ENERGY
|
GAIN ENERGY
APPRENTICE
LEVEL1
|
THE
ENERGY BLOCKAGE REMOVAL
PROCESS
|
THE
KARMA CLEARING
PROCESS
APPRENTICE
LEVEL3
|
MASTERY
OF RELATIONSHIPS
TANTRA
APPRENTICE
LEVEL4
|
2005 AND 2006 |
THE MASK OF SANITYSection 4: Some questions still without adequate answersPart 2: What is wrong with these patients?67. Legal competency and criminal responsibility
|
67. Legal competency and criminal responsibility It has been mentioned that the psychopath does not often cooperate willingly in treatment over any considerable period of time and that he also seems to be remarkably free from the ordinary legal and penal restraints that prevent others from repeatedly carrying out antisocial activity. Questions of legal competency and criminal responsibility play a fundamental part in the efforts of society to cope with psychopaths. Let us consider these concepts more closely. The term competency in connection with our present problem is pertinent to questions of legal commitment, which is a procedure by which the psychiatric patient can, when necessary, be placed under treatment and appropriate restrictions even if this has to be done against his will and, if necessary, by force. Responsibility seems in many respects to be another aspect of the same thing. The incompetent person has been legally pronounced unable to look after his own affairs or make his own decisions about crucial matters. If a person is held to be legally responsible by a court, he is then considered to be culpable for any crime or other misdeed he may have committed and hence subject to legal penalties. Many assumptions, SOME QUESTIONS STILL WITHOUT ADEQUATE ANSWERS 421 some of them about matters on which few entirely agree, lurk in various degrees of disguise in the almost limitless implications of these terms. Probably most laymen, and perhaps some physicians, think of both incompetency and a lack of legal responsibility as identical with psychosis or insanity. As so helpfully pointed out by Davidson,68 this is incorrect, or at least incomplete and sometimes misleading. According to the law, Uncle John's will may be entirely valid, although he insisted for years that he talked with his dead grandmother and was diagnosed as having schizophrenia. Every psychiatrist knows people who hallucinate and are delusional but who should not be deprived of their liberty and sent against their will to institutions. A good example is offered in a 50-year-old woman who for fifteen years has carefully listened to a voice from her stomach which she "knows" is real and which often directs her. Advice given by the voice has on the whole been quite sensible and practical - never irrational! She has for a decade come at intervals to the outpatient clinic. So far as can be ascertained, her life has been undisturbing to others, and she has, with fair competency, carried out her own affairs. It is true, nevertheless, that nearly everywhere in the United States it is usually necessary for medical evidence to establish the presence of a "psychosis" and for the court to pronounce a patient "insane" before he can be committed or in any way handled therapeutically or prophylactically against his wishes. Mental deficiency, it is true, may also serve as a basis for such action, although it is sometimes the practice to say that the degree of deficiency is so great as to render the patient psychotic. There are those who will argue that nevertheless he does not have a "psychosis." The technicalities of procedure vary from state to state. Items redolent of necromancy, and in which the glow of witch fires is still reflected, are not uncommon in these doings. Until after publication of the first edition of this book, in my native state the patient was "charged, with being a lunatic." Most physicians and jurists would perhaps agree that for practical purposes incompetency, in the sense of making legal commitment advisable, indicates a disability (disorder or deficit) of such degree that the patient cannot be counted on to make a (normally) correct appraisal of his condition and (therefore) to choose what treatment or protection he needs. In considering the questions that arise concerning legal competency and responsibility, let us remember that the determination of competency, on which commitment depends, is usually carried out by a few selected experts-a lunacy commission. On the other hand, as Cumming so well emphasized, questions of responsibility on which terms of imprisonment or 422 THE MASK OF SANITY even the death penalty may depend are determined by a jury of twelve laymen.64 Usually when a person is legally adjudged incompetent, it is on the basis of his being psychotic. Sometimes, however, a person who is psychotic may be held legally responsible because he is considered as knowing the nature and quality of his criminal deed and that it is wrong. A case referred to by Guttmacher is illustrative. Let us quote from his interesting discussion:105 Spencer married a woman who had been raped about six years before. The man was found guilty of rape and was given a sentence of five years. They usually give longer sentences in Maryland, but he got five years. Spencer's wife, a very