Today we’d consider neurosis, predominately anything that includes maladaptive coping and not major mental illness, like schizophrenia or bipolar disorder. Ex. somatoform disorders, factious disorders, sexual and gender identity disorders, eating disorders, adjustment disorders, substance abuse disorders, and others maladaptive coping
Major mental illness, think neurochemical, biological problems, like dementia, schizophrenia, bipolar disorder, cognitive disorders, head traumas
Psychosis is by DSM definition: experiencing hallucinations, delusions, grossly disorganized behavior or catatonia, disorganized speech (thought process). The courts use a medical model of insanity and I can get into that later.
Hallucinations: Auditory, visual, gustatory, somatic, tactile, *visual are rare
Delusions: bizarre, jealousy, erotomania, grandiose, of reference, persecution, somatic, thought broadcasting, thought insertion
Speech/Thought process: tangential, circumstantial, word salad, echolalia, clang association, neologisms, loose associations
Disorders associated with psychosis, substance abuse, mood, bipolar, schizophrenia, schizoaffective, borderline,
The M’Naghten rule of insanity (English law), M’Naghten killed the private secretary of Prime Minister Robert Peel and he was acquitted. In response the house of lords made a rule that stated “to establish a defense on the grounds of insanity, it must be clearly proved that, at the time of the committing of the act, the party accused was laboring under such a defect of reasons, form disease of the mind, as not to know the nature and quality of the act he was doing; or, if he did know it, that he did not know he was doing what was wrong” 10 Cl. & F. 200, 8 Eng. Rep. 718 (H.L. 1843). This was in 1843 and both England and US adapted the rule.
Then the US implemented the Irresistible Impulse rule because people didn’t like the M’Naghten rule. The Irresistible rule says, in sum, due to a mental disease the person had no free will to choose between right and wrong and that without the mental disease the incident would not have occurred.
Then in 1954, in Durham v. US introduced the product test, which stated “ an accused is not criminally responsible if his unlawful act was the product of mental disease or defect.” 214 F.2d 862 (D.C. Cir. 1954). This became a problem when the St. Elizabeth hospital, that conducted the insanity evals for DC decided to include personality disorders, including sociopathic personality disorder into the ranks of mental disease. And most criminals fit that standard.
So in MacDonald v. US, DC decided the following instructions to a jury should be given “the jury should be told that a mental disease or defect includes any abnormal condition of the mind that substantially affects mental or emotional processes and substantially impairs behavior controls”.
After this yet another test was used and for the most part adapted in all states that allow the insanity defense ( Idaho, Montana, and Utah don’t allow it). The American Law Institute (ALI) rule states “ A person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either or appreciate the criminality (Wrongfulness) of his conduct or to conform his conduct to the requirements of the law” The second prang of this rule excluded psychopathetic personality as a mental disease or defect. During the Hinckley trail both the ABA and APA recommended the removal of the volitional prong (control over behavior) but to keep the appreciation prong, that because of the mental disease or defect the person could not appreciate the wrongfulness of the act. This was essentially adapted by US congress in 1984, 20 states as of 1995 used the ALI test, NH used the product test, and other states use some form of the M’Naghten /cognitive impairment only test.
Other issues with mental states is in question: Automatism Defense, which is if your not conscious during the offense, your not responsible, examples are crimes committed during sleep, crimes committed during a state of unconsciousness induced by a head injury, hypnotic suggestion, shock created by bullet wounds, or metabolic disorders such as hypoglycemia, anoxia, or involuntary ingestion of drugs or alcohol, epilepsy or dissociation. Most courts limit the automatism defense holding that a person claiming one of the above can’t if the disability was experienced before and reasonable steps could have been taken to prevent the act. Ex pet mal or grand mal seizures, has an accident, MD notifies the DMV, person drives again and has an accident, are they responsible? Example of schizophrenic who stops meds? Dissociation doesn’t work well in the US
Mens Rea (Diminished capacity) Mens Rhea is describes the various levels of culpability. Specific intent refers to those crimes that requires some thinking, premeditated, aggravated assaults, assault with intent to rape. General intent means that the person was conscious or should have been conscious of their physical actions and their consequences, manslaughter, battery, rape. From this grew the diminished capacity doctrine which allows a defendant to use clinical testimony related to mens rhea without having to assert the insanity defense. We don’t waste time here because for the most part it is not used in the US. It was used allot in CA until it was abolished in 1981. currently diminished capacity plays a role in sentencing more than at trail for guilt or innocence, usually as a character testimony.
Actus Reus Testimony – the physical act or omission required for conviction of a particular crime and this act or omission is one that the person has physical control over. This happens in three situations, the first is when the defense wants expert testimony to prove they did not commit an act “ I am not the kind of person who would have raped her”, if the prosecution wants expert testimony that the person did commit the act, “ he is the type of person to rape” or to inform if a crime did occur, “she is evidencing symptoms of rape trauma”. Proof of character testimony that they are the type to commit or not to commit an act.
Self-defense, Provocation, Duress, and Entrapment.
