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PubMed1981

Legal "rites": criminalizing the mentally ill.

1. Because of more stringent civil commitment criteria, persons formerly hospitalized on a civil commitment now enter the system on criminal observation orders, having been arrested, booked, and often jailed for minor offenses such as vagrancy, shoplifting, or disorderly conduct. This represents a criminalization of the mentally ill. 2. In a single forensic system (Wisconsin) there was an increase of 73% in such commitments following court decisions and legislative revisions setting forth new commitment criteria. This increase was principally in criminal observations, although this rise was evident as well in "unable to stand trial" commitments. It was not present in "not guilty by reason of insanity" adjudications. 3. Aside from the obvious untoward effects per se of criminalizing mentally ill persons, other untoward effects occur in terms of prolonging hospitalization, depriving those persons of prompt treatment, and putting unnecessary and inhumane pressures on the family and the community, as well as on the mentally ill person himself. 4. The "freedom" to the penniless, helpless, ill, and finally arrested, jailed and criminally committed is not freedom at all--it's abandonment. The "right" to be demented, agonized and terrorized in the face of treatment which cannot, because of legal prohibition, be applied is no right at all--it's a new form of imprisonment. The "liberty" to be naked in a padded cell, hallucinating, delusional, and tormented, is not liberty--it is a folie à deux between pseudo-sophisticated liberals and an unrealizing public. The delusion is that if one changes the name of something to something else, or if one substitutes a jail for a hospital or a preoccupation with legal rites for honest concern over patients' rights, he has done something significant, useful and important, or at least something.

Adult↗

PubMed1995

Paranoids in the legal system. The litigious paranoid and the paranoid criminal.

Paranoid symptomatology involving suspicions, a sense of being wronged and persecuted, along with an implacable will to retaliate against one's enemies, often translates into litigious struggles. Paranoids resort to the judicial arena to act out their own internal psychopathologic needs. Examples are offered of the many ways litigious paranoids may present within the legal system, as well as how interventions by the psychiatrist may be useful. Criminal behavior by paranoids, under the sway of full-blown delusions of various types, is discussed and analyzed. Historical cases are described (Hadfield, M'Naghten), and more contemporary cases are discussed according to diagnostic subtypes. The central importance of paranoid delusions in insanity defense cases and the exculpatory effect of various delusional subtypes are examined.

Crime↗

PubMed1995

Traumatic brain injury and criminal behaviour.

The clinical characteristics of traumatic brain injury (TBI), the association of TBI with lasting behavioural problems and neuropsychological deficits, and the use of the insanity defense in criminal proceedings in relation to TBI are discussed. Furthermore, the possible abuse of the incidental association of a TBI to the commission of a crime is explored. A framework of evaluation is described to determine the relevance of the association of TBI and the ultimate commission of a crime.

Brain Injuries↗

PubMed1993

The disposition of criminal charges after involuntary medication to restore competency to stand trial.

The United States Supreme Court, in the recent case of Riggins v. Nevada, extended its examination of the issue of involuntary treatment with anti-psychotic medication to the mentally disabled facing criminal trial. Although this was an extreme case where the defendant faced a possible death sentence, the involuntary administration of anti-psychotic medication to restore 'competency to stand trial' always raises unique medical and moral questions. This highly controversial issue has received little empirical investigation. We report here on the first study to follow-up on the disposition of the criminal charges of persons committed to a hospital for the restoration of 'competency to stand trial' who refused anti-psychotic medication and for whom involuntary treatment was sought. We have previously reported on the characteristics of these cases (N = 68) and aspects of their outcome in the hospital. This cohort of patients represents virtually all indicted felony offenders in New York state who were incompetent to stand trial and for whom involuntary treatment with anti-psychotic medication was requested between 1986 and 1990. The present retrospective report focuses on the disposition of the criminal charges for such cases, in a state that does not have a death penalty. Tentative inferences are considered based on the findings that persons who were involuntarily restored to 'competency to stand trial' had a variety of dispositions of their criminal charges, including plea negotiations that resulted in foreshortened incarceration and several cases of insanity acquittals. Suggestions for further and more conclusive studies are proposed.

Antipsychotic Agents↗

PubMed1994

[Effect of assassination attempts on Lafontaine and Schäuble on public opinion about psychiatric patients. Part 1: 1990 development].

