This essay will examine the role of mental disorder in the aetiology of violence, using some heinous examples to support the arguments presented.
It is widely agreed that many prisoners suffer with mental illness and psychological fragility (Corston Report 2007). However one must be mindful of the fact that the Equality Act of 2010, and similar laws preceding this legislation, stipulate that the disabled must not suffer any discrimination whatsoever. Therefore, even the title of this module “crime, mental illness and dangerousness” may be called into question as it plainly infers that the mentally ill or disabled have a propensity towards violence. This is plainly discriminatory as the prevalence of violence is ubiquitous in our society. Indeed “nature red in tooth and claw” is an accepted truism of the animal kingdom of which we are undoubtedly a part. The doctrine of “survival of the fittest” dictates that the aggressive hunter will bring home the bacon while the timid and timorous will starve to death. Therefore mankind undoubtedly evolved to be an ingenious as well as a vicious enemy (Darwin 1872; Dawkins 1989; Buss 2005).
That healthy and strong specimens of all species are aggressive predators is an accepted truism. However, most of us belonging to the Homo sapiens species endeavour to keep the baser instincts in check via exercising gargantuan self control! This is no mean feat as we are hard wired for aggression. Our brains contain neural structures such as the limbic system and hippocampus that elicit aggressive behaviour when stimulated.
Sometimes these structures become abnormally stimulated as a result of an organic pathology. For example let us take the case of a homicidal killing spree where the crazed perpetrator finally shot himself with his weapon. An autopsy found a massive brain tumour in the limbic system. This interesting case indicates how an organic malfunction of the brain may lead to violent acts. If the limbic system was not wired for aggression then the irritating tumour may have elicited other strange behaviour. An organic pathology of the brain known as Capgras Syndrome, may result in the belief that a loved one is an imposter masquerading as a real person (DePauw & Szulecka 1988). This once caused a sufferer to murder the “robot that is pretending to be my Mother”! Capgras syndrome is caused by damage to the right hemisphere, possibly as a result of a stroke or epilepsy. Many strange behavioural syndromes may be caused by damage to the delicate brain (Sacks 1985).
Other cases of explosive violence have occurred after ingestion of red wine containing congeners and histamines. There is no doubt that a strong link exists between alcohol consumption and violence. This is partly due to the disinhibitory effect of alcohol on the brain. This ties in neatly with our previous assertion that our baser impulses need to be constantly reined in by our executive command which is situated in the prefrontal
lobes. The prefrontal lobes are essential for forward planning and self control (Giedd et al 1985; Sowell 1999). Damage to these areas, following a traffic accident, may result in impulsive and aggressive behaviour. Any brain damage can result in personality changes that may lead to violence or even homicidal hypersexuality.
Drinking alcohol depresses neural activity in the reasoning cerebral cortex with the result that latent lurking tendencies to violence are unleashed. Certain people also have a genetic intolerance to alcohol which means that they are unable to metabolise it in their liver. They may also have a mutation of the liver enzyme aldehyde dehydrogenase. This defect is very common in Chinese and Japanese people who may turn bright red if they consume alcohol. Others may react to alcohol by becoming excessively violent and have no recollection whatsoever of their behaviour. We do not tend to call lager louts mentally disordered yet their behaviour clearly represents a risk to the public. The Saturday night is great for a fight ethos may lead to serious injuries, and much violence occurs as a consequence of inebriation.
Following the same line of enquiry of substance misuse, there is a danger that certain drugs may elicit violent behaviour. Stimulants such as cocaine may leave the user vey paranoid (Barton 2003; Bean 2008). Other legal highs such as the bath salt Ivory Wave may lead to a paranoid psychosis. The new super strength Skunk may leave smokers feeling very paranoid owing to the high levels of tetrahydrocannabinol (THC).This type of strong cannabis has been bred via genetic modification of seeds. Many of these recreational drugs raise levels of the brain neuro transmitter dopamine. Dopamine levels have been correlated with pleasure. For instance, a strong cup of coffee will raise dopamine levels as does gambling and sex.
However, excess dopamine may cause pleasure to become paranoia. The phenothiazine drugs used to treat schizophrenia work by lowering brain levels of dopamine. Heavy skunk smokers may experience paranoid psychosis and imagine that people are talking about them behind their backs. A chef high on skunk stabbed Abigail Witchells in the back of the neck leaving her to bring up her children in a wheel chair. A paranoid person may feel that people are mocking him or even following him. The paranoid delusions may become all encompassing and this is when a dangerous scenario may emerge. Paranoia is clearly correlated with the aetiology of violence. A label of paranoid schizophrenia may be given by a forensic psychiatrist or the person may escape unlabelled if the episode is a transitory one.