frail person, died without medical attention while this man was serving his penitentiary sentence. The cause of death was not determined, but Spencer was sure that her death was the result of the rape, which had occurred six years before, about three years before he had married her. The idea possessed him that his wife was not going to be able to rest in her grave unless she was really avenged, and he decided that it was his mission in life to right this great wrong. A few months after this man had been released from the penitentiary, Spencer went up to him and asked him to take a walk. They started walking down the road together, and Spencer was overheard by some people who passed to say, "You have been responsible for my wife's death. I hear voices at times telling me that I must kill you. Her spirit will never rest unless I carry out this request. I know that I am likely to hang for it and it's the wrong thing for me to do, but there is nothing else left for me to do." Whereupon he killed him. He pleaded insanity and the court, upheld by the court of appeals, ruled that he was not insane. The court of appeals said it was clear that the witness heard Spencer say that he was doing what he knew to be wrong and that he would be punished. That was all that the court needed to know in order to satisfy itself that he was a responsible agent. The patient discussed by Guttmacher, despite the hallucinations which would surely have caused most psychiatrists to call him psychotic, was regarded as "responsible" because of his own statement to the effect that it was wrong to commit murder. An important question must be asked. Just how much knowing of the quality and nature of the act, just how much and what sort of evaluation and emotional appreciation of it, is proved or indicated by such a statement from a man who is hallucinating? It is not unusual to find patients with schizophrenia who can pronounce correct verbal judgments about matters they fail to evaluate sanely or react to normally. Recently a man was examined who had almost succeeded in strangling his wife to death. He "knew" this act was wrong at the time, was not apparently angry with her, and was glad he had been prevented from killing her. He had felt influences "from within" which were more SOME QUESTIONS STILL WITHOUT ADEQUATE ANSWERS 423 effective in determining his decisions and acts than the impulse to avoid murder and to have his wife remain alive. This patient, who also had hallucinations and was obviously psychotic and schizophrenic, apparently did not attempt murder because of deficiency in the "intellectual" concept of right and wrong but probably because his personality was so altered that appreciation, the emotional significance, of the act was (otherwise) diminished or disordered. Another patient with schizophrenia may recognize his child, say that he loves his child, express all the correct attitudes "intellectually" about the situation, and still be so disordered in his responses that he will let the child drown or burn to death without making ordinary efforts to save him. In contrast with these, the psychotic paranoiac as he plans an assassination may be able to feel strong hate and destructiveness (to experience criminal intent) similar in degree and quality to that of the normal man. In the case discussed by Guttmacher, definite evidence of irrationality was demonstrable. But the contrary evidence of a localized rationality at the crucial point of being able to express an opinion that to kill the man was wrong was accepted as proof that he knew the nature and quality of the act. It might be said that here we have a "lesion of the intellect" demonstrated, but the lesion was not demonstrated to be in such a place as to prevent the man from making the rational statement about his deed. Though competency and responsibility often seem to be two aspects of the same question in legal matters, there may be good grounds for sometimes considering them separately. Early in my experience with psychopaths I was struck with the idea that much might be gained if they could be considered psychotic. With the first edition of this book, in 1941, I expressed this opinion. I was led into this position by repeatedly observing how little a fully developed psychopath succeeds in leading a normal or acceptable life, and how badly needed was some means to control his antisocial and selfdefeating proclivities. I was not really thinking about responsibility from the other point of view; that is to say about whether or not the person should be regarded as guiltless of crimes and other antisocial activities. For many years I have consistently tried to emphasize my strong conviction that psychopaths should not be regarded as psychotic in the sense of being "innocent because of insanity" of the wrongs they do. I still feel as strongly as ever that the psychopath's defect constitutes a major disability for normal participation in human affairs, but I am convinced that I made a great mistake in expressing myself in such a way as to give the impression I believed he should be regarded as blameless, or not legally responsible for his misconduct. Despite traditional concepts