Over-medicalization of crime?

Kelly McAleer, Psy.D., concisely discusses the strengths and drawbacks of mental health courts in two recent blogs. This "solution" has gotten a lot of attention in the last couple years.

There are many arguments pro and con, mostly about what helps defendants in mental health courts, and what the price tag or savings is in tax dollars. But I see very little, if any, discussion of a more basic jurisprudential problem, namely the medicalization of crime. This involves fundamental social risks and costs, as much as outcomes for individual "mentally ill" defendants.

When we believe a defendant should be treated for mental illness rather than punished, we assume one or both of two propositions: 1. punishing people doesn't benefit society as much as treatment; 2. mental illness caused the defendant's misbehavior or otherwise made him or her not culpable.

I'm not interested in the first of these propositions now, except as it may be monitored by the second.

In some circumstances, we don't and shouldn't blame people for their behavior. If a man is forced at gunpoint to drive while drunk and there's no accident, a DUI citation would be gratuitous. If a recently returned prisoner of war has a terrifying nightmare and unknowingly slaps her husband in the middle of the night, she probably needn't be prosecuted for domestic violence.

The trick has always been where we draw the line. I just think we've gone far, far beyond what makes any social, ethical/moral sense. Culpability itself can never be a scientific medical question.

Criminal defense attorneys say the "not guilty by reason of insanity" defense is now a tougher sell to most juries than it has ever been. Everyday people don't believe psychiatric expert testimony, and psychiatrists are always available to contradict each other anyway, as long as they're paid by whichever side. Public cynicism is thus very deeply ingrained. Mental health courts may really be an elitist scheme to bypass traditional "unenlightened" popular justice.

Compassion, tolerance and leniency toward bad behavior can quickly become an unaffordable luxury if times get hard and violent. Forensic psychiatrists, and all medical professionals, had better hope that mental health treatment regimes work extremely well (which they certainly do not!) with increasing acceptance and fanfare over mental health courts.

The more crime is medicalized, the more the medical profession will own it and be blamed for it's continuation or increase.

Unfortunately, if this goes badly it may also strike directly against public confidence in the rule of law, or even in rationality as an appropriate quality of public policy.

The Witchfinder General and the Sad Clown

D. J. Jaffe's Wall Street Journal oped of March 26, together with an April 9 response by Michael J. Reznicek, M.D. demonstrate the near total confusion of psychiatry and the law. I believe the single biggest social advance of the twenty first century could come with a precisely opposite trend, separation of psychiatry and the law.

Jaffe writes of a "young man obviously in need of mandatory lifetime violence-preventing medications", and Reznicek claims "incarceration and medication often work well together" to enhance public safety. Both presume with these statements that traditional criminal justice -meaning punishment reliably administered upon conviction for crimes clearly defined - is impractical or useless.

Jaffe's concept of "violence-preventing medications" is not merely idealistic, as characterized by Reznicek. It's Orwellian psycho-totalism, anti-scientific and ultimately incoherent. The National Alliance on Mental Illness (an organization to which Jaffe's Treatment Advocacy Center happens to be closely related) has always insisted that mental illness itself does not make anyone more prone to violence. That's supposed to be a cruel falsehood, born of superstition and conducive of discriminatory stigma.

More than a few people believe the exact drugs Jaffe is pushing actually cause increased violence. It seems to me that recent black box warnings required by the FDA directly imply this.

The best violence-preventing medication would probably be cyanide: 100% effective, the patient is never violent again after a single dose! Psychotropic meds only "reduce violence" by giving a human being sufficient neurological disability to prevent self-determined action. Dehumanization is the real medical plan. "Therapy" is utter fraud.

Reznicek's combination of "incarceration and medication" is much closer to reality than Jaffe's delusion, but it's not socially palatable. People are supposed to be either punished or treated depending upon whether they are bad or mad. The pretense that we can separate bad from mad is the justification for "forensic psychiatry" and the insanity defense. Anyone who spends more than a couple hours in a state nuthouse knows perfectly well this is a very bald pretense. It keeps lots of public union members employed as security therapy aides and encourages the citizenry to believe they are liberal and enlightened, but it doesn't improve conditions anywhere or make anyone safer.

The violent criminals who are released from Elgin Mental Health Center under the standard plan - i.e., as brainwashed mental health consumers-for-life forced to believe they have a chemical imbalance in their brains they must treat with psych drugs - are pissed off, ticking time bombs. Sooner or later they stop taking the meds because they just can't stand them. Then they look around for their best chance at payback.

This is where we get Columbines and Fort Hoods from. Guys like Jaffe and Resnicek use those tragedies to hook us again with their bogus solutions. NAMI Massachussets has recently been trumpeting the stats of military suicide as an indication of a need for more treatment. But any increase in suicide is coincident with more psychiatry in the armed services! It's all a rolling disaster of misconceived causes and effects, slow motion mass hysteria on a level not seen since the great witch hunts and the plagues of the middle ages.

Michael J. Reznicek, M.D. is a sad clown with a bad job, who probably knows better. I work with a lot of guys like that.

D.J. Jaffe on the other hand, may be our modern Matthew Hopkins. Let's just hope that ultimately, his career will look as short as that of the notorious Withchfinder General.

Jesse James - Bill Zwecker

Chicago Sun-Times columnist Bill Swecker says he is "not qualified to address" the issue of whether sex addiction falls into the same category as alcoholism or drug addiction.

Nonsense! Who does he think is qualified?

Does Zwecker see all kinds of predictable, high rates of success in "treating" any of these addictions? Where are the presumed experts, who are qualified to say what an addiction is with such accuracy and authority that we will all agree on whether Jesse James should be blamed or rehabilitated for cheating on Sandra Bullock?

What qualifications exclusively entitle somebody to address ubiquitous, mundane human failure?

With what pretended experts are we so enthralled, that we reflexively bow without even knowing their names,  that we abdicate universal human experience to honor them, and arbitrarily enrich them with ceded social territory?

BILL! You ARE qualified, man. So am I.

Anybody is allowed to speculate about categories and the foibles of their neighbors. Take back human experience, suffering and struggle from the psychototalist usurpers! They don't know what they're doing, and "rehab" gets screwed up all the time.

If you want to make, or help, somebody else behave better, you sure have to confront them and persuade them yourself, face to face!

If you don't feel like doing that, fine. But spare the world these delusions of experts and systems. There probably aren't any.

And just shut up about Jesse James. Get him the hell out of the newspaper!