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PubMed1995

[Ethical dilemmas in geriatric psychiatry].

In a review of the literature the author outlines the basic ethical problems of contemporary European gerontopsychiatry, as apparent at international congresses of gerontopsychiatric societies in Berlin (1993 and 1994) and Amsterdam (1994). Ethical dilemmas include in the first place abuse of old people, ethics of drug trials with insane patients and the right of a dignified death of psychiatric patients in general and insane patients in particular. The author holds a critical view of the legalization of euthanasia. A substantial part of the paper is devoted to the development of discussions regarding the legalization of euthanasia in Holland. It seems that as long as euthanasia will be restricted to the terminal stages of generalized malignities, it could be adopted also in other European countries incl. the Czech Republic. The author has a very critical and negative attitude to frequently practised dysthanasia, not only in the mentally healthy but also in psychiatric patients. He refutes inadequate medical intervention from the sphere of heroic medicine in particular in insane patients in the terminal stages of degenerative brain diseases.

Aged↗

PubMed1976

[150 years of psychiatric therapy].

The treatment of insane persons in the last century is briefly described. A more liberal and unrestrained treatment was introduced at the turn of the century, and chiefly agriculturally oriented insane asylums were established at that time. The question of persons trained to care for subjects afflicted with insanity was increasingly gaining in importance, and the aim was to have available a pool of skilled nursing personnel. Treatment by inducing artificial fever is outlined in addition to a brief description of a more activ treatment of patients by the Simon-Gütersloh method. In 1925, a "neuro-psychiatric dispensary" was established in the Soviet Union. Later, there were introduced such methods as insulin shock treatment and electroconvulsive therapy and, more recently, treatment with psychopharmaceuticals, the latter being drugs used in the treatment of emotional disorders in modern psychiatric hospitals. Inpatient and outpatient treatment is further developed with the establishment of day/night hospitals, and the need is pointed out to develop a system of care for mental patients on the model of that which exists in the Soviet Union.

Electroshock↗

PubMed1998

[Epilepsy, society and rights].

Although from the medical point of view epilepsy is considered to be a neurological disorder, this has not always been so. It was once included in the group of psychiatric disorders by the medical profession and others. In the case law of the Supreme Court, epilepsy is defined as a typical endogenous psychosis, and therefore as insanity. This would lead to its inclusion in the grounds for exoneration from criminal responsibility and has therefore been invoked as grounds for immunity from prosecution by many offenders. This has proved to be a two-edged sword, since the concept of insanity has led to these patients suffering social rejection. Medicine and Law have never found it easy to understand each other. However, now more than ever, some degree of mutual understanding is necessary when passing judgement on a person, since the Law progresses more slowly than Medicine does. Thus, today we would question a series of offences referred to in this paper, which used to be classified as insanity due to epilepsy. From a legal point of view we advocate a clear classification of epilepsy as a neurological disorder. This would doubtless lead to epileptics being more socially acceptable.

Attitude to Health↗

PubMed1987

Violence in sleep: medico-legal issues and two case reports.

Reported cases of violence during sleep are reviewed. Two new cases are reported where the subjects were charged respectively with attempted murder and murder; both were acquitted on the grounds of non-insane automatism. Clinical features and aetiological factors are analysed. The legal concepts surrounding non-insane automatism are discussed and criticized.

Adolescent↗

PubMed1984

Public opinion of forensic psychiatry following the Hinckley verdict.

The authors obtained opinions of forensic psychiatry in a community survey following the not guilty by reason of insanity verdict in the Hinckley trial. A majority of respondents expressed little or no confidence in the specific psychiatric testimony in the Hinckley trial and only modest faith in the general ability of psychiatrists to determine legal insanity. Respondents' general and specific attitudes were strongly related. Younger people and women were more positive in their views of psychiatry in the courtroom.

Adult↗

PubMed1985

Examining the application of the guilty but mentally ill verdict in Michigan.