and 424 THE MASK OF SANITY confusions, can we not conceive of a defect that seriously incapacitates and calls for restraining measures, without assuming that this defect necessarily absolves the subject from culpability and penalties of the law? Whatever in the psychotic patient there is that may render him not responsible, or less than normally responsible, for crime, cannot, in my opinion, be found in the psychopath's defect. Many psychiatrists and jurists have protested over many decades against the M'Naghten Rules and have insisted that judgment should be made not on cognition (knowing) alone but that other aspects of the personality should be considered. In response to this criticism, the concept of "irresistible impulse," an alleged abnormality of the will, was advocated years ago and was adopted as law in some parts of the United States. This theory of "irresistible impulse" so often advanced by the defense in questions of criminal responsibility deserves a brief discussion. As traditionally interpreted, the M'Naghten Rules obviously center examination on an assumed intellectual faculty.108 The concept of a pathologic and genuinely irresistible impulse attempts to center it on another assumed and discrete faculty, a hypothetical will. Quoting again from Guttmacher: 105 Seventeen of our states … [in 1948] recognize that it is not only a question of whether a man knows that what he is doing is wrong, but [also] whether his will power is sufficiently undermined by mental disorder that he cannot adhere to the right, in which case he is not considered a responsible agent. Hall expressed the belief that even where the irresistible impulse test was recognized in theory, it was not often respected in practice.108 Nothing could be more obvious than the follies that may arise when an attempt is made to localize illness in a hypothetical volition dismembered from the integrate of human functioning. Arguments as to whether an impulse is pathologically strong or whether what resists it is pathologically weak soon become little more practical or more enlightening than arguments about priority between the hen and the egg. As Hall points out, it has been said that if legal questions are determined on such a basis "you will soon make irresistible an impulse which now is resistible and resisted because of penal law."108 A prominent psychiatrist is quoted as saying:108 From a psychological point of view, the impulse could not have been resistible, since the act was carried out in accordance with the impulse. It is difficult for me to conceive of an impulse which is resistible but not resisted. Attempts to apply the M'Naghten Rules to a concept of faculty psychology vividly illustrate the weaknesses of faculty psychology. Attempts, within the confining framework of its assumptions, to examine not only an SOME QUESTIONS STILL WITHOUT ADEQUATE ANSWERS 425 intellect but also a will are unlikely to be helpful since in neither pursuit can we encounter a reality of experience but must continue to deal with only verbal abstractions. Many psychiatrists over several decades have been extremely bitter in their criticism, and sometimes in their ridicule, of the M'Naghten Rules which for over a hundred years constituted the chief legal guide in determining criminal responsibility. As given by Hall, the essential points of the M'Naghten Rules lie in this statement:108 To establish a defense on the grounds of insanity, it must be clearly proved that at the time of the committing of the act the party accused was labouring under such a defect of reason from disease of the mind as not to know the nature and quality of the act he was doing or, if he did know it, that he did not know he was doing what was wrong. Some of this criticism of the traditional rules has apparently been based on the wish by expert witnesses to express the opinion in psychiatric terms rather than in those familiar to the law and to laymen. Violent denunciation of the rules has also apparently been related to the concept of psychic determinism so vigorously espoused by Freud and very popular among psychiatrists for several decades. This doctrine is regarded by many as one of Freud's most important discoveries and as a foundation stone of dynamic psychiatry.190 Although it is often assumed to be a fact established by psychoanalytic research, we may note that Freud and all his followers have produced no scientific evidence whatsoever to support it. It remains purely an assumption. A truly logical conclusion from psychic determinism would, of course, abolish the concept of personal responsibility altogether and along with it the basis of law and all the value judgments that underlie ethical conduct and even rudimentary civilization. Let us bear in mind, however, that those who profess allegiance to the doctrine almost never follow it to the inevitable conclusions it logically demands. There are many, nevertheless, who respond to its influence sufficiently to arrive at peculiar and interesting assumptions. Some of these are now popularly regarded as the essence of a liberal and scientifically enlightened mind. Going part of the logical way, but not all the way, they