Struggling with a psychological (kind of philosophical) debate

Hi folks. Looking for a solid debate and I am extremely open to all ideas so spill :-)

In the wake of the John Holmes decision and a local and much less relevant decision, I've been thinking to myself about a few things. So we knwow the John Holmes decision but it's a bit important to my topic to quickly explain the other case. A guy I have had in my ER many, many times has just been given 7 years in jail for basically a crapload...as in tons of counts...of petty crimes. He has had prior prison time. He essentially wants to be psychiatrically admitted and pretends all the time to be both deaf and blind despite us literally showing him on camera recordings that he has talked, heard and seen things. He's completely full of it. Anyway...so he finally made the police say "enough" after twice abusing emergency services

Anyway...this guy has never been given a Axis I diagnosis...but has been given Axis II - Antisocial personality disorder...So for those who don't know, there are of course multiple differences between Axis I and Axis II...Generally speaking they consider Axis I the mental/emotional/mood/psychotic/etc disorders. On Axis II however are the "behavioral" disorders...such as antisocial, histrionic, borderline, etc. So I have the following two questions to pose to the minds of ATS

As I have in past mental health threads, I am asking...can we please not get into an argument over the legitimacy of psychiatry/psychology/therapy/DSM/etc at least until the second part which you'll see why in a moment

So here it is...

1. When professionals (agree or disagree) discuss Axis I disorders such as Bipolar Disorder, Schizophrenia, and PTSD the overwhelming agreement is that these disorders cannot be helped be they caused by brain chemistry, nature/nurture or some traumatic event...potentially a mix of things. On the other hand, they "behavioral" disorders (Axis II), often with the exception of borderline personality disorder, are thought to be "controllable." For example, people diagnosed as borderline and histrionic will often do their best to draw immense amounts of attention to themselves and often in negative ways...lying, cheating, or sucking people into relationships only to play victim and push people away. With antisocial disorder, there is a mindset that is criminal and uncaring in nature. But again the often tie-in is that professionals believe these behaviors are controllable. The question is though, if someone grew with a terrible, abusive family, then would these "controllable" behaviors really be controllable?

I am trying to state as simply as I can...so essentially I am asking do you think there is a difference between someone who is borderline versus someone who is bipolar in the question of controllable behavior?

2. But the bigger discussion is this question. We talk and listen to stories like John Holmes and in this case it's pretty clear he was guilty...but again I am not interested in discussing specific case guilt/innocence in the manner of evidence...instead I wanted to talk about reason

So for this discussion we are assuming Holmes is 100% and unquestionably guilty. But...there is also the question of his sanity and mental health. If he was indeed mentally ill, is he responsible for his crimes? If so, why do we let others go for insanity defenses? If not then do we need to drop the insanity defense altogether?

Finally,

3. One of the statements I hear often is that "what sane person would murder someone anyway?" That to me opens even more of a moral quandary. Is anyone who moves to murder, be it cold blood or revenge, sane/mentally well? If not do we need to stop blaming others altogether? If so do we need to blame everyone 100%? Is a middle ground truly possible?

Thanks all

This might be a bit of a side line, but the problem I have is how do you define for example PTSD, if a person shows most of the systems then that seems to be enough, but the person/s making these decisions depend on there training, experience, dynamics of the team they work in, but the main factor is there own life experiences and emotional experiences colour the actions they see . I know of cases where doctors have said a person is not beyond normal depressed only to be found by another team to be very depressed. I know of many people who were diagnosed as manic depressed, only to be diagnosed by another team as Schizophrenia The point im making is that mental health is based on best guess there is no blood test for all the disorders. I have tried to use non medical terminological so every one can understand

I believe that if someone can go and kill a bunch of people, they are not mentally all there. They are suffering from some mental illness to even think about doing such a thing. I think they might also have some aggressive tendencies, I'm not sure how this fits into diagnosis? If they were to be studied, personality disorders would come to light and they would need to be helped with a certain amount of medication to control their aggressive tendencies. I do not think this goes for all murder cases. I think that some people kill for revenge, which can come down to them suffering depression in some cases. Definately it depends on the individual. They would need to be assessed to determine if they fit any of the criteria that you present. But most likely they do.

a reply to: KyoZero

It's rather one of those nature/ nurture things. I don't have time to replay thoughtfully at the moment but will think on your post and get back to you as I can....

