'Psychotic' crimes can not be put down to mental illness 

Former Tipperary hurler Seamus Troy was left with PTSD after a life-threatening violent attack in Cork city centre. Picture: Padraig Hogan

Suffering a violent crime leaves psychological scars that take a lot longer to heal than physical injuries. 

This was highlighted very poignantly recently by Seamus Troy who has developed Post Traumatic Stress Disorder (PTSD) having endured a life-threatening violent attack while going about his daily life. He no longer leaves his house for fear of another attack. 

This is a very rational response to a completely irrational event. The effects of violence on both our physical and mental health are well documented. 

Consequences include increased incidences of depression, anxiety, posttraumatic stress disorder, and suicide; increased risk of cardiovascular disease; and premature mortality. 

These are severe and drastic health outcomes. The root psychological symptom underlying most of these conditions is fear.

We most fear violence that is random, senseless, and unpredictable and unfortunately, we tend to associate this with mental illness. 

In fact, people are often more reassured to know that someone was stabbed to death in a robbery gone wrong than by a “psychotic man”. It is a pertinent question to ask if there is a fundamental link between psychosis and violence. The public seems to think so. 

The popular misconception is that brutal, violent, and senseless crimes are committed by people who are “mentally ill” or “sick”. The media has a major influence on connections between mental disorder and crime, particularly serious violent crime with headlines such as “Beaten in a psychotic episode” or “Man Hospitalised after psychotic assault”, just two recent headlines.

But what is psychosis? According to psychiatrists, a psychosis is a condition that affects the way the brain processes information. Essentially, it causes the person to lose touch with reality. 

The HSE Mental Health Services outline four main symptoms associated with a psychotic episode: hallucinations; delusions; confused and disturbed thoughts; lack of insight and self-awareness. 

Hallucinations occur when a person perceives things that don't exist. Contrary to popular belief, hallucinations are more commonly experienced in the auditory rather than visual domains. Hearing threatening voices, for example, or voices that command the person to do something that they would not otherwise do. 

A delusion is a belief in something that's not true. Those who are suffering from a psychosis may have disturbed and confused patterns of thought.  Signs of this include: 

• Rapid and constant speech; 
• Disturbed speech; 
• Or a sudden loss in the train of thought. 

All of these symptoms can be terribly frightening and distressing for those who experience them, and equally for those who may witness them.

Psychosis itself is only a symptom, not an illness. A mental or physical illness, substance abuse, or extreme stress or trauma can be the underlying cause. In fact, there is no one cause and those who manifest symptoms of a psychosis may do so differently. But we must be very cautious in our assumption that a psychosis or psychotic episode is the root cause of violence. This does a terrible injustice to the huge number of people who are living daily and successfully with such conditions. 

When considered in a slightly different way, the question we must ask is whether psychosis is a risk factor for potential violence. Research into this area has produced mixed results and finds that the perpetration of violent acts depend on numerous other potential factors. 

And this is the nub of the argument. 

A psychosis or any other form of mental illness is not, in and of itself, a direct cause of violence. As tempting as it is to attribute a frenzied and violent attack to the psychosis alone oversimplifies the issue enormously and does little to aid our understanding of this kind of mental distress.

There are likely to be other factors that aggravate or trigger either a psychotic episode or indeed a violent act. Violence should not be considered in the narrow focus of mental illness alone. I have previously written about stalking and familicide and in both cases, it's clear that mental illness by itself does not adequately account for such extreme behaviours. 

There are likely to be other deeper psychological factors at play that can become masked within mental illness.

This argument should not diminish the experience of Seamus Troy nor his subsequent suffering. In trying to heal his body, rebuild his life, and repair that delicate psychological balance that allows us to function, it is vital that victims of such crimes are supported. 

This case exposes two critical issues for society. One is how we understand, support and care for victims of violent crime, the second is how we understand, support and care for those who suffer from mental illness. 

There are complex needs to be addressed for both victims of violent crimes and those who perpetrate them. These are not necessarily mutually exclusive issues but complex nonetheless. 

 Dr Ciara Staunton is a Senior Co-ordinator at Adult & Continuing Education, UCC where she delivers courses on Forensic and Criminal Psychology.