Ship of Fools: How to cure stigma?

Thread: How to cure stigma? Board: Oblivion / Ship of Fools.

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Posted by chive (# 208) on :

I was utterly horrified to see this headline in the Sun today (not that I think the Sun is a reputable source of anything news related). It is particularly appalling when it is compared with this study that shows that mentally ill people are far more likely to be the victims of crime and to have their crime reports ignored.

Coming on the back of this story less than a fortnight ago it is clear, that at least in the UK, that stigma against mentally ill people is a)very real and b)almost socially acceptable.

As a press release from a group of mental health charities shows the Sun's headline is at best disputable and at worse wrong.

How do we address this issue? What can be done to reduce the stigma faced by those with mental health problems? How can societal beliefs be changed so they are more reflective of reality?

I have mental health problems myself so I find that reporting such as this impacts on how people treat me and react to me.

But anyway, I'm going to the shops now, I will try to avoid murdering anyone. I look forward to your thoughts when I get back.

Posted by Raptor Eye (# 16649) on :

As with every prejudice, only if we associate with people who have severe mental health problems will we ever tear down our imagined caricatures, let alone realise that we can learn from these human beings and see Christ in them at times.

What is the standard supposed to be for 'normal' mental health, anyway? We all surely fall short of it by degrees! I know I do.

Posted by Erroneous Monk (# 10858) on :

I wonder how many people are killed by Sun readers every year.

Posted by Pigwidgeon (# 10192) on :

I haven't had my coffee yet. I thought the thread title was "How to cure stigmata."
[Eek!]

Posted by Gramps49 (# 16378) on :

In the United States we have the National Association on Mental Illness, NAMI. Our congregation is a member. We also work through the Faith Action Network to advocate for social justice.

I see there is an organization in Great Britain called Together. There might also be other groups. I certainly would join and advocacy group and work with them to address the stigma.

What is the Sun's policy on letters to the editor? I would suggest sending them a letter with your thoughts.

Posted by chive (# 208) on :

quote:
Originally posted by Gramps49:
What is the Sun's policy on letters to the editor? I would suggest sending them a letter with your thoughts.

I have to admit that it's a long time since I've read the Sun but the last time I did it's letters page seemed to have the policy of letters being very short and preferably about breasts.

Posted by Schroedinger's cat (# 64) on :

I don't think the Sun - or most of its readers, in all honesty - are really bothered about truth and accuracy. A good headline is about their limit. So whatever you do, some people will remember that 1200 people have been killed by the mentally ill.

The headline was appalling, and the furore I have seem on twitter today does show how many people find this offensive. I also note that the Daily Express - not a paper known for its tolerant and balanced reporting - did a much more balanced article on the same topic (I would like to it, but cannot find the article).

How to cure stigma (and I too read it as stigmata!)? By more people being prepared to admit to having mental illness. Which can only happen when the stigma is reduced, so it is a vicious circle.

I think the statistic that needs to be made clear is that 1 in 4 people suffer from a mental illness of some sorts, according to the statistics. I believe it is probably substantially higher, if you count those with minor illness for whom medication is not appropriate, and those who will not seek help for it.

This means that your family, your work group, your table in the pub has someone with mental illness around it. If people could get their heads round that, and understand that this does not make them dangerous, or in fact any different from Ted-before-I-knew-he-had-a-problem, then we might start to reduce the stigma.

Posted by moonlitdoor (# 11707) on :

I don't think arguing the toss about statistics is the way to go, personally. Mentally ill people probably are over represented in the group of people who have done some particular bad thing. And under represented in the group of those who have done a different bad thing. Likewise with groups of those who have done some good thing.

I expect the same is true of gay people, and other groups that might be stigmatised. Male people dominate the category of rapists, but it's still only the rapists who have committed a rape, not the rest of the men.

Posted by IngoB (# 8700) on :

quote:
Originally posted by chive:
As a press release from a group of mental health charities shows the Sun's headline is at best disputable and at worse wrong.

Uh, well, no - it doesn't. What they call "disputable" there appears to address the subtitle: "Shock 10-year toll exposes care crisis", not the title "1,200 Killed by Mental Patients". And frankly, their comment even on that is hardly what I would call reassuring (the number of homicides of people with mental illnesses has remained steady and some say it has been going down recently).