In 1990 two assassination attempts against prominent German politicians were carried out by mentally ill persons. In the same year we conducted three representative surveys of the adult population of the FRG (old Länder and West Berlin) which allowed us to investigate the impact of both events on the attitude of the public towards the mentally ill. Already shortly after the first violent attack there was a marked increase of social distance, i.e. those questioned were less willing to have contact with a schizophrenic man. After the second assassination attempt the tendency to reject such a person increased again significantly. This applied to all forms of relationships studied. The increase of social distance is explained by the re-activation of the stereotype of the dangerous and unpredictable "insane" person.

Adolescent↗

PubMed1993

The criminal liability of the mental patient in Jewish law (Halacha).

The legal status of the mentally impaired has been dealt with in Halachic literature since the third century. This article presents four Halachic viewpoints regarding the exemption of the mentally ill patient from legal responsibility in tort and criminal law: lack of mental awareness; lack of free will; lack of judgment; categorial personal status. Halachic legislations with regard to the liability of the insane predate the criteria as applied by modern psychiatry. The similarities between the Halachic and contemporary medicolegal approaches are presented.

Bible↗

PubMed1993

[Homicide and mental disease].

The number of homicides committed by insane persons has increased from 1980 to 1989. Among those charged with homicide and attempted homicide who have been subjected to judicial psychiatric observation, 60% are schizophrenic and 17% have paranoid psychoses. Other psychotic conditions are relatively rare. The homicides took place most frequently within the household and in most cases were psychotically motivated. The cause of the increased frequency of homicides is discussed. The liberal treatment strategy employed at psychiatric institutions, and the short duration of the treatment, are thought to be important in this connection.

Forensic Psychiatry↗

PubMed1993

Post-traumatic stress disorder and the law: critical review of the new frontier.

Since its debut in the psychiatric nomenclature in 1980, post-traumatic stress disorder (PTSD) has had a dramatic impact on criminal and civil jurisprudence. PTSD has created a cottage industry among both criminal and negligence attorneys and mental health practitioners. The diagnosis first achieved public notoriety when it was introduced as a new basis for the insanity defense. More recently "syndrome evidence" of the subtypes and variations of PTSD have encroached on the substantive criminal law of self-defense. In addition, the diagnosis may have an impact on such traditionally legal and factual determinations as the credibility of witnesses and may undermine conservative tort doctrine that attempts to cabin psychic injury. The emerging legal area of victims' rights has been strengthened and paradoxically divided by PTSD. Yet the newly defined disorder of PTSD has not borne such a heavy forensic burden easily. Indeed the diagnosis poses for psychiatry some of the very problems it supposedly solves for legal purposes, including the illusory objectivity of the causative traumatic event and the expert's dependence upon the victim's subjective and unverifiable reports of symptomatology for the diagnosis.

Combat Disorders↗

PubMed1995

Chronic fatigue syndrome associated with a psychotic state resulting in multiple murders.

A 28-year-old, ambitious, academically successful Asian man with a zeal for hard work develops infectious mononucleosis and its resultant lethargy and fatigue. He becomes depressed, then develops symptoms of mania before turning floridly psychotic. In his psychotic state he develops grandiose delusions about being the second son of God after Christ and takes it upon himself to rid the world of all evil by defeating the anti-Christ. He kills four people and seriously injures a fifth. He is arrested and found not guilty by reason of insanity. He remains a diagnostic puzzle for a long time before starting to respond to neuroleptic medication.

Adult↗

PubMed1996

Trial by jury; a pilot study of juror perception of mental health professional testimony in NGRI pleas for first degree international homicide.

The authors present a pilot statistical study of the way in which jurors perceived psychiatric/psychological expert testimony in ten court trials for first degree intentional homicide in which a plea of not guilty by reason of mental disease or defect had been entered. The reader is offered a short history of the insanity defense, of the trial by jury, and a discussion of the desired professional and personality prerequisites looked for in choosing a mental health expert. The study is based on a detailed protocol devised by two of the authors--a forensic psychiatrist and a psychologist--assessing various parameters of the professionality and demeanor of the experts on the basis of a statistically valid number of juror responses to the questionnaire. The results show that the jurors perceived the expert testimony as a useful, but not determinant factor when reaching their verdict. This is consonant with the definition of the rationale for using expert testimony as given by the Federal Rules of Evidence.

Adult↗

PubMed1996

Establishing standards for criminal forensic reports: an empirical analysis.