(Melton, Petrila, Poythress, Slobin, 1970)
Pervasive pattern of disregard for, and violation of, the rights of others that begin in childhood or early adolescence and continues through adulthood
Also referred to as sociopathy, psychopathy, or dysocial personality disorder
Characteristics:
~failure to conform to social norms, unlawful
behavior
~deceitfulness, by lying, using aliases or conning
others for profit or pleasure
~impulsivity or failure to plan ahead
~irritability and aggressiveness, physical assaults
~reckless disregard for the safety of others or self
~consistent irresponsibility, inconsistent work or
failure to honor financial responsibilities
~lack of remorse, indifferent to or rationalizing what
they have done to others
*Must be 18 years of age
*Evidence of a conduct disorder with onset before the age
of 15
*Behavior does not occur during course of schizophrenia
or manic episode
(DSM-IV)
comorbided: Substance abuse, mood disorder, anxiety, paraphilias, malingering (Kenneth Bianchi- hillside strangler tried MPD)
Causes:
Criticisms on APD:
APD focuses on criminal behavior lacking the two factor structure of the HARE and is indistinguishable from severe or persistent criminalality.
Research says about causes APD
Appears to be heredity
Children not biological to parent with SPD are still at higher risk than those without
Higher testosterone levels in other species is associated with aggression, in our prison population of violent offenders – not of high levels in general population
Low serotonin levels and 5HT association with impulsivity and aggression
Damage to prefrontal lobes with EEG and PET scans,
Brain waves are slower than adults and more like children, possibly indicating slow maturatation
Real evidence is in the history of APD:
Gluceck’s research on 500 delinquent and non-delinquent in the 40’s found delinquents were more likely to with parents who were alcoholic, criminal, divorced or separated parents, absence of at least one parent, parents were often hostile and rejecting, inconsistent and erratic in discipline, and most used physical punishment.
Today all the research tells us:
the loss of a parental figure is important: Bowlby
divorce is not as important as initial relationship between the parents
erratic and inappropriate punishment is the worst!- Dutton’s stuff punished but don’t know why, in front of others, ?
poorly supervised by adults as children
tend to choose similar friends
childhood abuse
(Black, 1999)
Delinquency in general: Characteristics of those in
system:
Demographics:
The early initiation
Males
Educational domain
Low expectations and little commitment to education
Low participation in after school activities
Low achievement in early grades
Poor verbal ability
Conduct/ behavior
Truancy
Acting out
Lying
Early stealing
Religious domain
Low attendance at church
Peer Influence
Heavily influenced by peers
Nonconforming
High risk involvement
Early and heavy substance abuse
Precocious sex
Psychological factors
Hyperactivity
Anxiety
Aggressiveness behavior
Congenital factors
Handicapping conditions
Household composition
Inconsistent data
SES
Low SES
Parent role
Lack of bonding with parents
Abusive
Low communication
Repressive
Parental practices of high risk behavior
History of criminality
Violence
Mental illness
Alcoholism
Community neighborhood
Urban
High crime
High mobility
Community school
Repressive environment
Tracking ability
Ineffective school management
(Dryfoos, 1990)
40% of boys and 25% of girls dx with conduct disorder will go on to become antisocial. (Black, 1999)
A repetitive and persistent pattern of behavior where the rights of others are violated or major age-appropriate societal normals or rules are violated
Characteristics (3 or more in the last 12 months, and one in the past 6 months)
*Aggression to people or animals
~ bullies, threatens or intimidates
~ initiates physical fights
~ has used weapons that can cause serious harm
~ physically cruel to people or animals
~ stolen while confronting a victim
~ forced someone into sexual activity
*Destruction of property
~ deliberately started a fire with intention of causing
harm
~ deliberately destroyed others’ property (other than
firesetting)
*Deceitfulness or theft
~ has broken into someone’s house, building or car
~ often leis to obtain goods or favors or avoid
responsibility
~ has stolen items of nontrivial value without
confronting a victim
*Serious violation of rules
~ breaks curfew beginning before age 13
~ has run away form home overnight at least 2ce or
1ce for long time
~ truant form school beginning before the age 13
*Behaviors causes clinically significant impairment in social, academic, or occupational functioning
* Under 18 years of age
*Types:
312. 81 childhood-onset type –onset of at least one criterion prior to age 10
312. 82 adolescent-onset type-absence of any criterion prior to age 10
312. 89 Unspecified – onset unknown
Severities
Mild: few if any conduct problems & problems cause only minor harm to others
Moderate: number of problems and severity of harm
between the two
Severe: many problems or causes considerable harm
What improves it? Robins study indicates that marriage, age, strong family ties, (Gluek) found job stability, (robins (brief jail terms v. none or lengthy) (Black, 1999)
Not all children will grow up to be APS or psychopaths
Difference between Conduct disorder kid and psychopaths:
What Hare labels selfish, callous and remorseless use of others
Grandiose sense of self-worth
Need for stimulation/proneness to boredom
Conning/manipulating
Lack of remorse of guilt
Shallow affect
Callous/lack of empathy
Parasitic lifestyle
Lack of realistic long-term goals
Irresponsibility
Failure to accept responsibility for own actions
When looking into the background of offenders, psychopaths do not have the same dysfunctional home life that other offenders have had
313.81 Oppositional Defiant Disorder F91.3
A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which 4 or more of the following are present
Characteristics:
~ often losses temper
~ often argues with adults
~ often actively defies or refuse to comply with adults requests or rules
~ often deliberately annoys others
~ often blames others for mistakes or misbehavior
~ easily annoyed by others
~ is often angry and resentful
~ is often spiteful or vindictive
*causes impairment in social, academic or occupational functioning
*behavior does not occur during a psychotic episode or mood disorder
*doesn’t met the criteria for conduct disorder
MacDonald discovered that in his sample the serial killers had three similarities in their background: During childhood they were firesetters, were cruel to animals, and were bed-wetters. Bedwetting formally called enuresis and it is the repeated voiding of urine into bed or cloths whether involuntary or intentional, happens twice a week for at least 3 consecutive months or causes impairment in functioning and child is over 5 years of age. There is nocturnal or diurnal, or both.
