June 23, 2024 (Updated on June 24, 2024)

I always know that I shouldn’t read an article written by Freddie deBoer when one appears in my news feed. It’s the same visceral reaction I get when I see a news article citing the Treatment Advocacy Center, an organization that has caused much harm to the psychiatric survivor community by lobbying for coercive interventions against people who experience mental illness.

In 2017, deBoer got canceled by the progressive community for making threats to another journalist, but in recent years he has reemerged with a large platform, getting consistently published at places like The New York Times. In 2021, deBoer wrote about the incident somewhat evasively and defensively on his blog, revisioning what transpired from the way others remembered things, stating that he “was threatened with arrest regarding an unrelated matter,” and ascribing his behavior to “a psychotic episode due to untreated bipolar mania.” Since his reemergence, deBoer has become an aggressive cheerleader for coercive psychiatric intervention.

It’s in this context that I occasionally come across deBoer’s writings and find myself not surprised by his ableism. His latest essay for New York magazine is a perfect example of how white men still need to learn to de-center themselves from certain conversations. There are so many falsehoods and errors in this piece that it would be too long an exercise to correct all of them, so I’m just going to address three main points:

1. First, deBoer falsely contends that liberals are less ableist towards people with mental illness. For example, he writes that many people in New York City would never openly admit that they fear unhoused people or people who are exhibiting psychosis in public spaces, and yet these readers’ comments on a New York Times article from last month tell otherwise. The public’s attitudes towards people with severe mental illness have generally not improved in the decades since such opinions started being measured, and it’s not hard to find supposed liberals blatantly expressing their ableism in daily conversations.

Contrary to deBoer’s contention that liberals and the media have been allies to disabled people, many scholars acknowledge that mainstream media coverage fearmongers on issues of homelessness, mental illness, and their alleged associations with crime. If you look on this page of the website, you’ll find many such instances of liberal media’s ableist coverage. As well, approximately 90% of universities, our supposed bastions of liberal values, have instituted policies to surveil and remove students experiencing mental illness from campus. In March, Democratic Governor Gavin Newsom of California succeeded (barely) in passing a ballot measure that forces removal and “treatment” of unhoused people. Democrats have also frequently weaponized psychiatry against their political opponents when it suits them, then cry foul when Republicans do the same in return.

It should not be surprising that political elites increasingly point fingers at society’s most marginalized during a time of unprecedented levels of income inequality and austerity. When there are less resources to share, people will embrace opportunities to cut off those who can’t work or live within the cutthroat, debilitating systems we’ve built. Ultimately, these types of essays by pundits like deBoer are disingenuous in their framing, presenting the issues as a false choice between carceral solutions (both physical and chemical) and leaving people in need to fend for themselves.

2. Much of deBoer’s essay leans on the “conclusive studies” and “facts” he presents about mental illness and its purported associations with violence, as well as an attempt to deconstruct a phrase that many of us have become familiar with by now: “[people experiencing mental illness] are more likely to be the victims of violent crime than the perpetrators.” DeBoer contends that the statement is “meaningless,” because it tells us nothing about whether people who experience mental illness are more violent than the general population.

For the original source of the statement that “[people experiencing mental illness] are more likely to be the victims of violent crime than the perpetrators,” academic papers frequently cite a 2008 literature review in Psychiatric Services, which found enormous variance in the estimated rates of violence among people with severe mental illness, from 2.3% among outpatients to 50.4% in a sample of committed inpatients. The variability in estimates expose the problems of measurement inherent to these studies, both in how violence is counted and how the outcome depends on the sample type being used. For example, the authors note that 27 of the 31 (87%) studies they reviewed used patient samples from clinics and hospitals, and two-fifths of the participants in the often-cited MacArthur studies (see below) are involuntarily committed patients. Use of these unrepresentative samples creates ascertainment bias, which inflates the estimates of attributed violence and result in the studies having limited generalizability.

It’s also telling that deBoer trivializes the fact that people who experience mental illness are at greater risk of being victimized, because contrary to deBoer’s interpretation that there is no meaningful between-group comparison with people experiencing mental illness and the general population, the review by Choe et al. found that indeed, people experiencing severe mental illness are more likely to be victims than perpetrators of crime, but also that a huge disparity in risk of victimization exists between this group (25%) and the general population (3%). In this context, it’s significant and revealing that deBoer invokes Jordan Neely, the Black, unhoused person who was murdered on a New York City subway train in 2023, to make his case for psychiatric coercion, since (as I’ve argued before) deBoer and organizations like the Treatment Advocacy Center are concerned entirely about containment rather than the safety and protection of unhoused people, who are disproportionately vulnerable to victimization. This fact is especially important given that so much abuse occurs in residential and detention facilities.

