Friday, November 7, 2014

Mental disorder is a cause of crime: what is "mental" in "mental disorder"?

Numerous definitions of “mental” have been attempted over the years, but consensus on its definition remains to be established (just as its two sibling words, "psyche" and "spirit", but let us focus on mental here). This is noteworthy, as it is a core definition not only in sciences on the mind and its disorders, but also in legislation and cultural references. "Mental disorder" is a key phrase for forensic psychiatry in many legislations, and it is important that we strive to be as clear as possible about how we use and what we mean with the term. After a brief foray into the body-mind problem next week, we will return to "disorder" in a fortnight. But let's focus on the "mental" part of "mental disorder" for now. 

In forensic psychiatry, as clincians, we will probably have to do with some examples of what mental can, and cannot, be. The task of further definitions belongs rather to philosophers, or the field of jurisprudence, or even to philology. It is interesting to try to grasp how the Greek and Latin words for mind, soul and spirit have evolved in the European languages, and often have come to refer to differnt or overlapping concepts in different contexts. 

Psychiatry has also used several words, such as mind, psyche or senses, without clear definitions and without too much worries over distinctions. Historically, it has tended towards mind and mental in the Anglo-Saxon culture, and towards psyche, soul or senses in continental European or Scandianvian cultures (but these are merely tendencies, just as psychiatrist means "doctor of the soul" in English, references to "mental" are common in French, German or Swedish).  

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, American Psychiatric Association (APA) described mental as: a) inner experiences, relating to mood, thought content, or sensory experiences, b) behavioural patterns, and c) cognitive functions such as learning, social understanding and reality assessment.

As these descriptions refer to different ways of conceiving the human, let us refer to them as aspects of the mental. 

The first aspect, inner (subjective) experiences, denotes the inner life that a subject can be aware of. Mental representations are not limited to sequences of language but may be “iconic” or non-symbolic, merging sensory input with memories and emotions.

Subjective experiences are made the object of science by methods that are basically hermeneutic in a wide sense and dependent on the clinical encounter. The requirement that scientific knowledge should be possible to generalize to persons other than those under direct observation is as important for assessments of inner experiences as for behaviour observations or tests of abilities.

Cognitive processes represent knowledge of the world and the self and are thus intrinsically linked to learning and structured by language. Learning, and the ability to learn, are more accessible for quantification than inner experiences, and may, in part, be evaluated by tests.

The behavioural manifestations of the mental were once proclaimed by behaviourist philosophers and psychologists to be the only aspect accessible for scientific exploration. Behaviours do indeed lend themselves to quantification by various forms of assessments based on their observability (self-rate, collateral, or clinician-rated), but it may be misleading to refer to "mental" aspects if behavioural manifestations are all that have been studied. 

Generally, these descriptions of mental aspects complement each other, and together form an ideal for clinical work. In the forensic context, however, test-retest reliability, transparency, and objectivity become more important than comprehensiveness. Behaviour assessments and cognitive tests may therefore be more acceptable and useful than hermeneutic assessments of inner experiences.


In forensic psychiatry, the concept of "mental" may thus be limited to include only such law-bound patterns of behaviours and faculties that are possible to describe by replicable metods.

This blog post is partly excerpted from the paper "Mental disorder is a cause of crime" co-authored with Susanna Radovic, Christer Svennerlind, Pontus Höglund and Filip Radovic in 2009. 

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