Criminal acts and serious mental disorders: prison or psychiatric institution?

People with serious mental disorders who have committed

a criminal act have a different profile, that are incarcerated 

or hospitalized in a psychiatric institution.

"We see a clear difference between people with mental illness, which as a result of a crime are found guilty (incarcerated) and those which are declared not criminally responsible (psychiatric institution)," says Dr. Alexandre Dumais, the first author of the study and a researcher at the Institut Philippe-Pinel de Montréal, as well as to the University Institute in mental health of Montreal. "Since the adoption of the Bill C-30 in 1992, the number of accused suffering from serious mental disorders such as schizophrenia has greatly decreased in the centers of federal detentions. Conversely, the number of persons found not criminally responsible (NCRTM) has increased and these people find themselves in the network of the psychiatry", complete the clinical assistant professor at the Faculty of Medicine of the University of Montreal and a psychiatrist at the Institut Philippe-Pinel de Montréal.

The purpose of this research, carried out in collaboration with the Center for Studies on the control measures in the mental health of the University Institute in mental health of Montreal, was to compare the profile of individuals suffering from serious mental disorders, which result in an offense, are either incarcerated (I=44) or who have been declared NCRTM and who are hospitalized in a health care unit of Forensic Psychiatry (H= 59). To obtain these results, the researchers have analyzed the data from a broad program of research which has explored the clinical profiles and socio-demographic of men suffering from serious mental disorders1.

Results

In the case of persons declared NCRTM who are hospitalized, researchers have observed differences with those who are incarcerated.

Higher level of education among people NCRTM (equivalent Secondary 5): 25% for the incarcerated versus 54% for the NCRTM
greater use of specialized mental health services among people NCRTM: 40% for the incarcerated versus 73% for the NCRTM.
More history of suicide attempts among incarcerated: 66% for the incarcerated versus 34% for the NCRTM
more criminal history with or without violence among incarcerated: 71-80% for the incarcerated vs. 25-29% for the NCRTM
more concurrent disorders with drugs or alcohol and a level of psychopathy higher among incarcerated persons.
"This study confirms the work of my colleagues of the Institut Philippe-Pinel de Montréal, namely that prisoners who have a mental disorder Serious have a particular profile, particularly with criminal behavior and psychopathic traits," said Jean-François Pelletier, a researcher at the University Institute in mental health of Montreal and an assistant professor at the Faculty of Medicine of the University of Montreal. "For their part, the profile of persons hospitalized NCRTM differs from the people who are incarcerated by the fact that they use more mental health services and that they are often already followed in psychiatry before committing their offense," explains Mr. Pelletier.


"The characteristics of the incarcerated persons lead to criminal behavior and the receding of psychiatric care they would need," says Dr Dumais. "An offender, it punishes but when it is also ill, should the treat! As well, new models of shared care between the systems of justice and health will need to be put in place to better deal with these patients and reduce the risk of violent behavior or antisocial. Some initiatives have seen the light of day in different countries, but have not yet been tested formally using rigorous research methods. The next studies will need to be interested in these models to determine which are effective." he concludes.

Why We Love Serial Killers

Serial killers have become major players on the public stage and in the media since the 1970s. The great prevalence of serial killers in the popular culture indicates that I am not alone in my fascination with them. Serial killers are transformed into larger-than-life popular culture celebrities through the combined efforts of law enforcement authorities, the news and entertainment media, and the public’s appetite for the macabre.

Exaggerated depictions of serial killers in the mass media have blurred fact and fiction. As a result, real-life killers such as Jeffrey Dahmer and fictional ones like Hannibal “The Cannibal” Lecter have become interchangeable in the minds of many people.

When you bring up the name of an infamous real life predator such as Jack the Ripper or Ted Bundy in conversation with a group of people, it is clear that serial killers are a hot topic. Some folks actually become gleeful in their demeanor when discussing them. Why is that?

Could it be that some of us have a macabre fascination with serial killers for the same reason(s) that many of us are morbidly drawn to stare at a catastrophic automobile accident unexpectedly encountered along a highway?

