Real in Their Consequences: A Sociological Approach to Understanding the Association between Psychotic Symptoms and Violence

Abstract

Studies conducted over the past three decades have consistently reported an association between mental illness and violence. We propose a sociologically inspired explanation for this association by referring to the Thomas Theorem--if situations are defined as real, they are real in their consequences. We identify a small subset of psychotic symptoms, termed 'threat/ control-override' symptoms, that tend to induce violence because they influence the definitions of situations. Our data come from an epidemiological study conducted in Israel that includes a psychiatrist- administered diagnostic interview. We find an association between violent behaviors and psychiatric diagnosis that cannot be accounted for by sociodemographic variables. Threat/control-override symptoms also are strongly related to violent behaviors and explain a substantial part of the association between violence and psychiatric diagnoses. Other equally severe psychotic symptoms are not related to indicators of violence when threat/control-override symptoms are controlled. These findings support our explanation for the association between mental illness and violence, and challenge the stereotype that most people with mental illnesses are dangerous