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.