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Concept: Insanity defense

92

Four assumptions frequently arise in the aftermath of mass shootings in the United States: (1) that mental illness causes gun violence, (2) that psychiatric diagnosis can predict gun crime, (3) that shootings represent the deranged acts of mentally ill loners, and (4) that gun control “won’t prevent” another Newtown (Connecticut school mass shooting). Each of these statements is certainly true in particular instances. Yet, as we show, notions of mental illness that emerge in relation to mass shootings frequently reflect larger cultural stereotypes and anxieties about matters such as race/ethnicity, social class, and politics. These issues become obscured when mass shootings come to stand in for all gun crime, and when “mentally ill” ceases to be a medical designation and becomes a sign of violent threat. (Am J Public Health. Published online ahead of print December 12, 2014: e1-e10. doi:10.2105/AJPH.2014.302242).

Concepts: Health care, Mental health, Sociology, Mental disorder, Violent crime, Psychiatry, Mental illness, Insanity defense

27

The experience of hearing a voice in the absence of an appropriate external stimulus, formally termed an auditory verbal hallucination (AVH), may be malingered for reasons such as personal financial gain, or, in criminal cases, to attempt a plea of not guilty by reason of insanity. An accurate knowledge of the phenomenology of AVHs is central to assessing the veracity of claims to such experiences. We begin by demonstrating that some contemporary criminal cases still employ inaccurate conceptions of the phenomenology of AVHs to assess defendants' claims. The phenomenology of genuine, malingered, and atypical AVHs is then examined. We argue that, due to the heterogeneity of AVHs, the use of typical properties of AVHs as a yardstick against which to evaluate the veracity of a defendant’s claims is likely to be less effective than the accumulation of instances of defendants endorsing statements of atypical features of AVHs. We identify steps towards the development of a formal tool for this purpose, and examine other conceptual issues pertinent to criminal cases arising from the phenomenology of AVHs.

Concepts: Auditory system, Experience, Knowledge, Psychosis, Logic, Reason, Legal terms, Insanity defense

17

Homelessness and mental illness have a strong association with public disorder and criminality. Experimental evidence indicates that Housing First (HF) increases housing stability and perceived choice among those experiencing chronic homelessness and mental disorders. HF is also associated with lower residential costs than common alternative approaches. Few studies have examined the effect of HF on criminal behavior.

Concepts: Psychology, Randomized controlled trial, Sociology, Crime, Mental disorder, Schizophrenia, Homelessness in the United States, Insanity defense

6

A subgroup of individuals becomes entrenched in a “revolving door” involving corrections, health, and social welfare services. Little research has investigated the numbers of people that are in frequent contact with multiple public agencies, the costs associated with these encounters, or the characteristics of the people concerned. The present study used linked administrative data to examine offenders who were also very frequent users of health and social services. We investigated the magnitude and distribution of costs attributable to different categories of service for those in the top 10 % of sentences to either community or custodial settings. We hypothesized that the members of these subgroups would be significantly more likely to have substance use and other mental disorders than other members of the offender population.

Concepts: Sociology, Distribution, Mental disorder, Mental illness, Subgroup, Welfare economics, Insanity defense, Social welfare function

0

In this article, I compare and evaluate R. D. Laing and A. Esterson’s account of schizophrenia as developed in Sanity, Madness and the Family (1964), social models of disability, and accounts of extended mental disorder. These accounts claim that some putative disorders (schizophrenia, disability, certain mental disorders) should not be thought of as reflecting biological or psychological dysfunction within the afflicted individual, but instead as external problems (to be located in the family, or in the material and social environment). In this article, I consider the grounds on which such claims might be supported. I argue that problems should not be located within an individual putative patient in cases where there is some acceptable test environment in which there is no problem. A number of cases where such an argument can show that there is no internal disorder are discussed. I argue, however, that Laing and Esterson’s argument-that schizophrenia is not within diagnosed patients-does not work. The problem with their argument is that they fail to show that the diagnosed women in their study function adequately in any environment.