I cannot access the Sun article, so I don't know what the facts and sources behind this really are, or what spin the Sun puts on it. But the number of murders in the UK have been going down in general, both in absolute numbers and in relative ones, see here. So if there has been a reduction in murders by the mentally ill, it may be no more than a reflection of say better policing or higher living standards.

Furthermore, based on the numbers provided at this link, I calculate for the ten years 2002/3 to 2011/12 a total of 8,879 murders in the UK (England + Wales + Scotland + Northern Ireland). If the Sun figures are correct, then 1,200/8,879=13.5% of all homicides were carried out by mentally ill people. Now, that seems rather high. For example, Schizophrenia prevalence is about 1% in the population.

I do not have access to what the Sun considered as "mentally ill" in their sums. But we may very well be able to say something like "a person with these kinds of mental illnesses is five times more likely to become a murderer than a healthy person". (I made that "five times" up. I do not know the number. The above suggests though that it could be significantly >1.)

That then would be a rather scary fact. How we deal with that fact is a medical and policy question. But simply pretending that it does not exist will not help. And it is not helpful for this in a direct manner that mentally ill people are also at a greater danger of being murdered. This is not some kind of tit-for-tat game where one murder strikes out the other. If the mentally ill are being killed more, then that is terrible and needs to be looked at. If they kill more, then that is also terrible and needs to be looked at.

Posted by Jengie Jon (# 273) on :

IngoB

You are aware of this article I take it. It is very rare for anyone to commit murder, even with a five fold increase would still be very rare. As to prevalence Mind give mental health difficulties in a given year, so it would seem that the risk of mentally ill people killing someone is less than for the sane people.

Jengie

Posted by churchgeek (# 5557) on :

quote:
Originally posted by Gramps49:
In the United States we have the National Association on Mental Illness, NAMI. Our congregation is a member. We also work through the Faith Action Network to advocate for social justice.

What does it mean for a congregation to be a member of NAMI? I mean in practical terms. Does it make a difference in anything the congregation does?

quote:
Originally posted by Schroedinger's cat:
I think the statistic that needs to be made clear is that 1 in 4 people suffer from a mental illness of some sorts, according to the statistics. I believe it is probably substantially higher, if you count those with minor illness for whom medication is not appropriate, and those who will not seek help for it.

This means that your family, your work group, your table in the pub has someone with mental illness around it. If people could get their heads round that, and understand that this does not make them dangerous, or in fact any different from Ted-before-I-knew-he-had-a-problem, then we might start to reduce the stigma.

That's the point. As IngoB says, if there really is a greater likelihood that mentally ill people will commit crimes, or be victims of crime, that needs to be addressed. But there is still the question of stigma. Full disclosure: I'm mentally ill (bipolar type 2). The discourse about mental health and gun violence in particular here in the US tends to make me nervous. When people hear in the news that such-and-such mass murderer is thought to have been bipolar (but he's dead now, so we'll never know for sure) or something like that, it reinforces the stigma. If all anyone ever hears about bipolar is that a bipolar guy shot up some public place and killed a bunch of people, then when I say I'm bipolar, what are they supposed to think of me? Hopefully, my openness will help curb the stigma somewhat in my circles of influence.

Also, in the US, mental illness is covered under the Americans with Disabilities Act (ADA). That's important to know and to let your employer or supervisor know. Even putting it in terms of a disability helps take it out of the realm of character flaws or spiritual problems.

But I still find that when I'm having problems, even well-meaning people suddenly become very patronizing. They talk to me as if I'm a child, and tell me things that make me wonder if they think my mental illness is nothing more than my never having learned how to think properly or react properly to life. Which of course it isn't. I try to focus on the fact that they're trying to help, but it's pretty frustrating. At the same time, I know it's frustrating for them as well, because they also feel powerless.

(I've been unbalanced a bit lately, so this is really important to me right now.)

