Being a mental health professional, does it change your view of criminals?

[surftheiop]

I was curious how being a mental health professional effects how you think about people who commit heinous crimes.

Whenever I used to read the news and hear about some murderer/rapist/etc. or something I would just think they are terrible people and deserve to be locked up and rot in jail forever.

Since taking taking this adult psychopathology class, whenever I hear about some terrible crimes I think "man this guy probably had a genetic predisposition and then had major childhood trauma/abuse and now is Borderline, etc."

I still think "man we need to get this guy off the streets before he kills more people", but I don't feel like the guy "deserves" to rot in prison. I mostly just feel bad for the circumstances he must have lived through that would allow him to commit such sick crimes.

Or like when some deathrow inmate is qouted as having no remorse, I used to hate his guts, but now I just feel terrible for him and can't imagine how deprived a life without the capacity for empathy would be.


Was curious if you all had any thoughts on the matter. (Especially people in forensics like whopper)

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[Solideliquid]

I think that training as a psychiatrist, and seeing and learning about people in all their shades of gray, does allow you to have different thoughts about the actions people take.

I don't know if I feel significantly different about people who choose to rob a store or rape someone. Learning to become a psychiatrist has allowed me to appreciate the fact that mental illness is pretty rampant in humans and that some people can and do commit vile acts while suffering from a mental illness. I'm not in a position to decide if these people committed crimes because they were mentally ill, and what if any different kind of punishment/treatment they should receive.

 

[sunlioness]

About the actions themselves? No, not really. Behavior is a choice. Unless someone is totally psychotic, they have the power to choose their course of action and to determine right from wrong. This is true regardless of their genes and whatever past traumas they may have had. And there are plenty of people out there with the same genes and trauma histories who don't choose to do these things.

I think understanding someone's history allows us to understand what prompts certain behaviors. It can even allow us to have some measure of compassion for the perpetrators. But it never absolves them of the responsibility for their actions or bearing the consequences of said actions.

That's my $0.02, for what it's worth.

 

[surftheiop]

About the actions themselves? No, not really. Behavior is a choice. Unless someone is totally psychotic, they have the power to choose their course of action and to determine right from wrong. This is true regardless of their genes and whatever past traumas they may have had. And there are plenty of people out there with the same genes and trauma histories who don't choose to do these things.

I think understanding someone's history allows us to understand what prompts certain behaviors. It can even allow us to have some measure of compassion for the perpetrators. But it never absolves them of the responsibility for their actions or bearing the consequences of said actions.

That's my $0.02, for what it's worth.

yeah that sounds about right, if we could rationalize away things based on someone's history we would have a pretty dangerous society.

 

[whopper]

I haven't seen this problem, I figure because I haven't worked in a prison & because I've not worked in states that have this problem. There supposedly is a large number of people in prison who may have deserved an NGRI defense, but they are in states without a forensic psychiatric infrastructure to detect if they were mentally ill & not competent to stand trial.

That being said, almost every honest forensic psychiatrist I've met still think antisocial PD people commiting crimes deserve to go to prison. My definition of honest is they're not willing to say anything for a few hundred dollars an hour to get someone a mental health defense.

I've never seen any honest psychiatrist or psychologist who understood forensics think that people who willingly committed crimes & didn't meet the McNaughton standard didn't deserve to go to prison.

One perspective I've seen is how sex offenders are (mis)treated by the system. One guy I had, his apartment burned down, and his meds were in his apartment. He ended up decompensating because he couldn't get more medication in time before his psychosis reoccurred. He couldn't keep in contact with his parole officer due to his psychosis, and because of his sex offender status was put into a forensic facility. He's been there for years, is on good behavior, but the institution can't discharge him because they can't a facility that'll take him.

 

[Heathcliff]

I highly recommend The Psychopath: Emotion and the Brain. I read this book during my Neurology rotation (after I got tired of reading about headaches, strokes, seizures, etc.) and it absolutely changed my view of people who commit heinous crimes and show no remorse.

