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Friday, September 3, 2010

Criminology - Mental Disorder and Crime

Mental Disorders and Crime

What are Mental Disorders?
Mental disorder is sometimes referred to as mental abnormality, and many psychologists now refer to it as psychopathology. These three terms are used in the literature, but basically they refer to the same group of people. Each term refers to States of mind which give rise to some form of problem, usually for the individual. The term mental disorder shows that the mind is in a state of confusion; it is not working properly; i.e., it is suffering from a disease. The term mental abnormality denotes that the state of mind is both uncommon and unpleasant; it shows a negative or bad element. People afflicted with such conditions are referred to as suffering from a psychopathology because it is an illness the symptoms of which are mainly psychological. 'Psycho' indicates the mental element and 'pathology' represents the illness, the overt symptoms produced by an underlying cause or disease. The main object of the psychologist is to treat the underlying pathology or illness. Different schools of psychology have differing ideas about the causes and cures for the various mental illnesses. Some stress physical manifestations - biological or neuro scientific-where the use of chemical therapy and surgery is common. Others look more to cognitive or behavioural understanding and, possibly, alteration.

Different Types of Mental Disorders
Different types of Mental Disorders can affect a person which includes:
• Neuroses
• Schizophrenia and paranoia
• Major affective disorders
• Transient situational disorders
• Psychosomatic disorders
• Sociopathic disorders
• Alcoholism and Drug Abuse
• Organic Brain Syndromes
• Mental Retardation
• Behavior Disorders of Childhood

In this presentation we are mainly concerned with the first three types of disorders.

In the neuroses we find faulty learning often in early development, leading to persistent feelings of threat and anxiety in facing the everyday problems of living. Since the individual's ordinary methods of coping-including the "normal' use of ego-defense mechanisms- prove inadequate, the person tends to rely increasingly on one or more neurotic patterns. These patterns share in common search for relief from feelings of threat and anxiety. While they may, alleviate such feelings, they exact a high price in self-defeating behavior.
The individual is said to exhibit neurotic behavior if he frequently misevaluates adjustive demands, becomes anxious in situations that most people would not regard as threatening, and tends to develop behavior patterns aimed at avoiding rather than coping with his problems, Curiously, he may, realize his behavior is irrational and maladaptive but feel unable to alter it. Although neurotic behaviour is maladaptive, it does not involve gross distortion of reality or marked personality disorganization, nor is likely to result violence to the individual or others. Rather neurotics are typically anxious, ineffective, unhappy, and often guilt ridden individuals who do not ordinarily require hospitalization but nevertheless are in need of a therapy.

Types of Neurotic Behaviour
While the neuroses embrace a wide range of behaviors, the common core is a maladaptive life-style typified by anxiety and defense-ori¬ented avoidant behavior. Basic to this neurotic life-style are
(a) The neurotic nucleus - the faulty evaluation of reality and the tendency to avoid rather than cope with stress, and
(b) The neurotic paradox- the tendency to main¬tain this life-style despite its self-defeating and maladaptive nature.

The Neurotic Nucleus
The neurotic nucleus is a circular process in which the individual feels basically inadequate, evaluates everyday problems as threat¬ening, and attempts to deal with the resulting anxiety by avoidance and defense-oriented reactions. The end result is a self-defeating life style which, blocks, personal growth and self-fulfillment. Usually the neurotic has trou¬ble establishing and maintaining satisfying interpersonal relationships, feels vaguely guilty for trying to avoid rather than cope with reality, and is dissatisfied and unhappy with his way of life.

There are three key facets of Neurotic Nucleus:
1.) Feelings of inadequacy and anxiety
2.) Avoidance instead of coping
3.) Self-defeating behavior and blocked personal growth

The Neurotic Paradox
Human beings tend to be highly pragmatic in doing what works - in learning and modifying their behavior in accordance with adjustive demands. Yet the neurotic clings to his estab¬lished coping pattern despite the fact that it is ineffective, self-defeating, and leads to dissat¬isfaction and unhappiness. This situation is what is known as the neurotic paradox.