Posted by sophs (# 2296) on :

quote:
Originally posted by IngoB:

quote:
Originally posted by chive:
As a press release from a group of mental health charities shows the Sun's headline is at best disputable and at worse wrong.
Uh, well, no - it doesn't. What they call "disputable" there appears to address the subtitle: "Shock 10-year toll exposes care crisis", not the title "1,200 Killed by Mental Patients". And frankly, their comment even on that is hardly what I would call reassuring (the number of homicides of people with mental illnesses has remained steady and some say it has been going down

This is a link to the full research, there is also a very good guardian piece about the statistics behind it. Basically the 1200 figure is people with established mental health problems (738) and people who at the time of the murder may have had psych problems. This is a huge difference, and the people who did the research have been all over twitter trying to explain that the Sun have manipulated the figures.

[ 07. October 2013, 19:55: Message edited by: sophs ]

Posted by sophs (# 2296) on :

Sorry for the double post, but within the group of patients, 74% had alcohol problems and 76% had non prescriptions drug problems. I can't find the statistics amongst general homicides, but I imagine the figures are similar. I'd say this was a higher risk factor than people with mental health problems

Posted by Twilight (# 2832) on :

quote:
Originally posted by churchgeek:
When people hear in the news that such-and-such mass murderer is thought to have been bipolar (but he's dead now, so we'll never know for sure) or something like that, it reinforces the stigma.

Yes, it does, to a huge extent.
Dr. E Fuller Torrey reminds us of that on his treatment advocacy.com and in his books and lectures.
In The Insanity Offense, he calls deinstitutionalization a national catastrophe, turning thousands of people with severe schizophrenia and bipolar out onto the streets without medication or basic care.

For years Torrey has been keeping track of crimes in which severe mental illness has played a part, in order to back his drive for treatment and the opening of institutions geared to care for the severely mentally ill. He has noted the rise in stigma after each publicized incident.

If we provide good health care for more people the numbers published by newspapers like the Sun will go down and we wont have to keep reminding people that the number of violent crimes done by people with bad colds is probably much higher.

Posted by Gramps49 (# 16378) on :

For my congregation it means the local NAMI group uses our place free of charge. We also will participate in letter writing campaigns dealing with mental health problems.

Posted by Dave W. (# 8765) on :

quote:
Originally posted by IngoB:
I do not have access to what the Sun considered as "mentally ill" in their sums. But we may very well be able to say something like "a person with these kinds of mental illnesses is five times more likely to become a murderer than a healthy person". (I made that "five times" up. I do not know the number. The above suggests though that it could be significantly >1.)

That then would be a rather scary fact.

Why is that scary? According to this Wall Street Journal web page, in the US from 2000 to 2010 men committed nearly 10 times as many murders as women. Is that more scary? Less scary? Equally scary?

Posted by Porridge (# 15405) on :

Part of the "stigma" problem is that, like many such situations, it's grounded (in a very limited way) on a tiny seed of truth. I know this from occasionally accompanying clients on their forays into "the community."

My clients are people with developmental disabilities plus a mental illness diagnosis. Many have been institutionalized for longish chunks of their lives (IMO, that should lead to yet a third Dx, because long-term institutionalization, especially during the developmental years, has long-term devastating effects on human behavior -- but that's another thread).

Here's the tiny seed of truth:

Most of us take for granted the extent to which our "normal" social interactions and behavior within a shared culture are "scripted" and therefore predictable. I ask "How are you?" and you answer "Fine" regardless of whether that's actually true. That sort of thing.

People with significant cognitive and/or perceptual differences, and people with some kinds of MI, often react and respond to common situations in atypical ways. Example: one former client had a truly weird reaction to a certain color. In public, she would approach anyone, including strangers, wearing this color with unusual vocalizations and gestures.

To someone being approached, or someone observing, this makes my former client seem highly unpredictable -- and therefore scary, even possibly dangerous. "Good grief," we think, "If this is what she does in Situation A, what will she do when B happens? She might do anything!"

This places us on alert, even high alert. We notice, and start questioning, everything she does with enough scrutiny so that even run-of-the-mill behavior takes on significance for us.