It is a well researched book which shows, as one Amazon.com reviewer put it, that "psychopathy is a genetic, biologically determined disorder that affects emotional makeup." After reading it, it was perfectly understandable why Dennis Rader (the BTK killer) had a flat affect when he described his crimes in court.

 

[toby jones]

Sigh. Well, I suppose I'd feel remiss if I didn't say something on this topic...

The course I'm involved with teaching at the moment has students consider the following case:

http://www.medicalnewstoday.com/articles/4022.php

Or, for those who can't be bothered following the link, it is basically a case of the presence and absence of pedophilia covarying with the presence and absence of a tumor.

They need to consider whether or not the man is morally responsible for his pedophiliac actions according to (their interpretation of) Aristotle's theory of moral responsibility. This is important (in part) because Aristotle's theory has been extremely influential on the legal notion of moral responsibility in western legal settings; his theory seems to accord with our own intuitions reasonably well; and his theory kind of attempts to deal with a serious objection to the effect that nobody is morally responsible (praiseworthy or blameworthy) for anything they do.

Aristotle's theory is (roughly) that we are morally responsible for actions that aren't involuntary. Involuntary actions are actions that are done in certain kinds of ignorance (e.g., of particular details of the action etc) or actions that are due to external force. (I could go on but I won't).

Problem for Aristotle's theory: Suppose that our beliefs and desires are caused (which is to say 'forced') by things outside our control - such as by our genes or by our parents (who we surely didn't choose to be born to) or our environment (which we surely didn't choose to be placed in). Then it seems that all our actions are the result of force which is to say they are involuntary which is to say that nobody is morally responsible (praiseworthy / blameworthy) for anything they do.

What enables us to say that this man is not morally responsible for his behavior because his behavior was caused by forces outside his control (his tumor / the state of his brain) while simultaneously enabling us to say that other adult humans are morally responsible for their behavior even when their behavior is caused by forces outside their control (the state of their brain)?

Aristotle also says that while we don't choose ends / desires (what seems good to us) we deliberate on different options that are means to our ends. He thinks that deliberative actions form a subset of voluntary actions. Since some people clearly do have the capacity to deliberate and deliberative actions are a subset of voluntary actions (for Aristotle) it thus seems that some people do have the capacity for voluntary action.

He seems correct that the capacity for rationality is something that accords with our intuitions around whether an agent is or is not morally responsible. Adult humans are paradigmatically deliberative and morally responsible; animals, infants, people with certain kinds of intellectual handicap / mental disorder / disease paradigmatically are not.

But it seems that we don't choose to have the capacity to deliberate, rather that is something that is forced on us... But then we do in fact hold people morally responsible for some of their actions (praise / blame) and excuse them for others so we need to say something about where we draw the line.

Oh, what a puzzle...

IMHO:

- Deliberative capacity works well to delimit the scope of moral responsibility. Tough **** that we didn't deliberately choose to be born with a deliberative capacity - simply having it is enough to make us morally responsible agents.

- There are issues around whether the tumor altered the apparent good (what seemed desirable e.g., having sex with children) vs altering the rational capacity (ability to inhibit acting the way he did). That might make a difference...

- EITHER: Control isn't required for moral responsibility (merely having a deliberative capacity is enough) OR: Even though nobody is morally responsible (in the sense that their acts are ultimately caused by things outside their control / force) we are still justified in holding people to be morally responsible for some of their actions. I think this is ultimately a linguistic decision and there isn't much of a substantive difference between those options)

- Whether the universe is deterministic (A predicts B with 100% accuracy) or whether there are irreducible quantum indeterminicies (A predicts B to 0.5, A predicts C to 0.25, A predicts D to 0.25) things are ultimately determined (or the probabilities are fixed) by things outside our control. We still have reason to hold people morally responsible, however. Firstly because it impacts on their future offending (preventing it) and secondly because it impacts on others offending (modelling). People often have this intuitive distinction between law being about 'evil' where people should be 'punished' in a retributive fashion whereas psychiatry being about 'illness' where people should be 'rehabilitated' where we have pity / compassion for them. Personally... I think this distinction should be broken down. Not to say that the mentally ill should be treated as criminals, but rather that criminals should be rehabilitated too. Not that there are enough resources to rehabilitate the legally insane... But that is my ideology, anyway...

