Schizophrenia not always an indicator of violence

NASHVILLE — He heard voices “telling him to do things.” He was destructive, breaking household items such as a coffee table and a jewelry box. He had “thoughts of suicide as well as homicide.”

All of these details, pulled from records provided by the Murfreesboro Police Department, illustrate Vincente Montano’s history of mental illness. The reports include his mother’s assertion that he was a paranoid schizophrenic, a diagnosis she told police he received in 2006 from a Murfreesboro, Tenn., doctor.

On Wednesday, police say, 29-year-old Montano went into a theater in Antioch. He was armed with a hatchet and an airsoft-style gun and he carried two backpacks. Authorities said he attacked three people during a screening of Mad Max: Fury Road before being killed by officers he confronted outside. Police have confirmed he was homeless.

It will never be clear whether mental illness influenced Montano’s decision to go into the Carmike Hickory 8 Cinema.

But mental health experts describe schizophrenia as a distorted view of reality that can result in a combination of hallucinations and delusions. Typically, experts say, those delusions are about someone or something attempting to harm the individual with the illness. Schizophrenia affects about 1% of the population and can be hard to diagnose.

Studies show that violent behavior is uncommon, albeit problematic, for people with schizophrenia, and experts say that a history of violence — and not a history of mental illness — is the biggest indication of future aggressive acts.

“There’s not research or evidence that directly links schizophrenia to violence,” said Dr. Frank Drummond, chief medical officer of Mental Health Cooperative, a Nashville-area psychiatric services and counseling organization. “... Each case is still very individual.”

Montano was arrested at least once in Murfreesboro, had mental health issues and was committed four times — twice in 2004 and twice in 2007, Metro police spokesman Don Aaron said. That includes a February 2004 incident in which officers responded to an attempted suicide and transported Montano to Middle Tennessee Medical Center, which is now known as Saint Thomas Rutherford Hospital, according to police reports.

The attacker did not have a record with the Tennessee Department of Mental Health and Substance Abuse Services, the state mental health system, according to officials. It is unknown where else Montano may have received treatment, but Aaron said it is believed that three of Montano’s mental health commitments were in Murfreesboro and one was out of state.

Schizophrenia usually manifests between the ages of 18 and 25, with early symptoms of withdrawal and a change in personality, Drummond said. Unusual thinking or thoughts can lead to worse symptoms.

Dr. Howard Burley, the medical director and assistant commissioner of the state department, said some elements of Montano’s behavior were typical for a diagnosis of paranoid schizophrenia.

The mental condition, he said, can cause people to become isolated from their families, which can make getting them help even more difficult.

“If the person is really fixed in what they believe, it can be hard to convince them they have a problem and get them in treatment,” Burley said.

In 2004, Denise Pruett told police she could no longer deal with her son’s “mental instability.”

On Feb. 18 of that year, officers responded to an attempted suicide where a “very destructive” Montano had been hearing voices, according to police reports, and he was transported to the hospital. On Sept. 5 that same year Montano was charged with simple assault of an officer and resisting arrest after police responded to an alleged domestic violence disturbance between mother and son.

During the police visit, Montano became agitated and “flailed his arms wildly” at an officer. This was Montano’s only arrest in Tennessee, according to the Tennessee Bureau of Investigation. Those charges were dropped later under the condition that Montano take his medication and follow instructions from his doctor.

Though police reports indicate that — at least in 2004 — Montano had a type of medication, the records do not detail the name of the medication or for what type of illness or disease it was being taken. Reports also suggest there had been disagreements between Montano and his mom about his medication.

During the September 2004 incident, Montano told police that “his mother controls him and will not let him keep his medication prescribed to him,” according to filed reports. His mother told police her son was schizophrenic and that she “fears that her son will not responsibly take his medication.”

Medical experts say a support system can be just as important as medication when it comes to seeking treatment for mental illness.

“Very often you go through a period where you stabilize the symptoms, the person stops taking their medication and then they rebound in the symptoms again,” Burley said. “Each time it becomes a little more challenging to get the person stabilized.”

Homeless patients can be tougher to help, Burley said, because they are hard to reach and lack that stable support.

Burley said patients often feel like they don’t have a problem and stop treatment, until they become a danger to themselves or someone else.

With paranoid schizophrenics, he said, the danger is mostly to the individual.

“One of the assumptions people may jump to is that people with paranoid schizophrenia may be more prone to violence,” Burley said. “That’s not the case. They’re more likely to be a victim themselves.”