Forensic complications25

If someone with a generalized psychotic disorder like schizophrenia becomes sufficiently disorganized, functioning in the community becomes impossible. In contrast, many patients with delusional disorder retain a sufficient grasp of reality to continue existing in society, sometimes indefinitely. However, this does not imply that their illness is quiescent. Intellectual ability, capacity for reasoning and the form of thought remain relatively intact, but the delusional process worsens. They retain the ability to brood on their beliefs so that normal thought processes and delusions interweave, as do normal and abnormal behaviours. Anger may express itself explosively, but some individuals may carry out violent actions in a very calculated way, believing that a just vengeance is being exacted. Afterwards there may be real regret and a clear awareness of a wrong against society, but nevertheless the actions are seen as justifiable and necessary.

In 1843 the English legal system devised the McNaghten Rules following the trial of McNaghten, a deluded assassin, and these attempted to define the relationship of delusion to crime. Subsequently they were found to be inadequate, since they dwelt on cognitive misapprehension and largely ignored the roles of emotion, volition, and the capacity for behavioural control. Nowadays the principal issue in cases of delusionally motivated crime is whether or not the accused appreciated the rightfulness or wrongfulness of his action at the time. In delusional disorder the patient is usually aware that by societal standards his deed is legally and morally wrong, but that awareness resides within the normal non-delusional aspect of his mental functioning. Within the confines of the delusional system, the person unswervingly believes that it was necessary to behave as he did.

In such cases, the judge and jury are placed in a quandary, made worse by the individual's frequent arrogance (which is at least partly grandiosity), self-justification, and ambivalent expression of regret. The ability to acknowledge the wrongness of one's act in general terms and even show remorse for it, while also asserting that it was necessary to carry it out, may well be regarded as indicating wilfulness or hypocrisy. Then, paradoxically, culpability may be determined by the content of the delusion, although this usually has minor relevance to the disinhibition of behaviour. Thus, as Goldstein (5!> has pointed out, if the person felt threatened because of a delusional belief and reacted, as he genuinely perceived, in self-defence, his degree of blame may be adjudged to be low. But if he were equally deluded and carefully plotted revenge, this might be seen as highly culpable. Such a distinction cannot be defended logically either in the clinical situation or at law.

Delusional disorder defies any definition of insanity in black or white terms; it is both black and white. Because few psychiatrists, even in the forensic field, are familiar with its detailed characteristics, psychiatry has had limited success in educating the legal profession about the subtleties of the illness or the conundrum that delusions can induce such abnormal behaviour in an individual who superficially appears rational and for significant periods of time is effectively sane even though the illness is always present.

Funny Wiring Autism

Funny Wiring Autism

Autism is a developmental disorder that manifests itself in early childhood and affects the functioning of the brain, primarily in the areas of social interaction and communication. Children with autism look like other children but do not play or behave like other children. They must struggle daily to cope and connect with the world around them.

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