The whole issue of labelling mental illness is a large and possibly vexatious one that has been discussed by numerous psychologists (Szasz 1960; 1963; Laing 1960; 1961; 1964)). There was also an interesting study whereby psychiatrists pretended to be insane and hallucinating and were admitted to hospital. Once inside they behaved normally yet the staff refused to release them or recognise that they were “cured” of their psychosis! (Rosenhan 1973).
Notwithstanding the difficulties of constructing mental illness it is an indisputable fact that paranoia is the flip side of aggression and is a worrying forensic symptom. Indeed Sigmund Freud wrote that paranoia was the projection outwards of a person` s inner base instincts. He called this murky subconscious repository of evil the ID (Freud 1933; 1940). So, for example, a person who did not like his mother in law might imagine that she hates him. Freud felt that the dislike of the relative had become projected out and then turned back against the perpetrator. So when we dislike someone we automatically deduce that this person does not like us. This is a simple explanation of the mechanics of paranoid thinking. It is therefore easy to understand how paranoia may lead to unpleasant acts being carried out to redress the imagined slights and insults.
For example it is well known that taking anabolic steroids may result in a paranoid syndrome known as Roid Rage (British Medical Journal). Men take steroids to bulk up their physique. However the steroids also induce rage and paranoia. The recent case of Raoul Moat illustrates the dangers of anabolic steroids. Moat was very fond of taking steroids to hone his masculine physique. He managed to continue taking them while in prison.
While in prison he heard that his girlfriend was dating a supposed policeman. Fuelled with a paranoid Roid rage he plotted revenge and as soon as he was released he embarked on a killing spree. One may speculate that had Moat not been taking steroids the tragic events might never have unfolded. Anabolic steroids taken to bulk up muscle are based on testosterone, nature` s own hunting and killing hormone. It has been
reported that there is a culture of steroid use in the Welsh valleys by narcissistic young men keen to look fetching. This desire to be real men may have resulted in the reported street brawls that have been gracing the pages of the popular press in South Wales recently (Messerschmidt 1993; 2000).
The symptom of paranoia is therefore one to be taken extremely seriously by a mental health professional. It is arguably a very salient red flag warning of future violence. A paranoid person is not usually amenable to reason either. If a paranoid person imagines that others are plotting to kill him then he may decide to launch a pre-emptive strike to protect himself.
The paranoid person may think that the person who is following him is intent on harm. A whole set of elaborate and interconnected delusions may be constructed around the delusions of persecution. If he is a patient in a hospital he may suspect that the staff members are out to get him. This scenario has resulted in mental hospital staff sometimes tragically being murdered. Paranoia is an extremely dangerous warning sign, yet it is often ignored. Sometimes patients have indicated that they are experiencing paranoid urges of violence to their psychiatrist and they are inexplicably gaily sent on their way to the outside world. They are then free to commit heinous and barbaric acts as they attempt to eliminate the perceived threats.
Sometimes the paranoia takes the form of voices that encourage wicked deeds. The Yorkshire ripper, Peter Sutcliffe, heard compelling voices telling him to rid the world of prostitutes. It has been speculated that such voices are the result of the inner articulations that are made when one thinks to oneself. In other words these voices are the very own thoughts that have been amplified by unknown neural processes. Thus the Yorkshire ripper spoke angrily to himself and believed that his thoughts were extraneous. There have been numerous murders committed as a result of hearing commanding voices and this schizophrenic symptom must always be taken seriously (Eronen et al 1996; Taylor & Gunn 1999). It is possible that raised dopamine facilitates this process of hearing ones own thoughts aloud. Thus I would originally argue that paranoid schizophrenia as opposed to hebephrenic or silly schizophrenias is the most dangerous form of schizophrenia.
Another precursor of violence may be raised levels of depressive cortisol that is brought on by situations of “helplessness” as described by Seligman (Seligman 1977; 1979). In these cases normally loving Fathers may irrationally murder their children as the cortisol causes a deep and irrational fatalistic despair.