 

[PsyDGrrrl]

What a can of worms this question can be -

I work in a forensic hospital with both people committed as incompetent to stand trial and some NGI's. Several things have definitely changed in me as a result of working here.

1) An overwhelming number of people are criminalized for being mentally ill. Many of my patients' charges (their alleged "crimes") are the direct result of being un- or undermedicated and inadequately treated schizophrenics and bipolars. As in, a homeless man with chronic schizophrenia, undifferentiated type, becoming a "sex offender" because he was masturbating in public and now is charged with a felony for failing to register - something we see way too often. It would be hard enough for someone without mental illness to remember to go check in and "register" with the PD every 5 days when you're homeless, let alone someone with such severe mental illness.

Rather than treating people and keeping them out of trouble, they commit crimes (often out of necessity to survive) and end up in the legal system as "criminals." This may be why the country's prisons and jails are now the largest "treatment facilities" for people with serious mental illness.


2) Then, there is psychopathy - no mental health treatment works for these people, and punishment (i.e., long prison terms) has little effect either. These people do not have mental illness - they have moral illness. They have a complete lack of conscience and the ability to be a part of cooperative human society. The latest findings from science show us that their brains are fundamentally flawed in a way that makes them, dare I say, unhuman. Scarier still is that the genetic basis means we can't always prevent psychopathy, unlike the old belief that it was due to abusive/neglectful homes which would imply that early intervention and a "healthy" environment could prevent it. I honestly don't know what the answer is. It would be wrong to advocate for the death penalty or indefinite warehousing of them, but there's nothing else we can do to protect society from these predators. Whereas I have empathy and can understand the crimes of the seriously mentally ill, I have no empathy or forgiveness for these people.

 

[toby jones]

...

 

[grandslam521]

Whereas I have empathy and can understand the crimes of the seriously mentally ill, I have no empathy or forgiveness for these people.

Why is that?

 

[PsyDGrrrl]

Why is that?

Because it's close to impossible to have empathy for people who don't. As in, empathy means being able to share someone's experience and take their perspective. The thoughts, motivations and experiences of psychopaths are outside of the normal range of human emotional experiences that those of us with consciences can tune in to. I can't empathize with someone whose shoes I could never have the capacity to imagine being in.

I'm not talking about antisocial behavior, breaking rules or being aggressive. Those are within the range of experiences that we can all share. I'm talking about the predatory mind, seeing other human beings as objects and not people.

 

[surftheiop]

Because it's close to impossible to have empathy for people who don't. As in, empathy means being able to share someone's experience and take their perspective. The thoughts, motivations and experiences of psychopaths are outside of the normal range of human emotional experiences that those of us with consciences can tune in to. I can't empathize with someone whose shoes I could never have the capacity to imagine being in.

I'm not talking about antisocial behavior, breaking rules or being aggressive. Those are within the range of experiences that we can all share. I'm talking about the predatory mind, seeing other human beings as objects and not people.

Im not saying we should say what their doing is "ok".

But dont you atleast feel bad for them? I would definately pity someone who doesnt have the capacity to have many "normal human feelings", but is stuck with a human body and the societal constraints that come along with it.

Sure we might need to lock them away to protect ourselves, but I really feel terrible for these people seems they are forced to live such deprived lives.

 

[toby jones]

If pharma invented a medication that gave psychopaths the capacity to empathize (just suppose for the sake of argument) then would you classify them with the psychiatric?

Lets say you go to the zoo to look at a tiger through the bars. It is a hungry tiger. It would eat you if it had the chance (it is incapable of empathy for you). Do you feel similarly about the tiger and the psychopath?