At the other end of this, we encounter the vicious circle: in US culture, to need help of certain kinds is in itself stigmatizing; so people who genuinely need help (and/or their families/carers) avoid seeking it. This leads to assorted oddnesses (which might be "correctable") going uncorrected, leading to more public oddness, leading to more odd encounters, reinforcing the "unpredictable" notion, which builds credence to the "potentially dangerous" myth.

Posted by Marvin the Martian (# 4360) on :

quote:
Originally posted by Dave W.:
According to this Wall Street Journal web page, in the US from 2000 to 2010 men committed nearly 10 times as many murders as women. Is that more scary? Less scary? Equally scary?

It certainly means that I will be more "on guard" in situations involving an unknown man than in situations involving an unknown woman.

But even in those situations, there's a reasonable expectation that the other person will be following social norms and behaviours. What many people find scary about people with certain mental illnesses is the way that expectation disappears. Earlier this year a schoolgirl on the same bus route I use to get to work every day was fatally stabbed for absolutely no reason whatsoever by a paranoid schizophrenic. It's all well and good saying the rest of us shouldn't let that affect how we react to other people with similar mental illnesses, but when the thought - some of my fellow passengers might now say the knowledge - that they might randomly decide to stab you for no particular reason and with no provocation is there in your mind it's very difficult to ignore.

Obviously that doesn't apply to all mental illnesses. But it does apply to some, and yes it's scary.

Posted by no prophet (# 15560) on :

Health policies that have decreased services to people with mental illnesses have completely degraded the safety net for them here. From housing assistance, income support, day programs, access to psychiatry and community mental health nursing. The only place that seriously mentally ill people have experienced an increase in services is from the legal system here. So no support means they are exposed to risks. I formerly worked in provincial mental health services 25 years ago. The whole community support system has been unfunded and dismantled in favour of hospital care for problems corporations can get their name on, like MRI machines, breast cancer centres etc. Even when mental health is targetted for private donations it is about hospital beds, not about what the vast majority of patients actually need.

Your situation my be different but we also have more mentally ill people arrested either under the Criminal Code or Mental Health Act and taken to either jail or hospital. Hospital usually means assessment for self or other harm risk and quickly sent on their way. I don't actually think these 'non-voters' are of much interest to anyone, particularly politicians.

Posted by churchgeek (# 5557) on :

quote:
Originally posted by Gramps49:
For my congregation it means the local NAMI group uses our place free of charge. We also will participate in letter writing campaigns dealing with mental health problems.

Thank you to your congregation for doing that!

Posted by IngoB (# 8700) on :

quote:
Originally posted by Jengie Jon:
You are aware of this article I take it. It is very rare for anyone to commit murder, even with a five fold increase would still be very rare.

No, I wasn't. But I see no reason whatsoever for you to bring it up. It is a technical point about using ratios of risks rather than odds. Nothing in what I said indicated that I would even run into trouble with that. For example, if I took the ratio of murder rates, I would be doing a relative risk calculation, not a relative odds calculation, which is perfectly interpretable. And even if for some reason I were to take odds into ratio, then the fact that these are rare occurrences would mean that I would basically get the same results as with relative risks. A point made in the very first paragraph of the paper you reference.

(For anyone who has no idea what this is about, yet is interested: Odds of 1 (to 1) mean a 1/(1+1)=50% risk, odds of 2 (to 1) mean a 2/(2+1)=66.7% risk. If I take the ratio of odds here, it is 2/1=2 so a 100% increase from 1. If I take the ratio of risks, it is 66.7%/50%=4/3=1.33, so merely 33% increase. However, consider instead odds of 0.1 (to 1), which means a risk of 0.1/(0.1+1)=1/11=9.09% and odds of 0.2 (to 1), which means a risk of 0.2/(0.2+1)=1/6=16.7%. In this case the relative risk is 16.7%/9.09%=11/6=1.84, whereas the odds ratio is again 2. Obviously that's much closer. As the odds/risks get lower and lower, both ratios become more and more alike. So in the case of murder, with really low odds and risks, there's basically no difference at all...)

quote:
Originally posted by Jengie Jon:
As to prevalence Mind give mental health difficulties in a given year, so it would seem that the risk of mentally ill people killing someone is less than for the sane people.

