Mad or bad? (Take #37)

Mr Man’s Wife raises discussion on the “Austrian cellar man”

Stories such as this one infuriate me. Once again we have a lawyer who is paid far too much money to try to find a way of reducing the punishment of a man who has undeniably committed a heinous crime, and the best he can come up with is “he couldn’t help it; he’s mentally ill”.

Previously on mentalnurse there has been debate on the pathologising of behaviour and it’s not a simple argument to resolve. We are, on one hand, a product of everything we are and experience; but, on the other, as humans we have ability to rationalise and, ergo, we can exercise choice.

This juxtaposition has been something of a burden for mental health law for many years - at what point does someone cease to be culpable?

MMW again;

Are we going to get to the stage where no crime is punishable? Will every crime be attributed to mental illness? Will all murderers, rapists, and paedophiles be regarded as victims of illness rather than bad people? Where does it end?

In my opinion, it doesn’t really matter: If they do something against society - they lose their right to be a part of it. What needs to change is how we deal with those who offend our social laws and values.

As a mental nurse working in forensic mental health, I’ve seen very few (by comparison) of people who break the law in the context of a mental illness. That is, if you exclude all those who have intellectual impairment, substance misuse, personality disorder and psychopathic traits.

It is my opinion that this latter cluster of ‘presentations’ no longer (nor ever did) belong in the mental health system. They are not mental illnesses - they are pathological conditions or behaviours which are not characterised by a transitional illness - but simply who the person is.

At present, this latter cluster often present within the forensic mental health system simply because it is felt prison is not the right place for them (by nature of a natural infirmity) or because their behaviours indicate “something is not quite right” (eg borderline personality).

Unfortunately, for those who break the law and require secure provisions away from society, mental health services have been the default service for anything that doesn’t fit prison. There is no other alternative.

It is widely accepted (without a single reference on that blanket statement - despite extensive research) that those who present differently - require different ‘treatment’. Mental illness requires traditional psychiatric treatment; psychopathic behaviour requires strict, structured systems; personality disorder requires behavioural therapies; intellectual impairment requires the service to provide an ‘external brain‘ to make life and survival more achievable. So why do these different presentations all get lumped together into one generalised service?

I do believe tho that much behaviour can be pathologised. But I agree with not ‘excusing’ all behaviours simply because we can pathologise them. These non-mentally ill - but ‘clearly not right in the head’ people are not appropriately placed in mental health care.

Is this as stupid as it sounds? But perhaps the perfect disposals for these individuals;

Psychopaths can go star in Exile Island.

Personality Disorders in Big Brother.