Organized Stalking and Psychiatric Persecution

March 14, 2011

Victims of Organized Stalking: Delusional, Schizophrenic, or the Targets of Psychiatric Persecution?

By Robin B. Webster Introduction The United States and the former Soviet Union have a history of using psychiatric commitment, or its threat, to silence dissent and marginalize citizens for racial, ethnic, political, and other reasons (reviewed by Whitaker, 2002, p. 215). Today, the internet is littered with similar claims from many individuals who live within the United States and other western countries (keywords: targeted individual, organized stalking, gang stalking, cause stalking, multi-stalking, community stalking). Many of these online claims include accounts of being followed around by groups of people and other more debilitating forms of harassment; reportedly as part of efforts to motivate victims to file complaints with the police. In the absence of credible evidence, the threat of civil commitment is real. The following essay attempts to assess whether there could be statistical support for these group-stalking claims using data published by the United States Department of Justice. Layperson For readers unfamiliar with psychiatry or statistics, I will set aside space for drawing conclusions using language I hope most people can understand. These sections will contain a heading Summary, 2 inch margins, and purple type to make it easier to skip through the denser material to find these intermittent summaries. These asides wont occur very often, only when I suspect the complexity of what Im trying to say may be overwhelming for some readers who have no background in statistics or psychiatry, or little tolerance for mind-numbing statistical calculations. The primary psychiatric diagnostic manual used within the United States and many other western countries is the Diagnostic and Statistics Manual IV-TR (DSM-IV-TR), which is written and published by the American Psychiatric Association (APA, 2000). Based on my understanding of its contents, which is informed somewhat by a Bachelor of Science degree in Psychology (non-clinical) and spending close to a decade in psychotherapy as a patient, people who claim that they are being stalked by multiple perpetrators could receive a diagnosis of persecutory delusional disorder or paranoid schizophrenia. I then determined the estimated prevalence of these disorders based on published medical research and government websites. The prevalence of these disorders was then compared to the results of a recent survey of stalking statistics published by the United States Department of Justice (U.S. DOJ, 2009a). By doing this comparison I hope to determine the estimated prevalence of persecutory delusions among people claiming that they are being stalked by more than one perpetrator. Persecutory Delusions Persecutory delusions fall within the broader classification of delusional disorders (APA, 2000, p. 323328) and can be distinguished from schizophrenia by the absence of characteristic symptoms like prominent auditory or visual hallucinations, bizarre delusions, disorganized speech, grossly disorganized or catatonic behavior Persecutory delusions are defined as follows (APA, 2000, p. 325):

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This subtype applies when the central theme of the delusion involves the persons belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals. Small slights may be exaggerated and become the focus of a delusional system. The focus of the delusion is often on some injustice that must be remedied by legal action (querulous paranoia), and the affected person may engage in repeated attempts to obtain satisfaction by appeal to the courts and other government agencies. Individuals with persecutory delusions are often resentful and angry and may resort to violence against those they believe are hurting them. I was unable to find reliable data that determined the prevalence of persecutory delusional disorder in the United States. Even though the broader category of delusional disorder also lacks well-researched demographic data, current estimates suggest a prevalence rate of around 0.03% (APA, 2000, p. 326). If we use the estimated 2010 U.S. Census Bureau data for the adult population aged 18 and older (U.S. Census Bureau, 2011a), this suggests approximately 70,114 Americans suffered from delusional disorder in 2010. Those suffering from persecutory delusions would therefore represent some fraction of this number. Summary The best estimate available suggests 0.03% of the U.S. adult population suffers from delusional disorder. This translates into 70,114 Americans suffering from this disorder in 2010. The percentage experiencing persecutory delusions is some fraction of this number. Differential Diagnosis Discriminating between delusional disorder and other psychotic disorders can be difficult. If someone expresses a persecutory delusion in the absence of other psychiatric symptoms, then they would likely be diagnosed as suffering from persecutory delusional disorder. Should the victim also claim to be experiencing hallucinations related to the delusions central them, but only of a tactile or olfactory nature, then a diagnosis of persecutory delusional disorder would still apply. If such hallucinations are prominent, unrelated to a central theme, auditory, and/or bizarre, then a diagnosis of paranoid schizophrenia or some other type of schizophrenia might be given. A bizarre delusion is one that cant be plausible, such as believing other people are from Mars or are walking around without internal organs. Plausible delusions include being persecuted by groups of people. What follows is a table attempting to show the diagnostic criteria that could lead a person suffering from persecutory delusions to receive different diagnoses: Symptoms Nonbizarre delusions, 1 month Bizarre delusions Hallucinations: tactile and olfactory related to delusion Hallucinations: prominent auditory, including unrelated to delusions Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms, such as lack of emotions Social/occupational dysfunction Delusional Dis. Paranoid Schiz. Other Schiz. Yes No Maybe No No No No No Yes Yes Yes Yes No No No No or mild Yes Yes Yes Yes Yes Yes Yes Yes