Maybe you feel differently about the tiger because presumably it does have some empathetic capacity (e.g., if it is a female tiger towards its young) even though it doesn't have empathy towards you. Surely there are different kinds of things that we could empathize with, though. I'd feel badly for the tiger if it didn't get food and water (I know what it feels like to be hungry and thirsty) even though I might not be able to have a moment of empathetic attunement or something more paradigmatically human with the tiger. Does the tigers inability to empathize with my hunger / thirst undermine my ability to empathize with it in those respects? Do you find yourself unable to empathize with the psychopath in any respect?

 

[billypilgrim37]

Do you feel similarly about the tiger and the psychopath?

Toby, you're THIS close to a ph.d in philosophy, and seriously, you just compared a psychopath and a tiger?

It's a good thing you're joining us dullards in the medical profession

I would be shocked if this thread doesn't get some Godwin action in the next five posts.

 

[toby jones]

Sigh. It was the 'predatory mind' comment that did it.
If the psychopaths nature is such that he/she has a 'predatory mind'
And the tigers nature is such that he/she has a 'predatory mind'
And having a 'predatory mind' (and inability to empathize) is what is relevant for our attitude towards them then insofar as they are analogous our attitude towards them should be the same.

Am I losing it do ya think?

 

[surftheiop]

Sigh. It was the 'predatory mind' comment that did it.
If the psychopaths nature is such that he/she has a 'predatory mind'
And the tigers nature is such that he/she has a 'predatory mind'
And having a 'predatory mind' (and inability to empathize) is what is relevant for our attitude towards them then insofar as they are analogous our attitude towards them should be the same.

Am I losing it do ya think?

i thought it was a pretty good analogy, i mean psyDgirl did basically say psychopaths weren't human in her opinion

" The latest findings from science show us that their brains are fundamentally flawed in a way that makes them, dare I say, unhuman. "

 

[BabyPsychDoc]

About the actions themselves? No, not really. Behavior is a choice. Unless someone is totally psychotic, they have the power to choose their course of action and to determine right from wrong. This is true regardless of their genes and whatever past traumas they may have had. And there are plenty of people out there with the same genes and trauma histories who don't choose to do these things.

I think understanding someone's history allows us to understand what prompts certain behaviors. It can even allow us to have some measure of compassion for the perpetrators. But it never absolves them of the responsibility for their actions or bearing the consequences of said actions.

That's my $0.02, for what it's worth.

I agree that behaviour is a choice, but it becomes a choice at the point when it has already been heavily influenced by genetics/physiology/environment of a given individual.

Case in point - Jamie Bulger http://en.wikipedia.org/wiki/Murder_of_James_Bulger, a toddler that was tortured and murdered by 2 10-11 yo juvenile delinquents who just wanted to see what it feels like to kill a human being. Once you learn how these two were raised, it is difficult to be just angry with them - you can't help but feel sorry for them (NB - you can feel sorry for them without absolving them from the responsibility for their actions). I mean, both kids were raised in large families, on welfare, with drunkard fathers - plenty of both physical and emotional abuse, as well as neglect. How much choice does one really have after being so thoroughly ****ed up by their childhood experiences? I do not think anyone has the answer to this question; our understanding of the issue will continue evolving along with our understanding of brain development in the context of interplay between different biological and environmental factors.

 

[billypilgrim37]

Sigh. It was the 'predatory mind' comment that did it.
If the psychopaths nature is such that he/she has a 'predatory mind'
And the tigers nature is such that he/she has a 'predatory mind'
And having a 'predatory mind' (and inability to empathize) is what is relevant for our attitude towards them then insofar as they are analogous our attitude towards them should be the same.

Am I losing it do ya think?

