Friday, December 26, 2014

Mental disorder is a cause of crime: "crime" vs. psychiatric phenotypes

The term “crime” is in no less need of a precise definition than “mental”, “disorder”, or “cause”. Leaving aside the legal definition, let us consider how crimes, generally in the form of violent, sexual or aggressive behaviours against others, are approached from the perspective of being caused by mental disorders. 

The focus on mental disorder also directs the searchlight of forensic psychiatry towards individual criminal acts or towards patterns of criminal behaviors occurring in individuals rather than to crime as a societal or group phenomenon. For a number of questions, this is too narrow a perspective.

A crime takes place in a situation, between people, and the vast majority of crimes are clearly influenced by the situations in which they arise. Only rarely is a crime planned and determined by a single mind. A major shortcoming of the psychiatric approach is the emphasis on the individual and the relative down-tuning of the role of the interaction between people, including co-perpetrators and victims. 

The capacity to empathize and act compassionately shows not only a constitutional inter-individual variation but also an intra-individual variation in partially state-dependent actual functioning (cf. Constantino & Todd, 2003; Gabbard, 2004). Each and every one of us may stop forming meta-representations of the other’s mind, the ordinary household quarrel being just as good an example as more dramatic scenes of conflict. 

A person who commits a heinous crime on his own is more likely to differ from the normal variation on at least some mental features than someone taking part in a similar crime as part of a group of offenders. Even small groups may release dynamics that deprive their members of inhibitory forces. A mathematical hypothesis to predict an individual’s actual capacity for empathy (E) would assume that his or her natural capacity for empathy (e) should be divided by the square root of the number of people (n) involved and interacting in the actual act.

Another situational factor that plays a major role in the background to many violent crimes is the influence of drugs. These effects are not easily defined in relation to other mental factors or to situations. Alcohol, for example, may trigger aggression and reduce inhibitory faculties but can also diminish reactivity and reduce anxiety, thus acting as a susceptibility factor or as a protective factor depending on the situation, the degree of influence, and the subject’s other psychological and psychiatric problems. When faced with the task of explaining the background to a particular criminal act, aspects of reduced or changed mental abilities have to be considered in the context of situational, social factors, each of which may constitute an INUS condition.

Perhaps due to this empirical dilemma, psychiatric research has instead attempted a shortcut to explain crimes by diagnosing patterns of crimes as mental disorders. Here, the lack of definitional clarity has become abysmal. Diagnoses such as kleptomania, intermittent explosive disorder, paedophilia, or psychopathy, have been defined on the basis of criminal behaviour patterns and mainly researched among convicted offenders. In order to have them constitute mental disorders, heterogeneous aspects of inner phenomena or cognitions have been assembled into diagnostic designations. By their circular reasoning and limited empirical support from general population studies, these diagnoses have continued to fuel heated controversies about which aspects should be counted as “belonging” to the respective syndromes. It came as no surprise when a recent large-scale meta-analysis of the predictive value of the different “facets” of psychopathy for crimes showed that the strongest predictor was – criminal behaviours (Walters, 2008).

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

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