The insanity defense has come under increased criticism after the highly publicized acquittal of John Hinckley, Jr. A variety of proposals have been suggested to rectify the perceived injustices of an insanity acquittal. In 1975 Michigan passed a guilty but mentally ill statute that allowed for individuals to be found mentally ill at the time of the offense but still criminally responsible for their actions. The authors review the history of the Michigan statute, scrutinize an empirical study of the statute's effectiveness, and debate a number of controversial issues. They suggest that guilty but mentally ill may be a misleading verdict established because of purely political motives.

Commitment of Persons with Psychiatric Disorders↗

PubMed1985

Treatment planning for the patient who is incompetent to stand trial.

National attention has focused on criminal defendants who plead not guilty by reason of insanity, but the insanity defense is rarely successful. A far larger number of criminal defendants, estimated at 9,000 annually, are admitted for forensic and civil hospitals because they are found incompetent to stand trial. Once hospitalized, many of these defendants face the likelihood of indefinite commitment. This paper discusses issues related to he concept of incompetency to stand trial and presents an approach to treatment planning and programming designed to restore patients to competency.

Commitment of Persons with Psychiatric Disorders↗

PubMed1988

An overview of psychiatric treatment approaches to three offender groups.

The chances for successful management of three groups of mentally ill offenders--insanity acquittees, sexual offenders, and offenders with alcohol problems--can be maximized by using specific diagnostic and therapeutic techniques for each group. The recommended model for treatment of insanity acquittees is based on a single administrative organization to oversee treatment programs, which include clearly defined inpatient and outpatient components and careful monitoring of conditional release to the community. Techniques for the diagnosis of sexual offenders include bioimpedance and physiological measures of sex hormone levels and penile tumescence. Medication with antiandrogens and cognitive behavioral treatment using covert sensitization and operant aversion are among the appropriate therapeutic modalities. Treatment of persons charged with alcohol-related crimes should be matched to the severity of the alcohol problem. Legal intervention supplemented by brief treatment programs may be effective for offenders with lesser degrees of alcohol abuse. For offenders with more serious alcohol problems, longer group treatment or detoxification may be necessary. Treatment of alcoholic criminals may be most effective in peer groups in institutional settings, where legal coercion can be used to encourage compliance.

Alcoholism↗

PubMed2000

The mental state at the time of the offense measure: its validation and admissibility under Daubert.

Melton et al. (Melton GB, Petrila J, Poythress NG, Slobogin C: Psychological Evaluations for the Courts (ed 2). New York: Guilford, 1997) recently advocated the use of the Mental State at the Time of the Offense (MSE-Offense) measure not only as a screen for insanity evaluations but also as the sole measure in "obvious" cases of insanity. Given this recommendation for expanding the role of the MSE-Offense, the current authors have evaluated the available data based on its construction and validation. We found fundamental flaws in its development and grave shortcomings in its validation. Based on these limitations, we conclude that the MSE-Offense is unacceptable under the Daubert standard (Daubert v. Merrell Dow Pharmaceuticals, Inc., U.S. 113 S. Ct. 2786 (1993)) for either the screening or determination of criminal responsibility.

Crime↗

PubMed2001

Psychiatric defenses in New York County: pleas and results.

Studies that have investigated the use of the insanity defense have revealed that the defense is rarely interposed. Few of these studies provide information on the use of psychiatric defenses other than insanity or report on how such cases were adjudicated (e.g., by trial or plea agreement). The current investigation examined all defendants who were indicted for felonies and who proffered any type of psychiatric defense in New York County (one of the five counties that comprise New York City) from 1988 to 1997. Plea, acquittal, and success rates and the manner by which cases were adjudicated are summarized. Prior research reveals that the general public believes that the defense is frequently used and often succeeds. However, in New York County, psychiatric defenses were proffered by only .16 percent of all indicted defendants.

Commitment of Persons with Psychiatric Disorders↗

PubMed1992

Automatisms--the current legal position related to clinical practice and medicolegal interpretation.

