2.2.5: Psychosis
- Page ID
- 69435
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Psychosis is a condition that impacts how your brain processes information and is present in some severe mental illnesses, including schizophrenia and mood disorders such as depression and bipolar disorder. Most individuals experiencing breaks from the shared reality of the general population do not engage in aggressive or criminal behavior; in fact, people with mental disorders are more likely to be victims of violence than perpetrators (Elbogen & Johnson, 2009). Psychosis can generate specific hallucinations, such as hearing voices or seeing things that do not exist, and delusions, where a person experiences strongly held but false beliefs that may include paranoid ideas about being persecuted (American Psychiatric Association, 2013). In rare cases, the nature of the hallucination or delusion can lead to inappropriate “self-defense” or other criminal behavior that would be understandable considering the beliefs held during a psychotic break (Chan & Shehtman, 2019; McNiel et al., 2000).
Although some psychosis can lead to violent behavior, far more often, people with active mental illnesses are charged with minor offenses that begin a long cycle of involvement with criminal justice systems. A major depressive episode with catatonic features in a homeless person looks very much like loitering in the eyes of police. One study found that 40% of police encounters with people with mental illness involve non-violent crime, and another 40% involve non-criminal mental health crises, bizarre behaviors, and/or criminal victimizations. Only two in 10 police interactions with people with mental illness involved any type of violent crime (Brink et al., 2011).
Substance Abuse Disorders
Substance abuse disorders are characterized by difficulties reducing substance use, causing problems in one’s personal and work life (American Psychiatric Association, 2013). Because many substances are in themselves illegal to possess and use, the defining behavior of substance abuse is criminalized if the addictive substance is restricted.
Aside from the inherent criminal behavior of using a prohibited substance, the tripartite conceptual model (Goldstein, 1985) outlines three main ways that substance use is connected to violent criminal behavior (see Table below).
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Tripartite Conceptual Model of the Drug/Violence Nexus |
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Systemic crime |
Crime related to the drug trade, including selling drugs and the violence associated with that. |
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Economically compulsive crimes |
Results from people engaging in money-making crime to support their substance use. |
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Psychopharmacological-driven crime |
The substance itself produces an effect on the brain and behavior, resulting in crime or violence. |
Legal codes that criminalize addiction set the stage for systemic and economically compulsive crimes. If access to drugs that people are addicted to is against the law, unlawful organizations that provide drugs to people with addictions become highly profitable and are maintained through violence if necessary. If people addicted to drugs are less likely to have the ability to support themselves through legal means, they will be more likely to commit crimes to meet their needs. Countries such as Portugal have been decriminalizing drugs in favor of on-demand treatment, resulting in reductions in drug use and related crimes. See How Portugal Won Its War on Drugs for a summary of Portugal’s approach.