Nah, you still got it

I find it a little interesting to consider my own development of thought towards psychopaths. At some point, in the liberal arts education, I think we all start seeing the locus of control to be well outside of the psychopath to some extent, and learn to not blame them for their horrific actions. We start asking the questions like "How can you kill someone and NOT be mentally ill." We declare them ill, blame a society that could nurture psychopathy, and order off the top of the wine menu at Olive Garden and listen to Arcade Fire.

But after enough socialization into the medical profession, we start making arbitrary distinctions that we become more and more comfortable with. We start making distinctions of "this is the mental illness" and "this is the patient just being an *******" and "these are the bits that we can say overlap, but don't really change the fact that an ******* is still an *******."

I've not processed any of this nearly enough to say anything smart about it, but if you'd have asked me if psychopaths were "bad" or "sick," I would have said "sick." Now I just say, "I don't understand the question." And that's a big difference, to me at least.

 

[OldPsychDoc]

I'd just like to throw one other twist at this question.
In my practice setting, I far more frequently encounter the victims of psychopaths than the perpetrators themselves.
In dealing with the wreckage of manipulative boyfriends, child molesters, abusive mothers and the like, I think that there is a sense of outrage which gets automatically switched on. It is counter-transferentially challenging at times to keep one's empathetic equilibrium while helping the depression, anxiety, PTSD, and resultant personality disorders that stem from this.

 

[PsyDGrrrl]

Sigh. It was the 'predatory mind' comment that did it.
If the psychopaths nature is such that he/she has a 'predatory mind'
And the tigers nature is such that he/she has a 'predatory mind'
And having a 'predatory mind' (and inability to empathize) is what is relevant for our attitude towards them then insofar as they are analogous our attitude towards them should be the same.

Am I losing it do ya think?

The difference between psychopaths and tigers is that tigers are able to form attachments/bonds with other tigers (i.e., their babies). Psychopaths are not.

 

[BabyPsychDoc]

I'd just like to throw one other twist at this question.
In my practice setting, I far more frequently encounter the victims of psychopaths than the perpetrators themselves.
In dealing with the wreckage of manipulative boyfriends, child molesters, abusive mothers and the like, I think that there is a sense of outrage which gets automatically switched on. It is counter-transferentially challenging at times to keep one's empathetic equilibrium while helping the depression, anxiety, PTSD, and resultant personality disorders that stem from this.

It helps me to think that those manipulative boyfriends, child molesters etc were once victims themselves. Their deeds may be outrageous, but the "perps" themselves deserve pity, too.

 

[nancysinatra]

Nah, you still got it

I find it a little interesting to consider my own development of thought towards psychopaths. At some point, in the liberal arts education, I think we all start seeing the locus of control to be well outside of the psychopath to some extent, and learn to not blame them for their horrific actions. We start asking the questions like "How can you kill someone and NOT be mentally ill." We declare them ill, blame a society that could nurture psychopathy, and order off the top of the wine menu at Olive Garden and listen to Arcade Fire.

But after enough socialization into the medical profession, we start making arbitrary distinctions that we become more and more comfortable with. We start making distinctions of "this is the mental illness" and "this is the patient just being an *******" and "these are the bits that we can say overlap, but don't really change the fact that an ******* is still an *******."

Am I the only person in America who's never been to an Olive Garden?

To me it seems like the tiger is predatory as a matter of survival, which we can all relate to on some level. Even medical students for example, are "predatory" in their own way, even if we do not eat each other. We don't think of each other's humanness when we are competing for good exam scores, for instance. The psychopath, on the other hand, is not being predatory in order to survive, or competing for limited resources. The psychopath is just perverted. What they're doing is totally unnecessary.

The Donner Party--wouldn't they be more comparable to the tiger? And people do have to struggle to comprehend the Donner Party's actions, but we don't think of them as psychopaths.

I agree that there are arbitrary distinctions we begin to make somewhere in medical school that erase the kindly categories of a liberal education with its sympathy for many forms of human weakness which it regards as illness. It starts early on, and happens throughout the training, not just in psych. For example, childhood leukemia is totally not seen as the fault of the patient or anyone around the patient, but adult diabetes is at least partially the fault of the patient, if not entirely, and alcoholism is associated with a large amount of "fault" and that fault can extend to people outside the immediate patient and include "enablers" as well.

