Political Violence and Mental Health

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Given the fact that the alleged murderer of Jo Cox has been charged, it is important that any discussion of the surrounding issues is contextualized by the requirements of the criminal justice system. There is guidance on reporting restrictions and contempt of court provided by the Crown Prosecution Service here.

But if we step outside this immediate British context, to consider another “lone wolf”, Omar Mateen, who committed the appalling slaughter at the Pulse night club in Orlando, then there are contested accounts in the mainstream media whether his motivation was the political expression of jihadi terrorism, or due to poor mental health. According to CBS:

The suspect had been married to Sitora Yusufiy for several months before divorcing in 2011, Milton reports.
“He was mentally unstable and mentally ill,” Yusufiy told reporters in Boulder, Colorado. Although records show the couple didn’t divorce for two years after the marriage, Yusiufiy said she was actually only with Mateen for four months because he was abusive. She said he would not let her speak to her family and that family members had to come and literally pull her out of his arms.

Yusufiy said she was “devastated, shocked, started shaking and crying” when she heard about the shooting, but she attributed the violence to his mental illness, not any alliance with terrorist groups.

It is surprising the speed with which commentators take as good coin the mental health assessments of non-professionals with a link to the alleged perpetrators, and this betrays “common-sense” misconceptions about mental health. Of course crimes are committed by individuals, and the mental health of those individuals needs to be professionally assessed, but as an article by three practicising mental health professionals, Maryam Hosseini, Christina Girgis and Faiza Khan-Pastula, recently argued in connection with reporting of Omar Mateen.

Lately, the term mental illness has come up a lot when we talk about mass shootings. For many, words such as “bipolar” have become almost synonymous with violent and unpredictable. It’s human to look for reasons, to find any cause that could explain senseless or atrocious acts. But blaming “mental illness” is a dangerous precedent that moves the conversation in the wrong direction.

The fact is, we cannot know yet why Mateen took his disastrous course; the reasons are likely complex, and we are in no position to hazard a guess, much less diagnose from afar.… As psychiatrists, it scares us whenever we read the words bipolar in relation to mass shootings. It increases the stigma against an already vulnerable population without addressing any attributable cause.

… Mental illness is a broad term, one that can mean a lot of things to a lot of people. It doesn’t really help us understand a person’s state of mind, and it does not always correlate to an actual psychiatric diagnosis.

The term “bipolar” has become a colloquialism. It has come to mean someone who is irritable, has frequent mood swings, outbursts of rage, lacks restraint. … But that’s not bipolar disorder. Bipolar disorder is not outbursts of anger. In fact, when someone has daily mood swings from minute to minute with trivial triggers, bipolar disorder is a pretty unlikely diagnosis.

Bipolar disorder occurs in 2.6% of the population, according to the National Institutes of Mental Health, and is characterized by distinct episodes of depression, distinct episodes of mania or hypomania, and distinct episodes of normal mood, or euthymia. It is not a set of pervasive characteristics that a person displays daily throughout his or her life. It is an illness, separate and distinct from the person, which has no bearing on his or her character and is not related to personality traits. This is an important distinction to make, particularly when we look at risk factors for violence. … In fact, most times what the public calls bipolar disorder or generalizes to be “mental illness” could actually qualify as antisocial personality disorder or some variant. Those people know the difference between right and wrong and may feel no remorse for their actions.

Jessica Rosenberg, from Long Island University, argues in a persuasive paper on “Mass shootings and Mental Health Policy” that popular debate linking high profile incidents of violence with poor mental health has had a prejudicial effect, not only increasing the stigma attending mental health, but also leading to some changes in public health policy that have been ill considered, enacted as they were in the highly politically and emotionally charged aftermath of violent events which may not have even been associated with actual mental illness.

Let us be clear, the connection between violence and mental health is a complex one, but most violence is not attributable to poor mental health:

Research suggests that demographic and economic factors, such as being young, male, and of lower socioeconomic status, are the major determinants of violence (Stuart, 2003). Although teasing out a causal connection between mental illness and violence is difficult, a large body of research shows that violence by people with serious mental illness, such as schizophrenia or bipolar disorder, is rare and accounts for approximately only 4 – 5% of violent acts (American Psychiatric Association, 1994; Appelbaum & Swanson, 2010; Fazel & Grann, 2006; Monahan et al., 2001). Moreover, when people with mental illness are violent, it is almost always interpersonal (87%), typically occurs in the home, and the targets are usually family and/or friends. In contrast, the vast majority of violent acts are associated with crime, not mental illness (Stuart, 2003). Persons with mental illness are far more likely to be victims, rather than perpetrators, of violence (Hiday, 1995; U.S. Department of Health & Human Services [HHS], 1999).