Major
clinical description of the psychopath from Cleckley’s The Mask of Sanity
(1976) has 16 characteristics:
~Superficial charm and intelligence
~Absence of delusions or other signs of irrational thinking
~Absence of nervousness or psychoneurotic manifestations
~Unreliability
~Untruthfulness or insincerity
~Lack of remorse or shame
~Inadequate motivated antisocial behavior
~Poor judgment and failure to learn form experience
~Pathological egocentricity and incapacity for love
~General poverty in affective relations
~Specific loss of insight; unresponsiveness in general interpersonal relations
~Fantastic and uninviting behaviors with drink (and sometimes without)
~Suicide rarely carried out
~Sex life impersonal, trivial, and poorly integrated
~Failure to follow any life plan
(these traits are also found in histrionic, naraccistic, antisocial, and borderline)
Hare would later take this list and test his test construction coming up with two factors, the first being selfish, callous and remorseless use of others. The second being labeled chronically unstable and antisocial lifestyle.
Chronic
Associated with criminalality but that doesn’t mean all psychopaths are criminals or
that all criminals are psychopaths
PCL-R is a 20-item symptom scale
Glibness/superficial charm
Grandiose sense of self-worth
Need for stimulation/proneness to boredom
Pathological lying
Conning/manipulating
Lack of remorse of guilt
Shallow affect
Callous/lack of empathy
Parasitic lifestyle
Poor behavioral controls
Promiscuous sexual behavior
Early behavioral problems
Lack of realistic long-term goals
Impulsivity
Irresponsibility
Failure to accept responsibility for own actions
Many short term marital relationships
Juvenile delinquency
Revocation of conditional release
Criminal virility
PCL-SV
Superficial
Grandiose
Deceitful
Lacks remorse
Lacks empathy
Doesn’t’ accept responsibility
Impulsive
Poor behavioral controls
Lacks goals
Irresponsible
Adolescent antisocial behavior
Adult antisocial behavior
inner speech lacks emotional punch
weak capacity for mentally picturing the consequences of their behavior
20% of all man and women in prison are psychopaths
responsible for 50% of serious crimes
recidivism is higher than other offenders
313.89
Reactive Attachment Disorder of Infancy or Early childhood
Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 as evidenced by:
A) Persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, excessive inhibited, hypervigilant, or highly ambivalent and contradictory responses
OR
Diffuse attachments as manifested by indiscriminate socialibility with marked inability to exhibit appropriate selective attachments
B) no MR or developmental disorder
C) Pathogenic case as evidenced by:
~Persistent disregard of the child’s basic emotional needs for comfort, stimulation, and affection
~Persistent disregard of the child’s basic physical needs
~ Repeated changes of primary caregiver that prevent formulation of stable attachments
Level One: Pre conventional Reasoning
No internalization, behavior based on rewards and
punishment
Stage 1: Punishment and obedience orientation
Obey because told to and fear punishment
Stage 2: Individualism and purpose
Children obey when they want to and when it is in their best interest
Level Two: Conventional Reasoning
Abide by internal standards, but they are the standards of
others they are using
Stage 3: Interpersonal norms
Children adapt parents moral standards,
seeking to be good
Stage 4: Social system morality (up to age 10 yo)
Children obey based on their understanding of
social order, law, and justice
Level Three: Post conventional Reasoning
Morality is internalized and not based on others, sees
moral choices, explores options and decides based on
personal moral code
Stage 5: Community rights versus individual rights:
Recognizes laws are important but that laws change and should for some values, like liberty, values and laws are relative and may change depending on situations (age 20 to 22)
Stage 6: Universal ethical principles
When faced with a conflict between conscious and law, will risk self for consciousness, for right based on a universal human rights
References:
Sarah’s Brain
High Risk: Children without a Conscious by Magid, K. & McKelvey, C.A.
Without Conscience by Hare, R.
Diagnostic & Statistical Manual, IV by American Psychiatric Association