Therein lies the central question of book. Why are so many people, including myself, fascinated by serial killers? Answering this intriguing sociological question and shedding light on serial killer myths, while providing compelling new insights into serial homicide are the primary objectives of my new book Why We Love Serial Killers: The Curious Appeal of the World’s Most Savage Murderers. See http://www.docbonn.com/why-we-love-serial-killers.html

Highly stylized and pervasive news media coverage of real-life serial killers and their horrible deeds transforms them into what I refer to as celebrity monsters. In order to understand why so many people in society are captivated by serial killers, it is necessary to examine the social agents and processes that promote them.

Unlike other books about serial killers which only focus on the behavior of the criminals, this book offers an exploration into the dark nature of society itself and its powerful appetite for the gruesome, while also providing new and unique insights into serial murder. The groundbreaking approach in this book provides a penetrating sociological look at the public’s fascination with serial homicide.

This book is unique in its examination of serial killers as popular culture personalities. Unlike most other books on this subject, the primary focus of Why We Love Serial Killers is not on the crimes of serial killers. Much has already been written about that. Although this book offers many new insights into serial homicide and provides shocking facts and anecdotes for true crime enthusiasts, the really unique contributions of this work lie in explaining why serial killers fascinate so many people, and how and why serial killers are transformed into morbid popular culture personalities or “celebrity monsters.”

In many ways, serial killers are for adults what monster movies are for children—that is, scary fun! However, the pleasure an adult receives from watching serial killers can be difficult to admit, and may even trigger feelings of guilt. In fact, the research conducted for this book reveals that many people who are fascinated with serial killers refer to it as a guilty pleasure.

The average person who has been socialized to respect life, and who also possesses the normal range of emotions such as love, shame, pity and remorse cannot comprehend the workings of a pathological mind that would compel one to abduct, torture, rape, kill, engage in necrophilia, and occasionally even eat another human being. The incomprehensibility of such actions drives society to understand why serial killers do incredibly horrible things to other people who often are complete strangers.

As such, serial killers appeal to the most basic and powerful instinct in all of us—that is, survival. The total disregard for life and the suffering of others exhibited by serial killers shocks our sense of humanity and makes us question our safety and security.

The research I conducted for this book reveals that the public loves serial killers for a number of interrelated reasons. First, they are rare in the business of murder with perhaps twenty-five or so operating at any given time in the U.S. They and their crimes are exotic and tantalizing to people much like traffic accidents and natural disasters. Serial killers are so extreme in their brutality and so seemingly unnatural in their behavior that people are drawn to them out of intense curiosity.

Second, they generally kill randomly, choosing victims based on personal attraction or random opportunities presented to them. This factor makes anyone a potential victim, even if the odds of ever encountering one are about the same as being attacked by a great white shark. Third, serial killers are prolific and insatiable, meaning that they kill many people over a period of years rather than killing one person in a single impulsiveact, which is the typical pattern of murder in the U.S.

Fourth, their behavior is seemingly inexplicable and without a coherent motive such as jealousy or rage. They are driven by inner demons that even they may not comprehend. Many people are morbidly drawn to the violence of serial killers because they cannot understand it and feel compelled to.

Fifth, they have a visceral appeal for the public similar to monster movies because they provide a euphoric adrenaline rush. Consequently, their atrocity tales in the news and entertainment media are addictive. Finally, they provide a conduit for the public’s most primal feelings such as fear, lust and anger.

Schizophrenia Symptoms, Signs, and Coping Tips

Schizophrenia is a challenging disorder that often makes it difficult to distinguish between what is real and unreal, to think clearly, manage emotions, relate to others, and function normally. Suspecting that you or someone you love has schizophrenia can be a stressful and emotional experience. But that doesn't mean there isn't hope. Schizophrenia can be successfully managed. The first step is to recognize the signs and symptoms. The second step is to seek help without delay. With the right self-help, treatment, and support, you can learn to manage the disorder and lead a satisfying and fulfilling life.

What is schizophrenia or paranoid schizophrenia?