conclude that when crimes are committed, it is never the fault (responsibility) of the criminal but, inevitably, the fault of society.57 Zilboorg, one of those who vigorously criticized the law, and the M'Naghten Rules especially, had this to say:301 When they all individually and jointly [judges, lawyers, and jury] ask me whether the defendant in the dock is in my opinion insane, I 426 THE MASK OF SANITY must candidly state, if I am to remain true to my professional knowledge and faithful to my oath, first, that I do not understand the question, and, second, that since I don't understand the question, I do not know whether the defendant is insane or not. I admit the situation is embarrassing and puzzling to all concerned, but it is beyond my knowledge and power to remedy or alleviate it. Continuing a discussion of what he considered to be the basic differences between medical man and jurist, Zilboorg goes on to say:301 We have reached a rather disquieting parting of the ways. This is undesirable from both your [the jurist's] point of view and mine. Your rules are unintelligible to me, and my inability to follow them is unintelligible to you. It is a matter of no little importance that joint action be continued, that every effort at cooperation be made to fit our social instrumentalities to the needs of the patient. It is important that new knowledge and understanding be used in these efforts. It is doubtful, as Hall points out, that the substitution of psychiatric terminology for the legal phrases would be of much practical or immediate help. To quote from Hall again: 108 Imagine that, instead of a judge's instructions in terms of prevailing rules he said "... essential to the psychopathic personality may be a defective organization of the autotely ... and unsatisfactory adjustment of the heterotely." ... If, instead of "knowledge" or "understanding," "control," or "act," the language of the law ran in terms of id, ego, and super-ego, the psychiatrists would understand, but would many lay persons be much enlightened even after they were informed that the "id" is the "true unconscious," that the "ego" is that part of the mind that is "regulated by the reality principle," and that the "super-ego" is a sort of inner monitor synonymous with conscience? It seems likely that Hall's suggestions offer more hope for common understanding and for effective action (the need for such action is particularly urgent and obvious so far as psychopaths are concerned.) He suggests that concepts generally agreed upon in psychiatry be utilized to "implement the M'Naghten Rules."108 It is doubtful if any psychiatrist today conceives of personality function only in the abstractions of faculty psychology. The human being as we know him is integrated. We do not find him "thinking" without also "feeling." We do not observe acts of volition altogether free of emotion. Continuing, Hall clarifies the very point on which he feels agreement may be reached and which intelligent action may follow: 108 This view of the participation of the rational functions, including evaluation, does not imply any depreciation of the role of the instincts in normal conduct. For consistently with this theory, one asserts the fusion of various aspects of the self. This means that moral judgment SOME QUESTIONS STILL WITHOUT ADEQUATE ANSWERS 427 ("knowledge of right and wrong") is not reified as an outside, icy spectator of a moving self; on the contrary, the corollary is that value judgments are permeated with the color and warmth of emotion, as is evidenced by the usual attitudes of approval that coalesce with right decisions. Indeed all action, especially that relevant to the penal law, involves a unified operation of the personality.... The M'Naghten Rules provide an analytical device for dissecting this action. If these rules can be thus used by the jurist, it seems obvious that as psychiatrists we can venture honest and sensible opinions on whatever evidence of medical impairment we find that may alter such a "knowing." When no longer dismembered and falsified in two-dimensional aspect but considered in all that we sometimes imply by "appreciation," "realization," "normal evaluation," "adequate feeling," "significant and appropriate experiencing," the term does not restrict us solely to a discussion of the patient's reasoning abilities in the abstract. In very impressive and helpful studies over a period of many years, Hall108-112 has brought out from the viewpoint of our legal coworkers in this area facts, appraisals, and suggestions which I feel can enable us to deal honestly and more effectively with questions of legal responsibility and competency. He has also politely but convincingly demonstrated some of the confusion contributed by us as psychiatrists to important issues. Interestingly enough, Hall demonstrates in our own psychiatric writings examples of the very dogmatism, the archaic and unrealistic approaches, and the adherence to dubious theory at the expense of vital fact which we have so readily ascribed to the law and its interpreters and so vigorously denounced. If the jurist and the psychiatrist would approach our problem from the viewpoint