I've always thought we should avoid this confusion altogether and simply think about the protection of society.
Determining how much will was involved or not is irrelevant to me.

If someone shows to have dangerous behavior repeatedly, we should restrain his/her freedom of action.
Period.

a reply to: KyoZero

If he was indeed mentally ill, is he responsible for his crimes?

Can I just skip to here please?

Why is this question asked over and over? If you are mentally ill, see a doctor....If that doesn't fix ya, hit up a mental ward...YES he is absolutely responsible for his crimes...Why wouldn't he be? Because he could be mentally ill? Let's just say he IS mentally ill, would that make you absolve him of his crimes if it was your family in that theater?

So I don't think "brain chemistry" has any more pull on someone's psyche than their wiring between brain areas. Also I think both chemistry and wiring can be altered through certain types of therapy, such as neurocognitive feedback.

I also question such assumptions in this thread as -anyone who thinks of murder is ill/insane-. Maybe a woman thinks like this, and her strategies are more different than a males, but most guys who have been through enough experiences in life have thought to some extent of outright murdering someone else. I sure as hell have. Maybe a chunk of guys push this down, repress, or it's never fully conscious even though they attach a feeling state to the subconscious anchor. The difference is most sane people will imagine, then drop, or find a way of releasing without committing the act. I think the same holds true for rape. There's a reason women fantasize about it, and well so do guys. It's part of our species history, alpha males dominate their choice of females.

Now we live in society, and their are social norms trying to trap us in through shame, and legal repercussions. It works on most, then we have this tool called psychology which tries to tell us we're ill if we think/feel otherwise. Again, in my mind it's not the instinct which is issue, it's the lack of impulse control, or rational thought to curb one's desires after weighing the consequences and probability of being caught. So are some people stupid? Yep. Are some people wired funky? Yep. Are some people maladapting to the environment, or rather adapting in a way that the culture at large disagrees with? Yep.

As for axis 1 and 2, I just don't know, doc. I think the current system of organization is infantile, and we'll likely have to rework it after we advance our understandings in neuroscience and emerging, adjacent fields that are bringing us objective analysis into the dark pits of psychology.

a reply to: imod02

Yeah...maybe a sideline but you make an important statement on the question itself. I was mainly wanting to avoid people who wander in just to say "psychology is a joke...this question is a joke." Yes I agree that people's own personal bias seems to seep in almost every time so I have to wonder when I make my diagnoses, are they going to be agreed upon or more importantly did I do a proper service to the client themselves? Good points all around

mmirror

I'm sorry I don't know why I am this lazy but I still haven't figured out (see also: got off my butt and asked) how to multi quote

See that's what always nags me in cases of murder or serial/spree killers, etc. I personally cannot think of any scenario where I would take a life without an extreme reason such as last second defense in a case like having a concealed carry and being held at gun point. In a case of revenge I am always left wondering if this person is so emotionally harmed by whatever set of events got him/her thinking this way. Or in the case of something more like first-degree murder...is anyone who commits such an act mentally stable in the first place?

And before anyone goes out of context...I am not saying I believe those statements...just that they make me think. The problem is if I were to open this can of worms, does a slippery slope begin where I have to say "well nobody who would commit murder is all with it...therefore your sentence is commuted." In the past we have on many occasions transferred to a ward instead of prison or released due to insanity pleas. I guess really I was just interested in hearing some viewpoints...not to help me even make my decision because ultimately any decision I would ever have to make on a case should be my own original thought and on a case-by-case basis.

Thanks for the response

No worries FyreByrd...if you come back I look forward to it...if not...ain't no thing

Bluesma

I'm not in disagreement by any means. Danger is danger and we prove that daily in this country. I am no jailer, police officer, judge or juror but I have made my attempts to rein in concerns or personal or external safety by means of psychiatric admissions to those who have presented imminent risk. Granted an admission is sometimes 3 days at best but we do what we can to avoid dangerous situations. But if say, John Holmes was undeniably schizophrenic and by some magic we could find out without any doubt that his illness caused him to commit the shooting, shouldn't we still have him placed somewhere that he couldn't harm again? So as stated I am not in disagreement with you

Chrisfishenstein

Thanks for joining...look I am not sure why you have to bring in an emotional plea like the pretend event of my family being in the theater...I also am not sure why you feel you need to keep responding if you are irritated by this question...