Schizophrenia is a brain disorder that affects the way a person behaves, thinks, and sees the world. The most common form is paranoid schizophrenia, or schizophrenia with paranoia as it’s often called. People with paranoid schizophrenia have an altered perception of reality. They may see or hear things that don’t exist, speak in strange or confusing ways, believe that others are trying to harm them, or feel like they’re being constantly watched. This can cause relationship problems, disrupt normal daily activities like bathing, eating, or running errands, and lead to alcohol and drug abuse in an attempt to self-medicate. Many people with schizophrenia withdraw from the outside world, act out in confusion and fear, and are at an increased risk of attempting suicide, especially during psychotic episodes, periods of depression, and in the first six months after starting treatment.

While schizophrenia is a chronic disorder, many fears about the disorder are not based on reality. Most people with schizophrenia get better over time, not worse. Treatment options are improving all the time and there are plenty of things you can do to help yourself manage the disorder. Schizophrenia is often episodic, so periods of remission are ideal times to employ self-help strategies to limit the length and frequency of any future episodes. Along with the right support, medication, and therapy, many people with schizophrenia are able to manage their symptoms, function independently, and enjoy full, rewarding lives.

Early warning signs of schizophrenia

In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Often, friends or family members will know early on that something is wrong, without knowing exactly what.

In this early phase of schizophrenia, you may seem eccentric, unmotivated, emotionless, and reclusive to others. You may start to isolate yourself, begin neglecting your appearance, say peculiar things, and show a general indifference to life. You may abandon hobbies and activities, and your performance at work or school can deteriorate.

The most common early warning signs include:

1. Depression, social withdrawal
2. Hostility or suspiciousness, extreme reaction to criticism
3. Deterioration of personal hygiene
4. Flat, expressionless gaze
5. Inability to cry or express joy or inappropriate laughter or crying
6. Oversleeping or insomnia; forgetful, unable to concentrate
7. Odd or irrational statements; strange use of words or way of speaking

While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, getting treatment early will help.

Symptoms

There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all symptoms, and the symptoms of schizophrenia may also change over time.

Delusions

A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies, such as:

Delusions of persecution – Belief that others, often a vague “they,” are out to get you. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”).

Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, you might believe a billboard or a person on TV is sending a message meant specifically for you.

Delusions of grandeur – Belief that you are a famous or important figure, such as Jesus Christ or Napoleon. Alternately, delusions of grandeur may involve the belief that you have unusual powers, such as the ability to fly.

Delusions of control – Belief that your thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).

Hallucinations

Hallucinations are sounds or other sensations experienced as real when they exist only in your mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia, often occurring when you misinterpret your own inner self-talk as coming from an outside source.

Schizophrenic hallucinations are usually meaningful to you as the person experiencing them. Many times, the voices are those of someone you know, and usually they’re critical, vulgar, or abusive. Visual hallucinations are also relatively common, while all hallucinations tend to be worse when you’re alone.

Disorganized speech

Schizophrenia can cause you to have trouble concentrating and maintaining a train of thought, externally manifesting itself in the way that you speak. You may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.

Common signs of disorganized speech include:

Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next.

Neologisms – Made-up words or phrases that only have meaning to you.

Perseveration – Repetition of words and statements; saying the same thing over and over.

Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").

Disorganized behavior

Schizophrenia disrupts goal-directed activity, impairing your ability to take care of yourself, your work, and interact with others. Disorganized behavior appears as:

• A decline in overall daily functioning
• Unpredictable or inappropriate emotional responses
• Behaviors that appear bizarre and have no purpose
• Lack of inhibition and impulse control

Negative symptoms (absence of normal behaviors)

The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals, such as:

Lack of emotional expression – Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions.

Lack of interest or enthusiasm – Problems with motivation; lack of self-care.

Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal.

Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in monotone.

Treatment for schizophrenia

As upsetting as a diagnosis of schizophrenia can be, ignoring the problem won’t make it go away. Beginning treatment as soon as possible with an experienced mental health professional is crucial to your recovery. At the same time, it’s important not to buy into the stigma associated with schizophrenia or the myth that you can’t get better. A diagnosis of schizophrenia is not a life-sentence of ever-worsening symptoms and recurring hospitalizations. With the right treatment and self-help, many people with schizophrenia are able to regain normal functioning and even become symptom-free.