The neurotic paradox can be understood in terms of two basic patterns
(a) The immediate relief front anxiety that comes from the momentary avoidance of situations perceived as threatening; and
(b) The continued and inappropriate perception of certain everyday situations as threatening. These patterns may operate in varying degrees and combinations, but their net effect is the tendency to maintain neurotic coping behavior despite its self-defeating nature.
Since the neurotic responds by avoidance to the earliest cues signifying the approach of the feared stress, he is able to protect himself from anxiety. But at the same time, he is prevented from testing the situation to see if what he fears is, in fact, realistic.

For example, let us take the case of a young man who is very much in love with a woman. They are engaged and have made wedding plans. However, she meets someone else to whom she is greatly attracted and abruptly breaks the engagement, terminating their relationship. He reacts with intense feelings of self-devaluation, anxiety, and depression, coupled with a considerable measure of hostility. Then his behavior follows a new pattern. Whenever a relationship with a woman begins to get serious, he experiences anxiety and breaks it off. In short he has acquired a conditioned fear of close relationships with members of the opposite sex, and his anxiety and avoidance behavior do not permit him to try out the possibility that he might be more successful this time. Thus the fear and avoidance behavior are maintained because they are reinforced by the reduction of anxiety each time he breaks off a relationship that is starting to become serious.

Specific Neurotic Patterns
1. Anxiety Neurosis: Anxiety neurosis is the most common of the various neurotic patterns constituting 30 to 40 percent of all neurotic disorders. It is characterized by chronic anxiety and apprehensiveness, which may be punctuated by recurring episodes of acute anxiety. But since neither the anxious expectations nor the acute anxiety attacks appear to stem from any particular threat, the pervasive anxiety is said to be “free-floating.”
2. Phobic Neurosis: Involves various fears the individual realizes are irrational but from which he cannot free himself.
3. Obsessive- Compulsive Neurosis: Involves various fears the individual realizes are irrational from which he cannot free himself.
4. Hysterical Neurosis: Consists of two types:
a. Conversion Type: With symptoms of physical illness such as paralysis or loss of hearing without underlying physical pathology; and
b. Dissociative Type: Including such reactions such as amnesia and multiple personality.
5. Hypocondrical Neurosis: Involves pre-occupation with one’s bodily functioning and various presumed diseases.
6. Neurasthenic Neurosis: Involves chronic fatigue, weakness and lack of enthusiasm.
7. Depressive Neurosis: Involves abnormally prolonged dejection, associated with internal conflict, interpersonal loss or environmental setback.

Schizophrenia and Paranoia
Schizophrenia and other psychoses display symptoms that typically include delusions, hallucinations, and various kinds of bizarre behaviour. Here we are dealing with individuals who are either temporarily or chronically unable to cope with their problems and evidence severe psychological decompensation. Typically they require professional help and supervision, often involving hospitalization. Thus, in general, the psychoses are more serious and disabling— at least psychologically—than the neuroses or the psychosomatic disorders. It may be emphasized, however, that there is not always a sharp dividing line between them, particularly between neuroses and psychoses. Occasionally, for example, a neurotic disorder may blend almost imperceptibly into a psychosis if stress and personality decompensation become increasingly severe.

These disorders can be divided into three major categories:
(a) Schizophrenia
(b) Paranoid disorders, consisting of paranoia and paranoid states
(c) Affective disorders, including manic-depressive reactions and involutional melancholia.
Schizophrenia and paranoia are considered to be thought disorders, while the affective psychoses are dominated by mood disturbances. Paranoid disorders are distinguished from schizophrenia primarily by the narrower limitations of their distortion of reality and by the absence of other psychotic symptoms.

