Psychosis and violence: the case for a content analysis of psychotic experience

There has been a great deal of debate about the dangers psychiatric patients pose to the general population. Recent studies appear to confirm a moderate but reliable association between mental illness and violence. The nature of this association, however, is unresolved. Considerable evidence suggests that much of the violent behavior observed in the mentally ill is not random but is motivated and directed by psychotic symptoms. In many cases, the behavior appears to be a predictable and in some ways rational response to irrational beliefs (delusions) and perceptions (hallucinations). The content and themes of a psychotic patient's delusion or hallucination often imply a specific course of violent action. Unlike studies of associations between violence and broad categories of subject characteristics (e.g., mental illness), an analysis of the association between violence and the content and themes of psychotic symptoms could be much more informative. Conceivably, such an analysis could identify not only psychiatric patients at risk for committing violence but also those individuals who are at risk for becoming targets of their violence.