Treatment basics

The most effective treatment strategy for schizophrenia involves a combination of medication, therapy, lifestyle changes, and social support.

Schizophrenia requires long-term treatment. Most people with schizophrenia need to continue treatment even when they’re feeling better to prevent new episodes and stay symptom-free. Treatment can change over time, though, so your doctor may be able to lower the dosage or change medication as your symptoms improve.

Medication for schizophrenia works by reducing psychotic symptoms such as hallucinations, delusions, paranoia, and disordered thinking. But it is not a cure for schizophrenia and is much less helpful for treating symptoms such as social withdrawal, lack of motivation, and lack of emotional expressiveness. Finding the right drug and dosage is also a trial and error process. While medication should not be used at the expense of your quality of life, be patient with the process and discuss any concerns with your doctor.

Therapy can help you improve coping and life skills, manage stress, address relationship issues, and improve communication. Group therapy can also connect you to others who are in a similar situation and gain valuable insight into how they’ve overcome challenges.

Self-help

Medication and therapy can take time to take full effect but there are still things you can do for yourself to help manage symptoms, improve the way you feel, and increase your self-esteem. The more you do to help yourself, the less hopeless and helpless you’ll feel, and the more likely your doctor will be able to reduce your medication.

Schizophrenia: The 7 keys to self-help
Seek social support. Not only are friends and family vital to helping you get the right treatment and keeping your symptoms under control, regularly connecting with others face-to-face is the most effective way to calm your nervous system and relieve stress.  Stay involved with others by continuing your work or education—or if that’s not possible,  consider volunteering, joining a schizophrenia support group, or taking a class or joining  a club to spend time with people who have common interests. As well as keeping you  socially connected, it can help you feel good about yourself.
Manage stress. High levels of stress are believed to trigger schizophrenic episodes by  increasing the body’s production of the hormone cortisol. As well as staying socially  connected, there are plenty of steps you can take to reduce your stress levels,  including relaxation techniques such as meditation, yoga, or deep breathing.
Get regular exercise. As well as all the emotional and physical benefits, exercise may  help reduce symptoms of schizophrenia, improve your focus and energy, and help you feel  calmer. Aim for 30 minutes of activity on most days or if it’s easier, three 10-minute sessions.  Try rhythmic exercise that engages both your arms and legs, such as walking, running,  swimming, or dancing.
Get plenty of sleep. When you’re on medication, you most likely need even more sleep  than the standard 8 hours. Many people with schizophrenia have trouble with sleep,  but getting regular exercise and avoiding caffeine can help.

Causes

While the causes of schizophrenia are not fully known, it seems to result from a complex interaction between genetic and environmental factors.

Genetic causes

While schizophrenia runs in families, about 60% of schizophrenics have no family members with the disorder. Furthermore, individuals who are genetically predisposed to schizophrenia don’t always develop the disease, which shows that biology is not destiny.

Environmental causes

Studies suggest that inherited genes make a person vulnerable to schizophrenia and then environmental factors act on this vulnerability to trigger the disorder.

More and more research is pointing to stress, either during pregnancy or at a later stage of development, as a major environmental factor. Stress-inducing factors could include:

• Prenatal exposure to a viral infection
• Low oxygen levels during birth (from prolonged labor or premature birth
• Exposure to a virus during infancy
• Early parental loss or separation
• Physical or sexual abuse in childhood

Abnormal brain structure

In addition to abnormal brain chemistry, abnormalities in brain structure may also play a role in schizophrenia. However, it is highly unlikely that schizophrenia is the result of any one problem in any one region of the brain

Diagnosing schizophrenia

A diagnosis of schizophrenia is made based on a full psychiatric evaluation, medical history, physical exam, and lab tests to rule out other medical causes of your symptoms.

Criteria to diagnose schizophrenia
The presence of two or more of the following symptoms for at least 30 days:
Hallucinations Delusions Disorganized speech Disorganized or catatonic behavior Negative symptoms (emotional flatness, apathy, lack of speech)