Concepts: Psychology, Sociology, Mental disorder, Schizophrenia, Disability, Schizoid personality disorder, Family therapy, Insanity defense

0

Individuals acquitted as not guilty by reason of insanity (NGRI) are usually committed to psychiatric hospitals for treatment until they are considered suitable for conditional release back to the community. The clinical evaluations that inform conditional release decisions have rarely been studied but provide an ideal opportunity to examine the reliability and validity of complex evaluations in the field. For example, to what extent do forensic evaluators agree about an acquittee’s readiness for conditional release? And how accurate are their opinions? We reviewed 175 evaluation reports across 62 cases from Hawaii, which requires 3 separate evaluations from independent clinicians for each felony NGRI acquittee referred for conditional release evaluation. Evaluators agreed about an NGRI acquittee’s readiness for conditional release in only 53.2% of evaluations (κ = .35). Courts followed the majority evaluator opinion in 79.3% of all cases but ruled in an opposite direction from the majority evaluator opinion in more than a third of cases in which evaluators disagreed. Evaluators accurately differentiated those conditionally released acquittees who remained in the community from those who were rehospitalized in 62.4% of cases. Among the 43 insanity acquittees who were ultimately released, evaluator agreement was significantly associated with rehospitalization within 3 years. When the evaluators unanimously agreed that conditional release was appropriate, only 34.5% were rehospitalized. When the evaluators disagreed, 71.4% were rehospitalized. Overall, results reveal poor agreement among independent evaluators in routine practice but suggest that opinions may be more accurate when evaluators agree than when they disagree. (PsycINFO Database Record

Concepts: Hospital, Evaluation, Belief, Psychometrics, Reliability, Psychiatry, Psychiatric hospital, Insanity defense

0

Public perception, fueled not only by popular and news media but also by expert claims that psychopaths are archetypes of evil: incorrigible, remorseless, cold-blooded criminals, whose crimes manifest in the most extreme levels of violence. But is there empirical evidence that psychopaths truly are what they are portrayed to be? If so, should the law respond, and adjust its treatment of psychopaths in court - permitting psychopathy to be admitted under an insanity defense and/or resulting in mitigation? In this paper, we demonstrate that fundamental questions from the law to science remain unanswered and must be addressed before any alternative treatment of psychopathy can be considered. As it stands, psychopaths cannot be reliably defined or diagnosed and, as we will demonstrate, even the presumed link with criminal dangerousness is problematic. We conclude that the current legal approach should not be modified, however, if preliminary findings regarding impairments in impulsivity/self-control are confirmed, some, but not all individuals who fall under one definition of psychopathy may merit different treatment in future.

Concepts: Law, Crime, Mental disorder, Criminology, Antisocial personality disorder, Psychopathy, Insanity defense, Remorse

0

This paper traces the significance of the diagnosis of ‘moral insanity’ (and the related diagnoses of ‘monomania’ and ‘ manie sans délire’) to the development of psychiatry as a profession in the nineteenth century. The pioneers of psychiatric thought were motivated to explore such diagnoses because they promised public recognition in the high status surroundings of the criminal court. Some success was achieved in presenting a form of expertise that centred on the ability of the experts to detect quite subtle, ‘psychological’ forms of dangerous madness within the minds of offenders in France and more extensively in England. Significant backlash in the press against these new ideas pushed the profession away from such psychological exploration and back towards its medical roots that located criminal insanity simply within the organic constitution of its sufferers.

Concepts: Psychology, Medicine, Mental health, Sociology, Mental disorder, Psychiatry, Social status, Insanity defense

0

This article looks into the establishment and development of two criminal asylums in Norway. Influenced by international psychiatry and a European reorientation of penal law, the country chose to institutionalize insane criminals and criminally insane in separate asylums. Norway’s first criminal asylum was opened in 1895, and a second in 1923, both in Trondheim. Both asylums quickly filled up with patients who often stayed for many years, and some for their entire lives. The official aim of these asylums was to confine and treat dangerous and disruptive lunatics. Goffman postulates that total institutions typically fall short of their official aims. This study examines records of the patients who were admitted to the two Trondheim asylums, in order to see if the official aims were achieved.

Concepts: Sociology, Crime, Criminal law, Criminology, Institutionalisation, Insanity defense, Erving Goffman, Asylums

0

The role of mental illness in violent crime is elusive, and there are harmful stereotypes that mentally ill people are frequently violent criminals. Studies find greater psychopathology among violent offenders, especially convicted homicide offenders, and higher rates of violence perpetration and victimization among those with mental illness. Emotion dysregulation may be one way in which mental illness contributes to violent and/or criminal behavior. Although there are many stereotyped portrayals of individuals with dissociative disorders (DDs) being violent, the link between DDs and crime is rarely researched.

Concepts: Psychology, Sociology, Crime, Mental disorder, Violent crime, Violence, Psychiatry, Insanity defense