expressed by Hall, it seems to me that much nonsense and tragedy could be avoided. After referring to typical arguments between those who argue for "reason" as a criterion and those who in contradiction emphasize "will," he says: 108 Opposed to these views and avoiding their particularistic fallacies is the theory of the integration of the self.... In terms of this theory any interaction with the environment is integrated in the sense that the various functions of personality coalesce and act as a unit. Although it is useful to distinguish the important "modes" or attributes of such action, the various functions are not actually separate. On the contrary, the affective, the cognitive, and the conative functions as well as all others interpenetrate one another. Thinking (knowing, understanding) e.g., fuses with tendencies to action and it is permeated also in varying degrees by the warmth of the emotions.... Hence it is arbitrary and formalistic to assert that the psychotic's rational functions, including his knowledge of right and wrong, are unimpaired. 428 THE MASK OF SANITY There is only a certain awareness, a bare calculation unsupported by the strong pillar of sensitivity that, in normal adults, effects identification with a prospective victim or stimulates a vivid imagining of other consequences of the intended behavior; in short, the Psychotic's conduct is unaccompanied by actual understanding of the moral significance of his action. Many of these quotations illustrating arguments over the M'Naghten Rules and claims made by some psychiatrists that we are in a position to bring truly scientific knowledge to bear on crucial problems, still dealt with by antiquated methods, are from articles published over the last ten or twenty years. They are retained in the current edition of this book because I believe they are still pertinent to problems that have not yet (1975) been satisfactorily settled. Despite the excellent points made by Hall, vigorous criticism of the law and particularly of the M'Naghten Rules has continued over the decades, chiefly from psychiatrists but also from jurists. Many of those who have expressed such bitter dissatisfaction with the M'Naghten Rules welcomed the Durham Rule as a tremendous and triumphant step forward. This rule pronounced by Judge Bazelon in 1954 is to the effect that a defendant must not be held criminally responsible "if his unlawful act was the product of mental disease or mental defect."111 Speaking of the Durham Rule, Fortas has said, Its importance is that it is a charter - a Bill of Rights for psychiatry."83 Judge Bazelon received official honors and a certificate of commendation from the American Psychiatric Association. Along with many psychiatrists, prominent legal scholars have enthusiastically expressed the conviction that "science," "scientific facts," and "the latest knowledge of human behavior" have made the M'Naghten Rules obsolete. They apparently assume that all this alleged psychiatric enlightenment can now be freely applied to legal problems. On the other hand, Hall and some other critics have expressed fear that the Durham Rule might lead to the destruction of our jury system in criminal trials and turn over questions of guilt and responsibility to narrow experts who, however adequately trained in their limited field, may not really qualify as all-knowing judges on such questions and all that they involve. Hall110 and Cumming64 express the fear that various unproved and widely differing theories might be utilized by psychiatric witnesses to make arbitrary and absolute judgments that would have little relation to scientific fact. They also develop arguments that illustrate the danger of leaving such complex value judgments on such imponderables as the judgment of criminal responsibility solely to any experts known today. Although it is maintained by some that psychiatrists now have a scientific method of arriving SOME QUESTIONS STILL WITHOUT ADEQUATE ANSWERS 429 at such a decision, the points made by Hall and Cumming raise grave doubts about this assumption and suggest that this is an area not yet proved accessible to methods that are genuinely scientific. Forcing the methods of science, or a caricature of these methods, into areas which science is not now equipped to deal with does not endow judgments in these areas with validity, whatever words we may use to state the case. This specious and misleading practice has sometimes been called scientism.57 It is interesting to note that in 1907 Grasset99 brought forth under the term "physiological responsibility" a concept very similar to that embodied in the Durham Rule. Grasset advocated that the judgment of responsibility be made merely on whether or not the capability of the organism is impaired. In this old concept he avoids decisions about free will versus determinism. He also refuses to confine his inquiry to disparate conceptual abstractions such as "knowing," feeling," or "will." Instead he keeps his attention on the integrated reality of human functioning. It has been customary over the decades for lunacy commissions to pronounce psychopaths competent and for juries to pronounce them sane