I’ve been tidying up my thinking somewhat since I wrote “From my dead hand”, getting straight (I hope) that there seemed to be a distinction between mental illness and the broader category of mental disorder, and discovering just how controversial the whole issue was.
A recent BMJ editorial and its responses give the flavour of the debate. The editorial writers favoured the narrow distinction, and argued in support of well-known research that mental illness (psychosis) is not associated with violence; while a forensic psychiatrist took issue with so narrow a definition, because it excludes the wider category of mental disorder (substance abuse and personality disorders) that do seem to be overrepresented among criminal offenders. The on-line responses to the editorial range from considered, poignant, to ideological. Unfortunately, we seem to have a choice between stigma and denial: stigma for mentally ill people (or anyone who fits the profile) who then endure societal and judicial discrimination, and denial of the increased risk associated with certain disorders, which in turn results in people not being able to recognize true danger signals.