Mental Health Purge

RE: http://www.zenbuffy.com/2011/08/time-to-institutionalise-pz-myers/

The important take-away from this is that not all Mental Health issues are the same and the vast majority of people with Mental Health issues pose absolutely no threat to society. That everyone agrees on.

Blah blah blah, we all know already right? No we don't, so it DOES bear repeating because mentally ill people are unfairly discriminated against. I get that, in fact I said it on twitter "it's fine & reasonable to remind everyone that mental illness <> violent". This is all good stuff. Unfortunately, none of it applies to what PZ Myers actually said or the remainder of content of the article.

Where @zenbuffy's post goes awry is when it resorts to distorting the truth. Specifically:

@zenbuffy's blog: PZ’s blog is not about Markuze’s spam, though, but about his mental health

This is a clear distortion of the truth. Quotes straight from PZ's blog entry:

Every morning when I get up and get on the computer, the first thing I do is delete the pile of spam from Dennis Markuze
...
Over the years — I've been getting these threats from Markuze since 1993
...
As a target for over almost twenty years, I've been watching this guy escalate — his hate messages have gotten crazier, more vicious, and more frequent.
...
rambling death threats
...
they've had this deranged man making death threats on their watch for over a decade, and have done nothing

So, PZ is clearly concerned about the content, frequency, and escalation of Markuze's behavior (not to mention probably thousands of others of us). Markuze's mental health only comes into question as a RESULT of his unacceptable level and scale of behavior. Markuze has also shown a clear pattern of escalation even to the point of physically showing up at events where PZ Myers and others are speaking.

And absolutely nothing PZ Myers said groups every person with any random mental health issue together. He simply doesn't do that so nearly all of what @zenbuffy wrote it completely irrelevant, attacking a Strawman. Associating Markuze's specific violent, anti-social behavior with a potential mental illness is NOT the same as equating mental illness with violent behavior in general.

@zenbuffy's blog: Statistically, people with a mental illness are more likely to be the victims of violence than the perpetrators

And here, @zenbuffy seems to ask us to lump all mental health issues together by citing broad studies that show, on the whole, people with mental health issues don't pose a greater threat to society than people on average. And while I ABSOLUTELY agree with the need to fight against discrimination against MOST mental health issues these studies break down when you look at individual cases and specific types of mental illness as well as specific patterns of behavior (such as showing patterns of escalation).

There are very good reasons that SOME people with mental health issues are institutionalized and the vast majority of others are not. But neither PZ nor myself are suggesting that everyone with mild depression should be locked up as a matter of course. But those who make DEATH threats, and show up at conferences stalking you, absolutely need to be detained, questioned, and possibly given a psych. And if Markuze has a mental health issue get him the help he needs. If he DOESN'T, then he needs to be arrested and locked in prison for his criminal behavior.

In a 2008 metastudy Perpetration of Violence, Violent Victimization, and Severe Mental Illness: Balancing Public Health Concerns they reported:

CONCLUSIONS: Perpetration of violence and violent victimization are more common among persons with severe mental illness than in the general population.
...
Studies analyzing the Epidemiologic Catchment Area data found that approximately 2% of persons without a mental disorder perpetrated violence in the past year, compared with 7% to 8% of persons with severe mental illness.

THIS DOES NOT MEAN ALL PEOPLE WITH ANY FORM OF MENTAL ILLNESS ARE A DANGER (what is funny is no matter how many times I say this I know that some readers will make this accusation, just as they are against PZ). This just stresses the fact that you cannot lump all people with mental health issues together.

But neither is it accurate to claim "mentally ill people are no more violent than average" as @zenbuffy did, especially not when the study she links to support this claim http://archpsyc.ama-assn.org/cgi/content/full/55/5/393 actually looked at "people discharged from acute mental health facilities" (please note the ACUTE, as opposed to Markuze who has been at this for 20 years) and the relationship of substance abuse to violence in that population. The actual conclusion from this study was:

Results There was no significant difference between the prevalence of violence by patients without symptoms of substance abuse and the prevalence of violence by others living in the same neighborhoods who were also without symptoms of substance abuse. Substance abuse symptoms significantly raised the rate of violence in both the patient and the comparison groups, and a higher portion of patients than of others in their neighborhoods reported symptoms of substance abuse. [emphasis mine] Violence in both patient and comparison groups was most frequently targeted at family members and friends, and most often took place at home.

Conclusions "Discharged mental patients" do not form a homogeneous group in relation to violence in the community. The prevalence of community violence by people discharged from acute psychiatric facilities varies considerably according to diagnosis and, particularly, co-occurring substance abuse diagnosis or symptoms.

So, if you are looking at discharged patients they have a higher incidence rate of violence correlated with their higher substance abuse rate. This does not support @zenbuffy's broader claim of "mentally ill people are no more violent than average". One big disconnect is that these are people discharged from mental health treatment. Nevermind that it doesn't establish a causative link and ignores the question of self-medication (such as in "Drug Abuse as Self-Medication for Depression: An Empirical Study", "Drug abuse in schizophrenic patients: clinical correlates and reasons for use", et al.).

If you want to quote 'science' at me stop lumping all mental health issues together and show me a study on people who make repeated death threats over a period of 20 years, and who show patterns of escalation including showing up physically in hotels where people you have made Death Threats against are present.


Over on twitter a 'friendly' skeptic decided to set me straight:

@Gurdur: @ColdDimSum let's see if you can refute one tiny thing in the post by @zenbuffy. ColdDimSum, the science is against you. Now try very hard.

I replied: @Gurdur how about where @zenbuffy writes "PZ’s blog is not about Markuze’s spam" - a blatant lie, we're done - that wasn't hard

@Gurdur: @ColdDimSum Ah so you're merely name-calling. No rational argument at all. I'm so unsurprised. Making a blog post beyond you? cc @zenbuffy

Note how he failed to address the gross misrepresentation that I called out and instead accused me of "name-calling".

But you got your blog post so you are #winning


Gurdur goes on to be very confused:

I replied: @Gurdur Oo! science vs strawman! battle of the century - I can do that too: pb.rcpsych.org/content/16/3/1… @pzmyers 11 in 38 threats yielded violence

My tweet CLEARLY says it's attacking a strawman (hint: science vs strawman), that doesn't stop our friendly skeptic from plowing ahead:

@Gurdur: @ColdDimSum IOW: citing psychiatrist/patient figures to say anything about life in general or Mabus is simply wrong + unscientific. Learn!

BINGO Mr Gurdur! - just like citing a study on "people discharged from acute mental health facilities" doesn't inform us about the specific risk of a specific individual nor the general population of people with mental health issues. Especially when even that study shows the incident rate is HIGHER in the target population, correlated with higher substance abuse (not even caused by, just correlated).

Mr Gurdur then proceeds to threaten to expose me, ooooooo:

@Gurdur: @ColdDimSum what you fail at is how to analyse psych stats. In my upcoming blog post I shall cite you as example of ignorance of the science

Way to go, Idaho.