Forensic psychologists and forensic psychiatrists (about 80% of whom were certified by a specialty board) were surveyed regarding their beliefs about the necessary and appropriate content for reports on competency to stand trial (CST) (N = 102) and criminal responsibility/not guilty by reason of insanity (CR) (N = 96). Report elements concerning the identification of the defendant and evaluation methods (e.g., names, relevant dates, charges, data sources, notification to defendant of the purpose of the evaluation, and limits on confidentiality) were generally seen as "essential." Clinical data such as psychiatric history, current mental status, and current use of psychotropic medication were also seen as essential, as were data elements specific to each forensic question (e.g., understanding charges/penalties, possible pleas, and roles of trial participants for CST, and collateral information and defendant's description of alleged offense for CR). While most respondents agreed that it was important to provide an opinion about and reasoning for any diagnosis and its relation to the psycholegal question, there was lack of consensus regarding the propriety of offering "ultimate opinions," particularly concerning CR. Although there was general cross-disciplinary agreement regarding the appropriate content for criminal forensic reports, there was some disagreement as to the degree of importance of certain elements. Implications for practice and the development of professional standards are discussed, including advantages and cautions about using these data to influence issues of standards and policy.

Adult↗

PubMed1996

California's diminished capacity defense: evolution and transformation.

Diminished capacity survives in California as a severely attenuated mens rea defense known as diminished actuality. Some other states have similar limited strict mens rea defenses. The lost advantages of California's former expanded concept of diminished capacity are reviewed. As opposed to the all-or-none insanity defense, mens rea defenses permit the trier of fact to find gradations of guilt but are generally inapplicable unless the elements of a crime are redefined to permit consideration of motivational aspects, as California had done. The change from diminished capacity to a diminished actuality defense was a return to the complex, somewhat artificial legal concept of intent and a resurrection of confusing and antiquated common law definitions. The change was made in response to an unpopular jury verdict and a political climate in which little interest existed or still exists for understanding the reasons behind the commission of any crime. Some of the later restrictions imposed by the California Supreme Court on allowing voluntary intoxication to reduce murder to voluntary manslaughter logically should not apply to mental illness. Knowledge of the complex mens rea issues and the various relevant current defenses is essential for any forensic psychiatrist evaluating defendants in jurisdictions in which such defenses are admissible.

Alcoholic Intoxication↗

PubMed1997

Group dynamics in forensic pretrial decision-making.

This study examines how forensic evaluators' opinions that pertain to diagnosis, competency to stand trial, and criminal responsibility (Maryland's version of the not guilty by reason of insanity plea) are rendered at a state forensic hospital for defendants pleading not criminally responsible. Pretrial evaluations completed independently by a psychiatrist, a psychologist, and a social worker were presented at a forensic staff conference where psychiatrist and psychologists openly "voted" on diagnosis, competency to stand trial, and criminal responsibility. These results were then sent to the court. The purpose of this study was to assess the clinicians' level of agreement and the role that conformity played in the decision-making process. A sample of twenty court-ordered pretrial evaluations of defendants examined at the hospital between March and June 1991, with evaluators' opinions generated by a secret ballot, were compared with a matched control group from an earlier time, when opinions were generated by open ballot. The study was designed to compare the opinions of forensic evaluators in the issues of diagnosis, competency to stand trial, and criminal responsibility between the two samples. The defendants in the experimental group and the control group were matched on the basis of age, race, sex, and offense. It was hypothesized that with secret ballot voting there would be a greater disparity of agreement regarding diagnosis, competency to stand trial, and criminal responsibility opinions compared with the open method of voting. However, the results of this study did not support that hypothesis. There was little disparity on forensic opinions rated either by secret or open voting.

Adolescent↗

PubMed1998

Clinical symptom presentation in suspected malingerers: an empirical investigation.

