Recently in Mental State Category

Language is used to express thought, but sometimes the terms we use get in the way of proper analysis of the situation. One situation so impaired is discussion of "the homeless." Use of a single term for everyone without a permanent residence tends to obscure the fact that different people are in that situation for very different reasons, and different causes call for different solutions.  There are at least three subgroups, sometimes called the "have nots," the "cannots," and the "will nots."

C.W. Nevius has this sad story in the SF Chron on one of the "cannots." For this subgroup, homelessness is just one facet of what is fundamentally a mental health issue.

As mentioned previously, there's intense interest among mental health researches about the relationship between marijuana use and mental illness.  Several past studies have suggested a link between marijuana use and risk of psychosis, but untangling the relationship has been tricky.  On the one hand, lots of people use marijuana and don't develop major mental illnesses like schizophrenia.  So, perhaps the relationship is just happenstance.  Yet other research suggests that for some, marijuana really can worsen existing mental illness and perhaps trigger episodes of psychosis for those with family histories of schizophrenia and psychotic illnesses.  After all, marijuana is a powerful psychoactive drug. 

Maia Szalavitz has a well-balanced article in July 21st issue of Time magazine which includes this assessment:

That marijuana can have such incompatible effects in schizophrenia patients -- enhancing mood while exacerbating hallucinations and delusions -- is not surprising, when its chemical makeup is considered. One chemical called delta-9 tetrahydocannabinol (THC) is known to cause hallucinations and in high doses can even make healthy people feel paranoid or suffer brief attacks of psychosis. But another component of marijuana called cannabidiol (CBD) has anti-psychotic effects.

Indeed, there's much we don't know about marijuana and the various chemicals it contains likely have a variety of effects depending on dose and the individual user.  That the human body contains its own endocannabinoid system suggests that legitimate medicinal purposes are likely, but that in no way means that it's harmless. 

Remy Melinda at Live Science has an article on the diagnosis of Intermittent Explosive Disorder (IED) which features this quote from Professor Emil F. Coccaro of the University of Chicago:

IED is a behavioral disorder that is a medical condition in the same way that depression or panic disorder is -- it is not simply 'bad behavior,'" said Emil F. Coccaro, a professor of psychiatry and behavioral neuroscience at the University of Chicago. "Aggressive behavior is under genetic influence and IED runs in families.

All behavior is under the influence of genes, that's what it means to say that we are biological creatures.  But just because some defined behavior is under genetic influence does not mean it's pathological in any medical sense.  After all, some folks are impatient at red lights and drive too fast, but they do not need medical intervention any more so than those who experience displeasure at waiting in line at the bank.  No, these folks need to learn what every parent teaches a child: patience is a virtue."

Now some may argue that the very idea of IED is that the behavior is so out of the ordinary that it must be pathological: that we're not talking about tempestuous drivers but those who exhibit behavior that is so disproportionate to the circumstances that it's, well, pathological.  But, of course, this doesn't help because the marker between conduct that is unwise and pathological cannot be merely that it's pathological.

The real lure of IED is the idea that it involves impaired volition - an irresistible impulse.  And linking it to genetic influences simply furthers the notion that folks with immodest tempers simply can't help themselves because of their biology.  It's the new biological predestination which strongly implies that we can't blame people for their conduct because their genes (or brains) made them do it.  But our brains (and genes) are us.   

Psychiatrist Jeffery Schwartz from UCLA has this interesting analysis:

[T]his vast output of neuroscience research over the last many years is largely a waste of money. Why? Because it doesn't really have any real world human application. Neuroscience is increasingly looking like a passing fad - at least in its current version. Until it changes to a form in which conscious attention has physiologic effects or has a dynamic causal role in how the brain functions, all this research is basically not applicable to anything that's particularly useful, and so the whole thing has been a gargantuan waste of money.

Schwartz is right insofar as so much of current neuroscience research operates under the assumption that the brain operates independently of the person; that the "user" is just along for the ride.  Or as was wisely said many years ago:

It is well known that there are many depraved persons who, by continued indulgence in vice and crime, have so debased and debauched their moral sense and blunted their susceptibilities that the 'still small voice' of conscience no longer responds to the dictates of human or divine law, and fails to utter warning against the impulse of greed or passion.

Hat tip: Brains on Purpose

NPR is doing a series on psychopathy and responsibility.  The series is a timely one given the growing interest in the field of neurolaw and those who argue that psychopaths should be entitled to excuse or substantial mitigation due to their impaired brains.  In today's segment airing on NPR I offer a skeptical- albeit brief - view.  

