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A fictional character who is insane (in the psychotic, out of touch with reality way) is usually also violent. Thus, in typical TV-land logic, if you become psychotic, you must also become violent—even if you never were before.
A character who already resorts to violence will turn on their friends instead of fighting whatever enemy they usually fight.
What's more, the fictional psychotic will not only be invariably violent, they'll actually be more lethally effective than a sane person. Count on the villainous psychotic to be a nigh-unstoppable assassin who's mastered Offscreen Teleportation rather than, say, a poor deluded individual uselessly arguing with or attacking their own hallucinations, or getting caught during their very first crime because they weren't trying to escape.
This is usually used to enhance the frightening aspect of a character, since psychosis makes them unpredictable and their behavior unfamiliar. In a fight, they have terrifying Confusion Fu. Many slasher-film villains are insane; most characters perceived as psychotic are also violent and unpredictable. The very connotation of "escaped lunatic" is that of a violent person, an urban-myth trope that goes back as far as the first mental asylums. The same goes for "psycho", "madman", and "insane", all of which commonly imply violence or evil (or both).
Although over one third of the world population's qualify as mentally ill at some point, media coverage of mental illness is mainly comprised of extremely negative and derogatory depictions - as you can see on TV Tropes itself. Incompetence, violence or criminality are generally the forms that appear in fiction, with far less depiction of 'uninteresting' conditions such as depression, catatonia or harmless OCD. In 1999, characters in prime time television portrayed as having a mental illness were depicted as the most dangerous of all demographic groups, with 60 percent shown to be involved in crime or violence. Such negative depictions, including in children's cartoons, are thought to contribute to stigma and negative attitudes in the public and in those with mental health problems themselves, although more sensitive or serious cinematic portrayals have increased in prevalence.
Very occasionally, this can be Truth in Television: people with mental illnesses do commit slightly more violent crime than average. But it's not anywhere nearly as common as media would imply. In fact, they are actually more than eleven times more likelyto be victims of violence. Alcohol and drug abuse are associated much more strongly with violence, and when you account for the increased prevalence of drug and alcohol abuse among those with mental illnesses, the extra risk of violence vanishes completely... but that's not as interesting.
This is becoming more of a Discredited Trope, thankfully, as more writers are leaning towards interesting motives for violence, but still lingers on in the Horror genre. This trope is also loaded with Unfortunate Implications, as talking to a mentally ill person would more than likely result in an interesting conversation about the likelihood that the spaghetti there on the stove isn't real or a lot of that person's special interests than it would in your death.
See also: Ax-Crazy. Compare it with Sanity Has Advantages.
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Anime and Manga
Dragon Ball Z generally implies that the more insane the villain, the more powerful. The series went from the generally sane, but evil Frieza, to Cell, to the unbelievably psychotic being that is Majin Buu.
Higurashi no Naku Koro ni is full of this. In the plot's defense, it does try to justify it via Hate Plague, and one of these people — Keiichi — actually does have some violent background before coming into contact with said Hate Plague. Only Satoko doesn't get violent when it is activated, but she knocks Keiichi off a bridge in one continuity and kills both Shmion and herself in a PS2-only one. And she kills her parents. Of course, the main symptom of Hinamizawa syndrome is extreme paranoia, and when you think somebody is about to kill you, what do you do?
Farfarello of Weiß Kreuz falls under this, particularly in back story. As a child, he snapped and killed his whole family, despite apparently being a perfectly normal kid before hand.
Taken to the extreme in Soul Eater. Insanity, fear, madness, etc. is basically this universe's Virus. You can be infected with insanity, and being insane means that you have the urge to hurt things. By killing humans and eating their souls (which is what insane people do, apparently), one can actually become an Eldritch Abomination. This is how the series' Big Bad Asura became the Big Bad— he was a nervous person who succumbed to his fear, and took the life of an innocent human and consumed their soul in order to gain power. (Ironically enough, consuming the soul of a corrupted, insane person in this series has no negative side effects whatsoever.)
Andrea Cavalcanti/Benedetto in Gankutsuou is an effortlessly charming fop who happens to also be a wild-eyed rapist with daddy issues. Best demonstrated when he tries to rape his fiance Eugenie and suddenly attacks Haydee.
It warrants mentioning that he stabs out her eye... with his fingers. Why? Because he's just that crazy.
