Recently in Mental State Category

While today's news focuses on the current Archives of General Psychiatry article reporting 1 in 5 college aged students has a personality disorder, another article just released in the American Journal of Psychiatry deserves as much attention - probably more.

The article by Jacques Baillargeon and colleagues titled Psychiatric Disorders and Repeat Incarcerations: The Revolving Prison Door examines the link between mental illness and risk of multiple incarcerations.  Of note, the authors narrowly construe their definition of mental illness to include only four categories:  major depression, bipolar disorder, schizophrenia, and non-schizophrenic psychotic disorder.  Thus, they wisely excluded substance abuse disorders in their calculations which have greatly inflated the results of similar previous studies. The study included 79,211 inmates who began serving a sentence between September 1, 2006, and August 31, 2007.

Irrespective of the debates about culpability and psychopathy, the noted traits of the psychopath - the glibness, lack of remorse, irresponsibility - speak volumes about the type of folks given the psychopathic label. And while merely reading a court opinion in no way makes a diagnosis, the case of O'Kelly v. State (#S08PO916) provides a chilling account of someone likely deserving of that label:

Christopher Lane at the L.A. Times has this op-ed on the development of the forthcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. As noted before, it's a solid bet the diagnostic manual will grow with each edition:

Over the summer, a wrangle between eminent psychiatrists that had been brewing for months erupted in print. Startled readers of Psychiatric News saw the spectacle unfold in the journal's normally less-dramatic pages. The bone of contention: whether the next revision of America's psychiatric bible, the "Diagnostic and Statistical Manual of Mental Disorders," should be done openly and transparently so mental health professionals and the public could follow along, or whether the debates should be held in secret.

One of the psychiatrists (former editor Robert Spitzer) wanted transparency; several others, including the president of the American Psychiatric Assn. and the man charged with overseeing the revisions (Darrel Regier), held out for secrecy. Hanging in the balance is whether, four years from now, a set of questionable behaviors with names such as "Apathy Disorder," "Parental Alienation Syndrome," "Premenstrual Dysphoric Disorder," "Compulsive Buying Disorder," "Internet Addiction" and "Relational Disorder" will be considered full-fledged psychiatric illnesses.

Hat tip: Mind Hacks

John Seabrook of the New Yorker has this in-depth article about Dr. Kent Kiehl at the University of New Mexico titled Suffering Souls. As the article details, Dr. Kiehl is the leading expert in the field of brain imaging and psychopathy. As part of his work with the Mind Research Network, Dr. Kiehl is using a portable fMRI machine to image hundreds of prison inmates and juvenile delinquents. The work is impressive and illuminating, but prone to Overclaim Syndrome as is evident near the end of the article:

Psychopathy also raises fundamental issues about justice. At the core of our judicial system is the assumption that someone who appears sane is culpable for his actions. (In the U.S., there is no insanity defense for psychopaths.) As Decety, of the University of Chicago, put it to me, “We still basically work out of a Biblical system of punishment—we don’t consider, in most cases, to what extent the offender’s actions were intentional or unintentional. But what neuroscience is showing us is that a great many crimes are committed out of compulsion—the offenders couldn’t help it. Once that is clear, and science proves it, what will the justice system do?” Joseph Newman told me, “I go around and give speeches to the staff in prisons, saying the inmates are not just assholes, and afterwards the guards come up and say, ‘Enjoyed your talk, Doc, but are you saying these guys aren’t responsible for their crimes?’ ”

Besides the fact that mens rea is very much part of American criminal law, there exist at least two problems with this sort of conclusion. First, despite the weight of neuroscience showing abnormalities in the brains of psychopaths, the theory that psychopaths have uncontrollable impulses remains unproven. This is no small matter as controllable impulses are writ large in human nature. Second, what matters for the law is not whether the brain is compromised but whether such impairments are so substantial that they deprive one of the ability to know their behavior was wrongful at the time of the alleged crime. Predisposition for behavior - which is what the hard line biological psychopathy crowd is asserting - is not sufficient to reduce culpability - and for good reason. We are all predisposed genetically towards behaviors. And some people, unfortunately, suffer worse biological deficits than others. But legal culpability is grounded in a social heritage which sets the exculpating bar high under the assumption that everyone brings liabilities to the responsibility table. Our society has determined that outside severe deficits in rationality, one is expected to conform their behavior according to the law irrespective of their biological imperfections.