I do not know how you come to this conclusion. The study linked to by sophs speaks of 74 patients per year (on average over 10 years here and in the following) that were convicted of homicide, a number that goes up to 115 per year if one counts symptoms of mental illness (and these were responsible to 122 homicides per year, i.e., some killed more than one person). Your numbers say that 102 out of 1000 people are diagnosed with symptoms, and 30 (24+6) out of 1000 will become patients.

I make the following definitions:

h1=number of murderers p.a. with mental illnesses
n1=number of people with mental illnesses
h2=number of murderers p.a. without mental illnesses
n2=number of people without mental illnesses

r1=h1/n1 risk of homicide with mental illnesses
r2=h2/n2 risk of homicide without mental illnesses

R=r1/r2 relative risk (if >1, then with mental illnesses riskier)

We know from Jengie Jon's link

p=n1/(n1+n2) risk of mental illnesses

with

p=102/1000=0.102 for symptoms
or
p=30/1000=0.03 for patients

And we have n2/n1=(1+p)/p.

We know from my previous post that there were 8879 murders over 10 years. Let's assume that double murders occur about as much for people without mental illnesses as for those with, then we have about 8879*115/122/10=837 murderers p.a. over this period of time.:

h1+h2=837

and we know from soph's link

h1=115 for symptoms
or
h1=74 for patients

therefore

h2=837-115=722 for symptoms
or
h2=837-74=763 for patients

We find

R=r1/r2=(h1/n1) / (h2/n2)=h1/h2*n2/n1=h1/h2*(1+p)/p

Thus

R=115/722*(1+0.102)/0.102=1.72 for symptoms
R=74/763*(1+0.03)/0.03=3.33 for patients

Thus I estimate that getting murdered by a patient with mental illness is over three times more likely than getting murdered by a mentally healthy person. This drops to only 72% increase in danger if we consider those with symptoms of mental illnesses (i.e., those in treatment are more dangerous than those who aren't).

quote:
Originally posted by Dave W.:
Why is that scary? According to this Wall Street Journal web page, in the US from 2000 to 2010 men committed nearly 10 times as many murders as women. Is that more scary? Less scary? Equally scary?

I second Marvin's answer to that above. Given what I have just calculated, there is not the same sort of escalation in likelihood of danger as for going from a woman to man if we go from a healthy person to a mentally ill person, even if that person is a patient. It is "only" a factor of about three, not ten. Interestingly enough, the gender gap is reduced for mentally ill people (it's more a factor of five than ten there). Still, it is a considerable further increase. So the difference between a mentally ill male patient and healthy woman in potential threat level is really striking.

Posted by Karl Kroenen (# 16822) on :

quote:
How to cure stigma?

I originally read this as how to cure stigmata and so the ensuring threads had me rather confused.

Posted by Dafyd (# 5549) on :

quote:
Originally posted by IngoB:
So the difference between a mentally ill male patient and healthy woman in potential threat level is really striking.

The thing is though it's a threefold increase on negligible is still negligible. It's not an order of magnitude increase. And it would have to be a couple of orders of magnitude to become practically significant.

Posted by Avila (# 15541) on :

quote:
Originally posted by IngoB:

quote:
Originally posted by Jengie Jon:
As to prevalence Mind give mental health difficulties in a given year, so it would seem that the risk of mentally ill people killing someone is less than for the sane people.
I do not know how you come to this conclusion. The study linked to by sophs speaks of 74 patients per year (on average over 10 years here and in the following) that were convicted of homicide, a number that goes up to 115 per year if one counts symptoms of mental illness (and these were responsible to 122 homicides per year, i.e., some killed more than one person). Your numbers say that 102 out of 1000 people are diagnosed with symptoms, and 30 (24+6) out of 1000 will become patients.

How are you defining a 'patient'? I am a patient at my doctors surgery as I am under treatment - as in I turn up at appropriate intervals and have prescription drugs.

The other thing is the stigma/desire for separation / denial that sane people can do terrible things that makes people read of a murder and start talking of the killer as mad/crazy/not in their right mind - even when there is no history or suggestion of mental ill health being involved.