Hidan of Naruto, though his "insanity" takes the form of membership in a cult that worships a god of murder and powers that combine violent self-mutilation with immortality and sympathetic magic. Since all the major characters are ninja, violence is a given.
Batman villains are serial representatives and offenders of this trope.
This results in part because of Characterization Marches On. The original Batman villains were master-criminals typical of pulp villains with no real motivations. The first Joker dressed in white paint and didn't have silly gag-based antics. After the 50s, where comics were subject to Bowdlerization, Joker became a harmless villain with gag based antics celebrated in the Adam West show. When Dennis O'Neil, Steve Engelhart and other writers sought to make Joker menacing again, they had to justify the gag-based elements which had become The Artifact as well as other motif-themed criminals such as The Riddler which became famous thanks to the Batman TV Series. Their solution was Hollywood Psych, and they added Arkham Asylum into the mix. Since then, all of Batman's villains were described not merely as supervillains but as psychopaths.
Frank Miller's The Dark Knight Returns partly plays this straight and partly parodies it, by showing how absurd Batman's conflict with supervillains become when made a discourse to the popular psychology and sociological analysis of prime time cable news. Popular psychologists and careerist shrinks like Bat Wolper tries to cure the likes of Two Face via plastic surgery that repairs the bad-half of the face. It turns out to be the wrong half, the real Harvey Dent was the scarred out part of his face, representing his guilt and self-loathing. The book also shows Joker closer to the original Bill Finger characterization as a joyless psychopath who speaks in a Creepy Monotone, although it does this by playing up the Foe Yay element to whole new heights. Batman himself in Frank Miller's books is shown to be somewhat of a Functional Madmen most of the times.
Alan Moore wrote The Killing Joke in part to reconcile all the elements of the earlier Joker origins with his new characterization as a psychopath, in the process he raised the question whether Joker can be truly held accountable for his actions on account of his mental illness, whether he can potentially be cured. While the "one bad day" element of Joker and the book's depiction of him as Batman's Shadow Archetype has endured, Moore felt that introducing realistic psychology is pointless with the function that Joker, as an entertaining supervillain, is supposed to perform.
Two-Face wasn't evil until one side of his face was ruined and (depending on the version) his insanity either began or became much worse. In fact, most Batman villains tend to fall into this category... with the exception (usually) of Humpty Dumpty, who saved Batgirl from falling off a building, fixed her dislocated shoulder, and went quietly to the asylum.
Deadpool becomes more unhinged than usual during the Black Box story arc of Cable & Deadpool. Even though he can't remember it later, it is revealed that he murdered a terrorist who was living on Cable's island. When asked why he did it, he replies that he doesn't know. Since his mind is more out-of-whack than usual, he just killed for no reason.
However, Deadpool was pointlessly violent since long before he was portrayed as insane.
In the book, there are very few supervillains and the ones who were, like Moloch, quit a long time ago when the first super-powered hero Dr. Manhattan arrived on the scene. The heroes however are full of neuroses. The Comedian is The Sociopath, a highly amoral Blood Knight who tries to justify his vision by repeatedly telling idealistic do-gooder heroes that At Least I Admit It. The backstory reveals a more complex, guilty, lonely and pathetic individual underneath that cynical facade. was already violent and unstable even before a certain dog incident, but after that he becomes even more violent, in his own words explaining that he had been merely soft before because he let his victims live.
Rorscharch is a Sociopathic Hero, described by Moore as "Batman without the excuses". He lives alone, prowls the streets and bars, believes in all kinds of Conspiracy Theories and sees himself as the Only Sane Man. Malcolm Long a sympathetic and realistic psychologist character is himself hurt and struck by Rorscharch's grim Black and White Morality after hearing about his Despair Event Horizon. What makes Rorscharch different is that he's not as consistent as he believes as seen in the end when he opposes Adrian Veidt's Utopia Justifies the Means atrocity using the same arguments that Rorscharch used in justifying Harry Truman dropping the bombs on Hiroshima and Nagasaki.
Nite Owl is more sane than other costumed heroes, but he does admit to Laurie that the costumes do give grounds to act out harmless Casual Kinkas seen when he and Laurie have sex in costumes after they couldn't make out in civilian identities.