Hat tip: Furious Seasons

Brain Overclaim Syndrome is pernicious in contemporary legal and behavioral science scholarship. Evidence of its infectious reach now appears in the journal Current Directions in Psychological Science in the article From Genes to Brain to Antisocial Behavior (subscription required) by the Professor Adrian Raine at the University of Pennsylvania. The abstract:

This review summarizes recent brain-imaging and molecular-genetic findings on antisocial, violent, and psychopathic behavior. A "genes to brain to antisocial behavior" model hypothesizes that specific genes result in structural and functional brain alterations that, in turn, predispose to antisocial behavior. For instance, a common polymorphism in the monoamine oxidase A (MAOA) gene has been associated with both antisocial behavior and also reductions in the volume of the amygdala and orbitofrontal (ventral prefrontal) cortex—brain structures that are found to be compromised in antisocial individuals. Here I highlight key brain regions implicated in antisocial behavior, with an emphasis on the prefrontal cortex, along with ways these areas give expression to risk factors for antisocial behavior. Environmental influences may alter gene expression to trigger the cascade of events that translate genes into antisocial behavior. Neuroethical considerations include how responsibility and punishment should be determined given the hypothesis that neural circuits underlying morality are compromised in antisocial individuals.

My goodness, I had no idea scientists had decoded the "neural circuits underlying morality."

Neurolaw is all the rage these days. The lure to explain behavior and social norms such as free will under the lens of reductionist biology abounds. And there is no question that the wealth of information about brains and behavior has vastly increased during the past twenty years. Yet the disparity between what is truly known about the link between biology and human behavior and the normative claims populating legal and science scholarship is breathtaking. Often ignored is the extreme complexity of the human mind and the infancy of the methods used in examining brains and behavior. Several recent articles highlight this simple and important fact.

Beware of reformers. Enthusiastic activists often dismiss weighty arguments on the other side and propose cures that end up being worse than the disease. So it was with the drive to deinstitutionalize the mentally ill. Certainly, there were abuses. Certainly, there were people involuntarily committed who shouldn't have been. But the Cuckoo's Nest crusade took it much too far. "Apparently drafted by the law firm of Frank Kafka and Lewis Carroll, the laws on the mentally ill that have emanated from the deinstitutionalization era are both absurd and tragic." (Torrey, Nowhere to Go: The Tragic Odyssey of the Homeless Mentally Ill (1988) pp. 29-30.) Homelessness is often the result of vesting the choice not to be treated in people whose illness makes them incapable of making an intelligent choice. The American Psychiatric Association task force called this "cloak[ing] neglect in the banner of freedom." (Lamb, et al., Summary and Recommendations, in Treating the Homeless Mentally Ill: A Task Force Report of the American Psychiatric Association (Lamb et al, eds. 1992) p. 3.)

But homelessness is not the only, or the worst, result of these misguided policies. In Saturday's Wall Street Journal, Elizabeth Bernstein and Nathal Koppel have this story:

The purported rise of brain scanning technologies in criminal cases has paralleled the growth of neurolaw within legal scholarship. But as with many new interfaces with law, the tendency to overplay the implications such technologies have regarding entrenched legal norms often ignores the mutable nature of our scientific understandings.

Vaughan Bell over at Mind Hacks has a great new post up titled The fMRI Smackdown Cometh which highlights the growing skepticism regarding many of the brain scanning claims made of late:

Over the last few months, the soul searching over the shortcomings of fMRI brain scanning has escaped the backrooms of imaging labs and has hit the mainstream.

Numerous articles in hard hitting publications have questioned some common assumptions behind the technology, suggesting a backlash against the bright lights of brain scanning is in full swing...

It starts with this simple question: what is fMRI measuring?

When we talk about imaging experiments, we usually say it measures 'brain activity', but you may be surprised to know that no-one's really sure what this actually means.

Bell provides a compelling litany of scholarly articles which highlight how much we do not know when it comes to the operations of the mind and the very real limitations of brain scans.