psychotic and dissociation symptoms in mothers.  The predisposition for mental illness in mothers needs to be evaluated before any irrational conclusions can be created.  There should be precautions applied if a possibility exists that a mother may develop a severe mental illness. 

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Conclusion

    Numerous people within society believe that mental illness is something that one should fear and look down upon.  Many are ashamed to associate with a mentally disordered person because of the stigma that encompasses their lives and functioning.  Several of the studies reviewed have a consistent theme, which is to support the mentally ill who are often misrepresented and misunderstood.  The common attitudes possessed by society deeply wound and lessen the self worth of a person.  The mentally ill begin to feel inferior and incompatible with the rest of humanity.  The shame and guilt incessantly perceived by the mentally ill results in a vulnerability that can lead to their victimization and learned helplessness.  One of the most important aspects of every study was the emphasis placed on various programs and seminars that should be offered to both the mentally ill and the public.  People have a tendency to trust everything that the media presents, when in hindsight this source is flawed.  The media patronizes and exaggerates mental illness, especially in relation to crime and violence.  Most disordered people will not commit a crime and if they do there are numerous other variables that have contributed to the deviance.  Blame cannot be solely placed upon mental illness because it adheres to the media’s influence and does not consider the other important factors that need assessment.
    Many different people are labeled with a mental disorder before an actual diagnosis is provided.  Society judges a person instantaneously when a mental illness is revealed.  People become more cautious and cease interaction with a person for the fear of being assaulted.  Some people believe that a disorder is contagious and will avoid the mentally ill for fear of contracting the “disease.”  The negative attitudes and beliefs possessed by society are detrimental to everyone who is personally associated with someone who is mentally ill.  The harmful effects can dehumanize a parent or spouse, and generate feelings of blame and hopelessness.  Mental disorders can be treated effectively if the proper medication and counseling services are provided to the patients.  These services have proven to be beneficial to both the patient and family members who are battling with the disorder and the discrimination from others.  The naiveté acquired by the public in regard to mental illness is apparent and universal.  Many cultures are very unsupportive and ashamed to associate with the mentally ill, as observed in the studied reviewed.  This universal position regarding mental disorders needs to be accurately assessed and reevaluated so that the public can understand that the mentally ill are not very different from the rest of the population, and that they deserve the same opportunities as everyone else.
    Other topics concerning mental illness could have been evaluated.  A common disorder not examined was borderline personality disorder.  This specific illness has been associated with violence and crime, for the impulsivity that is a common symptom can result in harmful consequences.  The rate which senior citizens and fathers commit violent acts could have been reviewed closely so that the stigma associated with this population could have been acknowledged.  People may attribute the murders executed by the elderly with Alzheimer’s disease or other forms of dementia.  The role of gender could have been evaluated to distinguish between the types of disorders and the various effects of stigma.  One last topic that may have been addressed is the identification of various assassins and their diagnosis of mental illness.  It would have been interesting to view the infamous murderers from history to discern whether mental illness was attributed to their actions.                
    The concept that crime is the consequence of mental illness must be eliminated.  There has been numerous research implemented that support the claim that various variables interact which result in the criminal behavior.  Only a small number of crimes are implemented by the mentally ill, and that most of the crimes are preventable and predictable (Gilligan, 1996).  The countless factors that account in violence behavior are apparent in most individuals.  If poverty, aggressive tendencies, feelings of shame and the inadequate feelings of self-worth all can result in violent behavior.  It should be emphasized that mentally ill people are not psychopaths who yearn to submit to various sadistic impulses.  The negative image that society has on the mentally ill is pessimistic and disheartening.  The inaccurate and mythical representations that many have about this population needs to be elucidated so that people can realize that there is nothing to fear.  The studies described yearn to identify the major causes for this collective timidity.  They were able to support the assertion that the mentally ill are not more prone to crime than the general public.  Although some criminals are diagnosed with a disorder, it was not the primary reason for the incident.  This association that is often influenced by the media and the personal constructs of people should be reduced and recognized as a falsity. 
    The stigma that affects the mentally ill can be very injurious to its victims because it reinforces their inferior images of themselves.  Many services should be established that advocate for the reduction of stigma.  Although it appears to be an unrealistic suggestion, it is imperative for the public to understand that the mentally ill are not violent predators.  People should be sympathetic to those who commit crimes and do not realize that they are in the wrong.  There are so many people in the world who need treatment and do not receive it.  If society is able to acknowledge this population and realize that they are lacking the social support to conquer their diseases, stigma would drastically be diminished.  It is society’s responsibility to recognize and assist those who are alone in their battle for dignity.  If this issue is not identified then the mentally ill will continue to adhere to the stigma and be isolated from society.  It is not appropriate for the mentally ill to blame themselves for their abuses, and it is tragic to observe how the public instantaneously absorbs everything the media conveys.  The influence of the media is so powerful that it will continue to affect the beliefs of the public until proper knowledge is acquired concerning the mentally ill and their stigma.    

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Relevant Links:

Anti-Stigma Organizations

NIMH Outreach Partnership Program

NAMI

National Mental Health Association

SAMHSA's National Mental Health Info. Center


If you have any questions, please do not hesitate to contact me at: jlewis@anselm.edu