Theodore Dalrymple has this op-ed in the WSJ with the above title. His thesis is that psychology, especially as popularized in Alfred Hitchcock's Psycho, enables perpetrators and others to rationalize that the person who committed the crime was not the "real" person. He analogizes this to belief in demonic possession.

"Psycho," then, is a medieval tale in modern costume. The Enlightenment never reached the Bates Motel.

David Bernstein at the Volokh Conspiracy sniffs it right:  This story from the Washington Times is problematic on so many levels:

"Imagery definitely affects children," said Dr. Sharon Cooper, a forensic pediatrician and faculty member at the University of North Carolina Chapel Hill School of Medicine. "Adult pornography is a good example of giving children unhealthy sexual images."

Pornography normalizes sexual harm, Dr. Cooper said. It shows children a lack of any kind of emotional commitment or relationship between two consensual partners, shows unprotected sexual contact and visual examples often of violent rape....

Children are very vulnerable as compared to adults because of the presence of mirror neurons in the brain, Dr. Cooper said. Mirror neurons are part of the brain that convince us that when we see something we are actually experiencing it.

Of course there are lots of reasons to be concerned about the ready access that many children have to pornography thanks to the internet.  And undoubtedly some of that access causes unhealthily values among developing teens about sex and relationships.  But to say that pornography in and of itself normalizes sexual harm begs the question how it does so.  To say that it occurs through some neurological component that's not well understood but presumably is broadly implicated in everyday living falsely implies a causative pathway.  This type of reasoning is common these days, with all sorts of complex human behaviors and experiences (e.g., learning) supposedly understood by the activation of neuronal tissue.  Yet to describe a physical process such as neuronal activation does little to explain why people experience, learn, or do what they do in everyday life.    It's a vapid simplification of the human experience and the mind.  

The WSJ has this fun feature diagnosing characters in movies. Hannibal Lecter, of course, has our favorite -- Antisocial Personality Disorder.

Childhood abuse has become the all-purpose excuse for various brands of criminal behavior, from murder to loitering.  Usually, although not always, the culprit is some long dead step-father or uncle.  It's best, from the defendant's point of view, to be able to blame someone who's no longer around to contest your version of events. 

One of the odd things about the typical abuse excuse is that it seems to make no difference how many decades it's been since the "abuse," or the lack of any particular causal connection to the crime.  It's never all that clear how your uncle's alcoholic fits created your "compulsion" to embezzle a few thousand from your employer to put a deck on the house.

I suppose it was just a matter of time before the abuse excuse seeped beyond criminal defense work, but I have to confess I was caught off guard by this latest item from pop culture.  It seems that childhood abuse caused some TV personality to discover  --  in rehab, naturally  --  that his father's mistreatment of him 35 years before made him cheat on his movie star wife.

Monday's decisions in the Graham and Comstock cases represent the latest edition in the Court's jurisprudence (albeit indirectly) on mental health law.  What is fascinating about this area of the law is how much it changes how we think about the criminal-civil divide.  Conventional wisdom holds that the nexus between mental illness and criminal justice shifted during the era of deinstitutionalization of the 1960s and 1970s.  This is surely true on many levels but it's often asserted as a straightforward matter:  with the emptying of state psychiatric hospitals the criminal justice system has simply absorbed those who have trouble controlling their behavior.   That is, institutionalization has remained steady - all that's changed is what institution is doing the heavy lifting.   And while there's some merit behind that idea it obscures the larger picture.  What has really changed during the past fifty years is how we think about crime, punishment and responsibility.

Also of note today is a case on federalism and commitment of sex offenders, United States v. Comstock.

The current issue of Psychiatric Services has several interesting articles examining the nexus between mental illness and crime.  Here are just a few (subscription needed):

From Characteristics and Experiences of Adults With a Serious Mental Illness Who Were Involved in the Criminal Justice System:

The findings of this study confirm that many individuals with a serious mental illness spend time in jail and are frequently rearrested. The characteristics of individuals who have elevated risks of misdemeanor arrests and of spending time in jail associated with these arrests are somewhat different than those of individuals who have elevated risks of felony arrests. Being male, being homeless, having an involuntary psychiatric evaluation, and not having outpatient mental health treatment in the previous quarter independently increased the odds of subsequent misdemeanor arrests and of additional days in jail. On the other hand, being black, being in a younger age group, having a nonpsychotic diagnosis, and having a co-occurring substance use disorder diagnosis were all independently associated with felony arrests. An involuntary psychiatric evaluation and the lack of outpatient mental health services in the previous quarter also increased the odds of a felony arrest, but the associations were not nearly as strong as they were for misdemeanor arrests. Because felonies typically result in longer incarcerations, it is not surprising that, with the exception of psychiatric diagnosis, all variables that increased the risk of felony arrest also increased the risk of additional days in jail.