When Harry Osborn became the third Green Goblin, he was not under influence of the Goblin Serum (though it was later retconned that his father did gave him some), but merely under the influence of drugs and insanity.
Darryl Cunningham's comic book Psychiatric Tales is an attempt to demystify mental illnesses and change their perception in media and in society. This trope is played straight in chapter "Antisocial Personality Disorder" (also known as "Mad Or Bad" on Darryl's blog). Other stories are actually an inversion, stating that people suffering from mental illnesses are more likely to be a victim of crime or harm themselves rather then anyone else.
Most slasher movie villains in general are either this or some supernatural thing that's returned for revenge.
The Silence of the Lambs: Hannibal Lecter. Jame Gumb. Frances Dolarhyde. Jacob Garrett Hobbes. Then again, when part of the premise of a series is that it's about catching serial killers...
Jack Torrence goes violently, and effectively, insane via cabin fever and alcoholism in The Shining, hunting down his terrified family with an axe. This is somewhat justified in the Stephen King novel, as being insane puts him under the hotel's control; that might also be true in the movie, though Stanley Kubrick deliberately leaves it vague.
In the TV miniseries remake Stephen King's The Shining, Jack (played by Steven Weber) is more clearly a nasty person only when he's drunk, an aspect King felt Kubrick's film lacked (in Nicholson's portrayal, Jack seems a bit scary even before he falls off the wagon). Problem is, Weber isn't nearly as frightening. As Kubrick said, when some of his actors complained he was pushing them into unrealistic, over-the-top performances, "Real is good. Interesting is better."
In Love Actually, Laura Linney's character's brother is in a mental hospital. We only see and hear from him briefly, and it seems he has some kind of paranoid disorder (he thinks the nurses are trying to kill him and wants to hire either the Pope or Jon Bon Jovi to perform an exorcism for him). When she visits him, he hauls off and tries to hit her without warning and for no reason. A hospital worker rushes in to stop him and then he's fine again.
In Miracle On34th Street, Doris worries that because Kris Kringle believes he's Santa Claus, he'll eventually become violent.
Subverted, in that not only is he harmless, well...
Psycho: Norman Bates seems harmlessly socially awkward at first, but he is gradually revealed to be a dissociating murderer.
The Jackal in Thir13en Ghosts is a terrifying vision of a man in a straight jacket and head cage, a ghost that screams as it approaches people. Played straight and then subverted. The bonus features on the DVD reveal he was a rapist, but deathly afraid of fulfilling this trope again, committing himself to a Bedlam House and willfully choosing to stay there when it burned down, dying in the fire. All of his visible wounds are self-inflicted.
All of the insane asylum residents in Kathryn Hulme's The Nun's Story embody this trope to some degree. The Archangel Gabriel attempts to rape Sister Luke, and another inmate, who is never caught, murders one of the nuns. Even the Abbess (who, much to Sister Luke's surprise, turns out to have been an actual abbess), turns violent when thwarted.
Mr Rochester's wife Bertha in Jane Eyre often snuck out from her room and tried to kill Mr Rochester a few times. She even bit and stabbed her visiting brother. And it culminated when she tried to set Jane's room on fire (not knowing Jane had ran away two months earlier), leading to the whole house burning down and her own Karmic Death.
In The Wheel of Time Series it is stated that any man to use magic will eventually be turned insane and then they will kill everyone around them. Heck the world was destroyed by 101 men who saved the world by sealing the Big Bad who then cursed the source of magic drove them insane and caused them to rip the world apart in a horrid frenzy of madness and killing.
It's not so much that they're violent as the fact that they're crazy and have the power to make their insane delusions reality. While one male channeler may or may not be a problem, over a hundred of them deciding that peaches are poisonous, or that mountains belong there, or that they're 100% certain a hurricane/earthquake is coming, and then using their powers to make these things happen, leads to a lot of death and destruction.
Although not always the reason behind all the killing and violence in A Song of Ice and Fire, certain characters, such as Gregor Clegane and Ramsay Snow/Bolton are portrayed as psychopathic and are responsible for some of the most sadistic atrocities in the series.
In The Wereling Trilogy, Mercy is a complete psycho who is violent by werewolf standards. According to Kate, this is because of excessive inbreed (which is also the only reason that they want Kate to mate with a newly-turned werewolf, to stabilize things). Kate's brother is just as bad. After Tom kills him, Kate shows how he kept the wallets of his victims as trophies.