To empirically investigate the usefulness and validity of clinical presentation and recent history variables in the detection of malingered psychiatric disorder, 30 criminal defendants involved in forensic evaluations, who had a documented history of psychiatric hospitalization preceding their arrest on the instant offense (low risk of malingering group) and 30 defendants who complained of psychiatric difficulties but had no history of psychiatric hospitalization or treatment (suspected malingering group) were studied. Each subject's mental status was rated, blind to psychiatric history, diagnosis, and psycholegal opinions, on a Likert-like scale for the uncommon nature of their symptom presentation. In addition, the final outcome of the court cases, whether they were found competent to stand trial, not guilty by reason of insanity, or evidenced diminished capacity was determined by obtaining the court disposition in each case. Based on the unusual nature of their presentation, the defendants suspected of malingering were discriminated from the low risk of malingering defendants with a 90 percent rate of correct classification. Suspected malingerers were found to evidence current psychiatric presentations inconsistent with their recent Global Assessment of Functioning, unusual symptom presentation, and hallucinatory experiences rated as atypical for psychiatric disorder. A high proportion of suspected malingerers were found competent to proceed. The results are discussed in terms of the usefulness of clinical identification of malingering.

Adult↗

PubMed2005

[Virginia Woolf as an example of a mental disorder and artistic creativity].

This is an attempt to evaluate the mental disorder that the novelist Virginia Woolf suffered, and to determine the relationship between her creativity and her insanity. What mostly characterizes her illness is the presence of typical phases of severely impairing depression and significant hypomania, culminating in suicide at the age of 59. This is a convincing life history of a bipolar II disorder, although the "broad bipolar spectrum" is less easy to define operational than bipolar disorder I. She was moderately stable as well as exceptionally productive from 1915 until she committed suicide in 1941. Virginia Woolf created little or nothing while she was unwell, and was productive between attacks. A detailed analysis of her own creativity over the years shows that her illnesses were the source of material for her novels.

Bipolar Disorder↗

PubMed1976

Reared in adversity: institutional care of children in the 18th century.

The earliest public pediatric care of the 18th century in this country took the form of "outdoor relief." Institutional care followed, first almshouses were built; then orphanages, hospitals, and dispensaries. Almshouses not only included workhouses but provided comprehensive medical services. Throughout the 18th century, people often referred to the almshouses as hospitals. As general hospitals, they rendered a variety of pediatric services to sick children, including the idiotic and hopelessly crippled, and the newborns delivered in the maternity wards; and they tendered services for well children, such as foundlings, abandoned children, and the children of destitute parents, placing infants in foster homes and indenturing older children for training in various trades and crafts. The voluntary hospitals, on the other hand, were for the "worthy" poor and limited their services to the insane and the curable sick. There were only two opened during the 18th century-the Pennsylvania Hospital in 1752 and the New York Hospital in 1791. The former excluded young children during the 18th century. Orphanages preceded the voluntary hospitals in point of time, offering many pediatric services to children, well and sick. Finally, at the end of the century, the independent dispensaries appeared, the first in Philadelphia in 1786. By the middle of this 20th century, practically all of them had been absorbed by hospitals. In these institutions, pediatric knowledge advanced and medical manpower developed even during the 18th century. By the end of that century, social movements began from which evolved the 19th-century concern for the welfare of children.

Adult↗

PubMed1994

The use of the Rey Memory Test to assess malingering in criminal defendants.

An attempt was made to evaluate the utility of the Rey Memory Test (Rey, 1964) to assess malingering in criminal defendants referred for inpatient forensic evaluation. The performance of 14 diagnosed malingerers was compared to a control group of 14 forensic inpatients who had been acquitted by reason of insanity. Malingerers performed significantly less well on the test than did controls. A previously suggested cut-off score of 9 items remembered (Lezak, 1983) resulted in correct classification of 86% of the subjects as either malingering or not malingering. However, a cut-off of 3 rows remembered correctly was found to be inappropriate because 57% of the controls would have been labeled incorrectly as malingerers.

Adolescent↗

PubMed1980

Suicide and the Victorian physicians.

From 1830 to 1900, medical opinion of suicide underwent significant changes in Britain. During the 1830s and 1840s physicians, like most of the populace, saw suicide as a legal and moral question. However, major changes in the suicide law had called for increased medical testimony in questions of "temporary insanity" in suicide, and alienists were forced to refine their thinking about what was still termed "self-murder." By the 1850s and 1860s such refinement continued, with emphasis falling on categorization and physiology, while the 1870s and 1880s saw far more attention paid to social factors determining suicide. Statistics became more reliable, and, increasingly, prevention and compassion were urged by a number of prominent practitioners. By the end of the century, earlier attitudes, particularly as to the criminal implications of suicide, were reviewed and mainly discarded. Emphasis was now on diagnosis and on the social significance of suicide.

England↗