The Diagnostic and Statistical Manual has a whole list of mental disorders and categories to define the mentally disordered. The manual is constantly being changed and updated in line with the current zeitgeist. It seems that the manual has now become so all encompassing that we are all in danger of finding a description of ourselves in it. If I very much like the sound of my own ideas and pearls of wisdom does that mean I am a histrionic attention seeking narcissist? When does my desire for a spotlessly clean house become an ominous sign of obsessive compulsive disorder? If I am afraid that my friends will desert me does that indicate a possible needy border line personality disorder? Just as the hypochondriac reading a medical book will start to imagine that he has every symptom so it is easy to be seduced by the fascinating range of symptoms in the DSM 1V. Indeed one may speculate that the only persons to escape a diagnostic label are the authors of such manuals!
The label of DSPD, dangerous, severe personality disorder has recently fallen out of fashion. The DSPD label has been hotly debated in the context of whether it is amenable to treatment. If someone is considered untreatable then there is no ground to detain that person in a mental institution. The whole area of civil liberties of the detention of the unwell was brought into the public arena by the Baxstrom Judgement of 1966. The case set a judicial precedent which facilitated the release of a thousand unlawfully detained inmates from hospitals for the criminally insane in New York. Interestingly there was not widespread carnage or violence as many of the detainees quietly reintegrated back into the community (Steadman & Keveles 1972). This example makes one question the skills of some mental health experts as well as the propensity to label deviant offenders as criminally insane.
Another category of offenders that may be prone to violence are those who lack fear or remorse. The term psychopath has been used to describe a constellation of traits that include callousness, egotism and lack of empathy (Cleckley 1977; Hare 1993; 2003). Recently the terms antisocial and dissocial personality have also been used to categorise those with a callous disregard for others. It has been speculated that there is an evolutionary niche for such ruthless behaviour and hence we see these latent psychopaths in the guise of successful bankers, politicians and businessmen (Babiak & Hare 2006).This type of person may possibly be inclined to ruthless and violent behaviour towards those who cross their path and attempt to thwart their ambitions. The MacArthur actuarial study found a high correlation between this type of antisocial personality and violent acts (Monahan et al 2001). The sociopath does not suffer hallucinations and generally has not lost touch with reality. He is cool and calculating and shows no fear. Indeed he may be cortically under aroused or have an abnormal amygdala which prevents him feeling fear. Therefore he or she is not technically insane according to diagnostic
criteria. However this is a type of amoral insanity that can lead to dangerous and heartless behaviour. A sociopath running a business may cut corners and endanger the lives of others. If an offender suffers from a dissocial disorder as well as a psychotic illness then the results may be catastrophic. This co-morbidity of traits presents a serious threat to the public and such offenders need to be kept secure.
Let us examine the question of how the mentally disordered might also become the victims of violence. Those who are of a very low I.Q. and substantial learning disabilities may present an attractive opportunity for exploitation by amoral sociopaths or even normal people (Conway 1994). Just as playground children are sometimes drawn to bully the weak and vulnerable so do adults sometimes maltreat those in need of most protection. The feeble minded may unquestioningly obey orders that may endanger their lives and even embark on suicide terrorist missions if told to do so. Causing fires, as in explosions is also part of the MacDonald triad. It has been noted that some DSPD offenders have a triad of behaviours that includes a fascination with setting fires and childhood cruelty to animals. This is known as the MacDonald triad and has been used to predict sociopathic behaviour by criminologists. (MacDonald 1963).The desire to cause explosions via terrorist acts could be considered as a manifestation of this fire starting sociopathic behaviour
Other cases of abuse may arise when a depressed person antagonises their spouse or partner with their constant moaning and groaning. This may cause the spouse to lose patience and lash out. Domestic abuse is very widespread and the neurotic partner may bring out latent hostility in their husband if they are depressed or annoyingly neurotic (Dobash & Dobash 1979; 1992).
The condition of senile dementia or Alzheimer` s disease may also lead to geriatric abuse by family or professional carers (Nadien 1995). There have been numerous scandals involving abuse of elderly patients in care homes by their supposed nurses. This condition can make the sufferer behave in an extremely exasperating manner and therefore poses a real challenge to the carers. Many have lost patience and slapped their patients (Wolf 1998).
It is often the case that those in a position of power or authority may be tempted to abuse that power. This finding was demonstrated by the infamous Stanford Prison experiment conducted in Stanford University (Zimbardo 1972). The pretend student prison guards behaved in such a bullying manner to the fake prisoners that the experiment had to be halted. People are easily corrupted by power and this has important implications for the weak and vulnerable in our society. Any person who is suffering from a mental disorder is therefore vulnerable to exploitation and even violence. A balance therefore needs to be struck between protecting the public and respecting the human rights and civil liberties of the patient. (Words-2500)
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