Sick and dangerous ?: Mentally ill people are often under general doubt 2

Sick and dangerous ?: Mentally ill people are often under general doubt

What's going on with these people? At the Frankfurt Main Railway Station, a 40-year-old man encounters a stranger off the platform in front of an incoming ICE. An eight-year-old dies. A few days later, a 17-year-old in London tosses a boy from the observation deck of the Tate Modern Museum on the tenth floor. A six-year-old man hits a canopy on the fifth floor and survives severely injured.

Violent acts are often attributed to people without mental illness

Two cases that occurred this month are that the perpetrators did not know their victims. Both men had mental health problems. The suspect from Frankfurt Central Station was undergoing psychiatric treatment and was likely suffering from paranoia. The psychiatry report is still pending.

Acts like these state that seriously mentally ill people are more dangerous than healthy people. But that's not true. "The mentally ill do no more violence than other residents," says Andreas Heinz, director of the Department of Psychiatry and Psychotherapy at the Charité Mitte Campus in Berlin.

The German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) also states on its website that violence related to people is mainly caused by people who do not suffer from mental illness. Nevertheless, people with mental illness would once again find themselves in great doubt in the public under general suspicion.

According to Isabella Heuser-Collier, no rule can be derived from individual violent acts

Allegations of the number of acts perpetrated by the mentally ill can give information about the inability to commit such crimes. Because: If the mentally ill become violent and the mental illness is widespread, they are often classified as guilty in court. Paragraph 20 of the Criminal Code states: "It is not the responsibility of a guilty person who, at the time of the crime, for example because of a pathological mental disorder or a profound disorder of consciousness, is unable to understand the injustice of the crime.

According to law enforcement statistics, about 0.2 percent of all acts of violence were committed in 2017 by people who were later classified as having no legal basis for mental illness, explains Hans-Ludwig Kröber of the Center for Forensic Psychiatric Assessment in Berlin. Perpetrators of homicides account for over 12 percent of perpetrators. "Only in the smallest but most serious criminal group do we have a disproportionate proportion of mentally ill offenders."

What happens in the minds of the perpetrators, what drives them? Isabella Heuser-Collier, director of the Psychiatry and Psychotherapy Department at Benjamin Franklin's Charité campus, emphasizes the rarity of such acts. "Because it's so rare, you can actually set the rule. From individual cases of violence against strangers of the past, we know that the perpetrators suffered from psychosis and acted in acute delusion," says a psychiatrist. For example, they feel haunted. Just like the 29-year-old who met a 20-year-old in front of an incoming subway in Berlin in January 2016. The young woman was immediately dead.

In psychosis, everyday knowledge is called into question

In April 2018, the 23-year-old grabbed a five-year-old boy at Wuppertal Central Station in front of his parents and two siblings and jumped with him in front of the train. The boy's father ran to the tracks, pulled the child from the man and rescued him. The defendants will later be diagnosed with schizophrenia. He had previously been noted by a number of minor offenses and had refused psychosis treatment.

Persecution mania occurs in psychoses. But what exactly is going on in the heads of the afflicted? "Everyday knowledge, which not all people usually ask for, is called into question," said Heinz, who is also chairman of the DGPPN. The affected then often began searching their surroundings for signs of danger, threat and persecution.

"They see something, like the flash of a CCTV camera, and they feel that it's giving them a sign," Heinz says. Or the afflicted believed that all their comrades were secret agents. If more and more everyday facts that become self-evident become questionable, then perhaps voices are added, people who have been involved in their own attempts to explain themselves, Heinz says.

Psychoses are often misleading

The term psychosis is often a synonym for schizophrenia. In fact, schizophrenia is a variant of psychosis. And unlike what is often assumed, schizophrenia has absolutely nothing to do with a split personality, points out Julia Arnhold, a psychologist and psychosis expert at the Professional Association of German Psychologists.

Schizophrenic diseases also include the fact that mental functions – thinking, perceiving, feeling and acting – are no longer functionally intertwined, Arnhold says. This limits the person's relationship to reality and its interaction with the social environment for the duration of the acute psychosis.

When asked if patients become violent, it depends on how vulnerable they are to delusions or hallucinations, Heinz says. "Mostly it happens that people get hurt or pull over."

Affected people want to defend themselves – this can rarely lead to violence

And there are other factors that increase the risk of violence among patients. In the first place is the external influence: the use of alcohol and drugs. Even lack of psychiatric treatment, lack of insight and impulsiveness increase the risk of violence.

Generally, psychotic experiences like paranoia lead to intense fears, explains psychologist Arnhold. In very rare cases, these fears can force them to defend themselves – and become aggressive towards strangers. (Dpa / Fwt)