From The Impact of Mental Illness Status on the Length of Jail Detention and the Legal Mechanism of Jail Release: 

Overall, the lengths of jail stays were found to be strikingly similar among persons with a diagnosis of a serious mental illness and those without such a diagnosis. Regardless of mental illness status, at least 50% of persons were released from jail within 30 days of entering. Furthermore, nearly half (49%) of those with serious mental illnesses had relatively unpredictable releases. Many such releases occurred after shorter incarcerations, typically with little or no notice, and an additional 8% left the jail for state sentences or incarceration in a state or other county facility.

The issue has many other good articles as well.

President Obama would have to go some to nominate an appellate candidate worse on criminal law issues than Goodwin Liu.

On the other hand, President Obama is a man of accomplishment.

Take a look at this remarkable piece today by Paul Mirengoff on Powerline:

 

The Senate Judiciary Committee will hold hearings this afternoon on the nomination of Judge Robert Chatigny to the Second Circuit Court of Appeals. Judge Chatigny can expect plenty of skepticism about his suitability, given his handling of a case involving Michael Ross, a Connecticut serial killer who raped and murdered at least eight women and girls.

The facts are summarized in this article in the American Spectator. Chatigny found that the sexual sadism of Ross -- known as the Roadside Strangler -- was a mitigating factor in his case. He went so far as to state that, given his sadism, Ross "never should have been convicted, or if convicted, he never should have been sentenced to death."

 

 

Another story about the supposed addictive effects of indoor suntanning.  The question is, under these criteria, what isn't addictive?  From the story:

Among those who scored positive for addiction, 78% said they had tried to cut down on the time spent tanning but couldn't, and 78% said they felt guilty about using tanning beds or booths too much.

Further, 26% said that, when they wake up in the morning, they want to use a tanning bed or booth, and nearly 1 in 4 admitted that they had missed scheduled activities -- social, occupational or recreational -- because they decided to go to a tanning facility.

In the summertime, I really like to indulge in ice-cream.  In fact, I've tried to cut down my consumption of ice-cream during the warmer months, but often fail.  Sometimes, I eat ice-cream when I should be grading exams or spending time at the gym.  What does this say about my relationship with ice-cream? 

"A lot of times, these people don't really want to hear that tanning may be a problem," he said. "I hear this a lot from my skin-cancer patients. They are sort of in denial."

I really don't like to admit to myself that ice-cream adds to my waistline.  And I don't like to acknowledge that it's bad for cholesterol levels.  In fact, I put it out of my mind as best as I can even though I know I shouldn't.

It's unclear how or why tanning can become compulsive, although exposure to UV light triggers production of brain chemicals called endorphins that boost mood. One study, published in 2006 in the Journal of the American Academy of Dermatology, found that frequent tanners experience some withdrawal symptoms when given naltrexone, a drug that blocks endorphins

When I eat ice-cream, my mood improves.  In fact, when I eat foods like ice-cream, endorphins are released.  And if I was given naltrexone, my desire for foods like ice-cream would be diminished.  What do suntanning and ice-cream have in common? 

"Tanning makes them feel relaxed and calm," said Dr. Steven R. Feldman, a professor of dermatology, pathology and public health sciences at Wake Forest University in Winston-Salem, N.C., and the senior author of the 2006 study. "People think it's just the warmth that feels good. But there is something that UV light does to people that gives them a sense of relaxation. It's like a small narcotic hit."

Both activities make people feel calm because both likely involve the release of endorphins (aka the "narcotic hit").   But it is pure foolishness to suggest that means such activities - consumption of food or indoor tanning - are addictive.  After all, the "narcotic" produced is endogenous and  part of the natural regulatory state of the body.   And as a matter of common sense, no one is knocking over banks or liquor stores to get money to feed their sun-tanning or ice-cream "habit." 

As Kent mentioned before, the factor a defendant claims in mitigation doesn't need to be a legal excuse.  And that is mentioned bluntly in this article from the journal Nature which discusses the nascent use of psychopathy as a mitigating factor based on brain scans:

The purpose of the work, Kiehl says, is to eliminate the stigma against psychopaths and find them treatments so they can stop committing crimes. But Dugan's lawyers saw another purpose. During sentencing for capital crimes, the defence may present just about anything as a mitigating factor, from accounts of the defendant being abused as a child to evidence of extreme emotional disturbance.