Chapter 15 Abnormal Psychology and the Law

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1 Chapter 15 Abnormal Psychology and the Law
ABNORMAL PSYCHOLOGY IN A CHANGING WORLD, NINTH EDITION Jeffrey S. Nevid/ Spencer A. Rathus/ Beverly Greene Chapter 15 Abnormal Psychology and the Law © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

2 Psychiatric Commitment and Patients’ Rights
Civil commitment – The legal process of placing a person in a mental institution, even against his or her will. Criminal commitment – The legal process of confining a person found not guilty by reason of insanity in a mental institution. Civil commitment in a psychiatric hospital usually requires that a relative or professional file a petition with the court, which empowers psychiatric examiners to evaluate the person. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

3 Predicting Dangerousness
Mental health professionals tend to over predict dangerousness—that is, to label many individuals as dangerous when they are not. Clinicians tend to err on the side of caution in predicting the potential for dangerous behavior, perhaps because they believe that failure to predict violence may have more serious consequences than overprediction. Overprediction of dangerousness does deprive many people of liberty. According to Szasz and other critics of the practice of psychiatric commitment, the commitment of the many to prevent the violence of the few is a form of preventive detention that violates basic constitutional principles. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

4 Predicting Dangerousness (Continued)
Should mental health professionals or school administrators have recognized signs of impending violence by Seung-Hui Cho, the man who went on a killing rampage at Virginia Tech in 2007? It is always easier after the fact to piece together fragments of a person’s prior behaviors as signs of impending violent behavior. Predicting a violent act before it occurs is a much more difficult task, however, even for professionals. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

5 The Post Hoc Problem Recognizing violent tendencies after a violent incident occurs (post hoc) is easier than predicting it beforehand. It is often said that hindsight is 20/20. Like Monday morning quarterbacking, it is easier to piece together fragments of people’s prior behaviors as evidence of violent tendencies after they have committed acts of violence. Predicting a violent act before the fact is a more difficult task, however. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

6 The Problem in Leaping from the General to the Specific
Generalized perceptions of violent tendencies may not predict specific acts of violence. Most people who have “general tendencies” toward violence never act on them. Nor is a diagnosis associated with aggressive or dangerous behavior, such as antisocial personality disorder, a sufficient basis for predicting specific violent acts in individuals. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

7 Problems in Defining Dangerousness
One difficulty in predicting dangerousness is the lack of agreement over what types of behavior are violent or dangerous. Most people would agree that crimes such as murder, rape, and assault are acts of violence. For example, driving recklessly, harshly criticizing one’s spouse or children, destroying property, selling drugs, shoving into people at a tavern, or stealing cars—as violent or dangerous. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

8 Base-Rate Problems The relative difficulty of making predictions about infrequent or rare events is known as the base-rate problem. If the suicide rate in a given year has a low base rate of about 1% of a clinical population, the likelihood of accurately predicting that any given person in this population will commit suicide is very small. You would be correct 99% of the time if you predicted that any given individual in this population would not commit suicide in a given year. But if you predicted the nonoccurrence of suicide in every case, you would fail to predict the relatively few cases in which suicide does occur, even though virtually all your predictions would likely be correct. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

9 The Unlikelihood of Disclosure of Direct Threats of Violence
The client in therapy is not likely to inform a therapist of a clear threat, such as “I’m going to kill _____ next Wednesday morning.” Threats are more likely to be vague and nonspecific, as in “I’m so sick of _____; I could kill her,” or “I swear he’s driving me to murder.” In such cases, therapists must infer dangerousness from hostile gestures and veiled threats. Vague, indirect threats of violence are less-reliable indicators of dangerousness than specific, direct threats. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

10 The Difficulty of Predicting Behavior in the Community from Behavior in the Hospital
Mental health professionals fall well short of the mark when making long-term predictions of dangerousness. They are often wrong when predicting whether patients will become dangerous following release from the hospital. One reason is that they often base their predictions on patients’ behavior in the hospital. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

11 Violence and Mental Disorders
Research evidence shows that mental illness is at best a weak predictor of violent behavior. Only a small minority of people with mental disorders commit violent crimes. Hence, we need to identify factors to help us better appraise the risk of violence. The general public’s perception of the mentally ill as dangerous is exaggerated by the media. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

12 Mental Health and the Law
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13 What are the rights of mental patients?
Popular books and films, such as One Flew Over the Cuckoo’s Nest, starring Jack Nicholson, have highlighted many of the abuses in mental hospitals. In recent years, a tightening of standards of care and the adoption of legal safeguards have led to better protection of the rights of patients in mental hospitals. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

14 Patients’ Rights Do involuntarily committed patients have the right to receive or demand treatment? Or can society just warehouse them in psychiatric facilities indefinitely without treating them? Consider the opposite side of the coin as well: May people who are involuntarily committed refuse treatment? Such issues—which have been brought into public light by landmark court cases—fall under the umbrella of patients’ rights. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

15 Right to Treatment Not until the 1972 landmark federal court case of Wyatt v. Stickney, however, did a federal court establish a minimum standard of care to be provided by hospitals. The case was a class action suit against Stickney, the commissioner of mental health for the State of Alabama, brought on behalf of Ricky Wyatt, a mentally retarded young man, and other patients at a state hospital and school in Tuscaloosa. The federal district court in Alabama held both that the hospital had failed to provide treatment to Wyatt and others and that living conditions at the hospital were inadequate and dehumanizing. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

16 Right to Treatment The case of Wyatt v. Stickney established certain patient rights, including the right not to be required to perform work that is performed for the sake of maintaining the facility. The court held that mental hospitals must, at a minimum, provide the following: 1. A humane psychological and physical environment, 2. Qualified staff in numbers sufficient to administer adequate treatment, and 3. Individualized treatment plans (Wyatt v. Stickney, 1972). © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

