At age 18, Eric’s future looks bright. A high school scholar, he is accepted to a prestigious college where he plans to study engineering. Sure, he misses his family and girlfriend, who has a year of high school left, but he keeps in regular touch via text, Instagram and Snapchat. At first, he seems to be handling the stress of a cross-country move and rigorous coursework well. But when his girlfriend breaks up with him and his classes are harder than he anticipated, things gradually change.  

Eric’s roommate, John – another engineering major – who first notices something is wrong. Although Eric has always been somewhat quiet and shy, he becomes increasingly distant and aloof. He starts wearing the same clothes for days at a time. He has trouble sleeping and often loses his train of thought. He complains that his food tastes funny. 

Eric’s roommate doesn’t know what to do. He shrugs everything off, even when Eric mentions that he thinks their college might be a front for an organized crime syndicate. When Eric accuses their suite-mates of talking about him behind his back and taking notes about him for “the boss,” he tries to talk some sense into Eric. However, when Eric accuses him of poisoning his food in order to sabotage his academic performance, things come to a head; John moves out. 

Eric is constantly afraid of being killed. He loses thirty pounds, refusing to eat anything in the cafeteria and limiting his food to prepackaged items. He worries that “they” will find out where his family lives and begin tormenting them. After his resident assistant finds him wandering the halls one night, angrily telling the “mafiosos who are threatening to kill me” to stop, he is hospitalized and diagnosed with schizophrenia. 

Who is Mentally Ill?

Eric is living in an inner war zone where he is constantly plagued by hidden enemies. They track him. They torment him. They sabotage his grades. They have even threatened his life. When you consider how terrifying that experience must be, it’s a wonder more psychotic individuals don’t commit to hurt someone. And, yet, like the vast majority of psychotic individuals, he has hurt no one. A study published in the American Journal of Public Health found that fewer than 5 percent of the 120,000 gun-related killings in the U.S. between 2001 and 2010 were committed by people diagnosed with mental illness. 

But what does the term “mental illness” even mean? Depression? The next time you get together with a group of friends, take a look around. One out of every 5 people experience clinical depression during their lives and any danger they pose is likely to be self-directed. Anxiety; the same odds apply. 

Should we be afraid of people with phobias or adjustment disorders or anorexia? The term “mental illness” covers a wide range of human conditions; there are more than 200 diagnoses listed in the most recent Diagnostic and Statistical Manual of Mental Disorders and very few of them have any relationship to violence. 

Even among the “serious” mental illnesses, a certain diagnosis tells us little about violence risk because, when it comes to untreated mental illness, it is specific symptoms (for example, hearing voices commanding the person to hurt someone else for a positive purpose, such as being ordered by God to carry out a special assignment) and behaviors (co-existing substance use, history of violence) that increase violence risk, not diagnosis. 

The Bottom Line

The link between mental illness and violence is indirect, often exaggerated and, in the majority of homicides, nonexistent. Does someone in the throes of a paranoid delusion or command hallucination ever hurt someone? Yes, which is just one of the many reasons why we all need access to psychiatric services. 

But it’s also important to remember that the highest risk factors for violence – anger, substance use, violent role models, poor impulse control, impaired empathy – are shared by people with and without mental illnesses.