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Paranoid Schizophrenia If delusions of persecution are accompanied by other symptoms, then the patient could receive a diagnosis of paranoid schizophrenia. These symptoms would include delusions and auditory hallucinations, but without symptoms common to other types of schizophrenia, such as disorganized speech, disorganized or catatonic behavior, or emotional flattening (APA, 2000, p. 312-314). The delusions are typically persecutory or grandiose, or both, but delusions with other themes (e.g., jealousy, religiosity, or somatization) may also occur. Typically there is a central theme to the delusions. Patients may appear anxious, angry, aloof, argumentative, patronizing, and/or overly formal when interacting with others. An increased risk of suicide or other forms of violence can sometimes accompany this condition. When tested, these patients show little or no cognitive deficits and are therefore often able to live independently. The prevalence of schizophrenia worldwide is approximately 4.53 per 1000 persons per year, or 0.453% (Saha, Chant, Welham, & McGrath, 2005). If we use 2010 U.S. Census projected estimates of the adult population (U.S. Census Bureau, 2011a, 233, 712,661) to calculate how many Americans this is, the number suffering from schizophrenia at any one time is approximately 1,058,718. Of these, approximately 40% would be expected to be diagnosed as having paranoid schizophrenia (World Health Organization [WHO], 1974). This would translate into 423,487 Americans suffering from paranoid schizophrenia at any one time. More recently released estimates of schizophrenia prevalence within the United States suggest the 12month rate for all types of schizophrenia is much higher, approximately 1.1% (National Institutes of Mental Health [NIMH], 2010). The U.S. Surgeon General estimated that 1.3% of the population suffers from schizophrenia (Surgeon General, 2011). The large discrepancy between worldwide and U.S. prevalence rates for schizophrenia has been attributed to the pervasive use of neuroleptic medications to treat schizophrenia in the United States, drugs which have been shown to produce a worse outcome when compared to placebo (Whitaker, 2002). Fewer Americans therefore recover from their break with reality than patients in other parts of the world, which prolongs their suffering and inflates prevalence rates by an estimated 300%. Profits by pharmaceutical companies are believed to be the root cause of this massive human rights tragedy. The higher estimates of schizophrenia prevalence has also been attributed to different analytical methods, but an overwhelming number of studies suggest the one year prevalence rate is between 0.4 and 0.5% (Saha, Chant, Welham, & McGrath, 2005). For our purposes, it seems more appropriate to trust world-wide prevalence rates since they were based on a meta-analysis of 188 studies from 46 different countries (Saha, Chant, Welham, & McGrath, 2005) rather than risk introducing artifacts associated with treatment outcomes, alleged conflicts of interest between the pharmaceutical industry and NIMH researchers, and methodological abnormalities. The symptoms most often expressed by paranoid schizophrenics include the following, from most to least frequent (WHO, 1974): y y y y y Lack in insight Suspiciousness Delusions of persecution Delusions of reference Ideas of reference y y y y y Unwillingness to cooperate Inadequate description of problems Delusional mood Flatness of affect (emotions) Auditory hallucinations

