
Real in Their Consequences: A Sociological Approach to Understanding the Association Between Psychotic Symptoms and Violence
Studies conducted over the past 3 decades have consistently reported an association between mental illness and violence. The authors 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. Identified were a small subset of psychotic symptoms, termed "threat/control-override" symptoms, that tend to induce violence because they influence the definitions of situations. The data come from an epidemiological study conducted in Israel that included a psychiatrist-administered diagnostic interview with 2,678 Ss aged 24–33 yrs. Results show an association between behaviors and psychiatric diagnosis that cannot be accounted for by sociodemographic variables. Threat/control-override symptoms are also 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 the authors' explanation for the association between mental illness and violence, and challenge the stereotype that most people with mental illnesses are dangerous.