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 is essential for understanding human behavior, mental health, and the intersection with societal systems such as the justice system.

Historical Conceptions of Mental Illness

Demonic Model and Early Treatments

Historically, mental illness was often attributed to supernatural causes, such as demonic possession. Treatments included exorcisms and witch hunts, reflecting a lack of scientific understanding.

The Medical Model and Asylums

During the Renaissance, the medical model emerged, viewing mental illness as a physical disorder requiring treatment. Patients were housed in asylums, which were often overcrowded and understaffed. Common treatments included bloodletting and the use of 'snake pits.'

Moral Treatment Reform

Reformers such as Phillippe Pinel and Dorothea Dix advocated for moral treatment in the 18th and 19th centuries, emphasizing dignity, kindness, and respect for patients. Despite these reforms, effective treatments remained elusive.

The Modern Era: Psychopharmacology and Deinstitutionalization

The development of antipsychotic medications like chlorpromazine (Thorazine) in the 1950s marked a turning point, leading to the deinstitutionalization movement in the 1960s and 70s. While many patients were released from hospitals, community support systems were often lacking, resulting in mixed outcomes.

Defining and Diagnosing Mental Illness

DSM-5 and the Biopsychosocial Model

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) is the official classification system for mental disorders. It provides diagnostic criteria and decision rules, emphasizing the need to rule out medical or substance-related causes first. The biopsychosocial model considers biological, psychological, and social factors in diagnosis and treatment.

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

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

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

Culture-Bound Syndromes

Certain mental disorders are culture-bound, while others (e.g., schizophrenia, alcoholism, psychopathy) are universal. Examples include:

• Malocchio (Italy): Headaches, fatigue, anxiety, and bad luck attributed to envy

• Calor do corpo/nervos (Portugal/Brazil): Fatigue, anxiety, and gastrointestinal issues explained by bodily imbalance or 'nerves'

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

Major Categories of Psychological Disorders

Anxiety-Related Disorders

Anxiety disorders are characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety. While transient anxiety can be adaptive, excessive and inappropriate anxiety is maladaptive.

• Generalized Anxiety Disorder (GAD): Chronic worry, tension, and irritability about many areas of life

• 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)

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

Mood Disorders

Mood disorders include depression and bipolar disorder, affecting nearly 10% of adults in North America. Depression is more common among women and those living in poverty, with genetic, environmental, and sociocultural risk factors.

• Major Depression: Periods of sadness, worthlessness, hopelessness, social withdrawal, and cognitive/physical sluggishness

• Bipolar Disorder: Extreme shifts in mood, motivation, and energy, including periods of depression and mania

Schizophrenia

Schizophrenia is marked by 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 behavior (e.g., emotional withdrawal)

• Disorganized behavior and cognition

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, erratic behavior (e.g., antisocial, borderline, narcissistic)

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

Mental Illness and the Justice System

Intersection of Mental Health and Legal Issues

Mental illness can increase the risk of legal problems. The insanity defense (NCRMD: Not Criminally Responsible by Reason of Mental Disorder) is a legal, not psychological, concept. Criminal guilt requires both a guilty action (actus reus) and a guilty mind (mens rea). Mental illness can negate mens rea.

NCRMD in Canadian Law

Section 16 of the Canadian Criminal Code states that no person is criminally responsible for an act committed while 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 spend time in jail or hospital, often longer than a typical sentence.

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

• Myth: Quick release for NCRMD. Reality: Release is rare and usually after longer detention than a criminal sentence.

Mental Illness in the Correctional System

Mental illness is significantly more prevalent in correctional settings than in the general population. Prisons are often ill-equipped to provide adequate mental health care, and harsh conditions such as solitary confinement can exacerbate psychological symptoms.

• ~70% of federally incarcerated individuals report mental health symptoms

• ~40% of incoming federal inmates meet criteria for a current mental disorder

• ~79% of incarcerated women have a diagnosed mental disorder

• Suicide rates in prison far exceed national averages

Effects of Solitary Confinement

Solitary confinement has profound psychological and neurological effects, including hallucinations, cognitive disabilities, insomnia, self-harm, paranoia, and suicidal tendencies. It can cause changes in brain structure and function.

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.

Additional info: The notes above integrate historical, diagnostic, and legal perspectives on psychological disorders, with a focus on the intersection of mental health and the justice system, as well as the impact of institutional practices on mental health outcomes.