The Myths of Mental Illness

1. The Myths of Mental Illness Chapter 4

2. What is Abnormal? Judgments between normal and abnormal differ depending on time and culture…….a social construction “Medicalization of deviance” Judgments of abnormality based on 3 Ds Distressing to self or others Dysfunctional for person or society Deviant: violate social norms Mental illness as a form of deviance and mental health as a form of conformity are difficult to define

3. Andrea Yates Case

4. Four Categories of Mental Disorders • Most likely associated with violent, serious criminal or antisocial behaviour • Schizophrenic disorders • Personality disorders (PDs) • Mood disorders • Paranoid disorders

5. WHAT Is A Psychopath? • Defined as a personality disorder with a cluster of interpersonal, affective, & behavioural characteristics • Dominant, selfish, manipulative individuals who engage in impulsive and antisocial acts • Feel no remorse or shame for behaviour that often has a negative impact on others

6. BEHAVIOURAL DESCRIPTIONS of a PSYCHOPATH Research by Cleckley & Hare Outgoing, Charming, & Verbally fluent Psychological testing – score higher on IQ tests Not mentally disordered by traditional standards Flat emotional reactions, inability to give affection, superficial emotions, impulsive, disregard for truth Cardinal trait: lack of remorse or guilt; semantic aphasia Not always criminals

7. The Criminal Psychopath • Demonstrate wide range of serious repetitive crimes with violence • Motives: • Primarily instrumental (planned, motivated by external goal, revenge or retribution)

8. Psychological Measures of Psychopathy See generally www.hare.org (good articles ) Psychopathy Checklist (PCL) http://www.minddisorders.com/Flu-Inv/Hare-Psychopathy-Checklist.html Assesses: two behavioural dimensions; interpersonal and emotional components & socially deviant lifestyle Score of 30 or above qualifies a person as a primary psychopath See Focus 4.1 in text

9. Mental Disorders Among Offenders High rates among prisoners More visible; more likely caught & plead guilty; revolving door Prevalence Rates of Psychiatric Disorders in a Sample of Defendants (Bland et al., 1990)

10. Mental Disorders Among Offenders • Most no more dangerous (exceptions may be subset of population – male, history of violence & current illness; schizophrenia (paranoid); substance abuse plus schizophrenia problematic) • Frontline: The New Asylums • www.pbs.org/wgbh/pages/frontline/shows/asylums

11. Re-Offending and Risk Assessment Two components of primary concern: Future criminal activity or violent acts (prediction component); danger to self or others Development of strategies to manage or reduce risk level (management component) Need for information that enable legal judgments, parole Errors and biases in making predictions Implications of errors varies – stakes may be high for individual or for society

12. Dangerousness and the Assessment of Risk • Canada at forefront • Actuarial instruments v. structured professional judgment • Violence Risk Assessment Guide (VRAG) • Historical/Clinical/Risk Management scaled (HCR-20) • MacArthur Network research • Specific types of violence: spousal, sexual, workplace • Measured primarily actuarial in nature

13. Dangerousness and the Assessment of Risk • Charles Joseph Whitman • http://www.youtube.com/watch?v=n22pRAK9N2Q&feature=related • James Huberty • http://www.youtube.com/watch?v=PjpL8HfWiiY • Risk factors unique for each individual

14. Profile of People Who are a Risk to Others

15. Risk Factors Associated with Violence Committed by People with Mental Disorders History of violence Personality factors Active symptoms & clinical diagnosis Failure to keep appts/take meds Drugs and alcohol Homelessness Situational factors Specific situations? Previous victimization? High levels of anger & poor impulse control? Hallucinations & delusions? Deterioration Social network, sense of belonging, easy access? Substance use, lack of supports –increases risk Specific to individual (past violence; crowding)

16. Mental Disorder and Criminal Behaviour • Schizophrenia • Complex and poorly understood • Behavioural manifestations varied: severe breakdown in thought patterns • Delusions (false beliefs about the world) • Hallucinations (auditory most common) • Aggression & violence serious problems • Characteristic positive & negative symptoms • Crime as a response to positive symptoms?

