Most of us are, unfortunately, very familiar with the stereotypical insane asylum; from One Flew Over the Cuckoo’s Nest to Girl, Interrupted, our popular culture represents those of us struggling with mental disorders as needing to be separated, confined, and hidden away—for their sake, or ours.
But it wasn’t always this way; as philosopher Michel Foucault wrote in his groundbreaking work, History of Madness and Civilization, a movement he referred to as the “Great Confinement” began sweeping across Europe in the 17th and 18th centuries, eventually reaching the shores of the U.S.
As part of this movement, people with mental illness were systematically removed from communities and locked away in asylums that functioned more as instruments of social control than as places of healing. He theorized that this shift from integration to isolation wasn’t about protecting society from dangerous individuals, but about managing those who didn’t fit neatly into emerging social and economic structures.
Today, centuries later, we’re still grappling with the legacy of that great separation. Despite overwhelming evidence to the contrary, popular culture and media continue to portray people with thought disorders like schizophrenia as dangerous threats lurking in our communities. But research tells a dramatically different story: those with mental illness are far more likely to be victims of violence than perpetrators of it. Even more remarkably, breakthrough treatments are now enabling people with thought disorders to live full, integrated lives.
The Uncomfortable Truth About Victimization
The statistics are stark and sobering. People with severe mental illness experience violent crime victimization at 2.5 times the rate of the general population—8.2% compared to 3.1% for everyone else. This isn’t a small statistical blip; it represents a massive vulnerability that society has largely ignored while focusing obsessively on the much rarer instances of violence perpetrated by those with mental health conditions.
The reasons for this heightened vulnerability are complex but understandable. During acute episodes, individuals may struggle to recognize dangerous situations or make sound judgments about personal safety. Social marginalization, often driven by stigma, increases exposure to predatory behavior while reducing access to protective resources and support systems. Many people with thought disorders face additional challenges like homelessness and poverty, which further compound their risk of becoming victims.
Meanwhile, research consistently shows that the vast majority of people with thought disorders pose no threat to others. In studies of people with schizophrenia, only about 15% showed any violent behavior over a year-long period, and most of that violence occurred when mental illness was combined with substance abuse—not as a result of thought disorders alone. Delusions, even the frightening “threat-control override” delusions that might seem most likely to trigger violence, show no association with increased aggressive behavior.
Why the Myth Persists
If the evidence is so clear, why do these misconceptions persist? The answer lies partly in how mental illness is portrayed in media and entertainment. News coverage disproportionately focuses on the rare cases where someone with a mental health condition commits violence, while the daily reality of victimization experienced by this population goes largely unreported. Movies and television shows routinely use mental illness as shorthand for unpredictable danger, reinforcing fears that have little basis in reality.
This stigmatization creates a vicious cycle. Fear-based narratives prevent people from seeking help when they need it most, leading to untreated symptoms and increased social isolation. That isolation, in turn, makes individuals more vulnerable to exploitation and abuse while reducing their access to the very support systems that could protect them.
A Revolution in Treatment
Perhaps most importantly, we’re witnessing unprecedented advances in treating thought disorders that offer genuine hope for recovery and community integration. In September 2024, the FDA approved xanomeline-trospium chloride (Cobenfy), breaking a 70-year drought in novel approaches to treating schizophrenia. Unlike traditional antipsychotics that target dopamine, this breakthrough medication works through entirely different brain pathways, offering significantly fewer side effects while treating both the positive symptoms (like hallucinations) and negative symptoms (like social withdrawal) that can be so debilitating.
Other revolutionary treatments are emerging from research labs worldwide. Scientists are exploring D-serine modulation, personalized medicine approaches that recognize the complexity and individuality of thought disorders, and integrated therapies that combine medication with cognitive behavioral therapy and peer support. Early intervention programs are showing remarkable success in preventing long-term disability when treatment begins promptly.
The results speak for themselves: 30-40% of treatment-resistant patients can now achieve better symptom control than ever before. Hospitalization rates are dropping while community integration improves. People with thought disorders are maintaining employment, building relationships, and living independently in ways that demonstrate the profound potential for recovery when proper support is available.
Integration Over Isolation
Foucault’s critique of the Great Confinement wasn’t just historical analysis—it was a call to recognize that social inclusion is itself therapeutic, not merely humanitarian. Modern research supports this insight: people with mental health conditions recover better when they’re integrated into supportive communities rather than isolated or institutionalized.
And this isn’t just philosophical theory or a utopian ideal: We have seen this work well at Rose Hill Center, where our three-stage process guides residents in learning life and self-care skills in a clinical setting before practicing them in our community environment, and then applying them with the full support of our team. This approach builds confidence as they develop and refine new skills in a safe space, where mistakes are an opportunity to learn on their journey toward recovery. In 2023, 95% of our residents came to us after being admitted to an in-patient facility within the previous six months; 88% of those residents did not require hospitalization a year after completing their care at Rose Hill.
To see Rose Hill’s results across society, a fundamental shift in how we approach mental health must occur. Instead of perpetuating fear-based narratives that justify exclusion, we need protective legislation against discrimination, investment in community mental health resources, and public education campaigns that replace myths with facts.
The path forward requires acknowledging people with thought disorders as valued community members who deserve protection and support, not suspicion and isolation. With revolutionary treatments now available and more on the horizon, we have an unprecedented opportunity to fulfill Foucault’s vision of integration over exclusion. The question isn’t whether people with thought disorders can live normal, productive lives—recent advances prove they can. The question is whether society will finally embrace them as the neighbors, colleagues, and community members they’ve always been, deserving of safety, dignity, and the chance to thrive.
