There’s a familiar temptation after incidents of mass violence to reach for an immediate explanation. Everyone wants to know why, says Dr. Sandy Simpson, chief of forensic psychiatry at the Centre for Addiction and Mental Health (CAMH).
“They need to be able to think they can find out why such a thing has happened so that things can be done to try to prevent it from happening again,” he says.
Less than 24 hours after last weekend’s deadly mass shooting in Toronto that killed two people and injured 13 others, the family of the man responsible offered the first slice of understanding.
In a statement, Faisal Hussain’s family said the 29-year-old struggled his entire life with “severe mental health challenges,” including depression and psychosis. The family briefly detailed their own struggle to get Hussain help, no doubt a familiar one for whose loved ones live with mental illnesses.
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“While we did our best to seek help for him throughout his life of struggle and pain,” they wrote, “we could never imagine that this would be his devastating and destructive end.”
In the days that followed, reporters have picked through the details of Hussain’s life: the teacher he confided in almost a decade ago about wanting to kill someone, his affinity for replica handguns, and his belief, per a police source, that he was the Joker from the Batman movies.
But in cataloguing every detail about Hussain’s mental health, piece by piece, what risk is there in conflating mental health issues with violence?
“It’s sort of popular parlance, only a crazy person would do a thing like that,” explains Sherry Glied, dean of the Robert F. Wagner Graduate School of Public Service at New York University.
“That’s just the way we talk about these things.”
And yet, Glied says, mental health issues as an indicator of violent behaviour is not a helpful way to predict and prevent future violence.
“The underlying prevalence of these conditions is really really high,” she says.
“It’s almost like saying males are at higher risk of committing homicide than females are. This is true, but you know half the population is male so it’s not going to take you very far.”
That isn’t to say there isn’t a link between mental illness and violence.
There is, Simpson says, but the nuance of it too often gets lost in the stream of revelations following violent attacks. In studying homicides, researchers have found those who have a psychotic illness are four to five times more likely to be violent than the general population. But even then, Simpson notes, just five per cent of homicides can be attributed to serious mental illness.
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“It’s not the diagnosis that puts you at higher risk, it’s the presence of acute symptoms,” he says. “If we treat those things well, then that risk falls below that of the general population. So it’s quite a nuanced and complex statement.”
The public discourse is very good at oversimplifying, Glied has found. She has co-authored numerous papers, including one published a few years ago in the American Journal of Public Health looking at the links between mental illness and violence.
“The journalist’s search for a mental illness explanation of aberrant acts will almost always succeed,” Glied wrote in that research paper. It’s a numbers game.
“If you’re looking through someone’s history because they’ve done something, the odds are they have a mental illness and that’s because the odds are that most people do,” she says.
Public conversations are starting to change, says Fardous Hosseiny, national director of research and public policy with the Canadian Mental Health Association.
“People are getting more and more aware that we shouldn’t be making that link but that’s not something that will change overnight,” he says.
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Hosseiny has been heartened this week to see people on social media push back at the idea that mental health is a predictor of violence. It’s a form of support, he says, when people pause and say, “Let’s wait until we know all the details before we make a conclusion… let’s not just link it to mental illness.”
That matters, Hosseiny says, because numerous wellness campaigns have worked doggedly over the years to encourage people to speak up about their mental health struggles, to get the help that they need. Narrow public discourse after a violent attack has the power to hamper those efforts.
“People with mental illnesses might go back into hiding for fear of being judged and labeled and untreated mental illness only gets worse,” he says.
“We know that if you don’t treat a mild or moderate form of depression that it can become a severe form of depression and lead to crisis situations.”