17. Inducing the Symptoms • Symptoms can be provoked in “normal” people • Sleep deprivation • Sensory deprivation • Bereavement • Trauma • Solitary confinement

18. Dangerous to others Unpredictable Hard to talk to Have only themselves to blame Would improve if given treatment Feel the way we all do at times Will eventually recover fully Could pull themselves together if they wanted to Not dangerous to others Predictable Easy to talk to Are not to blame for their condition Would not improve if given treatment Feel different from the way we all do at times Will never recover fully Can’t do anything to improve how they feel Think of a person with drug-related psychosis. Would you consider them to be either:

19. The real story about schizophrenia • www.youtube.com/watch?v=f4R6jln_eZg

20. The History of Mental Illness within the Law 1800’s – idea of insanity – Criminal Lunatics Act - insane person not blamed because the person was not acting as themselves but overcome by uncontrollable urges or delusions successful use of defence (not guilty by reason of insanity) resulted in acquittal and custody into an asylum

21. The History of Mental Illness within the Law • Flash-forward: Criminal Code in Canada • Basic idea behind defence did not change, changes made to terminology used, restrictions on time and some of the legal processes • Change ‘insanity’ to ‘mental disorder’ and provide more fair treatment (fitness hearing) • Change ‘NGRI’ to ‘Not Criminally Responsible’ • Review boards created; dispositions with time line

22. Mental Disorder and the Law Elements that must be present for criminal guilt: Actus Reus = physical act of committing a crime Mens Rea = mental intent to commit a crime Controversy with mentally ill is they are incapable of having mens rea in some instances

23. Fitness to Stand Trial and Criminal Responsibility Both fitness and CR are concerned with mental status CR is concerned with mental status at the time of the crime Fitness is concerned with the mental status at the time of the trial Fitness assessment must precede judgment of criminal responsibility

24. Fitness to Stand Trial • “Is unable on account of mental disorder to conduct a defence at any stage of the proceeding before a verdict is rendered or to instruct counsel to do so, and in particular, unable on account of mental disorder to a) understand the nature or object of the proceedings b) understand the possible consequences of the proceedings, or c) communicate with counsel.” • (Canadian Criminal Code)

25. The Insanity Defense Insanity is not being of sound mind, and being mentally deranged and irrational at the time the offence was committed Legally, insanity removes the responsibility of performing an act because of uncontrollable impulses or delusions e.g., hearing voices

26. The Insanity Defense • M’Naghten Rule: • Excuses a defendant who, by virtue of a defect of reason or disease of the mind, does not know the nature and quality of the act, or, if he does, does not know that the act is wrong. • Emphasis on cognitive elements

27. Influential Cases of the Insanity Standard • The Durham Rule • Assumed person cannot be held responsible for criminal act if suffering a mental illness • Excuses a defendant whose conduct is the product of mental disease or defect. • Brawner & Ali Rule (incorporates cognitive & volition elements) • Excuses a defendant who, because of a mental disease or defect, lacks substantial capacity to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of law. Excludes repeated criminal or antisocial behaviour (psychopaths & APDs )

28. So Where Does That Leave Us? As a group, no more likely than general population to commit crimes More visible presence within community Appear frequently in criminal justice system Co-occurring problems make them vulnerable

29. Mental Disorders as Defences • Dissociative Identity Disorder • Formerly multiple personality disorder • Presence of at least 2 distinct identities or personality states • Hillside Strangler (Kenneth Bianchi)

30. Amnesia Refers to complete or partial loss of an event or series of events Temporary Faking memory loss?

31. PTSD • Post-traumatic stress disorder • Characteristic symptoms following exposure to extreme traumatic stressor (identifiable cause for psychic damage) • Variants such as battered-woman syndrome

32. Personality Disorders (PDs) Occur when: personality traits become inflexible and maladaptive and cause significant functional impairment or subjective distress. Very important to note: virtually all individuals exhibit some behaviors associated with the various personality disorders from time to time.

33. Diagnosing Disorders DSM-IV-TR (APA, 2000) Contains detailed lists of observable behaviours that must be present in order for a diagnosis to be made Checklist of symptoms Some 400 mental disorders; revised periodically http://allpsych.com/disorders/dsm.html