As a caveat to that, there is a linkage between co-occurring psychiatric disorders and substance abuse, but the psychoactive effect of certain substances, primarily cocaine, methamphetamine, and alcohol, is considered to contribute to violence even in those without underlying mental health issues. The social problem here is substance abuse, not mental health.

Consultant Clinical Psychologist, Dr Elie Godsi, who has worked with a large number of perpetrators of violence, including at Rampton Maximum Secure Hospital, argues in his excellent book “Violence in Society: Reality Behind Violent Crime” that even some of those who commit heinous acts and find themselves in secure hospitals may in fact have been abnormally socialized so that the extreme violence was to them a rational response to situations as they perceived them, rather than being due to an underlying organic or biological illness. In some such cases therefore violence may be the result of an extreme social problem rather than an issue of individual psychopathology.

As Godsi argues:

We are living within a cultural frameworks that predominantly distort and obscure the reality of violence in society. The unquestioned belief in medical and scientific explanations, allied to a general culture in which genetics and biology are given massive prominence over environmental explanations, all adds up to a society that continues to exist in ignorance and collective denial.

The alacrity with which some, including liberals and those on the left, leap to an assumed link between political violence and mental health, including the uncritical acceptance of “common-sense” attribution of poor mental health by non-professionals, can be prejudicial against acknowledging that political violence can be a deliberate act. As Randall Law, a historian specializing in the study of terrorism, states:

Individuals or groups choose to commit terrorist acts as part of a process or rational and conscious decision making within particular political and cultural contexts. Thus terrorism is not, as it is often colloquially described, a kind of madness …. Terrorism is a communicative act intended to influence the behavior of one or more audiences.

The cultural presumption that Godsi refers to, of seeking genetic or biological explanations, chimes with the legacy “deep” theories of mental health, which were really quite poor science as they were based upon unfalsifiable propositions that can never be adequately tested, including narrative case studies, testimonials and clinical anecdotes. There is discussion of this by Lilliston and Shepherd in their article “New Religious Movements and Mental Health”. These deep theories continue to have a disproportionate hold on popular understanding of mental health, although they are now relatively marginal among clinical professionals.

For example, for Freud and his followers in the psychoanalytic school, good mental health is characterized by normal adjustment to the constraints of social norms, so that a well-adjusted person has “normative personal and sexual relationships,is a productive worker in a satisfying job, values most highly a normative family life, embraces the standard civic values and virtues and makes some contribution to the maintenance of those larger societal values”.

Other “deep” theories with a more “humanistic” perspective, for example, those of Carl Rogers, view humans as transcending their animal nature and having a need to pursue self-actualisation and a creative quest for understanding. Yet this still defines psychopathology in terms of social non-conformity, of deviation from an expected norm.

If good mental health is judged by the absence of behaviours which we assume should be evidence of psychopathology, then we end up with an unfalsifiable proposition that a person who acts crazy is crazy.

In the context of political terrorism, then we need to understand the degree to which the vulnerability landscape has shifted, to include so called “leaderless resistance”. The concept was made clear by Louis Beam, former Grand Dragon of the Texas Ku Klux Klan, who in 1983 called upon “like minded individuals to form independent cells that … … commit acts of terrorism without coordination from above”. The so-called “lone wolf” terrorists, who act either alone or in concert with a few close confederates, but who feel connected to a larger community through publications, both printed or on-line, and through interactions with a network of possibly geographically dispersed co-thinkers.

Tourish and Wohlforth, in their 2000 work, “On the Edge, Political Cults Right and Left”, drew attention to the degree to which political movements that seek to radically achieve transformative overthrow of the existing social and political order may exhibit some of the characteristics of so-called “New Religious Movements”, which is a non-perjorative term for “cults”, with the confusing caveat that some NRMs are not religions! I find the work of Tourish and Wohlforth somewhat sensationalized, but the foundation is sound, if we remove the assumption that supporting the status quo is automatically more rational than seeking to change it.

