We’re medieval. In our appreciation for and of mental illness, MI hereinafter. MI also tends to destigmatize. I respectfully submit that confusion and an almost criminal nescience are really the underlying bases for such profound misunderstanding as to MI. And nowhere is this seen better than in the courtroom via the astigmatic lens of criminal jurisprudence. In the matters of the insanity defense and NGRI courts have adopted and applied four — you heard me, four — essential standards and rules, all described herein. The M’Naghten Test, Durham Rule, Irresistible Impulse Test and Model Penal Code Test. In this podcast I attempt to explain how these tests seem quite different and easily accessible and applicable, but they fail to address the issues that are present in many crimes. In addition, I discuss what has to be done to change the way the law and psychiatry meet and merge and meld.
Scary doesn’t inspire empathic. In the case of those suffering from MI who’ve been incarcerated and have long criminal records and especially those who’ve exhibited violent traits and behaviors, empathy and sympathy are hard to come by. And one of the reasons is the very heart of the psychiatric diagnosis — it’s not tangible, readable, replicable, obvious and/or universally recognized. It’s not like a shattered femur, easily seen on X-ray, or the image of a tumor that a radiologist can easily and immediately read and, moreover, will be acknowledged and verified and agreed with by other radiologists. Psychiatric diagnoses don’t lend themselves to such uniform and accepted certainty. Perhaps until now. Enter imagery, PET scans and watch the explosion and evolution in the science of MI.
Advocacy angels. There are so many incredible individuals and organizations and efforts to address MI issues and remove the stigma that is so often associated it.
- The incredible work of my dear friend and esteemed jurist Judge Sol Wachtler and The North Shore-LIJ Health System’s Foundation and Law & Psychiatry Institute.
- The National Alliance on Mental Illness of New York City (NAMI-NYC Metro), a grassroots organization providing support, education and advocacy for individuals and their families of all ethnic and socioeconomic strata who live with MI.
- May I also commend to you the work of Dr. Jeffrey Lieberman, the Lawrence C. Kolb Professor and Chairman of Psychiatry at the Columbia University College of Physicians and Surgeons and Director of the New York State Psychiatric Institute. He’s the author of Shrinks: The Untold Story of Psychiatry that “traces the field from its birth as a mystic pseudo-science through its adolescence as a cult of “shrinks” to its late blooming maturity.”
- Dr. Eric Kandel and Charlie Rose for the Brain Series. Bravo!
- Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health. Dr. Volkow pioneered the use of brain imaging to investigate the toxic effects and addictive properties of abusable drugs. Her studies have documented changes in the dopamine system affecting, among others, the functions of frontal brain regions involved with motivation, drive, and pleasure in addiction.
- And no list of estimable contributions to the field would be complete without mention of a personal favorite of mine, James Fallon, author of The Psychopath Inside: A Neuroscientist’s Personal Journey into the Dark Side of the Brain. It details how Fallon, while studying brain scans to search for patterns that correlated with psychopathic behavior, found that his own brain fit the profile like the proverbial glove. One of the most frightening Eureka! moments in the history of science.