ANNAPOLIS – Dr. Roger Peele remembers clearly the day he was attacked by a mentally ill patient during a therapy session at the old St. Elizabeths Hospital in Washington, D.C. There was an attendant present when the patient slugged him, and after a scuffle Peele managed to wrestle the man to the floor.
That was 44 years ago and Peele, now chief psychiatrist for the Montgomery County government, says he has never been assaulted by a patient since. His experience is typical, experts say, and illustrates the rarity of attacks like the one that resulted in the beating death of prominent Bethesda psychiatrist Dr. Wayne Fenton on Sept. 3.
Vitali A. Davydov, a 19-year-old North Potomac man diagnosed as schizophrenic and bipolar, was charged with first degree murder in Fenton’s death and is being held without bond.
“I’ve never been assaulted in fifteen years…nor have I heard of any of my peers being assaulted,” said Dr. Jack Vaeth, a psychiatrist at Towson’s Sheppard Pratt Health System, who works with acutely mentally ill patients soon after they have been institutionalized and often before they have been assessed.
“When we don’t understand something, we’re often frightened by it,” Vaeth said. “We’re not around the mentally ill and we assume they’re dangerous.”
While no comprehensive statistics exist about the number of attacks against psychiatrists in the United States, mental health officials estimate that attacks on psychiatrists in private practice are rare because of the nature of clients being seen.
“In private practice, you’re usually looking at people who have the right to walk around society,” said Vaeth, who explained that these psychiatrists can pick and choose their clientele. Clients being seen in private practice are individuals that have not been committed to psychiatric facilities, he said.
“An attack that results in murder is pretty rare,” said Dr. Anthony F. Lehman, professor and chair of the Department of Psychiatry at the University of Maryland Medical Center. [Dr. Fenton’s killing] is an exceptional type of a situation,” he said.
While the presence of an attendant during a session with a potentially violent patient is desirable, psychiatrists often do not take such safety precautions. Paying attention to a client’s demeanor and reading voice and body signals are important in gauging when a situation may get out of hand, said Peele. Both the client and the psychiatrist should be able to leave the room at any point, he said.
Psychiatrists are “always sensitive to the fact that someone has that potential for violence but you see them week after week, month after month” and psychiatrists may begin to let their guard down, explains Peele.
The assault Peele experienced occurred in a psychiatric facility where physical attacks are more frequent than in private practices. An average of eight assaults per year occur in a typical psychiatric emergency service, according to a 2000 study published in Psychiatric Services, a journal of the American Psychiatric Association.
“Lots of psychiatrists [in psychiatric facilities] have been exposed to being assaulted,” said Peele who worked at St. Elizabeths, at the Northern Virginia Mental Health Institute and at George Washington University Hospital over his 46-year psychiatric career.
“Injuries to staff are not uncommon,” Peele said, who reported seeing “broken bones, bad muscular tears, and more serious permanent things” while working in psychiatric institutions.
Research shows that while unmedicated schizophrenics are prone to physical violence, the mentally ill who comply with their medication regimens are no more likely to commit violent acts than the population as a whole.
“In our experience, those that take their medications and are under psychiatric care display no more violence than the general population,” said Vaeth.
In a study published in the May edition of the Archives of General Psychiatry, 19.1 percent of schizophrenic individuals had a violent incident in a six-month period. This is compared to 2 percent of the general population without psychiatric disorders.
Substance abuse, an active psychosis and a history of violence are all predictors of future violence in schizophrenics, according to Lehman.
The majority of schizophrenics are non-violent and only a small fraction of total crime is being committed by people with schizophrenia, a disease that affects a little more than 1 percent of the population or about 2.4 million people, according to National Institute of Mental Health.
When schizophrenics do become violent that violence usually occurs in the home and is directed at family members, according to the NIMH.
Schizophrenics are much more of a danger to themselves, said Esther Kaleko-Kravitz, the executive director of the National Alliance on Mental Illness. They are much more likely to attempt suicide than the general population, with 10 percent, particularly young males, eventually committing suicide, according to NIMH.
Advocates for the mentally ill fear that Dr. Fenton’s killing may fuel the perception of schizophrenics as criminally violent.
“Every year there’s three or four high profile cases and it unfortunately gets generalized in the public’s mind. They see that a mentally ill person has committed [a crime] and the concern is that people with mental illness are violent,” Lehman said.
This public perception can interfere with access to care and contribute to social stigma, he said. “Ironically, it’s exactly the opposite of what Wayne Fenton would have wanted,” Lehman said.