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As this list shows, delusions of persecution are not the most frequent symptom observed. The number of patients expressing this symptom therefore represents some fraction of the total number of individuals suffering from paranoid schizophrenia. Summary The best estimate of the world-wide prevalence of paranoid schizophrenia is 0.453% (Saha, Chant, Welham, & McGrath, 2005). This suggests that 423,487 Americans suffered from this disorder in 2010. Much higher estimates by U.S. government agencies are tainted by allegations of conflicts of interest and poorer treatment outcomes, and for this reason the World Health Organizations estimate was used for this analysis. Of the number of Americans estimated to be suffering from paranoid schizophrenia, only a fraction experience delusions of persecution. Stalking Statistics In 2006 the U.S. Census Bureau, on behalf of the Bureau of Justice Statistics, U.S. Department of Justice, contacted an estimated 42,000 households in an attempt to estimate crime victimization prevalence rates within the U.S. population (U.S. DOJ, 2009a). The National Crime Victimization Survey (NCVS) is administered twice a year to these households, with households rotating out of the survey group after three years. In 2006, a one-time supplement was included which attempted to assess the prevalence of stalking victimization. An estimated 65,270 individuals (83%) completed the Supplemental Victimization Survey (SVS). The results of the SVS suggest the prevalence of stalking victimization in America in 2006 was 1.39%, which translates into 3,236,920 adult Americans in 2010. A significant percentage also reported two or more perpetrators (0.434% or 1,013,114 Americans in 2010), or expressed confusion about how many perpetrators were stalking them (0.090% or 210,341 Americans in 2010). I chose to interpret this confusion about the number of perpetrators as evidence of two or more perpetrators for the following reason: when most people think of someone being stalked they probably assume a wanna-be lover, exlover, or estranged spouse is the perpetrator, which conjures an image of the lone stalker. News reports over the years have invariably confirmed and solidified this bias. To overcome the inherent presumption of a lone stalker, something would have had to occur to create confusion about the number of stalkers involved. The number of victims reporting confusion will therefore be added to the number of victims reporting two or more perpetrators, which translates into an overall prevalence rate of 0.524% or 1,224,724 Americans in 2010. Defining Organized Stalking Should someone I trust confide in me that they were being stalked by more than one person, my reactions would go from shock to a creepy feeling, because group stalking would require premeditated planning sessions and orchestrated execution. This description seems to define organized stalking. Even though there may be some rare cases of two perpetrators acting independently, it seems more likely that most two-stalker encounters represent the visible face of a larger group-stalking effort. For this reason, victims reporting two or more perpetrators will classified as possible victims of organized stalking. Summary An estimated 3,236,920 Americans were victimized by stalkers in 2010. If we define organized stalking as a group effort between two or more people, and assume it would be 4

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extremely rare that more than one perpetrator would be targeting the same victim at the same time, then based on the stalking victimization survey 1,013,114 Americans were the victims of organized stalking in 2010. If we assume a lone stalker bias is prevalent and entrenched in the U.S. population, then being confused about the number of perpetrators suggests something happened to overcome this bias. Combining the number of confused victims with the number reporting two or more perpetrators therefore seems appropriate, which suggests that 1,224,724 Americans in 2010 were the victims of organized stalking activities. A Significant Percentage of Schizophrenics are Institutionalized An important consideration that affects this analysis is the number of persons suffering from psychosis who become segregated from society through hospitalization, long-term care facilities, or incarceration. These people would not be present in the stalking survey population. Again, there is no clear and consistent source of reliable data for the American populace. A large Danish cohort study of schizophrenia patients found that 23% were still institutionalized one year after the onset of treatment (Bertelsen, Jeppesen, Petersen, Thorup, Ohlenschlaeger, Le Quach, et al., 2009). Possible differences between treatment approaches in the United States and Denmark undermines the value of this estimate to some extent. World-wide estimates of inpatient schizophrenia populations suggest a prevalence rate of 0.175% (Saha, Chant, Welham, & McGrath, 2005). If we apply this prevalence rate to the U.S. adult population estimate for 2010, then 409,000 Americans were hospitalized due to schizophrenia during that year. The fraction of these people with a diagnosis of paranoid schizophrenia is unknown, but if we use the worldwide prevalence estimate for paranoid schizophrenia (WHO, 1974) then 163,600 of these inpatients suffered from paranoid schizophrenia. An estimated 2.0% of the Washington State prison population is schizophrenic (Corrado, Cohen, Hart, and Roesch, 2000). If we assume this is a reasonable estimate for the national prevalence of schizophrenia among prisoners, an assumption the authors of this study would support, then there were approximately 62,000 schizophrenia patients housed in U.S. prisons in 2010 (Cusac, 2009, p. 1-2). This would represent 5.86% of all Americans who suffered from schizophrenia in 2010. If we assume the worldwide prevalence of paranoid schizophrenia would be the same for incarcerated patients, then 24,800 prisoners suffer from this condition. If we add together the 163,600 inpatients and 24,800 prisoners predicted to be suffering from paranoid schizophrenia, then approximately 188,400 Americans or 44.5% of all persons suffering from paranoid schizophrenia are hospitalized or incarcerated at any one time. The total number of Americans predicted to be suffering from delusional disorder or paranoid schizophrenia at any one time is 493,601, which represents 0.21% of the 2010 U.S. adult population. If we subtract 188,400 from 493,601, then 305,201 Americans suffering from these two disorders are still living out in their communities. This represents 0.131% of the U.S. population. Summary Approximately 45% of all persons suffering from paranoid schizophrenia would be hospitalized or incarcerated and would therefore not be present in the stalking survey