The purpose for me opening this discussion was part selfish...in that I wanted to talk to some fine minds and open a dialogue...and part selfless...in that I wanted to open the lines of communication and see who could offer other people some new lines of thinking to ponder

Before you even say it...no I am not "un-calm" and I am not angry, offended, or anything else. I am calm as a cucumber while I post this

I've never understood the purpose of the whole "what if it was you/your family" thing...it's so emotionally charged and pointed. I get the idea of taking time to place yourself in a situation and I have indeed thought of what if I were a father or brother of one of the victims. The problem is most of the time when someone asks a question like yours, it's very emotionally-charged and meant to throw people off. This discussion was brought about as very open-ended and with the thought that it would be more of a discussion instead of placing ourselves in the scenario...quite simply, I wanted to propose the question of "what of this situation in your opinion?" Nothing more.

Some people would indeed absolve him. I personally am always on the fence on this so I decided to pop up a discussion on it...with good results I might add. ATS is a great place for these topics especially when approach respectfully

The one thing I would like to challenge you on is this. And make sure you read this because I am not interested in a cherry-pick out of context assault

You say that if you are mentally ill, why not see a therapist, or a psychiatrist, or admit yourself. I am 100% in agreement.

The problem with that is...when you are knee deep in a psychotic break, you aren't quite in the right mind to make these appropriate decisions for yourself. When you are manic, you are feeling way too good to recognize that a problem exists. When you are immensely depressed, you often don't feel the power to get out of bed let alone move to your psychiatry appointment. My point is, that in many cases, people may not be, or may not feel physically capable of doing these acts. All of these ideas I commend you on...in theory...the problem is your question doesn't include reality and reality is that many times...not always...but many times when someone is truly ill they either don't notice it, don't care, or don't have the ability in the moment or after to seek the proper care.

a reply to: KyoZero

Hiya Kyo,

I've written a handful of loooong replies to your OP and then discarded them for being too wordy or not nuanced enough. The questions are really existential, important and too weighty for internet drive-bys. So here's a drive-by anyway!! Sorry!

You and I have worked with some basket cases; societal detritus who, at best, are like rust that corrodes and spreads. That's the subjective side of things and we should always point our eyes at the higher ideals of what makes a society compassionate. In my opinion, of course...

I believe we should always have the option to deal with killers in ways that reflect the higher values rather than on their level. The debate won't ever end about what 'responsibility' truly entails. Holmes and guys like Dahmer kill a lot of people and intuition says they must be irrational (mad) to even conceive of such deeds. Not so irrational that they can't function in society or be logical enough to plan more crimes without capture. If we deal with them on their level, we'd put them down like rabid dogs and not give another thought about them.

Where I say 'rabid dogs,' it's not a bad analogy because we don't (or shouldn't) characterise vicious dogs as 'evil' or that they 'know what they're doing.' A crazy dog is a crazy dog. If some panel of psychologists can agree that so-and-so is insane, it seems reasonable that they are dealt with accordingly. There's a good body of academic research that's been sourced from the clinical studies of inmates and micro-biology is constantly finding gene markers that confirm genetic predispositions towards violence, sadism and murder. It's not a bleeding heart, cop-out to say these people aren't completely in charge of the bus.

The destinations of crazy bastards isn't much (if any) better than the destinations for lifers in the prison population. It's a nasty dog-eat-dog world with a hierarchy wherever they land up. In the UK we've got a notorious guy called Charles Bronson. He gamed the system to serve time in Broadmoor (for criminally insane) and then spent his time to prove his sanity to get back out of there and back in the general population of the prison system.

So for 1, 2 and 3, I suspect there's an ill-defined spectrum for 'sane' killers through to 'insane' killers. Although some will be hard to place, some will be clearly crazy or clearly 'sane' and the system's two-lane highway to life terms works as well as it can.