The interface between medicine and the law is an area which demands further investigation. There can be no criminal capability for an act unless the perpetrator had both the will to so act and the capacity to differentiate and choose whether or not to conform the particular behaviour to that dictated by the law. The capacity for choice must remain the fundamental issue. The range of conditions which can raise volition as a defence include: Somnambulism; post-traumatic syndromes; epilepsy; arteriosclerosis; or acts secondary to cerebral neoplasia. There is need to differentiate between reflex actions and automatisms and it is imperative that terms such as automatism or automatic behaviour are not perverted to allow an excuse for that which is inexcusable. Cases such as that of Cogdon, who was acquitted of murdering her daughter; Ramsbottom who was found guilty of causing a traffic accident despite having a stroke; Dennison in which a driver was found guilty despite epilepsy or Jenkins where the driver was initially found innocent of dangerous driving because of the unpredictable nature of diabetes are discussed. Special attention will be focused upon the case of Sullivan, a landmark in consideration of automatism in epilepsy. The paper examines insane verses non-insane automatism and the Australian legal system as it affects modern neurological practice. Suggestions are proffered as to how the law should be modified to better reflect justice as required within the context of modern medical knowledge. 'The social and psychological pressures that shape our criminals also shape-those who make and remake the laws which aim to control, punish or rehabilitate them, and those who try to change their behaviour.'

Australia↗

PubMed1993

Multiple personality disorder in criminal law.

The authors review the recent literature on multiple personality disorder (MPD), the most severe and chronic of the dissociative disorders, in relation to court cases of competence to stand trial, the insanity defense, and research on malingerers feigning MPD. Issues relevant in the assessment of competency and insanity are described. Features characteristic of MPD, including amnesia and alterations in consciousness and personality, have varying degrees of influence over the criminal behavior of an individual with MPD. As in other psychiatric disorders, the influence of MPD on an individual's competence to stand trial, and sanity, can be evaluated systematically. This article discusses a specific diagnostic tool, the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), an extensively field tested instrument that is potentially quite useful in forensic assessment of suspects manifesting dissociative symptoms and disorders. The particular advantages of the SCID-D will be reviewed in the context of some well known criminal cases involving MPD. Further research using diagnostic interviews for the systematic assessment of dissociative symptoms and MPD in criminal cases will continue to clarify the influence of these symptoms in a forensic context.

Adult↗

PubMed1993

The multiple personality and the criminal law.

Multiple personality disorder (MPD) is a growing phenomenon in the United States. The number of cases have mounted following the celebrated cases of 'Three Faces of Eve' and 'Sybil' that have been popularized over the past several decades. How can--or should--the criminal law deal with multiple personality? Should the defendant suffering MPD be deemed competent to stand trial, or be able successfully to assert the insanity defence, or diminished capacity or automatism? Does MPD qualify as a mental disease or defect under the test of criminal responsibility, which would call for commitment upon a finding of not guilty by reason of insanity? What is the effect of MPD on cognition or control? These issues are discussed.

Dissociative Identity Disorder↗

PubMed1995

"The tempest in my mind": cultural interfaces between psychiatry and literature, 1844-1900.

The professional literature of the first generation of American psychiatrists is replete with poetical passages drawn from the imaginative works of such English authors as Shakespeare, Byron, and Scott as well as the writings of residents of the asylums they tended. A close reading of such passages in the American Journal of Insanity (AJI), the central medium through which members of this nascent profession attempted to "popularize the study of insanity," suggests they were not simply textual ornaments or signs of the underdeveloped state of American psychiatry in the mid-nineteenth century. Indeed, literary manifestations of the imaginative minds of patients and renowned writers were scrutinized by psychiatrists seeking to advance their understanding of mental disease. Moreover, the English authors were often elevated to the status of medical experts and their poetry and prose were commended to fellow medical practitioners as sources of psychological insight. Toward the turn of the century psychiatrists' engagement with these literary forms was less pronounced in the AJI, due in large part to the impact of rising asylum populations and the coming of a culture of positivist medicine. Yet literary influences on psychiatric writing are still evident in this period, indicating the complexity of the cultural interfaces between psychiatry and literature and the importance of examining the historical processes that have served to define and distinguish the enterprise of the psychiatrist from that of the poet.