and responsible. It is in the concept of competency that we meet our primary problems when we attempt to provide any improvement in methods of dealing with the psychopath. It is difficult to examine the most important aspects of competency, however, without becoming entangled with essential implications of legal responsibility. If we attempt to make pronouncements about responsibility, we are likely, unless we take particular care to signify what we are talking about, to find ourselves submerged in metaphysics and attempting solutions of ultimate philosophic and religious problems. However important or transcendent these problems may be and however we may solve them for ourselves, we are not, as psychiatrists, qualified to solve them as experts. We are, let us say, not competent to serve in such a role nor are we responsible. In approaching questions of competency in the psychopath, it is plain that he shows no defect in theoretical reasoning and that he lacks all the outer or peripheral manifestations of psychosis and usually even of minor psychiatric disorder. If, however, we consider the record of his actual performance, we nearly always find ample evidence to say that he is socially incompetent in the sense that he cannot carry out a sane plan of life or avoid repeated antisocial acts and other acts seriously damaging to himself. McDougall long ago expressed a succinct and practical opinion on the essential question of competency: 192 In practice the criterion adopted is: Can the patient be trusted to look after his affairs without undue risk to himself and others? And there is no other criterion. 430 THE MASK OF SANITY As the reader must, I believe, agree, this sensible criterion, although regularly applied to any patient who has ever shown a delusion or a hallucination, is not in practice applied to those who lack these and some other traditionally accepted signs of "a lesion of the intelligence." If this criterion should be applied to psychopaths, it would be much less difficult to commit them and keep them under satisfactory control. Karl Menninger, also, in referring primarily to questions of liability for punishment, has made a point that should be helpful if we apply it to the commitment of patients who are not charged with crime. "The psychiatrist," he says, "asks not 'Is that man responsible?’ but 'Of what is he capable or incapable?' "210 Despite the cogency of this position, it is not the common practice of psychiatrists, if the patient is diagnosed as psychopathic personality, to ask themselves such a question. Or, if they ask it, they arrive at a strange answer, and by extraordinary methods. In estimating competency in most matters, intelligence as manifested in verbal reasoning carries a good deal of weight, but few who survive as adults continue to make the estimate entirely on this basis. Judgment is often spoken of as a matter somewhat different from and far more complicated than intelligence and is in general regarded as better demonstrated in behavior than in talk. In the old Stanford-Binet psychometric test we find the question, "Is it better to judge a man by his actions or by his words?" The normal 10-year-old child is supposed to answer this correctly. What disturbing thoughts may arise from this apply, I believe, as accurately to us in our role as psychiatrists as to legal authorities. Despite the widespread and sometimes bitter disagreement among psychiatrists and at times among legal scholars, most patients with psychosis who need treatment and who need restraint can be legally committed and controlled. Although many psychopaths are, in my opinion, far more disabled than a large proportion of committed psychotic patients and in far greater need of control, it is very difficult to have such a patient committed. Before any important step toward solving the problems created by psychopaths can be taken, some legal means of controlling their antisocial, heedless, self-damaging, and irresponsible behavior must be devised. If the Durham Rule devised by judge Bazelon is followed, the question of competency in the psychopath would depend chiefly on whether his abnormality is correctly defined as a "mental disease or mental defect." It has long been customary in psychiatry and law to distinguish sharply between this abnormality and all the conditions to which the terms "mental disease" or "mental defect" are applied. Few psychiatrists could doubt that crimes committed by a psychopath are the product of his aberration. The SOME QUESTIONS STILL WITHOUT ADEQUATE ANSWERS 431 psychiatrist-witness's opinion would, inevitably it seems, depend on whether or not he classified this aberration as "mental." This decision, it seems to me, would in turn substantially depend on whether or not this term is limited in its meaning to an assumed disparate faculty of cognition. Thus, as far as the psychopath is concerned, it would appear that the psychiatrist in court is faced with essentially the same decision, whether he testifies under the M'Naghten Rules or the Durham Rule. Either may be interpreted narrowly and confined to mere cognition or more broadly, as Jerome Hall108 suggests that the M'Naghten