Violence in Schizophrenia

The primary purpose of this paper is to highlight certain aspects of the etiology and the psychotherapeutic management of violence in schizophrenic patients. Its secondary purpose is to provide examples of a kind of interviewing technique developed by the senior author which seems to have proved, in several hundreds of teaching interviews over the past several years at the Sheppard and Enoch Pratt Hospital and at a variety of other institutions, reasonably effective for teaching, for evoking diagnostic data, and, not infrequently, for catalyzing the patients' psychotherapy.

This paper was written by the senior author, and the theoretical formulations it contains are his; he will write henceforth, therefore, in the first person singular. Bisco, Coutu, and Scibetta are listed as co-authors as my way of expressing my gratitude to them for their most kind permission to include data from my teaching interviews with patients who were in therapy with them—data which largely comprise this paper and are utterly indispensable to it.

Mr. Raymond Delaney,1 a 17-year-old freshman in a college near Baltimore, was admitted to the Sheppard and

Enoch Pratt Hospital after his mother discovered that he had hidden an Italian revolver, with bullets carefully selected to fit it, under his mattress, in the frankly and dispassionately admitted determination to kill a male classmate who had been “bugging” him since their high school years together in the Washington area. Both parents, from past experience, firmly believed him capable of carrying out this intention. The youth revealed, during his consultation interview with the college psychiatrist, that throughout his upbringing he had felt isolated as the smallest boy in his class, repeatedly picked on by his larger classmates, recurrently drawn toward the notion of joining a gang and shooting someone to relieve his frustration, and had become increasingly convinced that