Schizophrenia is the descriptive group of psychotic disorders characterised by gross distortions of reality; withdrawal from social interaction, and the disorganization and fragmentation of perception, thought, and emotion.

The condition in acute schizophrenia may be same as illustrated below:
Suspicious and frightened, the victim fears he can trust neither his own senses, nor the motives of other people… his skin prickles, his head seems to hum, and ‘voices’ annoy him. Unpleasant odors choke him; his food may have no taste. Bright and colorful visions ranging from brilliant butterflies to dismembered bodies pass before his eyes. Ice clinking in a nearby pitcher seems to be a diabolic device bent on his destruction.
“When someone talks to him, he hears only disconnected words. These words may touch off an old memory or a strange dream. His attention wanders from his inner thoughts to the grotesque way the speaker’s mouth moves, or the loud scrape his chair makes against the floor. He cannot understand what the person is trying to tell him, nor why.”

Often schizophrenia develops slowly and insidiously. Thus, the early clinical picture may be dominated by seclusivness, gradual lack of interest in the surrounding world, excessive daydreaming, blunting of affect, and mildly inappropriate responses. This pattern is referred to as process schizophrenia, and the outcome is considered generally unfavourable - partly because the need for treatment usually is not recognized until the behaviour pattern has become firmly entrenched. In the majority of cases, however, schizophrenia has a sudden onset, typically marked by intense emotional turmoil and a nightmarish sense of confusion. This pattern, which usually appears to be related to specific precipitating stresses, is referred to as reactive schizophrenia. Here the symptoms usually clear up in a matter of weeks, though in some cases an acute episode is the prelude to a more chronic pattern.
In both process and reactive schizophrenia, specific symptoms are legion and vary greatly from one individual to another, as well as with time. The basic experience in schizophrenia, however, seems to be one of disorganization in perception, thought, and emotion. Five categories of symptoms are commonly involved:

a) Breakdown of perceptual filtering
b) Disorganization of thought and emotion
c) Anxiety and panic
d) Delusions and Hallucinations
e) Withdrawal from reality.

Types of schizophrenia
i) Acute Type
ii) Paranoid Type
iii) Catatonic Type
iv) Hebephrenic Type
v) Simple Type

The term paranoia has been in use along time. The ancient Greeks and Romans used it to refer more or less indiscriminately to any mental disorder. In present time this term is reserved for cases showing delusions and impaired contact with reality but without the severe personality disorganization characteristic of schizophrenia.

Currently two types of paranoid psychoses are included under the general heading of paranoid disorders:
a) Paranoia, with a delusional system that develops slowly, becomes intricate, logical and systemized and centres around delusions of persecution and grandeur. Aside from the delusions, the patient’s personality remains relatively intact, with no evidence of serious disorganization and no hallucinations (unlike the symptoms in paranoid schizophrenia).
b) Paranoid state, with transient and changeable paranoid delusions lacking the logical and systematic features of paranoia, yet not showing the bizarre fragmentation and deterioration often found in paranoid schizophrenia. Usually the condition is related to some evident stress and is a transient phenomenon. Paranoid states often colour the clinical picture in other types of psychopathological reactions.

In paranoia the Individual feels that he is being singled out and taken advantage of, mistreated, plotted against, stolen from, spied upon, ignored, or otherwise mistreated by his “enemies.” Its delusional system usually centers around one major theme, such as financial matters, a job, an Invention, an unfaithful spouse, or other life affairs. A person who is falling on the job may insist that his fellow workers and superiors have it in for him be cause they are jealous of his great ability and efficiency. As a result, he may quit his job and go to work elsewhere, only to find friction developing again and his new job in jeopardy. Now he may become convinced that the first company he worked for has written to his present employer and has turned everyone here against him, so that he has not been given a fair chance. With time, more and more of the environment is integrated into his delusional system as each additional experience is misconstrued and Interpreted in the light of his delusional ideas.\

Manic-Depressive Psychoses
Kraepelin described the disorder as a series of attacks of elation and depression, with periods of relative normality in between and a generally favorable prognosis.
Actually, some individuals show only manic reactions and others only depressive reactions. Others, however, alternate between these two. Consequently, three major types of manic- depressive psychoses are commonly distinguished:
(a) Manic type,
(b) Depressed type, and
(c) Circular reactions.

