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Beyond Psychiatric Expertise

NCJ Number
94385
Author(s)
B Burstein
Date Published
1984
Length
271 pages
Annotation
This book examines the scope of the Durham standard, which assesses criminal responsibility for behavior by whether or not that behavior is the product of mental illness, explains why the application of this standard is so difficult, describes the standard's role in regulating society, and explores the variety of settings in which decisions on the 'product of mental illness' are crucial.
Abstract
To apply the Durham standard -- product of mental illness -- to any decision about human behavior, mental illness must first be defined and recognized. Six criteria of illness are indicated: (1) a cluster of characteristics which is (2) undesirable, (3) natural and rationally explainable, (4) predominately biological, (5) individual rather than social, and (6) beyond the individual's control or choice. It is concluded that in many evaluations of behavior, evaluators will reach differing conclusions about whether the above criteria are met. In such situations, it is argued that conclusions on the meeting of the criteria rest on opinion and policy rather than expertise or facts. The complexity of applying the Durham standard is further developed in a discussion of the difficulty of deciding whether particular behaviors by persons whom experts agree are mentally ill are the products of the mental illness. The issues considered are whether action can be caused by ideas, whether a person can be partly mentally ill and partly well, how the specific behavior between the sick and healthy parts of a person can be allocated, and how a psychiatrist can distinguish between behavior that is a direct product of illness and that which is a reaction to the illness. Acknowledging that decisions about societal reactions to various behaviors must be formalized, a framework for understanding how 'product of mental illness' is used and how it might be applied is presented. This framework is then applied to decisions pertaining to criminal responsibility, commitment to mental hospitals, a patient's desire to refuse treatment, guardianship of the elderly, the nullificaiton of contracts due to 'unsound mind,' requests for employment leaves of absence because of mental illness, and disability and personal injury judgments. The central theme of the book is that psychiatrists are no more qualified than many other professions to make decisions about the 'products of mental illness,' since it is a policy rather than a scientific decision. About 180 references are listed.