3. In addition to the aforementioned and problematic estimates of violence prevalence, deBoer also cites statistics in an attempt to show that “a highly disproportionate number of random acts of public violence are committed by the mentally ill.” “The research tells us so,” deBoer insists.

For example, he references a literature review that estimates that 6% of murderers may have schizophrenia even though people with schizophrenia represent less than 1% of the population, with the consequent that people with severe mental illness must be more likely to be violent. As I’ve written about at length here, deBoer is abusing statistics by committing a logic error known as the inverse fallacy. However, a more important mistake that deBoer is making here is inferring that anything but a one-to-one correspondence between a demographic statistic and an outcome variable (e.g. assuming that if 58.9% of the US population is white, then 58.9% of crime should be committed by white people) indicates a causal pathway between the group and the outcome.

When citing another literature review that he interprets as “conclusive” evidence of a small but significant association between mental illness and violence, deBoer accuses the authors of downplaying the findings for political optics when the authors caution that “only a small proportion of societal violence can be attributed to persons with schizophrenia.” Despite deBoer’s disbelief, the authors’ qualifying statement is actually warranted and supported by their examination of the evidence and understanding of what can properly be interpreted from the studies.

When deBoer and others improperly cite studies showing that the proportion of violent crime attributed to people with mental illness is greater than the proportion of people with mental illness in the population, they’re erroneously inferring that violent crime must be disproportionately caused by people experiencing mental illness. As Walsh et al. note, the population-attributable risk per cent “assumes that causality has been established. It thus fails to take into account other risk factors or confounding factors that may be operating in the association between a particular risk factor and disease.”

Steadman et al., using data from the MacArthur Violence Risk Assessment Study, matched a sample of 391 hospitalized patients with a comparison group of 519 people living in the same communities in Pittsburgh, and found that rates of violence among people diagnosed with severe mental illness were statistically indistinguishable from other people in the community after the interaction with substance use was factored into the regression model. The strength of this study is that both the patient and comparison groups lived in the same neighborhoods, which allowed the researchers to control for environmental influences, such as exposure to poverty and other violence in the community.

When deBoer and others with a pro-carceral agenda cite statistics that falsely claim that people with mental illness have a greater propensity to commit crimes than the general population, it’s important to understand that violence can never be attributed to single factors, especially not an entire demographic group or identity, except possibly being a male under the age of 24. Isolating these factors does not help us to arrive at a better understanding of the root causes of violence, but serves political pandering and scapegoating.

The kinds of public policies that deBoer’s flawed logic leads to are the wrong solutions. As Glied and Frank note in the American Journal of Public Health, “many proposed policy approaches, from expanded screening to more institutionalization, are unlikely to be effective.” Because a causal pathway from mental illness to violence has never been scientifically established, “expanded access to effective treatments, although desirable, will have only modest impacts on violence rates.”

Contrary to deBoer’s denial of victim blaming when he writes that Jorden Neely was “treatment resistant” (he points out that Neely had been in and out of court-ordered “care”), Glied and Frank come to a different conclusion, determining that the mental health care system is what needs to be fixed, and will need to offer treatments that people with severe mental illness will actually find helpful and consequently will seek out voluntarily. The authors write, “Indeed, studies find that many perpetrators had already been in contact with mental health service systems, suggesting the need for improvements in the effectiveness of treatment.”

To accept deBoer’s postulation that disabled people cannot be toxic, cannot do awful things, or cannot do anything for that matter without their behaviors being ascribed to mental illness or disability is incredibly flattening, and denies disabled people our humanity. Although deBoer pooh-poohs the idea that mental illness can be an identity (or a neurotype, as I’ve argued here), he simultaneously entreats us to accept that “To really love the severely mentally ill, you must be willing to accept all of what they are. In Jordan Neely’s case, that included being erratic and unstable as well as creative and bright, a habitual consumer of dangerous synthetic marijuana as well as a born performer, and a man whose mental illness contributed to a habit of committing random acts of violence.” Hmm.

Rereading deBoer’s 2021 non-apology, I can understand why deBoer feels compelled to retain his ableist views on mental illness and forced treatment. I’m all for people being allowed to move on after a process of accountability, but deBoer clearly positions his authority here, and the illiberal views he espouses on coercive treatment, on his lived experience, all while disparaging and contemptuously brushing aside the concerns from the disabled community and psych survivors. Does deBoer genuinely believe that unhoused people who are mandated by the courts to enter treatment will have the same access to social supports, housing, employment, and other opportunities that helped him to recover? I doubt it.

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