The symptom in manic-depressive reactions is colored by the predominant emotional mood of the patient, which may be one of elation or depression. Against this affective back ground, the patient may evidence a variety of psychological and behavioral symptoms, including delusions, hallucinations, and overtly aggressive or suicidal actions, that are roughly appropriate to the prevailing mood.

In manic reactions there are feelings of optimism and elation, accompanied by a speeding up of thought processes and activities and a decreased need for sleep. The individual is loud and boisterous, appears to have unbounded energy and enthusiasm, and is involved in all sorts of activities. He shows impaired ability to concentrate, is easily distracted, and changes rapidly from one trend of thought and activity to another. Judgment is impaired, sexual and other behavioral restraints are lowered, and the individual tends to be extremely impatient with any attempts to restrain his activities. Extravagant plans and delusions of grandeur are common: the person may envision himself as the ruler of the world, the most remarkable scientist who ever lived, or a great prophet who can solve the problems of all humankind.
In depressive reactions the individual experiences a feeling of profound sadness and loneliness, and the whole world becomes joy less and gray. Nothing seems worthwhile any more; emptiness prevails, and only bad things are expected. Thought processes and behavior are slowed down. The individual speaks slowly in a monotonous voice. He limits himself to brief answers to questions. He rarely poses questions; he avoids people and has a listless facial expression and a stooping posture. Self- accusatory and hypochondriacal delusion are common.

Manic types
Manic reactions are characterized by varying degrees of elation and psychomotor over activity. Three degrees are commonly delineated, denoting the progression of behaviour from mild to extreme degrees of manic excitement. Though these reactions differ in degree rather than kind, they merit separate consideration.

a) Hypomania: This is the mildest form of manic reaction and is characterized by moderate elation, flightiness, and over activity.
b) Acute mania: The symptoms in acute mania are similar so those in hypomania but are more pronounced.
c) Delirious mania. In the-most severe type of manic reaction the individual is confused, wildly excited, and violent. The condition may develop out of hypomania or acute mania but often appears suddenly.

Insanity and Crime

There are a number of ways in which the legal rules take mental illness into account. It can be a general defence or a special defence to a particular crime like murder. Mental illness is also a factor which may be taken into account in sentencing offenders where the individual may obtain treatment instead of punishment, but in this case it is only available if there is a form of treatment which it is thought may help the offender.

Definition of insanity
Insanity is a defence long recognised in criminal law as being available theoretically in respect of any charge. In the past the accused who successfully pleaded 'not guilty by reason of insanity' was sent to a mental institution for an indefinite period. Often the individual was never released. However insanity can be judged on the golden rules laid down by House of Lords in the M'Naghten’s case known as the M'Naghten Rules which principally said that:
“every man is to be presumed to be sane and to possess a sufficient degree of reason to be responsible for his crimes, until the contrary be proved (to the satisfaction of the jury); and that to establish a defence on the.ground of insanity, it must be clearly proved that, at the time of the comnlltting of the act, the party accused was labouring under such a defect of reason, from disease of me mind, as not to know the nature and quality of the act he was doing; or,ifne did know it, that he did not know hl\ias doing what was wrong.”

The Court further said that to declare insane a person it must be proved:
(a) that he was suffering from a disease of the mind and, as a consequence of this,
(b) he was labouring under a defect of reason, and as a consequence of this,
(c) he did not appreciate the nature or quality of his actions, or if he did¬ appreciate the nature or quality of his actions he did not :know that his conduct was wrong.

