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.

Historical Conceptions of Mental Illness

• Demonic Model (Middle Ages): Mental illness was often attributed to possession by evil spirits. Treatments included exorcisms and witch hunts.

• Medical Model (Renaissance): Emergence of the view that mental illness is a physical disorder requiring treatment. Patients were housed in asylums, which were often overcrowded and used ineffective treatments such as bloodletting and "snake pits."

• Moral Treatment (1700s-1800s): Reformers like Phillippe Pinel and Dorothea Dix advocated for humane treatment, emphasizing dignity and kindness, though effective treatments were still lacking.

The Modern Era of Mental Health Care

• Pharmacological Advances: The development of antipsychotic medications such as chlorpromazine (Thorazine) in the 1950s moderately decreased symptoms of schizophrenia and similar disorders.

• 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 insufficient community support infrastructure.

Defining Mental Illness

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) is the official classification system for mental disorders. It provides diagnostic criteria, decision rules, and emphasizes a biopsychosocial approach:

• Biological factors: Brain chemistry, genetics, neurodevelopment, and physical health.

• Psychological factors: Cognitive patterns, emotional regulation, personality, and coping skills.

• Social factors: Environment, culture, family dynamics, and socioeconomic status.

The DSM has expanded over time, increasing the number of recognized disorders, which has sparked debate about over-diagnosis and the influence of insurance requirements.

Diagnosis Across Cultures

Certain mental disorders are culture-bound, while others (e.g., schizophrenia, alcoholism) are universal. Culture influences the expression and interpretation of symptoms.

• Malocchio (Italy): Headaches, fatigue, and anxiety attributed to envy or the "evil eye."

• Calor do corpo/nervos (Portugal/Brazil): Fatigue and anxiety explained by bodily imbalance or "nerves."

• Taijin Kyofusho (Japan): A form of social anxiety focused on the fear of offending others, reflecting collectivist cultural values.

Major Categories of Psychological Disorders

Anxiety-Related Disorders

These disorders are characterized by excessive and persistent anxiety or maladaptive behaviors that reduce anxiety. Common types include:

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

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

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

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

Mood Disorders

• Major Depression: Periods of sadness, hopelessness, social withdrawal, and cognitive/physical sluggishness. Risk factors include genetics, stressful life events, and sociocultural environment.

• Bipolar Disorder: Extreme mood shifts between depression and mania, with high energy, impulsivity, and increased risk of suicide.

Schizophrenia

Schizophrenia involves significant breaks from reality, disorganized thinking, and problems with attention and memory. Symptoms are classified as:

• Positive symptoms: Hallucinations, delusions, thought disorder, movement disorder.

• Negative symptoms: Absence of adaptive behaviors (e.g., emotional withdrawal).

• Disorganized symptoms: Disorganized behavior and cognitive functioning.

Biological findings include larger brain ventricles, reduced frontal lobe activity, and neurotransmitter imbalances (dopamine overactivity, glutamate underactivity). Environmental risk factors include extreme stress, low socioeconomic status, minority status, prenatal environment, and cannabis use.

Personality Disorders

Personality disorders are enduring patterns of behavior that are maladaptive, distressing, and resistant to change. They are grouped into three clusters:

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

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

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

Borderline Personality Disorder: Marked by emotional instability, impulsivity, and unstable relationships, often rooted in early trauma.

Antisocial Personality Disorder (APD): Characterized by lack of empathy, disregard for others' rights, and often linked to conduct disorder and brain differences.

Psychopathy: Extreme form of APD with interpersonal/emotional deficits and social deviance. Associated with 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

Mental illness can influence legal outcomes, particularly through the insanity defense (NCRMD: Not Criminally Responsible by Reason of Mental Disorder). Insanity is a legal, not psychological, definition. Criminal guilt requires both actus reus (guilty act) and mens rea (guilty mind). Mental illness can negate mens rea.

NCRMD in Canadian Law

Section 16 of the Canadian Criminal Code states that a person is not criminally responsible if, at the time of the offense, they were suffering from a mental disorder that rendered them incapable of appreciating the nature and quality of the act or knowing it was wrong. Outcomes after an NCRMD finding include absolute discharge, conditional discharge, or detention in a hospital, depending on risk to public safety and treatment needs.

Myths and Realities of NCRMD

• Myth: NCRMD is frequently used and successful. Reality: Used in only 1% of felony cases and fails 75% of the time.

• Myth: NCRMD is a loophole for the guilty. Reality: Most NCRMD defendants are detained longer than if found guilty.

• Myth: Mentally ill people are highly dangerous. Reality: Most NCRMD cases are non-violent, with low recidivism rates.

• Myth: Quick release after NCRMD. Reality: Release is rare and usually after lengthy detention.

Mental Illness in the Correctional System

• Approximately 70% of federally incarcerated individuals report mental health symptoms.

• Mental illness is 2–3 times more common in prison than in the general population.

• Suicide rates in prison far exceed national averages.

• Correctional facilities often lack adequate mental health services, and harsh conditions (e.g., solitary confinement) can worsen symptoms.

Effects of Solitary Confinement

• Profound psychological impact: hallucinations, cognitive disabilities, insomnia, self-harm, paranoia, and suicidal tendencies.

• Neurological effects: changes in brain structure, neuron shrinkage.

Advocacy and Support

• Organizations such as the John Howard Society, Fred Victor, Elizabeth Fry Society, Addictions and Mental Health Ontario (AMHO), CMHA, and CAMH work to support individuals with mental illness and advocate for systemic change.