Towards A New Understanding of Psychosis and Violence

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I love my brother—and—my brother killed our mother.

This pair, this impossible simultaneous truth, is what I learned to hold.

There are many more of these pairs, pairs not specific to my family’s story.

The vast majority of people with serious mental illnesses are not violent—and—some people with untreated psychotic disorders can be.

Stigma around serious mental illness is based in exaggerated fears of violence—and—stigma around serious mental illness multiplies if we don’t discuss the rare cases of violence in the clearest terms possible.

To be as clear as possible, I want to dissect what I mean when I look at this question: Is there a link between untreated serious mental illness and violence against self or others?

All of my language here needs to be clear, every word.

To start, untreated. I’m referring only to diseases that are not treated, cases when psychosis is allowed to accelerate without medication. When we fail to treat diseases with medication, illnesses metastasize, have disastrous consequences. Tim had been without medication for four months when he killed our mother.

I’m also not speaking about all mental illness, but about diseases in a specific category, serious mental illness. One of our greatest mistakes is painting all mental illness with one broad brush. One in four Americans have a diagnosable mental illness. One in four Americans experience real pain from these illnesses, pain I don’t intend to minimize with this distinction. But the daily challenges that many of these millions face do not constitute serious mental illness. These mental illnesses don’t contort reality through the prism of psychosis.

And it’s that word—psychosis—that is essential here. Psychosis is the world-mangling symptom, the deadly insurrectionist.

Psychosis transformed Tim, led him to sprinkle our parents with salt, flee a floating coin in the basement, splash family members with a cup of water. Psychosis built in Tim, twisted his perception of our mother, made her someone who’d neglected him, someone who’d abused him, someone who’d raped him.

This is psychosis, the sinister symptom of untreated serious mental illness.

Though Tim’s specific psychosis led to violence, psychosis unwinds in myriad directions, can—much more commonly—lead to homelessness, substance abuse, petty crime.

When violence occurs, it is most commonly violence against self. Substantially more people with schizophrenia will die by suicide than will ever harm another person. For years, this was our fear for Tim.

And yes, sometimes there is violence against others. This is the rare violence, the violence extended outward, the violence Tim’s psychosis brought to our mother.

Mental illness—far too often—gets wedged between a murderer and his heinous crime. Far too often, the media, or politicians, or lawyers, pair mental illness with clear-eyed murderers—most often white men, men who murder with guns, men whose worlds were their own hateful construction.

During the 2017 trial of the man who massacred nine people in a Charleston, South Carolina, church, attorneys argued that mental disorders rendered the murderer only partially responsible for his terror. They posited half-hearted diagnoses—social anxiety disorder, mixed substance abuse disorder. Even if these diagnoses are to be believed, they do not spawn psychosis. Rather, they describe broader disorders that surround social anxiety, isolative behaviors, failure to blunt rage.

These disorders did not incite murder. Hate did.

So yes, we need to be extremely careful when discussing the link between untreated serious mental illness and violence.

I know too that Tim participated in a sport that condoned violence, that wrestling is about physically dominating an opponent, battering another person until they submit. I know that Tim learned that his body could be a weapon long before psychosis arrived.

I can understand how this conditioning, this history of combat, might suggest that Tim was programmed for violence, that violence was the only way he knew to exorcise his rage.

And  I  can’t  say  that  this  type  of  sport—a  sport  that  sanctions violence—doesn’t contribute to producing some violent men.

But until psychosis arrived, my brother had never attacked another person outside of a ring. He’d never put his fist through a wall or smashed a bottle on a counter. So yes, while his body had battered other bodies, to suggest that this background alone bred violence would be as negligent as claiming a house fire raged because of its wooden beams and not the match and gasoline that started the blaze. I know that this story—my brother’s story, my family’s story—is only a single piece of evidence. I understand the danger of extrapolating from our story alone.

And though our story is rare, it is far from an isolated incident. In 2013, a mother died at the hands of her son or daughter approximately three hundred times. I’ve scoured the sources that count these killings, FBI Supplementary Homicide Reports and other nationwide data on murder. Most suggest that this estimate, three hundred, is low.

I’ve read studies that have tracked these killings, that have analyzed the cause of these parricides, as the murder of one’s parent is termed. I’ve found media surveys that identify when untreated serious mental illness accompanies these killings in news reports, examined work by parricide experts from California, New York, Canada, England. In their findings—reports with titles like Raising Cain—many conclude that people in the grip of psychotic illness are responsible for at least two-thirds of parricides.

In 2013, two-thirds of the three hundred mothers who died at her son’s or daughter’s hands died because two hundred of these children had illnesses that had spiraled out of control. In 2013, there were two hundred other stories, two hundred other Tims, two hundred other tragedies like our own.

These are ugly stories. All of these stories have their brutal details—their bloodstained white Bibles, their bodies sprinkled with coins, their sledgehammers. After filling newspaper headlines, these stories are largely abandoned, left to congeal in the dark.

We are conditioned to fear these two hundred Tims. We are conditioned to fear the horror of their taboo killings, the real stories behind our pop culture reference points—insane asylum haunted houses, Hitchcock’s iconic Psycho.

We left these two hundred Tims untreated. By ignoring their stories, by ignoring their untreated serious mental illnesses, we let ourselves off the hook. If we ignore these worst-case scenarios, the rare unwinding of unmitigated psychosis into violence—violence almost always unleashed on loved ones—we are accessories to the disease’s murders.

It’s easier to set the Tims aside. It’s easier to let monsters disappear—in prisons, in forensic facilities—than to contend with the source of their monstrosity.

We can ignore the Tims, the rare worst cases—and—live in a world that cloaks mental illness in fear.

But we only conquer terror when we drag what scares us into the light. We only understand horror when we think about what we know, when we look at all the pieces.

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EVERYTHING IS FINE by Vince Granata. Copyright © 2021 by Vincent Granata. Reprinted by permission of Atria Books, a Division of Simon & Schuster, Inc.

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