So when a mentally ill person kills that fact is the main focus, and when a sane person kills they are implied to be mentally ill in some way. No wonder it spreads fear - the fear to admit to needing medical help until it is so serious it can't be ignored.

Twisted thinking and logic can come from a perfectly functioning sane mind - likewise the mentally disturbed mind can still find clarity of thought and insight.

Posted by Dafyd (# 5549) on :

quote:
Originally posted by Marvin the Martian:
It's all well and good saying the rest of us shouldn't let that affect how we react to other people with similar mental illnesses, but when the thought - some of my fellow passengers might now say the knowledge - that they might randomly decide to stab you for no particular reason and with no provocation is there in your mind it's very difficult to ignore.

It's true that the human mind is bad at assessing the risks of high impact low probability events. Especially when the prerequisite is itself not routine. For example, if the knowledge that aeroplanes sometimes crash is in your mind it's difficult to ignore. Even though you're safer in a plane than in a car. (And in the other direction, lotteries make some if not all of their money from people overestimating their chances of winning.) So yes ignoring the possibility may be hard, but just because it's hard doesn't mean it's not reasonable.

Posted by Dave W. (# 8765) on :

quote:
Originally posted by IngoB:

quote:
Originally posted by Dave W.:
Why is that scary? According to this Wall Street Journal web page, in the US from 2000 to 2010 men committed nearly 10 times as many murders as women. Is that more scary? Less scary? Equally scary?
I second Marvin's answer to that above. Given what I have just calculated, there is not the same sort of escalation in likelihood of danger as for going from a woman to man if we go from a healthy person to a mentally ill person, even if that person is a patient. It is "only" a factor of about three, not ten. Interestingly enough, the gender gap is reduced for mentally ill people (it's more a factor of five than ten there). Still, it is a considerable further increase. So the difference between a mentally ill male patient and healthy woman in potential threat level is really striking.

It still seems to me that something more would be required to show that the increased risk merits the "scary" description. If the mentally ill are statistically more likely to pose a physical danger, even by a substantial multiple, it just makes them "scarier" than something I wasn't particularly worried about anyway. I suppose a more compelling comparison would be with some other risk that I already did consider sufficiently dangerous to warrant taking steps to avoid it.

(And if the scariness consists in the violation of expectations regarding social norms and behaviors that Marvin refers to - well, it seems to me that the norms are pretty much in tatters in any case of physical assault, regardless of the mental health of the attacker.)

Posted by IngoB (# 8700) on :

quote:
Originally posted by Dafyd:
The thing is though it's a threefold increase on negligible is still negligible. It's not an order of magnitude increase. And it would have to be a couple of orders of magnitude to become practically significant.

First, homicide is an extreme of violence, both in terms of the act and the success of carrying it out. If I meet a man in a dark alley I'm more cautious than if I meet a woman not just because of the increased chance to be murdered, but because murder is an extreme on a spectrum of violence, most of which is more likely. I have no data on general violence committed by the mentally ill. But it is reasonable to assume that also other forms of violence are more likely.

Second, the importance of a risk does not only depend on the likelihood, but also on the consequence. If there is a minuscule risk of the milk in my fridge being spoilt, I'm not particularly worried. Even if that happens, it generally does not matter much. If there is a minuscule risk of getting murdered, then I am somewhat worried. Because if that happens, it matter more than almost everything. By the same principle a nuclear power plant is supposed to be guarded with particular diligence against catastrophic failure, because such failure tend to be catastrophic.

Third, and perhaps most to the point of the OP, there is always the question of whether I can avoid a risk, and what it would cost me to do so. Obviously, driving a car is a much higher risk to my life than dealing with mentally ill patients. I can avoid both, mostly (whereas some risks are more or less impossible to avoid). However, my life becomes a lot less comfortable if I avoid driving cars. So there is a risk - gain balance there. The question is then what do I gain by interacting with patients with mental illnesses. And while I think one can provide answers to that, the sort of gains available there for most people will be quite a bit more abstract (in one sense) or "emotional" (in another sense) than the rather straightforward gains provided by driving a car.

quote:
Originally posted by Avila:
How are you defining a 'patient'? I am a patient at my doctors surgery as I am under treatment - as in I turn up at appropriate intervals and have prescription drugs.