In Harry Potter, Bellatrix Lestrange, Voldemort, and the Gaunts are all utterly insane, presumably from inbreeding. All of them (Merope excluded) openly attack people for reasons including amusement. In a subversion, Order of the Phoenix shows us Alice Longbottom, who is so insane that she can't recognize her own son, but just stands around, smiling weakly and handing out bubblegum wrappers. There's also Lockhart, who is pretty much treated like an overexcited child.
The subversional ones are actually truer to life; the spoilered example is sedate, but utterly detached from reality, and occasionally wanders a bit. Lockhart doesn't just get treated like an overexcited child, he behaves like one as well; he's aware that he seems to be incredibly famous, but has no idea why, and the whole thing is an exciting mystery to him.
Peeta in Mockingjay when he is Brainwashed and Crazy. The first thing he does when he sees Katniss is try to strangle her. It is justified in that the brainwashing was specifically done to turn him against Katniss and make him want to do violent things to her.
After the main character of The Chronicles of Professor Jack Baling goes crazy trying to unlock the secrets of his student's perpetual motion machine, he ends up building a death ray. Violence ensues.
Live Action TV
River Tam from Firefly is psychotic, violent - and a protagonist. Her violence is directed at the bad guys (and also, for reasons that might have become clear if the series had continued, at anything with a Blue Sun logo). Before the experiments that made her psychotic, she was a normal, nonviolent (if extremely gifted) young girl. An example of a Justified Trope, since the aim of the experiments was to create a Super Soldier, and violence kind of comes with the package.
Also justified because they removed bits of her brain, including one part that was supposed to let her push things that upset or bothered her out of mind. So basically she's a psychic supersoldier who is totally incapable of ignoring something that causes her distress.
Alpha from Dollhouse appears to be this trope - the composite event that gave him a whole host of imprinted personalities made him into an insane genius and also a psychopathic killer. Actually an aversion, as his original personality was already psychopathic before the composite event, and by the time of Epitaph Two has developed a non-insane personality based on all of his component personalities, much like Echo.
In the Buffy the Vampire Slayer/Angel universe, Faith, after coming out of her coma and going rampaging, is repeatedly referred to as "psychotic", with direct reference to her violence. In fact, however, she shows no signs of delusions: she's on the edge of mental breakdown rather than past that point. When she does tip over, first temporarily while fighting Buffy-in-Faith's-body, then again when fighting Angel, the immediate effect is to make her more violent - but the first time she basically thinks she's beating up herself, and the second time she's trying to provoke Angel into killing her - a stark contrast to the torture, beatings, and attempted murder that mark her behavior when she's lucid! Furthermore, the second breakdown leads directly to her letting Angel help her, and therefore to her redemption.
I, Claudius manages to subvert this despite featuring the actual Caligula. His violent / psychopathic tendencies are explicitly shown NOT to follow from his psychotic delusions: he's a killer from childhood, but doesn't go mad until after he becomes Emperor years later. Livia and other murderous characters are described as "mad" by other characters, but are not shown as irrational - even Nero, explicitly called "as mad as... Caligula", is clearly nothing of the kind.
Insanity in Star Trek-land seems to consist of attacking people, yelling, having bulging eyes and sweating a lot. And being played by Morgan Woodward.
Partly justified in the two episodes of TOS featuring asylums — both times they were specified to be for the criminally insane, explaining why these insane people would be violent even if the overwhelming majority aren't. The Tantalus penal colony is for those deemed curable, Elba II is intended for the incurable (by modern Federation science), and dialogue implies it to be the only such installation in the Federation. It has eight patients.
Averted in Criminal Minds, where Reid points out that the insane are less likely to be violent, but that when they are, it's usually a lot worse than normal violence. Like in "With Friends Like These...". Up to Eleven. Reid's mother is also schizophrenic and lives full-time in an institution but has never hurt anyone. Of course, it's a shorter list the number of criminals on Criminal Minds who aren't mentally ill, and as it's almost never pointed out the majority of them are non-violent, this comes off a bit flat to some.
Subverted in an episode of The Closer- the father of a disorganized schizophrenic confessed to a murder even he thought his son had committed, when in fact the son had merely discovered the body.
