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Of the many contributions that Dr. Ber- ioral scientists acknowledge their inability to
make such predictions when called upon to do
nard Diamond made to the field of men- so by courts and other agencies (p. 452).
tal health law, none had more impact
than his 1974 article in the University of This article, and usually this paragraph,
Pennsylvania Law Review titled "The was cited by the United States Supreme
Psychiatric Prediction of Dangerous- Court (three time^),^ by lower federal
ness. "' courts (four time^),^ by the State Su-
The most quoted part of this piece is preme Courts of ~ l a s k a ,California
~
the penultimate paragraph: (four time^),^ color ad^,^ Connecticut
Neither psychiatrists nor other behavioral sci-
(twice),' Hawaii (twice),' I l l i n ~ i s Iowa
,~
entists are able to predict the occurrence of (twice),'' Minnesota, I New Hampshire
violent behavior with sufficient reliability to (five times),12 New Jersey,13 0hio,14 and
justify the restriction of freedom of persons on Washington,'' and by lower state courts
the basis of the label of potential dangerous-
ness. Accordingly, it is recommended that too many times to cite. While the piece
courts no longer ask such experts to give their was published 17 years ago, it is still
opinion of the potential dangerousness of any being cited by courts in 199 1. I 6
person, and that psychiatrists and other behav- In this brief tribute to Dr. Diamond's
pervasive and enduring influence on the
Dr. Monahan is Doherty Professor of Law and Professor
of Psychology and Legal Medicine at the University of field of mental health law, I would like
Virginia. Requests for reprints should be addressed to to touch upon the theme of his classic
John Monahan, School of Law, University of Virginia,
Charlottesville. VA 2290 1. article. I will not attempt to update the
research base upon which his quotation impact of the image of the mentally
rests. That has been done elsewhere." disordered promoted by the media.20
Rather, I will explore a related aspect of One content analysis performed for the
the connection between mental disorder National Institute of Mental Health2'
and violence, namely, how the public found that 17 percent of all prime-time
has perceived these two phenomena to American television programs classified
be associated and how these perceptions as dramas depicted a character as men-
have remained relatively constant over tally ill. Seventy-three percent of these
time and across cultures. I will first look mentally ill characters were portrayed as
at current Western perceptions, then re- violent, compared with 40 percent of the
view the historical evidence within "normal" characters, and 23 percent of
Western cultures, and finally address the the mentally ill characters were shown
cross-cultural literature. to be homicidal, compared with 10 per-
cent of the "normal" characters. Nor are
Current Perceptions
such images limited to television. A con-
One poll conducted by the Field
tent analysis of stories from the United
Institute'' for the California Department
Press International database2* found
of Mental Health asked 1,500 represent-
that in 86 percent of all print stories
ative California adults whether they
dealing with former mental patients, a
agreed with the statement, "A person
violent crime-"usually murder or mass
who is diagnosed as schizophrenic is
murder" (p. 64)-was the focus of the
more likely to commit a violent crime
article.
than a normal person." Almost two-
thirds of the sample (6 1 %) said that they Historical Perceptions
definitely or probably agreed. However, Such beliefs about the relationship be-
the public does not believe that mental tween mental disorder and violence are
disorder inevitably or even frequently not new and not limited to the United
leads to violence. In another survey of States. Since the origins of recorded his-
1,000 adults from all parts of the United tory, the general public has believed that
States conducted by the DYG there was a connection of some sort
Corporation19 for the Robert Wood between mental disorder and violence.
Johnson Foundation Program on References in Greek and Roman litera-
Chronic Mental Illness, 24 percent of ture to the violence potential of the men-
the respondents agreed with the state- tally ill date from the fifth century B.C.
ment, "People with chronic mental ill- As R o ~ e nnoted,
~ ~ in the ancient world
ness are, by far, more dangerous than "two forms of behaviour were consid-
the general population," while twice as ered particularly characteristic of the
many (48%) agreed with the proposi- mentally disordered, their habit of wan-
tion, "The mentally ill are far less of a dering about, and their proneness to vi-
danger than most people believe." olence" (p. 98). Plato, in Alcibiades 11,
Modern opinions no doubt reflect the records a dialogue between Socrates and
192 Bull Am Acad Psychiatry Law, Vol. 20, No. 2, 1992
"A Terror to their Neighbors"
devoted exclusively to the care of the inflicted upon him by magical means
mentally disordered was erected after the and his aggression was his way of pro-
Governor of the Virginia Colony in 1766 tecting himself' (p. 225).
addressed Patrick Henry and other Finally, Jane Murphy, a noted anthro-
members of the House of Burgess in pologist, r e ~ i e w e d *research
~ on re-
terms that barely bothered to paraphrase sponses to mental disorder in several
those of Benjamin Franklin 15 years Northwestern Native American and
earlier: "[I] recommend to your Consid- Central African ethnic groups. She re-
eration and Humanity a poor unhappy ported great similarities among people
set of People who are deprived of their in very different traditional societies:
Senses, and wander about the Country, There seems to be little that is distinctively
temfying the Rest of their Fellow Crea- cultural in the attitudes and actions directed
t u r e ~ . "That
~ ~ hospital, too, is still there. toward the mentally ill, except in such matters
as that an abandoned anthill could not be used
Perceptions in Non-Western as an asylum in the arctic or a barred igloo in
the tropics. . . . If the behavior indicates help-
Cultures lessness, help tends to be given, especially in
The belief that mental disorder is con- food and clothes. If the behavior appears fool-
ducive to violence is not unique to West- ish or incongruous. . ., laughter is the response.
If the behavior is noisy and agitated, the re-
ern cultures. Westermeyer and k - 0 1 1 ~ ~ sponse may be to quiet. sometimes by herbs
studied all persons known as baa or and sometimes by other means. If the behavior
"crazy" in 27 villages in Laos, a country is violent or threatening, the response is to
restrain or subdue (p. 1025).
that at the time of the research was
without a single psychiatrist, psycholo- Of course, the anthropological fact that
gist, or mental hospital. They questioned a popular belief has persisted since an-
family members, neighbors, and the tiquity and is found in all societies does
people seen as baa themselves about the not mean that the belief is valid. Un-
occurrence of violence and its relation- founded prejudices may also be persist-
ship to violence. They were told that 11 ent and widespread. But if the convic-
percent of their subjects exhibited vio- tion that mental disorder sometimes pre-
lent behavior shortly prior to acquiring disposes toward violent behavior is a
the baa label, and 54 percent were re- myth, it is nonetheless worth noting that
ported as violent after having become it is a myth that is both culturally uni-
baa. Also in the mid-1970s, Jones and versal and historically invariant.
Horne2' studied almost 1,000 people in
four isolated Aboriginal missions in the References
Australian desert. "Frequently," they 1. Diamond B: The psychiatric prediction of
concluded, "an aggressive act by the pa- dangerousness. 123 U Pa L Rev 339 (1974)
2. Schall v. Martin, 467 U.S. 253 (1984); Bare-
tient causes him to present clinically, but foot v. Estelle, 463 U.S. 880 (1983): Jones v.
with an explanation that was culturally United States, 463 U.S. 354 (1983)
3. Project Release v. Prevost, 722 F.2d 960 (2d
appropriate-he would claim, for ex- Cir. 1983); Suzuki v. Yuen, 617 F.2d 173
ample, that his symptoms have been (9th Cir. 1980); Hasenei v. United States,