Please do read the relevant links. I'm working with their definitions as well as I can (and I've shown my workings above).

quote:
Originally posted by Dave W.:
It still seems to me that something more would be required to show that the increased risk merits the "scary" description. If the mentally ill are statistically more likely to pose a physical danger, even by a substantial multiple, it just makes them "scarier" than something I wasn't particularly worried about anyway. I suppose a more compelling comparison would be with some other risk that I already did consider sufficiently dangerous to warrant taking steps to avoid it.

I'm not sure that the label "scary" requires a worked out reasonable risk assessment anyway. I'm certainly scared of spiders to an extent that is not reasonable (at least since I've moved away from Australia). However, see my comments to Dafyd above. Unlike spiders in the UK, mentally ill patients can kill or hurt me. Furthermore, it is usually fairly easy for me to avoid them, at least if they are identifiably mental ill.

I think the real discussion here will only start once we stop claiming that there is no rationale at all to avoid mentally ill people. There is. The question is rather what it is that motivates us to not follow this rationale.

Posted by Dafyd (# 5549) on :

quote:
Originally posted by IngoB:

quote:
Originally posted by Dafyd:
The thing is though it's a threefold increase on negligible is still negligible. It's not an order of magnitude increase. And it would have to be a couple of orders of magnitude to become practically significant.
Second, the importance of a risk does not only depend on the likelihood, but also on the consequence. If there is a minuscule risk of the milk in my fridge being spoilt, I'm not particularly worried. Even if that happens, it generally does not matter much. If there is a minuscule risk of getting murdered, then I am somewhat worried. Because if that happens, it matter more than almost everything. By the same principle a nuclear power plant is supposed to be guarded with particular diligence against catastrophic failure, because such failure tend to be catastrophic.

As I said in response to Marvin, humans are bad at processing unfamiliar high consequence low risk situations. We instinctively weight consequence over risk in a way that isn't borne out by any rational assessment.
Public fears of nuclear power, for example, are just not proportionate to the cost-benefit assessment.

[ 10. October 2013, 09:04: Message edited by: Dafyd ]

Posted by IngoB (# 8700) on :

quote:
Originally posted by Dafyd:
As I said in response to Marvin, humans are bad at processing unfamiliar high consequence low risk situations. We instinctively weight consequence over risk in a way that isn't borne out by any rational assessment. Public fears of nuclear power, for example, are just not proportionate to the cost-benefit assessment.

I call bullshit on that one. There is no such thing as a "rational assessment" of the consequence of my death to me. It is basically an infinitely negative outcome, as far as I am concerned, trumped only by "more infinitely valuable" matters strictly according to my assessment. You may well value my life by some "objective criteria" like insurance payouts, but that is essentially meaningless to me. And this is not an irrational stance, just because it is not "rational" in some kind of "calculation exercise" sense.

One could comment similarly on public fears about nuclear power. What may be "irrational" there is to not similarly fear some major chemical plants. However, the measure of a nuclear wasteland is not necessarily the insurance payout or for that matter how much money it costs to make this landscape habitable again. Also I've always been worried about risk assessment, and having worked as a summer student in a company that deals with constructing the pipes of German nuclear power plants did not help (boy, did that not help...). The "rationality" of these numbers gets put into question practically by events like Fukushima, of course.

Posted by orfeo (# 13878) on :

I have to wonder whether anyone being stabbed to death - or shot, or any other method - has been comforted in their final moments by thinking "well at least it was for a good reason".

Posted by EtymologicalEvangelical (# 15091) on :

quote:
Originally posted by chive
How do we address this issue? What can be done to reduce the stigma faced by those with mental health problems? How can societal beliefs be changed so they are more reflective of reality?

I have mental health problems myself so I find that reporting such as this impacts on how people treat me and react to me.

I think that the key problem is how we define "mental illness".

Over three years ago I started a thread on this subject (apologies for the transgression of Godwin's Law in the OP!). I don't think we actually came to a conclusion on this vexed question.