Impediments to Defense of Insanity

The major defect in accepting insanity as a defense is that there is no hard and fast definitions of mental capacity and impairment and nor can there be any precise assessment of whether, and how far, an individual was affected by a state of mind at the time of offence. The element of mens rea whether absent or present in an patient cannot be decided as the thought process is not very clear at present.

Relation of Mental Disorders to Crime

There is certainly no direct and simple link. There would appear to be some very severe cases where the mental element directly causes the criminality. There may be some cases be an indirect link: the illness may affect the individual in certain social ways which may, along with direct effects, make it more likely that a crime is committed. From the research it seems that there is an increased risk of violence in mental patients or those who have been treated in the past. However, the increase was only slight and not as important as some other factors, whilst the increased violence and illegality were usually manifested only in individual with current psychotic problems and could be precipitated by inappropriate reactions of others to the psychotic symptoms. The uncertainties suggest that the provision of proper of proper support in the community would be the most effective way of using the degree of current understanding.

Many studies have attempted to discover whether mental disorder or illness is associated with criminality. Most of these studies have been of people in prison, and ascertain how many prisoners are mentally ill. Glueck (1918) and Bluglass (1977) respectively found that 12 per cent and 2 per cent of their samples were suffering from psychosis, 28 per cent and 14 per cent were suffering from mental subnormality, and 19 per cent and 13 per cent were suffering from psychopathy. Bluglass also assessed that 2 per cent were suffering from. psycho-neurosis and 11 per cent were alcoholics or very heavy drinkers. Teplin (1990) notes that recent studies conclude that rates of severe mental illness amongst the prison population range from 4-5 per cent to 12 per cent and that even the most conservative of these is two to three times higher than the comparable rates in the general population. This does not necessarily prove that the crimes committed by these people were induced by their mental problem. It does not even prove that the mental problem existed prior to the criminality. It
could have been brought on through traumatic feelings of remorse or guilt, or through their treatment in prison. In order to prove a causative link, rather more is required. A better approach might be to study the criminal behaviour of psychiatric patients. Unfortunately, those studies which exist do not adequately explain their sampling or their diagnosis of various illnesses.

A fairly good study was carried out by Rollin (1969). He found that 40 percent of those admitted without recourse to the courts had a criminal record, and 36 per cent were persistent offenders. Of those admitted by the courts, 66 per cent had a criminal record and 44 per cent had previously had a custodial sentence. These figures do suggest some correlation between criminality and mental illness. If there is such a relationship, the way in which it develops depends on the types of mental illness. Before discussing that question, we need first to outline the way the criminal law and the courts have defined mental disorder and the significance of such recognition.

Schizophrenics and those with psychotic symptoms are at far greater risk of becoming homicide victims than other citizens, according to Danish researchers. Only drug users and alcoholics face greater risk.

Researchers at the Psychiatric Hospital in Arhus, Denmark, examined death records of 72,208 Danes, 18,000 of whom died of unnatural causes. The data was culled from the Danish Psychiatric Case Registry and published in The Lancet.
Similar findings were reported in a 2003 University of Southern California study. It found that adults suffering from schizophrenia are 14 times more likely to be victims of a violent crime than to be arrested for one.
More than one-third of individuals with schizophrenia or schizoaffective disorder were victims of crime, and 91 percent of those were violent crimes, including rape and assault. The report tracked 172 Los Angeles-based subjects for three years and was recently published in Psychiatric Services.

Neither set of researchers offered conclusive explanations for the disproportionate victimization of the mentally ill. Living in unsafe neighborhoods may make them easy targets, and symptoms such as paranoia might provoke violence in others or prevent victims from avoiding dangerous situations.

The latest research proves that most crimes by schizophrenia patients are non violent, mostly property offence but the rate of crime is as high as 4 times the normal patient. While the people suffering from depression commit murder followed by suicide and neurotic patients do not crime as such but may commit crimes such as Kleptomainia though very rare.

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