17 © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

18 O’Connor v. Donaldson Donaldson, a former patient at a state hospital in Florida, sued two hospital doctors on the grounds that he had been involuntarily confined without receiving treatment for 14 years, despite the fact that he posed no serious threat to himself or others. Donaldson had been originally committed on the basis of a petition filed by his father, who had perceived him as delusional. Despite the fact that Donaldson received no treatment during his confinement and was denied grounds privileges and occupational training, his repeated requests for discharge were denied. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

19 O’Connor v. Donaldson He was finally released when he threatened to sue the hospital. Once discharged, Donaldson did sue his doctors and was awarded damages of $38,500 from O’Connor, the superintendent of the hospital. The case was eventually argued before the U.S. Supreme Court. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

20 Youngberg v. Romero Nicholas Romeo, a 33-year-old man with profound retardation who was unable to talk or care for himself, had been institutionalized in a state hospital and school in Pennsylvania. While in the state facility, he had a history of injuring himself through his violent behavior and was often kept in restraints. The case was brought by the patient’s mother, who alleged that the hospital was negligent in not preventing his injuries and in routinely using physical restraints for prolonged periods while not providing adequate treatment. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

21 Youngberg v. Romero The Supreme Court ruled that involuntary committed patients, such as Nicholas, have a right to be confined in less-restrictive conditioning. The ruling also included a limited recognition of the committed patient’s right to treatment. The court held because, “there’s no reason to think judges or juries are better qualified than appropriate professionals in making such decisions.”

22 The Duty to Warn One of the most difficult dilemmas a therapist faces is whether to disclose confidential information that may protect third parties from harm. These difficulties are represented by: (a) whether or not a client has made a bona fide threat (b) information a client discloses in psychotherapy is generally protected as privileged communication (c) A 1976 court ruling in the case of Tarasoff v. the Regents of the University of California established the legal basis for the therapist’s duty to warn (Jones, 2003). © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

23 Right to Refuse Treatment
The rights of committed patients to refuse psychotropic medications was tested in a 1979 case, Rogers v. Okin, in which a Massachusetts federal district court imposed an injunction on a Boston state hospital prohibiting the forced medication of patients except in emergency situations. The court ruled that committed patients could not be forcibly medicated, except in the case of emergency—for example, when patients’ behaviors posed a significant threat to themselves or others. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

24 The Insanity Defense Insanity defense – A legal defense in which a defendant in a criminal case pleads not guilty on the basis of insanity. In the aftermath of the Hinckley verdict, the federal government and many states changed their statutes to shift the burden of proof to the defense to prove insanity. Even the American Psychiatric Association went on record as stating that psychiatric expert witnesses should not be called on to render opinions about whether defendants can control their behavior. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

25 Legal Bases of the Insanity Defense
The first was an 1834 case in Ohio that was ruled that people could not be held responsible if they are compelled to commit criminal actions because of impulses they are unable to resist. The second major legal test of the insanity defense is referred to as the M’Naghten rule, based on a case in England in 1843 of a Scotsman, Daniel M’Naghten, who had intended to assassinate the prime minister of England, Sir Robert Peel. The third major case that helped lay the foundation for the modern insanity defense was Durham v. United States in 1954. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

26 Legal Bases of the Insanity Defense
By 1972, the Durham rule was replaced in many jurisdictions by legal guidelines formulated by the American Law Institute (ALI) to define the legal basis of insanity (Van Susteren, 2002). These guidelines, which essentially combine the M’Naghten principle with the irresistible impulse principle, include the following provisions: A person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of law. the terms “mental disease or defect” do not include an abnormality manifested only by repeated criminal or otherwise antisocial conduct. (American Law Institute, 1962, p. 66) © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

27 Determining the Length of Criminal Commitment
The issue of determinate versus indeterminate commitment was addressed in the case of Michael Jones (Jones v. United States), who was arrested in 1975 and charged with petty larceny for attempting to steal a jacket from a Washington, D.C., department store. Jones was first committed to a public mental hospital, St. Elizabeth’s Hospital (the same hospital where John Hinckley remains committed as of this writing). Jones was diagnosed as suffering from paranoid schizophrenia and was kept hospitalized until he was judged competent to stand trial, about 6 months later. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

28 Determining the Length of Criminal Commitment
Jones offered a plea of not guilty by reason of insanity, which the court accepted without challenge, remanding him to St. Elizabeth’s. Despite the fact that Jones’s crime carried a maximum sentence of 1 year in prison, Jones’s repeated attempts to obtain release were denied in subsequent court hearings. The U.S. Supreme Court eventually heard his appeal 7 years after Jones was hospitalized and reached its decision in 1983. It ruled against Jones’s appeal and affirmed the decision of the lower courts that he was to remain in the hospital. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

29 Perspectives on the Insanity Defense
Thomas Szasz and others who deny the existence of mental illness have raised another challenge to the insanity defense. If mental illness does not exist, then the insanity defense becomes groundless. Szasz argues that the insanity defense is ultimately degrading because it strips people of personal responsibility for their behavior. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

30 Competency to Stand Trial
Competency to stand trial – The ability of criminal defendants to understand the charges and proceedings brought against them and to participate in their own defense. Far more people are confined to mental institutions on the basis of a determination that they lack the mental competence to stand trial than on the basis of the insanity verdict. People who are declared incompetent to stand trial are generally confined to a mental institution until they deemed competent or until it is determined that they are unlikely to regain competency. © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.

31 The End © 2014, 2011, 2008 by Pearson Education, Inc. All rights reserved.