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Lecture 15

Lecture 15

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Carleton University
PSYC 2400
Adelle Forth

Lecture 15: Fitness to Stand Trial (Ch. 8) Tuesday, March 1, 2011 - Today: Fitness to stand trial, also prevalence of mental disorder - First and last parts of Ch. 8 today - Middle (mental state at time of offence): Thursday - Summary due Friday** - No extensions - Should have been working on it—start it now - Worth 10% of mark - Midterm- average: 68% - Huge range- 23%-99% - We’re about the same average as last term’s - 1/5 got in A range—that’s very good - Can come and look over the questions - Distribution is skewed towards the upper end- fine - The plan is not to scale the marks - Do not predict this to change much for the final - Can go to any TA - Monday, Tuesday, Wednesday—professor has office hours 11:30 to 12:30 - Tamara would be the best one to ask about the assignment - Diagnosing mental disorder - DSM- the Bible of diagnosis - Diagnostic and Statistical Manual of Mental Disorder o Look for symptoms o Diagnose o Axis 1—serious disorders (schizo, bipolar, affective, mood disorders) o Axis 2—personality disorders (we’ll discuss more in psychopathy section) - Developed by APA (American Psychiatric Association) o Has been around for many years o 1952- first time it was published (small)  Wanted to increase the reliability of diagnoses  All psychologists should look for same symptoms, diagnose in same way  Critique—how reliable is this system?  In the rest of the world, the International Classification of Diseases (ICD) as well—published by the World Health Organization (they acknowledge DSM, but mainly use a different system)  The two systems can overlap—schizophrenia in ICD is similar to that in DSM (diagnoses and symptoms)  But there are some differences—major differences in psychopathy o There have been an increasing number of disorders  106 disorders in first version (DSM-I)  Republished in 1968—182 (DSM-II)  Republished in 1980—265 (DSM-III)  Republished in 1994—365 (DSM-IV) o Probably some disorder that you’d have some symptoms for  Issue about the expanding number  Are we having more disorders?  Are we better at assessing them?  Maybe new disorders have developed?  **DSM-V—rumour is that there will be decreased number of disorders—making major changes (particularly with personality disorders)  **DSM was never based on empirical research—it’s a consensus model—but there’s been a huge amount of research after the fact. It’s how it was produced in the first place that was quite different. o Certainly there have been temporal changes  Homosexuality in 1973—DSM removed it (it used to be a mental disorder)  Then put back in DSM-III as ego-distonic disorder (upset by sexual orientation)  **Being homosexual/lesbian—could be classified in DSM-I, but not in DSM-III o Also cultural differences  What is mental disorder, what would be symptom, etc.  This is the consensus from North America - Prevalence of mental disorders (lifetime diagnoses) o APD  Community: 3%  Offender: 57% *About ½ will fit the criteria—HUGELY different from the community. o Substance Abuse **MOST COMMON FOR BOTH  Community: 14%  Offender: 87% *This is why there’s such a focus on treatment of substance abuse in corrections. o Anxiety Disorder  Community: 3%  Offender: 16% *Higher than community o Depressive Disorders  Community: 7% *This is pretty common among community  Offender: 23% o Schizophrenia  Community: 1%  Offender: 2% *These are not the offenders who we will discuss today and Thursday (unfit to stand trial, not criminally responsible —very high rates in that sub-group)—not found mentally disordered at time of trial - Mental health of offenders is the current big mandate of Correctional Services of Canada o They have such high rates of mental health problems o Causes difficulties within the institutions o Male offender is 7x more likely to commit suicide than a similarly aged male in the community o Handling them in a prison atmosphere is probably not the best thing to treat their disorders—it might make them worse o 1) The higher rates could be because mentally ill individuals are more likely to get arrested o 2) People with mental disorders more likely to commit spontaneous, reactive crimes—more likely to get caught that someone who plans a crime (white-collar crime)—maybe o 3) Individuals with mental illness could be more likely to plead guilty to offences, waive their rights to remain silent (don’t understand rights), could collect more evidence - HUGE study in States (35,000)—prospective study o Assessed them for different disorders (serious) o Followed them up for 3 years o Asked questions about violence  **Link between mental disorder and violence in community samples  Stick, knife, gun in a fight?  Fire to destroy property?  Hit hard- injure, doctor?  Force sex? o Results  2% of those with no mental disorder said yes to one of those questions (engaged in violence)  Depression (Major Affective Disorder)- no difference with depression on its own  Schizophrenia—6% (3x higher risk)  Bipolar—4% (double the risk, but not dramatic)  Substance abuse—about 4% (double)  **COMORBIDITY—one or more disorders together  Depression and substance abuse (7%- huge difference)  Schizophrenia and substance abuse (nearly 10%!)  Bipolar disorder and substance abuse (nearly 14%!)  **What’s common is you’re adding substance dependence to the other disorders. Concern because of the prevalence rate in offender population, also concern in community because the comorbidity feeds into risk of violence. Need to provide treatment and support for individuals with substance abuse problems - Media o Rare to find positive results about mental illness o Usually find that mental disorder is linked to particular crime (usually very bizarre to get attention) o Study took sample of primetime TV shows—coded them, looked to see whenever character with mental disorder is portrayed  73% of the time, was portrayed as being violent o Print media—newspapers, etc.  86% of the time mental illness was mentioned, it was linked to violence o **In the community, violence is not that common in individuals with a mental disorder (depression, bipolar, schizophrenia) o **And even comorbidity only goes up to 14% (it’s not something like 80%, 90%, etc.) - General Social Survey in the States—done every two years as national representative sample of citizens 18 years and older o Stratified, national sample—could generalize results o Asked a bunch of questions, but in this survey, focused on depression, alcohol abuse, and schizophrenia o Decided not to use these labels- could generalize the beliefs in the individual o Just described the symptoms (hearing voices, withdrawing contact form others—schizophrenia) o Manipulated the ethnicity, education level of the characters in the vignettes o Should we legally force the individual to get treatment?  Schizophrenics—53% of Americans said yes  Alcohol problems—35% said yes  Depression—27% said yes o How would you feel if the person moved next door?  Schizophrenics—53% of Americans okay with it (half said no)  Alcohol abuse—62% okay with it  Depression—81% okay with it o How would you feel if the person worked closely with you?  Schizophrenics—34% okay **attitude particularly towards schizophrenics is negative  Alcohol abuse—24% okay  Depression—54% okay o Be friends with  Schizophrenics—63% okay  Alcohol abuse—69% okay  Depression—80% okay o Likely to be violent  Schizophrenics—53% yes **In vignette, no history of violence, nothing mentioned about violence—interesting that half the Americans thought it would be likely that character would be violent.  Alcohol abuse—35% yes  Depression—27% yes • **From 1996 to 2006, more positive attitudes towards depressive patients, not so accepting of schizophrenics— probably because we’ve had much education about it o Summary of findings  Media and public often links mental illness with violence  Most people with mental illness are not violent **96% do not— even with comorbidity, 86% do not.  People with mental illness are more likely to be a victim of violence • In institutions, people with serious mental illness are called “bugs” • The more able-bodied individuals target them (make them hold the cigarettes) • In younger offender institutions, they give up their desserts • Also victimized in society  Particularly with substance use comorbidity, more likely to be violent - Very specific issue in Criminal Code—need to plead guilty or not guilty at the beginning of the trial o Could say guilty—no trial—straight to sentencing phase o Not guilty—trial o The issue is if a defendant refuses to answer the question  Need to know why  This has a long history  Early 17 century Britain: they felt that a madman should not be executed because it would be a miserable spectacle, would
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