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The Myths of Mental Illness. Chapter 4. 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

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what is abnormal
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

four categories of mental disorders
Four Categories of Mental Disorders
  • Most likely associated with violent, serious criminal or antisocial behaviour
    • Schizophrenic disorders
    • Personality disorders (PDs)
    • Mood disorders
    • Paranoid disorders
what is a psychopath
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
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

the criminal psychopath
The Criminal Psychopath
  • Demonstrate wide range of serious repetitive crimes with violence
  • Motives:
    • Primarily instrumental (planned, motivated by external goal, revenge or retribution)
psychological measures of psychopathy
Psychological Measures of Psychopathy

See generally (good articles )

Psychopathy Checklist (PCL)

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

mental disorders among offenders
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)

mental disorders among offenders1
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
re offending and risk assessment
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

dangerousness and the assessment of risk
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
dangerousness and the assessment of risk1
Dangerousness and the Assessment of Risk
  • Charles Joseph Whitman
  • James Huberty
  • Risk factors unique for each individual
risk factors associated with violence committed by people with mental disorders
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


Situational factors

Specific situations? Previous victimization?

High levels of anger & poor impulse control?

Hallucinations & delusions?


Social network, sense of belonging, easy access?

Substance use, lack of supports –increases risk

Specific to individual (past violence; crowding)

mental disorder and criminal behaviour
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?
inducing the symptoms
Inducing the Symptoms
  • Symptoms can be provoked in “normal” people
    • Sleep deprivation
    • Sensory deprivation
    • Bereavement
    • Trauma
    • Solitary confinement
think of a person with drug related psychosis would you consider them to be either
Dangerous to others


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


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:
the real story about schizophrenia
The real story about schizophrenia
the history of mental illness within the law
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

the history of mental illness within the law1
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
mental disorder and the law
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

fitness to stand trial and criminal responsibility
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

fitness to stand trial
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)
the insanity defense
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

the insanity defense1
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
influential cases of the insanity standard
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 )
so where does that leave us
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

mental disorders as defences
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)

Refers to complete or partial loss of an event or series of events


Faking memory loss?

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

diagnosing disorders
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