Culture↗

PubMed2002

The defense of extreme emotional disturbance in New York County: pleas and outcomes.

A number of studies have investigated the use of the insanity defense; however, there are few reports on the use of other types of psychiatric defenses. This study explored the use of the affirmative psychiatric defense of extreme emotional disturbance (EED) in New York County (one of the five counties which comprise New York City). The results of the study indicate that, as in the case of the insanity defense, EED is rarely proffered by criminal defendants (plea rate 0.84%). The defense only prevailed on one occasion at a jury trial. While the EED defense was successful 39% of the time that it was entered, this was usually only when the prosecutor accepted the argument that was offered by the defense.

Forensic Psychiatry↗

PubMed2006

Medicalizing melancholia: exploring profiles of psychiatric professionalization.

The nineteenth century was the site of radical changes in understanding mental illness. The professionalization of psychiatry consisted primarily of the discipline's aspiration to the status of an expert medical subspecialty. While all forms of insanity were eventually reframed in medical terms, melancholia--for moral and nosological reasons--assumed a special role that made it an ideal diagnosis for conceptual reframing. Our analysis of the journal literature of the nineteenth and early twentieth centuries in North America and Germany traces several ways in which melancholia was medicalized. As the care for the insane shifted into the professional realm of physicians and medical terminology came to replace prior descriptors of mental illness, melancholia was replaced by depression. In addition, the process of delineating affective pathology assumed a distinctly medical flavor. Finally, melancholia was firmly medicalized when its boundaries blurred with neurasthenia. Differences in how ordinary affective terms became medicalized in German and North American psychiatry illustrate the importance of local historical approaches.

Affective Disorders, Psychotic↗

PubMed1976

Attitudes and feelings of criminal justice personnel toward the mentally ill.

The present study compared the attitudes and feelings of law-enforcement, corrections, parole and probation personnel, and college students toward mental illness. Modified versions of the Criminally Insane Scale (Khanna, Pratt, & Gardiner, 1962) and Attitudes Toward Mental Illness Scale (Cohen & Struening, 1962) were used in assessing these attitudes. Law-enforcement and corrections personnel tended to believe many of the stereotypic causes of mental illness, while the college students based their views on more current thinking. In addition, law-enforcement and corrections personnel indicated greater fear of the criminally insane than the other two groups. Possible causes and ramifications of these differences are discussed.

Attitude to Health↗

PubMedDate not supplied

European views on personality disorders: a conceptual history.

A historical account is offered of the European origins of the DSM-III-R category, personality disorder, and a differentiation is made between the history of terms, patterns of behaviors, and concepts. The concept of "disorder of character (personality)" developed in the nineteenth century, and was possible after notions such as character, constitution, temperament, and self received a psychological definition, and after the insanities became transformed into "psychoses." Terms such as "type" and "trait" were in turn ushered into the nineteenth century by faculty psychology and the phrenological tradition. Until the end of that century, "personality" referred to the subjective aspects of the self, and "personality disorder" meant alteration of consciousness (e.g., hysterical dissociation); the behavioral patterns dealt with by DSM-III-R as personality disorders were then called disorders of character and explained as states of volitional failure, or loss of coherence between cognitive, emotional, and conative functions, or of "automatism," i.e., the manifestation of lower (more primitive or animal) forms of behavior escaping the control of higher (human) ones. Character types and disorders were first considered as forms of attenuated insanity, and later on were made into a separate group whose membership could be attained via the visitation of a degeneration taint, neurological disease (e.g., encephalitis), or plain ill-breeding. The relevance of the intellectual background of the nineteenth century to these diagnostic changes is also discussed.

Europe↗