Psychological Disorders and the Justice System

Introduction to Psychological Disorders

Psychological disorders, also known as mental disorders, are patterns of behavior or experience that cause distress, impair day-to-day functioning, or increase the risk of harm. The study of these disorders includes their definition, historical treatment, diagnostic criteria, and their intersection with the justice system.

Defining Mental Illness

Criteria for Mental Disorders

• Maladaptive Behavior: According to the DSM, mental disorders are defined by patterns that cause distress, impair functioning, or increase risk of harm.

• Limitations: Not all maladaptive behaviors are mental illnesses, and some individuals may be considered mentally ill without meeting all criteria.

Historical Conceptions of Mental Illness

• Demonic Model: In the Middle Ages, odd behaviors were attributed to evil spirits, leading to exorcisms and witch hunts.

• Medical Model: Emerged during the Renaissance, viewing mental illness as a physical disorder requiring treatment. Treatments included bloodletting and confinement in asylums, which were often overcrowded and inhumane.

• Moral Treatment: Reformers like Phillippe Pinel and Dorothea Dix advocated for humane treatment, allowing patients more freedom and dignity, though effective treatments were still lacking.

The Modern Era of Mental Health Care

• Pharmacological Advances: The development of chlorpromazine (Thorazine) in the 1950s marked the beginning of effective antipsychotic treatment for disorders like schizophrenia.

• Deinstitutionalization: In the 1960s and 70s, many psychiatric hospitals were closed, and patients were released into the community. This shift had mixed results due to inadequate community support.

Diagnosis and Classification

The DSM-5 and the Biopsychosocial Model

• DSM-5: The official classification system for mental disorders, providing diagnostic criteria and decision rules. It emphasizes ruling out medical or substance-related causes first.

• Biopsychosocial Approach: Considers biological (e.g., genetics, brain chemistry), psychological (e.g., cognition, coping), and social (e.g., environment, culture) factors in diagnosis and treatment.

• Expansion of Diagnoses: The number of recognized disorders has increased significantly, raising debates about over-diagnosis and the influence of insurance requirements.

Culture and Mental Disorders

• Culture-Bound Syndromes: Some disorders are specific to certain cultures, while others (e.g., schizophrenia, alcoholism) are universal.

• Examples: Malocchio (Italy), Calor do corpo/nervos (Portugal/Brazil), Taijin Kyofusho (Japan).

Major Categories of Psychological Disorders

Anxiety Disorders

Anxiety disorders are characterized by excessive and persistent anxiety or maladaptive behaviors that reduce anxiety. They include generalized anxiety disorder, panic disorder, specific phobias, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

• Generalized Anxiety Disorder: Chronic worry, tension, and irritability about various topics.

• Panic Disorder: Recurrent, unexpected panic attacks and persistent concern about future attacks.

• Phobias: Unrealistic fear of specific situations or objects (e.g., agoraphobia).

• Obsessive-Compulsive Disorder: Intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) to reduce distress.

• OCD-Related Disorders: Hoarding, excoriation (skin picking), trichotillomania (hair pulling), body dysmorphic disorder.

Mood Disorders

• Major Depression: Persistent sadness, hopelessness, social withdrawal, and cognitive/physical sluggishness. Higher prevalence among women and those in poverty.

• Bipolar Disorder: Alternating periods of depression and mania (elevated mood, energy, impulsivity).

• Risk Factors: Genetic predisposition, stressful life events, and sociocultural factors (e.g., poverty, social isolation).

Schizophrenia

• Symptoms: Positive (hallucinations, delusions), negative (emotional withdrawal), and cognitive/disorganized behaviors.

• Brain Structure: Larger ventricles, reduced frontal lobe activity, and neurotransmitter imbalances (dopamine, glutamate).

• Environmental Factors: Stress, low socioeconomic status, minority status, prenatal environment, and cannabis use.

Personality Disorders

• Cluster A: Odd/eccentric (e.g., paranoid, schizoid).

• Cluster B: Dramatic/emotional/erratic (e.g., antisocial, borderline, narcissistic).

• Cluster C: Anxious/fearful/inhibited (e.g., avoidant).

• Borderline Personality Disorder: Intense emotional swings, unstable relationships, impulsivity, and maladaptive coping.

• Antisocial Personality Disorder (APD): Lack of empathy, disregard for others, often linked to conduct disorder and brain differences.

• Psychopathy: Extreme antisocial traits, under-reactive to stress, amygdala and frontal lobe abnormalities.

Uncommon Psychiatric Syndromes

• Capgras’s Syndrome: Belief that a loved one has been replaced by a double.

• Ekbom’s Syndrome: Delusions of infestation.

• Munchausen Syndrome: Fabrication of medical symptoms for attention or care.

Mental Illness and the Justice System

Intersection of Mental Health and Law

• Insanity Defense (NCRMD): Not criminally responsible by reason of mental disorder. Legal, not psychological, definition. Requires lack of intent (mens rea) due to mental illness.

• Canadian Criminal Code S.16: No criminal responsibility if, at the time of the act, the person was incapable of appreciating the nature/quality of the act or knowing it was wrong due to mental disorder.

• Possible Outcomes: Absolute discharge, conditional discharge, or detention in a hospital, based on risk and treatment needs.

• Myths: NCRMD is rarely used, not a loophole, and does not result in quick release. Most cases are non-violent, and individuals often spend longer in institutions than if convicted.

Mental Health in Correctional Settings

• Prevalence: Mental illness is 2–3 times more common in prison than in the general population. High rates among women and those in provincial detention.

• Challenges: Prisons are not equipped for mental health care, and conditions can worsen symptoms (e.g., segregation, lack of services).

• Solitary Confinement: Associated with hallucinations, cognitive disabilities, insomnia, self-harm, paranoia, and suicidal tendencies. Neurological changes can occur due to isolation.

• Case Examples: Kalief Browder, Edward Snowshoe, and Ashley Smith illustrate the severe consequences of inadequate mental health care in correctional settings.

Community and Advocacy

• Support Organizations: John Howard Society, Fred Victor, Elizabeth Fry Society, Addictions and Mental Health Ontario (AMHO), CMHA, CAMH.

• Role: These organizations work to support individuals with mental illness, reduce homelessness, and advocate for humane treatment and alternatives to incarceration.