The forthcoming new edition of the Diagnostic and Statistical Manual of Mental Disorders – the main reference work for the classification of mental disorders, whose fifth edition is due for publication in May 2013 – is already generating extensive debate. A sign of the fast-growing influence of DSM at a social level is offered by the concern, if not the panic, of some culturally and politically conservative groups. Few days ago, for example, several Italian MPs (belonging to the country’s biggest party) issued an interrogation to the Ministry of Health: they asked him to do everything he could in order to prevent the DSM V from including “preposterous” or “nonsensical” disorders, such as premenstrual syndrome, which in the MPs’ opinion, is “a physiological condition experienced by all women”.
These exaggerated fears are a sign of how influential the DSM is. Nowadays it is used worldwide by clinicians, national health agencies, private companies and policy makers. But with the increasingly important role played by scientific evidence in court, it is going to become a relevant reference in jurisprudence as well. One of the reasons why professionals in the legal field should pay attention to the new DSM has been made clear by Leonardo Tondo, a psychiatrist who was asked to write a couple of DSM’s entries. In Tondo’s opinion, the identification of new psychiatric disorder depends, at least in part, on the desire to help potential patients to get refunded for their psychiatric care expenses and to prevent people affected by mental disorders from being held legally responsible for the damages caused by their behaviour. This legally “exempting” aspect of the new formulation of disorders set out in the new edition of the DSM is strengthened by several attempts at individuating causal links between mental disorder and clearly identifiable cerebral lesions or dysfunctions – even if, of course, we are still very far away from precisely identify those causal links in the most relevant cases (think of schizophrenia, for example).
Many psychiatrists and philosophers feel nowadays that behaviours that violate the law and are included in the DSM-5 should not be considered of a criminal sort, since they are the products of neural disorders over which individuals have little or no control. In a society that increasingly, sometimes uncritically, accepts the idea that “one is one’s brain” (while one is seen as unable to control what happens in one’s brain), it could be argued that the broader the DSM, the narrower the penal code. For example, if compulsive hoarding disorder makes it into the DSM-5, will it be possible to convict a person whose heavy heaps of stuff cause the floor to collapse on the heads of his downstairs neighbours? Undeniably, therefore, the influence of the DSM on the application of the law is going to greatly increase in the next years. Still, the law is very much behind in matching itself with our knowledge of mental diseases (for example, the judicial systems seem to neglect the fact that the number of disorders included in the DSM has remarkably increased since its first edition in 1952). Much work has to be done in this respect.
According to many, a more humane jurisdiction could derive from a careful application of the DSM in our courts. It may be so. In this light, however, the research programs that aim at reducing mental diseases to neurological lesions or dysfunctions should be developed carefully and without strained ideological interpretations.
I believe it is absolutely correct to say that the legal understanding of mental diseases is lagging behind the science, although I would broaden the statement to say that the legal understanding of the mind is lagging far behind modern neuroscience. The states of mind given in the Model Penal Code, for example, are almost Cartesian in nature, and so it's not surprising that the treatment of mental disorders is similarly out of sync.
Unfortunately I think there are systematic forces in the legal world the tend to encourage this misunderstanding. Certainly scientific investigation should proceed without strained ideological interpretations in the interest of good science, but a criminal defense attorney is constrained by different responsibilities. To take a topical example, if a study correlates a certain brain lesion with a higher incidence of schizophrenia, and a client has such a lesion and committed a crime consistent with that disease, an attorney defending that client has a certain responsibility to introduce the study and suggest that the client be excused or get a reduced sentence due to mental disease. In a sense this is bad science, as the study is not conclusive and doesn't reach causality, but the client is owed all reasonable defenses and it is certainly possible, given the science, that the lesion caused him to be schizophrenic and to commit the crime. While I think the attorney must be responsible with scientific findings, conveying all the nuances of a contentious scientific controversy in a courtroom borders on the impossible and the necessary scientific literacy takes time to develop. So to some degree attorneys will probably always be pushing interpretations of new science beyond what science would consider proper.
I suspect the new DSM will be similarly prone to use and abuse. However, to the degree that it functions as a barometer of what society considers forgivable mental disorders, it should be used in the legal field, and I would hope its inevitable abuse could be tempered by advancing public knowledge of the complexity of neuroscience.
Posted by: Neuroscienceandlaw.wordpress.com | 10/06/2010 at 01:35 AM