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population. The prevalence of delusional disorder and paranoid schizophrenia among the general population (not institutionalized) is therefore 0.131%. Percentage of Organized Stalking Victims Predicted to be Suffering from Persecutory Delusions If we subtract 0.131%, which represents the estimated prevalence of delusional disorder and paranoid schizophrenia in the general population, from 0.524%, which represents the prevalence of stalking victims reporting two or more perpetrators, then 0.393% of the adult, non-delusional population is being victimized by two or more stalking perpetrators at any time. If we use the above definition of organized stalking, then 918,491 adult, non-delusional Americans were victimized by organized stalking activities in 2010. The number of stalking victims reporting two or more perpetrators is therefore four times the number who could be suffering from delusions of persecution (0.524% / 0.131% ). Summary Only one out of four people claiming to be a victim of group stalking activities would be predicted to be suffering from delusions of persecution. There is no rational explanation for predicting that persons suffering from mental health problems would be preferentially excluded from persecution campaigns. Given the above conclusion that organized stalking exists on a wide scale and targets approximately 918,491 adult, non-delusional Americans, then it seems reasonable to assume these persecution campaigns would target anyone perceived to threaten community safety, including people suffering from mental health problems. The prevalence rate of 0.524% for stalking victims reporting two or more perpetrators therefore implies that somewhere between 918,491 and 1,224,654 adult Americans were victimized by organized stalking activities in 2010. The definition of organized stalking could be made more stringent by limiting calculations to stalking victims reporting three or more perpetrators. The prevalence of these victims is 0.182%. If we add the victims confused about how many perpetrators are stalking them, then the rate increases to 0.272%. Subtracting the prevalence of persons suffering from persecutory delusions (0.131%) from both of these rates gives 0.051 and 0.141%, respectively. In 2010 this would represent a range of victims from 119,193 to 329,535 nationwide who are not delusional. The ratio of all victims reporting three or more perpetrators to those predicted to be suffering from delusions of persecution would range from 1.4 to 2.1. These numbers result in an estimated prevalence rate of 5 out of 7 to 10 out of 21 victims predicted to be delusional when using the more stringent definition. Summary Between 30 and 50% of all victims reporting three or more perpetrators, and 75% of all people reporting two or more perpetrators, are therefore predicted to be non-delusional. The number of non-delusional victims reporting three or more perpetrators in 2010 is estimated to range between 119,193 and 329,535. The range for non-delusional victims reporting two or more perpetrators is 918,491 and 1,224,654. Limitations of this Study This analysis is limited by a few shortcomings. These include the complete absence of data providing information about the prevalence of delusions of persecution in the U.S. population. The best solution seemed to be relying on known prevalence rates for the larger encompassing categories of delusional 6

