Paranoid Violence
Yesterday Officer Miosotis Familia was laid to rest in New York City. She was murdered by one Alexander Bonds, reportedly a paranoid schizophrenic. One of the saddest aspects of this tragedy is Bond’s girlfriend had brought him for medical evaluation days before the murder and even called the police on the day of the attack. Authorities in both cases dismissed the girlfriend’s justifiable concerns and did nothing to intervene.
Now several professional therapists have stepped up and pointed out that human psychopathology is notoriously difficult to predict and a practitioner should not be second guessed for a “bad call” when looked at in hindsight. And, I would concur with this position in perhaps 99% of cases. But, there is a glaring exception to this rule. There is one diagnosis which is invariably linked with violence: paranoid schizophrenia. Unlike “simple” schizophrenia and even other “schizoaffective” variants, paranoid schizophrenia sufferers all harbor violent urges. They often have conspiratorial and persecutional fantasies, which tend to drive the tendency toward violence. They ALWAYS pose a RISK. This is not to say that ALL are violent, but rather all have a potential for violence. Although the “traditional teaching” has been that there’s “no increased risk of violence”, more recent articles have challenged that teaching. The interested reader should look up “Evidence Supports Link Between Schizophrenia and Violent Crime”, by Leslie Sinclair, in Psychiatric News, published by the American Psychiatric Association, on September 2, 2011. In addition to scholarly articles, my personal experience with paranoid schizophrenics at various times in my clinical training supports the contention that these violent individuals are inherently dangerous. And, of course, a perusal of American newspaper reporting should make this point quite clear. Consider these famous names: Charles Manson (the Sharon Tate murders), David Berkowitz (Son of Sam), Mark David Chapman (John Lennon’s assassin), John Hinckley, Jr. (Reagan’s attempted assassin) and other less famous, but no less dangerous, perpetrators.
It is true, however, that the risk of violence CAN be substantially decreased with proper pharmacotherapy. But here’s the rub: for pharmacotherapy to work, the paranoi schizophrenics MUST TAKE THEIR MEDICATION. It is known that many paranoid schizophrenics who are well controlled on medications, STOP taking those medications for a variety of reasons. Apparently, many experience an improvement in mood during the early phases of medication withdrawal. Some then come to view the medication as “poisonous” and come to believe that it’s the MEDICATION that is making them sick. They come to suspect that their doctors and even their families are trying to poison them, further interfering with any attempts to try to treat them. And the situation continues to deteriorate.
Although it has become unfashionable to advocate chronic psychiatric institutionalization for all but convicted murders, society must face this unpleasant reality. Paranoid schizophrenics must be adequately medicated AND must be CLOSELY monitored. And if they are not deemed to be adequately medicated, and will not cooperate with recommended medication protocols, then they MUST be institutionalized until such time that the problem is rectified. And, if there are multiple episodes of regression, then chronic institutionalization must be mandated. If not, other innocents like Officer Familia will die at their hands.