In Being Human, vampires are shown to be the fantasy equivalent to drug addicts, making them go batshit if they don't get any blood. According to Herrik though, all people are that violent and vampires are just beyond any constraints.
In Six Feet Under, the one character who is bipolar is also psychopathic and tries to carve off the tattoo on his sister's back, after slicing off his own.
There's quite a few characters in Oz that fall under this.
JAG: Averted in "The Martin Baker Fan Cub", where only one of the four escaped mental patents from a VA hospital exhibits violent behavior (by grabbing a sidearm from a police officer) and two others are completely harmless with the mental acuity of small children.
The X-Files episode "Grotesque" has a Serial Killer who claims that he's possessed by some dark spirit. Scully thinks he suffers from a dissociative disorder and Mulder informs us that he spent the better part of his twenties in an insane asylum. The episode deals with the issue of spirit possession versus insanity.
In "Chimera", the monster-of-the-week is revealed to have got some kind of dissociative multiple personality disorder: split personality. The woman's overt self was not aware that it was her who was committing the murders.
Averted in Cracked a show about a team of police officers and psychiatric professionals assigned to deal with crimes involving the mentally ill. While many of the perpetrators are disturbed individuals, there have also been cases where insane people have been witnesses or victims, including a bipolar psychotic who saw a girl he had been trying to help get murdered, and a boy with Tourettes who tried to find assistance for an abandoned baby.
Space 1889 played straight the vast majority of NP Cs with the motivation “insane” are violent and hostile to the player characters.
Dungeons and Dragons 3.5 features several spells which can cause the target to become insane. An insane person has to roll on a chart to see what their character does; there is a 10% chance the character acts normally, a 20% chance to run away as quickly as possible, etc. The highest probability action (30% chance) is that the character attacks the nearest creature, friend or foe.
Also the spell Call Forth the Beast in the Heroes of Horror book. The next time the target goes to sleep, they immediately wake up with a bloodthirsty, psychotic attitude with the sole goal of as much violence and bloodshed as possible. After the spell wears off they fall back asleep and wake up with no memory of what happened.
In 4E, there is a whole host of powers that force your enemies to attack each other; most have "madness" or some synonym thereof right in the title.
The Marauders from Mage: The Ascension are Mages who went insane via mundane or magical means. In this setting, how a Mage perceives the world and believes how it should work is what changes reality. With hallucination and delusion, this becomes... somewhat skewed. The Marauders' existence itself is violence upon reality.
Warhammer and Warhammer 40,000: pretty much anyone corrupted by Chaos. And seeing as the Blood God Khorne is the incarnation of rage...
The main characters of Assassins are all this trope to some extent. Justified, however, in that they're all Real Life people who were crazy enough to kill a US President.
Borderlands and Borderlands 2 iconic psychos, of course. The sequel also has the Crazed Marauders, although it's arguable whether this counts as the regular Marauders are violent enough without being insane.
Count Waltz of Eternal Sonata tries to cause this by making the madness-inducing cure-all mineral powder relatively affordable. Because the madness only sets in after a period of time with the normal powder, most people don't make the connection. And in the meantime, you start being able to use magic. Waltz's motivation for doing this is to turn the population into insane magic-users, because those make good soldiers.
Though there are others who you never fight, such as the guy who just walks in a straight line, forever.
Kefka Palazzo from Final Fantasy VI. It says a lot about a character when his madness makes him The Dreaded on both the protagonists' side of the conflicts and the villains'. An NPC in Final Fantasy VI states that Kefka is a Psycho Prototype, having lost his mind after recieving the empire's first experimental Magitek Infusion, and in Dissidia: Final Fantasy it's implied that the process has made him unable to feel anything at all, except for when he is giving into his destructive urges.
Demon Lord Ghirahim from The Legend of Zelda: Skyward Sword. He's Ax-Crazy and has unabashed bloodlust, first promising to beat Link within an inch of his life, then burn him alive, and then finally torture him until he's deafened by his own screams.
An apparent invocation of this trope saw a British psychiatric charity condemn Man Hunt 2, despite the lead character- and most of the enemy characters- not actually being insane at all.
James Marcus of Resident Evil 0 is driven insane by his death (and subsequent rebirth via virally-infected leeches) which turns him from a relatively mild-mannered scientist into a revenge-fueled monster who slaughters an entire train full of workers— and then a training facility— and he's implied to have released the T-Virus in the first game, which leads to an entire city being NUKED.