It is perhaps useful to characterize the supporters of modern Jihadism as a New Religious Movement (NRM) though a particularly malign one; and it is a small stretch from that to seeing the parallels with the networks of white nationalist extremists. I offer this as a proposition worthy of consideration, rather than a firm conclusion, but there is a body of research that may be useful in evaluating this aspect of the terrorist threat,

I think part of the problem of discussing cult like behaviour is that the language is so value laden. Some of this has been deliberate, for example, discussion of “thought reform” models in professional psychiatry in the 1950s was partially informed by the idea that unwilling converts could be inducted and converted to Communism. It is relatively uncritical adoption of this cold war model which diminishes the work by Dennis Tourish and Tim Wohlforth; and can be summarized as a delegitimizing technique to isolate political radicals as “weird people who believe crazy stuff”

Pattison and Ness in their paper “New Religious Movements in Perspective” refer to a useful definition of religion (and correspondingly to secular belief-oriented organizations). The reason this is worth considering is that a corrective to the common-sense idea that someone who believes or acts differently may be crazy is examination that they may be judging themselves against values and social expectations that are different from the mainstream, and from the perspective of their sub-culture they are behaving in a normative way.

“A religion is to be found where persons take it for granted that their own ethos corresponds to the meaning of the Cosmos” Applying this definition … we recognize three analytical dimensions: 1) the creation of an ethos , 2) a process of cosmization, and 3) the reification of ethos with cosmos.

The relationships between ideology, ethos and belief is complex. Some taxonomy may help, where a mainstream religion or political movement to an extent possesses the virtue of verdicality (truth correspondence) between the belief groups ethos (their habitual character and behaviour), and their social cosmos ( the society they live in).

The language of sects and cults developed in mediaeval religious discourse, and has been adopted by ethnographers and sociologists, but it unnecessarily pejorative, hence the preferred term of NRM. It is worth exploring just because there has been extensive research and literature on the subject of sects and cults, and the similarity to the model of political groups which may incline to violence, means that there may be insights in how to deal with them.

A sect may be regarded as a variant of the mainstream politics or religion; and sect members may live in both the mainstream cosmos, and participate in the ethos of their group, despite the fact that there is tension; and lack of verdicality. For example, someone who believed themselves to be a white nationalist revolutionary in twenty-first century Britain, could function effectively in most situations, but their political practice is orthogonal to the social and political institutions of our society.

It is easy to see how the habitual description of violent, right wing extremists as “loners” corresponds to someone who has a relatively normal participation in society, but by choice seeks to limit their social interaction with those who share their beliefs and ideology.

It is also worth considering that a distinct political sub-culture that envisages a different social reality is unlikely to accept a self-marginalizing strategy like the Muggletonian cult. Someone who believes in racial supremacy and race-war, and who believes that their country has been betrayed by traitors and foreigners, will be inclined to act.

It is worth considering that groups like the English Defence League and Britain First both provide a mutual support network, and also popularize the idea that political, and if necessary violent, action can reconfigure society towards their own conception of it. Or in the terms that we have been discussing, a political sect will seek to resolve the issue of verdicality by seeking to change society to correspond to the ethos of the group.

On the left we are accustomed to the energy with which left groups respond to mass strikes or political crises, hoping that this will lead to a breakthrough, and their very orthogonality to the modalities of mainstream politics can mean that they are dynamic and effective at mobilizing popular campaigns. It would be easy to see how a popular campaign by mainstream politicians based upon opposition to immigration could excite far right extremists, and increase their motivation towards demonstrative violence, for which they have been planning for and fantasizing about for years.

The work of Dr Marc Gallanter, of the American Psychiatric Association’s Committee on Psychiatry and Religion suggests that, perhaps contrary to expectation, mental health within members of NRMs is actually better than that of the general population. Lilliston and Shepherd suggest some reasons why that may be the case, that membership of a tight-knit, counter-cultural group may be associated with a more clearly evaluated value system, and will foster a belief in their own self-efficacy, that is, they may be confident that their actions are leading to the results that they want to see. Both of these are associated with good coping mechanisms, and therefore associated with a good model of adaptive functioning when confronted with “stressors”, which is indicative of good mental health.

The truth about violent white supremacist groups is that they are not “crazy”, but they are dangerous. These are people who fundamentally oppose the tolerant values of our society, and are prepared to use violence to achieve what they want. We need to be very clear that this is a problem of politics, and not of mental health.

7 comments on “Political Violence and Mental Health

  1. I unfortunately published the first draft of this article earlier than I intended, without my final edit.

    Not much has changed, except I have deleted quite a bit.

  2. John on said:

    Andy Newman,

    A very timely and well considered piece of writing. There are multiple layers to this issue, but for me what is constantly abstracted is the role ideology plays in shaping a worldview to the point where engaging in an act of terrorism seems a perfectly natural response to real or perceived injustice.

