4. Mental Disorders and Crime
Within the psychodynamic theory of crime are mood disorders. Criminal offenders may have a number of mood disorders that are ultimately manifested as depression, rage, narcissism, and social isolation. One example of a disorder found in children is conduct disorder. Children with conduct disorder have difficulty following rules and behaving in socially acceptable ways (Boccaccini, Murrie, Clark, & Comell, 2008). Conduct disorders are ultimately manifested as a group of behavioral and emotional problems in young adults. It is important to note that children diagnosed with conduct disorder are viewed by adults, other children, and agencies of the state as “trouble,” “bad,” “delinquent,” or even “mentally ill.” It is important to inquire as to why some children develop conduct disorder and others do not. There are many possible explanations; some of the most prominent include child abuse, brain damage, genetics, poor school performance, and a traumatic event.
Children with conduct disorder are more likely to exhibit aggressive behaviors toward others (Boccaccini et al., 2008), and they may be cruel to animals. Other manifestations include bullying; intimidation; fear; initiating fights; and using a weapon, such as a gun, a knife, a box cutter, rocks, a broken bottle, a golf club, or a baseball bat. Adolescents with conduct disorder could also force someone into unwanted sexual activity. Property damage may also be a concern; one may observe these children starting fires with the ultimate intent to destruct property or even kill someone. Other unacceptable behaviors associated with conduct disorder include lying and stealing, breaking into an individual’s house or an unoccupied building or car, lying to obtain desirable goods, avoiding obligations, and taking possessions from individuals or stores. Last, children with conduct disorder are more likely to violate curfews despite their parents’ desires. These children also are more likely to run away from home and to be late for or truant from school. There is no question that children who exhibit the above-mentioned behaviors must receive a medical and psychological examination. It is important to note that many children with conduct disorder could very well have another existing condition, such as anxiety, posttraumatic stress disorder, drug or alcohol abuse, or attention deficit disorder (Siegal, 2008). It is important to recognize that children with conduct disorder are likely to have continuing, long-lasting problems if they do not receive treatment at the earliest onset. Without treatment, these children will not be able to become accustomed to the demands of adulthood and will continue to have problems and issues with a variety of relationships and even with finding and maintaining a job or occupation. Treatment of children with conduct disorder is often considered complex and exigent. It is rarely brief, because establishing new attitudes and behavior patterns takes time. As mentioned previously, early treatment offers a child a greater probability for improvement and for ultimately living a productive and successful life. An important component for the medical doctor or psychological clinician to consider is convincing the child to develop a good attitude, learn to cooperate, trust others, and eliminate fear in their lives. Behavior therapy and psychotherapy may be necessary to help the child learn how to control and express anger. Moreover, special education classes may be required for children with learning disabilities. In some cases, treatment may include prescribed medication, although medicine would ideally be reserved for children experiencing problems with depression, attention, or spontaneity/impulsivity. (For more information on conduct disorder, see http://www.aacap.org/.)
A second example of a disorder found in children is oppositional defiant disorder (Siegal, 2008). This is most often diagnosed in childhood. Manifestations or characterizations of oppositional defiant disorder include defiance; uncooperativeness; irritability; a very negative attitude; a tendency to lose one’s temper; and exhibiting deliberately annoying behaviors toward peers, parents, teachers, and other authority figures, such as police officers (Siegal, 2008). There is no known cause of oppositional defiant disorder; however, there are two primary theories that attempt to explain its development. One theory suggests that problems begin in children as early as the toddler years. It is important to note that adolescents and small children who develop oppositional defiant disorder may have experienced a difficult time developing independent or autonomous skills and learning to separate from their primary caretaker or attachment figure. In essence, the bad attitudes that are characteristic of oppositional defiant disorder are viewed as a continuation of developmental issues that were not resolved during the early toddler years.
The second theory to explain oppositional defiant disorder focuses on learning. This theory suggests the negative characteristics of oppositional defiant disorder are learned attitudes that demonstrate the effects of negative reinforcement used by parents or persons in authority (Siegal, 2009). It is important to recognize that the majority of symptoms observed in adolescents and children with oppositional defiant disorder also occur, at times, in children without this disorder. Relevant examples include a child who is hungry, tired, troubled, or disobeys/argues with his or her parent. It is important to note that adolescents and children with oppositional defiant disorder often exhibit symptoms that hinder the learning process, lead to poor adjustment in school, and most likely hurt the child’s relationships with others. Some of the symptoms of oppositional defiant disorder include frequent temper tantrums, excessive arguments with adults, refusal to comply with adult requests, questioning rules, refusing to follow rules, engaging in behavior intended to annoy or upset others, blaming others for one’s misbehaviors or mistakes, being easily annoyed by others, frequently having an angry attitude, speaking harshly or unkindly, and deliberately behaving in ways that seek revenge.
In regard to diagnosis, it is often teachers and parents who identify the child or adolescent with oppositional defiant disorder. However, children must be taken to a qualified medical doctor and/or mental health professional who will make an official diagnosis. Doctors will inquire into the history of the child’s behavior, which includes the perspective of all interested parties (i.e., parents and teachers) and will verify the results of any previous clinical observations of the child’s behavior. Psychological testing also may assist in assigning a diagnosis. As always, early detection and treatment are desirable. Actually, early treatment can often prevent future problems.
Oppositional defiant disorder may exist alongside other mental health problems, including mood and anxiety disorders, conduct disorder, and attention deficit hyperactivity disorder. Treatment for children and adolescents with oppositional defiant disorder will be determined by a physician who considers the child’s age, overall health, and medical history. The physician also considers the extent or totality of a child’s symptoms, the child’s tolerance for certain medications or therapies, expectations for the course of the condition, and the opinion or preference of the caretaker or parent. Most important, treatment could include psychotherapy that teaches problem-solving skills, communication skills, impulse control, and anger management skills. Treatment may also be in the form of family therapy. Here, the approach is focused on making changes within the family system with the desired goal of improved family interaction and communication skills. Peer group therapy, which is focused on developing social skills and interpersonal skills, also is an option. The last and least desirable treatment option is medication. (For more information on oppositional defiant disorder, see http://www.aacap.org/.)
5. Mental Illness and Crime
The most serious forms of personality disturbance will result in mental disorders. The most serious mental disturbances are referred to as psychoses (Siegal, 2008). Examples of mental health disorders include bipolar disorder and schizophrenia. Bipolar disorder is marked by extreme highs and lows; the person alternates between excited, assertive, and loud behavior and lethargic, listless, and melancholic behavior. A second mental health disturbance is schizophrenia. Schizophrenic individuals often exhibit illogical and incoherent thought processes, and they often lack insight into their behavior and do not understand reality. A person with paranoid schizophrenia also experiences complex behavior delusions that involve wrongdoing or persecution (Jacoby, 2004). Individuals with paranoid schizophrenia often believe everyone is out to get them. It is important to note that research shows that female offenders appear to have a higher probability of serious mental health symptoms than male offenders. These include symptoms of schizophrenia, paranoia, and obsessive behaviors. At the same time, studies of males accused of murder have found that three quarters could be classified as having some form of mental illness. Another interesting fact is that individuals who have been diagnosed with a mental illness are more likely to be arrested, and they appear in court at a disproportionate rate. Last, research suggests that delinquent children have a higher rate of clinical mental disorders compared with adolescents in the general population (Siegal, 2008).