Gregory AKA the Stray Dog in Rule of Rose fell into depression after his son's death. He ended up kidnapping other children as replacements and killing them when they didn't perform adequately, and stalking the countryside on all fours like a mad dog.
Subversion in Scribblenauts. Entering the word "Psycho" spawns a girl with a knife, but like any neutral NPC, she only attacks when frightened and holding a weapon.
Subverted by the Pyro. In meet the Pyro, the other classes talk about how scary she/he is, cut with images of him/her causing horrible destruction. However, when we see the Pyro's view, it turns out she/he sees the world as a colorful wonderland where he/she is bringing candy and happiness to the other classes. Of course, the real world effects of the Pyro's insanity are the same.
Many characters in the Twisted Metal franchise. Especially in Black where the entire cast has been broken out of an asylum and allowed to fight each other for the right to have their wish come true. This usually involves murder of some kind.
A variation appears in Survival of the Fittest with those who play the game, especially since many are eventually driven insane, if they didn't start out that way. By necessity, "players" are distrustful and hostile towards everyone else, as they aim to be the winner and Sole Survivor, and many attack all other people on sight. Sometimes this verges on Chaotic Stupid behaviour.
When Freeze Man from In Wilys Defense went insane, he started killing people for the fun of it, despite his being a robot and therefore breaking therules.
Both averted and played straight in Protectors of the Plot Continuum. Most agents are a little crazy, but those who have real-world disorders aren't any more violent than anybody else (which, granted, isn't saying much when it's a PPC agent you're talking about). However, insanity induced by contact with too much horrible fan fiction does occasionally make agents find themselves a flamethrower and start burning things.
Played straight and averted in Pyrrhic with some of the students. As a part of the experiment, they are forced to kill, but others were already verging on crazy before it. Some, like Tyra, thought that they were vampires, while others, like Jackson have begun to disassociate from reality due to what is heavily implied to be Danson messing with his mind. However, Jackson's is treated with respect, due to the circumstances and was perfectly sane before the experiment. Others like Marie play this straight.
Ren of The Ren & Stimpy Show is sort of an aversion. He's both insane and violent, there's no questioning that. However, he's only violent when he's being normal; when his psychotic tendencies are triggered, he becomes terrifyingly calm and never lays a mere finger on Stimpy. Instead, he gives elaborate To the Pain monologues. "Stimpy's Fan Club" and "Sven Hoek" contain possibly the best examples of that.
Donald Duck, in Mickey and the Beanstalk, shown in the trope picture, having a hunger-induced breakdown and attempting to kill their cow so he, Mickey and Goofy can eat.
Avatar: The Last Airbender: Azula has always had a penchant for violence, but she was most likely to only use it when it was most needed, to dire effect - an apt comparison to the trick for lightningbending. However, when she goes round the bend, her sadism and violence rocket the hell up. But on the realistic side, she gets considerably less effective when insane. It's doubtful the heroes could have defeated her if she'd stayed sane.
Interestingly, this is often subverted in Adventure Time. The three most obviously mentally unstable characters, The Ice King, Lemongrab, and the Tart Toter, aren't evil or violent. The former is a wizard who occasionally will battle Finn, but he isn't any more violent than the sane characters on the show. As for Lemongrab and the Tart Toter, these guys are just mentally unstable- not violent. It's the sane characters, aka Finn, Marceline, etc., who display occasional violent tendencies.
Usually inverted in Real Life. The mentally ill have little or no increased risk of committing crimes... but they are about ten times as likely to be the victims of crimes.
Mental health and medical communities say that people with mental illness are no more likely to be violent than anyone else. This is only sort of true. Mentally ill people aren't more dangerous, except that they are a lot more likely to have symptoms of alcohol or drug abuse, and those are linked to violence.
This comes from this study of acute psychiatric outpatients which I got out of this editorial in the New England Journal of Medicine.
Most mental patients are more likely to be dangerous to themselves than other people—nearly all mental disorders are correlated to a decrease in lifespan and increase rate of self-harm and suicide.
Almost inverted with at least one test on the connection between mental illness and violent crime: a whopping 4% of violent crime offenders were mentally ill.