Posted by chive (# 208) on :

quote:
Originally posted by IngoB:
Unlike spiders in the UK, mentally ill patients can kill or hurt me. Furthermore, it is usually fairly easy for me to avoid them, at least if they are identifiably mental ill.

Just to move from the general to the specific, IngoB I've mentioned I have a mental illness. If there was a shipmeet that you were thinking of going to and I mentioned I was coming would you change your mind? (Although I have actually met you and did refrain from murder.)

Also what do you mean by 'identifiably' mentally ill? I know a lot of people with mental health problems, some friends, some family, some colleagues, some because I must have spent years of my life hanging around waiting rooms at mental health places. I don't think I have ever thought 'ooh you look mentally ill' when I've seen someone.

Posted by orfeo (# 13878) on :

It is still the case that you are far more likely to be killed by someone you know than by a complete stranger.

But hey, that's okay, because at least the spouses, business partners and all those people who are far more likely to take your life will do it for a reason.

Posted by IngoB (# 8700) on :

quote:
Originally posted by chive:
Just to move from the general to the specific, IngoB I've mentioned I have a mental illness. If there was a shipmeet that you were thinking of going to and I mentioned I was coming would you change your mind? (Although I have actually met you and did refrain from murder.)

Yes, we have met, and it is unlikely that I would have avoided meeting you if I had known about your mental illness back then. FWIW, I used to walk to and from work in Birmingham, and that walk took me right past the Barberry, a National Centre for Mental Health. That never particularly disturbed me. I also do not think that all mental illnesses are created equal as far as danger to others is concerned. A depressed and a psychotic person present entirely different threat levels.

But I would generally increase my alertness levels if I knew for example that I am facing someone diagnosed to have psychosis. This need not be particularly apparent to that person, but it would make a difference if there was trouble.

quote:
Originally posted by chive:
Also what do you mean by 'identifiably' mentally ill? I know a lot of people with mental health problems, some friends, some family, some colleagues, some because I must have spent years of my life hanging around waiting rooms at mental health places. I don't think I have ever thought 'ooh you look mentally ill' when I've seen someone.

That was precisely my point. We generally do not know who is mentally ill and who isn't. Whereas for example we generally do know who is a man and who is a woman. But of course sometimes we do. A good colleague of mine had a severe mental breakdown close to finishing his PhD. While I never found out the official diagnosis, it turned him from a promising career to living "on the streets" (or at least away from treatment, and best I could tell, from a caring and concerned family). Since I knew this person for several years, it was quite clear to me that "something was deeply wrong". Yes, when he became more incoherent and weird, I became more guarded. I was still friendly, I hope, but watchful. This may not have been the optimal response for him, but I do not think that I behaved in a blameworthy manner.

There are also of course occasions where some person rants and raves in the streets. Now, I don't know whether they are drunk, besides themselves with anger, or mentally ill. But at any rate, my natural reaction is to avoid them. Once more, that is perhaps not the optimal behaviour pattern for them, but I do not consider it as blameworthy.

Posted by Dafyd (# 5549) on :

quote:
Originally posted by IngoB:
I call bullshit on that one. There is no such thing as a "rational assessment" of the consequence of my death to me. It is basically an infinitely negative outcome, as far as I am concerned, trumped only by "more infinitely valuable" matters strictly according to my assessment.

That would be fine if a person gave the chance of dying the same valuation across all circumstances. But people seem to give dying in a car accident or of lifestyle-related illnesses much less weight than dying under less likely circumstances.

Posted by Marvin the Martian (# 4360) on :

quote:
Originally posted by Dafyd:
But people seem to give dying in a car accident or of lifestyle-related illnesses much less weight than dying under less likely circumstances.

I suspect that's more to do with the level of control the person sees themselves as having over the situation. By being a good driver one can dramatically reduce ones chance of being in a traffic accident, but there is nothing one can do to avoid becoming the victim of a paranoid schizophrenic other than by avoiding any such (or even potential such) people completely. Which, of course, leads to the stigmatisation our OP speaks against.

There's also the whole "risk-reward" thing IngoB spoke of earlier. Driving and unhealthy lifestyles provide plenty of rewards to balance out the risks.

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