As a med student, to the extent that we are exposed to things like antisocial personality disorder, my impression at least is that it veers toward the "fault" end of that spectrum rather than the non-fault end.

I don't know how I will view things myself once I've learned more and worked more with patients. At this point, I guess I wonder how much the medical training sets us up to see people a certain way?

I will certainly say that for me, the socialization is working at least a bit. I am less tolerant of what I read and hear about people doing than before I came to med school, but that could also be accounted for by things like age, personal experiences... And, if a good explanation for behavior comes along, and it happens to involve illness, that would be persuasive to me in a way that I wouldn't maybe have understood prior to med school.

 

[Faebinder]

About the actions themselves? No, not really. Behavior is a choice. Unless someone is totally psychotic, they have the power to choose their course of action and to determine right from wrong. This is true regardless of their genes and whatever past traumas they may have had. And there are plenty of people out there with the same genes and trauma histories who don't choose to do these things.

I think understanding someone's history allows us to understand what prompts certain behaviors. It can even allow us to have some measure of compassion for the perpetrators. But it never absolves them of the responsibility for their actions or bearing the consequences of said actions.

That's my $0.02, for what it's worth.

 

[whopper]

As much as one can debate that someone may be a victim of their environment (e.g. an abusive father etc), that legally does not absolve them from a crime.

Further, there is no black & white & irrefutable evidence that having a bad upbringing makes one a criminal to the point where they can be excused for their crimes.

And if one does want to use the bad environment/stressor theory, separating antisocial people who have committed crimes from the rest of society would work to stop the cycle of spreading further pain & misery.

There may be biological factors in play with psychopathology & ASPD (and I'm only talking about that, not Axis I disorders that meet the McNaughton Standard), however its an area that is not very well understood to the point where we can start making inferences on the order of excusing people for a crime.

If you want to start arguing these people do not have a choice, you're also treading on other troublesome legal grounds such as citing that they cannot assume responsibility for their actions, and thus may lose their rights as a citizen, and may have to have state imposed guardians.

It could also open the door to psychologists & psychiatrists being able to incarcerate people who have had certain risk factors for ASPD without actually have committed a crime.

That IMHO would be too much of a Big Brother society.

 

[Therapist4Chnge]

It could also open the door to psychologists & psychiatrists being able to incarcerate people who have had certain risk factors for ASPD without actually have committed a crime.

...which is not too far from, "Minority Report", and everyone's favorite actor T. Cruise.

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My view on criminals is unchanged, except in the cases of pedophiles. The recidivism rates and research coming out of this area suggests little to no success in the "treatment" of this population, which has strengthened my belief that chronic offenders should not be released back into society.

 

[PsyDGrrrl]

There may be biological factors in play with psychopathology & ASPD (and I'm only talking about that, not Axis I disorders that meet the McNaughton Standard), however its an area that is not very well understood to the point where we can start making inferences on the order of excusing people for a crime.....
It could also open the door to psychologists & psychiatrists being able to incarcerate people who have had certain risk factors for ASPD without actually have committed a crime.

But not all people with ASPD are psychopaths. I think that ASPD can be a product of an environment, rather than (just) genes, where as psychopathy is a much more biologically-loaded (and more difficult to "treat") disorder.

 

[ThinkTooMuch]

you know im suprised some of you needed medical school classes to make you aware of the humanity even criminals posses. not trying to be a dick, its just fascinating to me.

 

[whopper]

you know im suprised some of you needed medical school classes to make you aware of the humanity even criminals posses. not trying to be a dick, its just fascinating to me.

I don't think its so much the medical classes which for the most part involve memorizing histo slides, the Krebs cycle, and pics of bullets leaving tunnels in people's brains.