Rules be interpreted. Decisions based on the M'Naghten Rules depend on the interpretation of the word "know," and with the Durham Rules on the interpretation of "mental disease or defect." It is hardly conceivable to me that a psychiatrist would arrive at anything but the same conclusion by either test in his opinion about a psychopath. Hopes at first were high that the Durham Rule would free psychiatrists from archaic legal restrictions and allow them to bring truly scientific knowledge to bear in court on questions of competency and responsibility.57,83 With the passage of time this enthusiasm has waned. The scientific knowledge to deal so well with these problems claimed so confidently by some psychiatrists seems not to have proved effective. In a 1974 issue of The American Journal of Psychiatry, Judge Bazelon, himself, expresses, in an article with the interesting title "The Perils of Wizardry,"20 what I believe is a disappointment similar to my own in the prospects of his widely acclaimed rule enabling psychiatrists to bring a new and scientific solution to the old problems. I fear that many psychiatrists overestimated what we have to offer. Let us quote:20 The experiment undertaken by my court in its 1954 decision in Durham v. United States* is a real lesson in regard to the role of psychiatrists in insanity defense. That case involved the formulation of a new test of criminal responsibility. It held that an accused person is not criminally responsible if his unlawful act was the product of a mental disease or defect. The purpose of this decision was to grant the psychiatrist his 100-year-old request to be allowed to tell what he knows and, just as importantly, what he does not know about the phenomenon of human behavior rather than face demands for conclusion resting on ethical, moral, and legal considerations beyond his expertise. The purpose of the Durham decision was not fulfilled. Psychiatrists continued adamantly to cling to conclusory labels without explaining the origin, development, or manifestations of a disease in terms meaningful to a jury. The jury was confronted with a welter of confusing terms such as personality defect, sociopathy, and personality disorder. What became more and more apparent was that these terms did not * Durham v. United States, 214 F 2nd 862, D.C. Cir., 1954. 432 THE MASK OF SANITY rest on disciplined investigation based on facts and reasoning, as was required for the fulfillment of the Durham decision. I regret to say that they were largely used to cover up a lack of relevance, knowledge, and certainty in the practice of institutional psychiatry. I am frequently asked, "Why don't you talk about what's wrong with courts and lawyers?" I have written countless opinions and articles and have delivered several "Bazelon jeremiads" about the problems in the practice of law before lawyers and judges. But here I am concerned with the culpability of psychiatrists in the failure to achieve the purpose of the Durham decision. First of all, psychiatrists did not acknowledge the limits of their expertise. Secondly, they failed to confront honestly and openly the conflicts that impaired their competence even when their expertise was sufficient and relevant.... I warned behavioral scientists not to fall into the same trap as described in The Wizard of Oz. In that Frank Baum classic, Dorothy and her companions followed the yellow brick road to find the Wizard of Oz, who lived in the Emerald City. They believed the wizard could give the tinman a heart, the lion some courage, and the scarecrow a brain. When they finally arrived, they discovered that the wizard was without expertise, a fake. In 1970 I commended the behavioral scientists for caring about people in distress but warned them of the dangers in playing wizard to the problems of society for which they had no expertise. The issue was not whether the behavioral scientists were good, but what they were good at. Despite some very important achievements in the last half-century, psychiatry does not today, in my opinion, possess newly discovered and well-established facts which afford a scientific answer to the ultimate questions that for so long have arisen and caused confusion in determining responsibility.57 Whatever rule is followed, when efforts to control the antisocial and self-destructive activities of a psychopath are being made, the verdict will probably depend on whether the estimation of his legal competency is based on outer appearance and the peripheral mechanisms of function or on his amply demonstrated incapacity to lead an adequate or socially acceptable life because of the serious inner pathology that only emerges in his actual- performance as a member of the social group. Many believe that the New Penal Code which seems to have supplanted the Durham Rule in most jurisdictions is a better rule than that of Durham or of M'Naghten. Even with this New Penal Code the interpretation of the terms mental disease and mental defect is likely to vary among psychiatrists and continue to cause difficulty in judgments about the psychopath. |
Energy Enhancement Enlightened Texts Psychopath The Mask Of Sanity
Section 4, Part 2
|