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disorder and paranoid schizophrenia to conduct this analysis, in spite the fact that this approach would overestimate the prevalence of these disorders. The exceptionally large discrepancy between official U.S. estimates of schizophrenia for its citizens and what researchers in other parts of the world have found, presented a significant quandary. I chose to use the data derived from a meta-analysis of 188 studies from 46 different countries (Saha, Chant, Welham, & McGrath, 2005). This decision was made largely to avoid introducing possible artifacts arising from methodological irregularities (Saha, Chant, Welham, & McGrath, 2005), alleged conflicts of interest, and poorer treatment outcomes (Whitaker, 2002). Defining organized stalking presented another quandary. In the absence of a formal definition, I chose to define organized stalking as being victimized by two or more perpetrators simultaneously. This decision was based on the assumption that it would be an extremely rare event for an average American to be stalked simultaneously by two or more people acting independently. To forestall possible objections to this definition, I also calculated the prevalence rate of non-delusional victims being stalked by three or more perpetrators and found the number of victims to be still quite high. Victims who were confused about the number of perpetrators were assumed to be stalked by two or more perpetrators. These victims were therefore counted as organized stalking victims. The basis for this last assumption is the perception that most people assume stalking involves a lone perpetrator. The prevalence of this bias would predict that something significant would have had to happen to undermine this bias enough for a state of confusion to emerge. In the absence of a way to calculate what percentage of these victims were being stalked by three or more perpetrators, a range was calculated instead between three or more perpetrators and three or more perpetrators plus confused victims. Conclusions and Discussion According to the above analysis, approximately 75% of all people who complain of being victimized by multiple stalkers are not delusional. If we use the more stringent organized stalking definition of three or more perpetrators, then 30 to 50% of all victims would not be expected to be delusional. These figures underestimate the true prevalence of non-delusional organized stalking victims because the fraction of people suffering from delusional disorder and paranoid schizophrenia, who are also suffering from persecutory delusions involving multiple stalkers, is unknown. One of the inclusion criteria for the stalking survey was that victims had feel their lives were in danger, therefore organized stalking victims experiencing mild stalking activities may not have been counted in the survey. The overall estimate of organized stalking victimization would be higher still if we assume that patients suffering from mental health issues would not be excluded from state-sponsored psychiatric persecution campaigns, an assumption that has historical precedence for U.S. citizens (Whitaker, 2002, p. 215). If we take into account these other factors then it seems likely that at least 50-75% of all persons complaining of being victimized by multiple stalkers are not imagining the fate that has befallen them. The analysis presented here supports the widespread existence of group stalking activities that could be victimizing over a million U.S. citizens each year. The predicted size of this demographic is inconsistent with random victimization and more consistent with the existence of an organized, nationwide effort to persecute certain segments of our society. Given the fact that victim reside in most areas within the United States, and complain of strikingly similar experiences, it seems reasonable to assume that organized stalking is operating on a national level. 7

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REFERENCES
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). Arlington, VA: American Psychiatric Publishing, Inc. Bertelsen, M., Jeppesen, P., Petersen, L., Thorup, A., Ohlenschlaeger, J., Le Quach, P. et al. (2009). Course of illness in a sample of 265 patients with first-episode psychosis: Five-year follow-u[ of the Danish OPUS trial. Schizophrenia Research, 107, p. 173-178. Cusac, Anne-Marie (2009). Cruel and Unusual: The Culture of Punishment in America. Yale University Press, New Haven Corrado, R., Cohen, I., Hart, S. and Roesch, R. (2000). Comparative examination of the prevalence of mental disorders among jailed inmates in Canada and the United States. International Journal of Law and Psychiatry, 23, p. 633-647. National Institute of Mental Health (2010). Schizophrenia. Retrieved February 2, 2011, from http://www.nimh.nih.gov/statistics/1SCHIZ.shtml Saha, S., Chant, D., Welham, J., & McGrath, J. (2005). A systematic review of the prevalence of schizophrenia. PLoS Medicine, 2, 413-433. U.S. Surgeon General. (2011?). Schizophrenia. Mental Health: A Report of the Surgeon General. Viewed April 14, 2011 at: http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec4.html U.S. Census Bureau (2011a). Retrieved March 20, 2011 from http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_PL_ QTPL&prodType=table Whitaker, R. (2002). Mad in America: Bad science, bad medicine, and the enduring mistreatment of the mentally ill. Cambridge, MA: Perseus Publishing. World Health Organization (1974). The international pilot study of schizophrenia. Schizophrenia Bulletin, 11, 21-34. Retrieved February 2, 2011, from http://schizophreniabulletin.oxfordjournals.org/content/1/11/21.full.pdf U.S. Department of Justice: Office of Justice Programs, Bureau of Justice Statistics Special Report (2009a). National Crime Victimization Survey: Stalking victimization in the United States. Retrieved February 2, 2011, from http://www.ovw.usdoj.gov/docs/stalking-victimization.pdf