PAUL S. APPELBAUM
Interpersonal violence is an inescapable reality of contemporary society. Pick up any newspaper or listen to any news broadcast and witness the litany of violence it reveals. Murder, sexual assault, child abuse, hate crimes, terrorism – the list seems endless, the details numbingly familiar, until the day's stories blend into yesterday's, and those into the accounts of last week and the week before.
Only a fraction of this violence, of course, comes to clinical attention and that is either because the victims seek assistance or, more pertinent to the focus of this volume, because the perpetrators believe themselves or are believed by others to have a mental disorder. Indeed, although persons with mental disorders account for a small proportion of violence in most societies, the public, stoked by the media, are disproportionately concerned about the risks posed by this group. A recent estimate in the United States put percentage of violent acts accounted for by the mentally ill at about three percent, (Swanson, 1994) and data from England suggest that the proportion of murders attributable to persons with mental illness has actually been falling over time. (Taylor & Gunn, 1999) But popular estimates of the proportion of psychiatric patients who are likely to commit violent crimes vastly exceed the actual number (Pescosolido, Monahan, Link, Stueve, & Kikuzawa, 1999).
The simultaneous fascination with and terror of violence committed by persons with mental disorders was illustrated graphically quite recently in the pages of a major newspaper. There at the front of the local news section, positioned precisely in the middle of the page, was a lengthy story describing a murder committed by a man whom the headline advertised as a “mental patient. ” His life, the crime itself, and the events leading up to it were all laid out in stark detail, in this article