    That no man does evil in his own mind is a truism that applies to every perpetrator of a heinous crime that has a political motive. I wrote on the Omar Mateen mass shooting for RT – https://www.rt.com/op-edge/347472-steinmeier-nato-germany-russia/ – making the point that he was not a child of ISIS (or its ideology) but of America (and its cultural values).

    Maladjustment and mental illness are two entirely different phenomena. Indeed, who’s to say that the status quo is rational and the maladjusted, when driven or compelled to acts of extreme violence, are not? Certainly not those who right now will be celebrating, albeit in private, the vile acts committed by Mateen and Mair.

    The taboo on such heinous acts is not a natural but a cultural taboo. The role of ideology in either distorting or cultivating a moral paradigm at odds with that of the status quo is I think under appreciated. How else could Hitler lead an advanced industrialised nation at the heart of Enlightenment Europe down the dark path he did?

  3. George Hallam on said:

    John: How else could Hitler lead an advanced industrialised nation at the heart of Enlightenment Europe down the dark path he did?

    Alternatively, it was going that way anyway and he just hitched a ride.

  4. Omagh on said:

    Interesting piece; it raises the problem too of a religious belief system in itself, freed from the rigging of some rational foundation. I find all main religions problematic for the simple fact that they don’t make any coherent sense, precisely because they go against the Kantian Copernican revolution which quite humbly – I like this humility, it is something religions’ all ultimately lack, hence their psychological power – a meditation on human finitude and eschews the more grandiose attempt to say what reality is. In a contemporary setting we have an interesting emergent philosophy, in speculative realism, that goes beyond the commonsense realism of ‘this is tree’ towards embracing a genuine weirdness with objects themselves and what, in all their complexities, they genuinely are. With this in mind, religion becomes a gross simplification of reality, more a puritanical moral compass that separates out humanity into fairly inane categories. Bad treatment of different categories is justified to reinforce the division creating a perpetual cycle. Religions, like cults and sects, create this perversion for a mono-identity, and monotheistic religions are all-defining. I can see how appealing it is to slip into a ‘one size fits all’ infinitude; the problem is what is gained psychologically, is lost in an ultimately -at core – inflexible concept that cannot blend with new ideas.
    Marxism has an old testament utopian bend in it and many remaining Marxists have a believers’ passion for their projects but what is lost is a sensitivity to the suffering of others, whose political projects oppose their own, even with the same evangelical zeal.
    Ultimately politics and religion, are sets of ideas that compete for some status to that grey area that
    is problematic – reality itself – in doing so they become, in part, acts of will. Violence is the ultimate expression of this, not sustained debate because violence is the purest form of the will to dominate, to submit the other side to your vision. Religion merely asks you do it else the violence of the ‘after’ will.
    The violence on both sides of the pond has been exploited in a way that suggests powerful political capital can be made from these slayings. Homophobic hatred has a powerful religious mandate and the political classes in the USA have been careful to be too critical of where religious ideas might create a cultural context for such hatred. Likewise , in the UK the Bremain camp have seized on Jo Cox’s death like vultures showing a desperation in their own camp to conflate all Brexiters as race haters. I wonder if there is any way back for the political classes – on both sides of the debate
    ( Farage’s appalling refugee advert) after this psyops routine.

    We are living in dangerous times where psychological buttons are easily located and activated in a context where so many political ideas are formed around such a narrow base. If politics can create the meaning that religion gives without the tricks we might be onto something but its clearly not going to happen with a murderous violent right-wing, a resurgent Islamism, America wedded to capital and resource expansionism and a Left that has not yet moved out of its political superstitions.

  5. Omagh,

    Thanks for that. The mainstream historical religions arose in circumstances where there was cultural homogeneity and the religion codified the expected behaviour that underpinned social reproduction.

    Of course all religions are man made because even if we accept that God’s grace has been revealed, it has been revealed to flawed humans whose understanding is contextualized by the society they live in , and the level of science, cultural development and empathy that surrounds them.

    In this sense religions have had a profound social foundation of codifying existing cultural arrangements – for good and for ill.

  6. Omagh: We are living in dangerous times where psychological buttons are easily located and activated in a context where so many political ideas are formed around such a narrow base. If politics can create the meaning that religion gives without the tricks we might be onto something but its clearly not going to happen with a murderous violent right-wing, a resurgent Islamism, America wedded to capital and resource expansionism and a Left that has not yet moved out of its political superstitions.

    Nicely put. Rational voices in this debate, voices that look for the political and class interests that lie behind the irrrational, over-emotional and moralistic rhetoric that has characterised the referendum debate on the Remain side (and the toxic discourse around migration that is the bourgeois Brexit campaign) need to be heard.