The tickle of curiosity. The gasp of discovery. Fingers running across the keyboard.

The tickle of curiosity. The gasp of discovery. Fingers running across a keyboard

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Sunday, September 22, 2013

Criminal Psych 101: Information for Writers


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Werner Erhard and Associates v. Christopher Co...
 (Photo credit: Wikipedia)
I have a masters degree in rehabilitation counseling, which means that I worked with people who had mental health issues created by or exacerbated by physical health issues. For example, I had a family whose father was electrocuted while working in the hospital. Because he was on site, doctors were able to save his life. However, he had a complete personality change and became prone to fits of physically-abusive rage. These were aspects that could not be changed, but the family had to deal with.

When I was practicing, I was a court ordered interventionist for families at risk. My population had at least one family member who was involved in the penal system AND displayed serious mental health concerns in the family including homicidal and/or suicidal ideations, and sexually deviant behaviors, among others. 

The following are some things that I think writers might find helpful when constructing their plot lines. I will also offer, that if you have a specific question, you can leave it below, and I will do my best to help.

One of the main things that I want to point out is that clients who are seeing a mental health provider because they want to improve their lives and someone who is court ordered to work with a mental health provider are different. 

Clinical:

* There of their own volition
* Generally honest and working hard to make improvements
* Client's privacy is protected under the law
* End goal is to become a better/happier person

Judicial orders:

* There against their will
* Typically uncooperative and uninterested in progress
* Information gleaned in the therapeutic setting does NOT fall under the same
   patient confidentiality laws
* Client is aware that the information can/will be part of their trial or other legal
   procedure (such as parole hearing)
* Client frequently tries to manipulate the mental health worker to influence their
   testimony and outcome.

So, I dealt with a lot of deception. The two main false presentations were malingering and defensiveness.

MALINGERING - the client pretends to have a mental health issue. Usually they do this to avoid being prosecuted. Malingering runs in cycles closely copying those stories that are found in the news. Clients usually didn't make up symptoms by doing research (in my client case load). Psych disorders and medical disorders tend to be fashionable - right now bi-polar is a big diagnosis. I personally know people who have been given this designation and are medicated for it when I am very clear this is not their issue. I am not digressing - I am pointing out that even clinicians, when not paying attention, can fall into this habit as well.  But if a client presented with PTSD, I would pay very close attention to their symptoms because PTSD is so prevalent in the news right now.
VIDEO QUICK STUDY (2:50)
AUDIO QUICK STUDY (2:38)

How could I pick out a malingerer? 
* VERY dramatic. Really pushing the envelope on wacked-out (yes, the clinically
  correct word) behaviors. So if your character is malingering, look up the
  symptom list in the DSM V (Should be in your library) and then magnify these
  behaviors.
* They drop the symptoms from time to time especially if they don't think anyone is
   watching. It's hard to maintain fake symptoms for long stretches of time. It's like
   constantly telling a lie; the brain is very engaged and becomes tired.

And then just to cloud things a bit, there is pseudo-malingering. That's when someone with a mental health issue pretends to have a different mental health issue because they think that will get them off the hook. Ex. Someone who is a psychopath presenting with PTSD symptoms. The mental health worker has to decide which symptoms are true and which feigned. It's a mess! But would make a GREAT PLOT TWIST!

DEFENSIVENESS - You can read this as the opposite of malingering. It's when a client, with OBVIOUS mental health issues, tries to present as stable. I had a client once who was trying to keep custody of her children. She was diagnosed schizophrenic, was non-compliant with her meds, and suicidal. When she went before the judge, she thought that the best way to keep her children in the home with her was to lie. (She was successful in keeping her six children, and the end result was catastrophic for the kids, I'm sorry to say.)


Now, while I am a counselor, typically the two titles seen in the legal system are:
Forensic Psychologists and Forensic Psychiatrists.

Forensic Psychologists 

* Have masters or PhD in psychology
* Can do psych testing
* Can offer expert testimony
* Can provide treatment and evaluation of progress  CANNOT prescribe
   medications
* Can attempt to establish a motivation in a crime
   Was it do to a substance abuse issue?
   Was it do to something that had happened to that person in the past?
   Was it do to a mental health disorder such as PTSD or Schizophrenia?


Forensic Psychiatrists

Regions of the brain affected by PTSD and stress.
Regions of the brain affected by PTSD and stress. (Photo credit: Wikipedia)
* Have medical degrees and residency in
   psychiatry
* Can do everything that a psychologist
   can do
* Can prescribe medications
* Can decide if the client is a danger to
   self and community leading to an
   involuntary mental health hospital stay
* Can establish if the crime was based
   on a medical issue - one such issue that
   is coming up in the news lately are the
   brain injuries sustained in football,
   and tumors growing on the brain.


Counselors, Psychologists, and Psychiatrists all:

ASSESS - evaluating people using psychological tests

Mental health workers do NOT get to make a judgement. They are only offering their expert opinions. For example, I could not declare someone insane and have someone placed in a medical facility involuntarily. I would present my information and the judge would rule about the sanity/capacity of the client.

Testing is used to help the courts understand the person being assessed
Test Examples:
General personality inventories Myers-Briggs
Beck Depression Inventory 
Rorschache Test Video Link to original test (9:05)
Weschler Memory Scale
Weschler Adult Intelligence Test Video Information Link (13:38)
Robert Hare's Psychopathy Checklist Animated List - Link (2:43)
Rogers Criminal Responsibility Assessment Scales Informational Link
English: At sea aboard USNS Comfort (T-AH 20) ...
 (Photo credit: Wikipedia)

Psychiatrists can add physical exams:
Blood work
Toxicology reports
Electroencephalograms
Cat Scans



TREAT - psychotherapy like talk therapy, art therapy, music therapy,
 behavior modification

TESTIFY
* Civil - family members of custody, guardianship, JD, medical do-not resuscitate,
   disability and loss in workers comp cases and social security cases
* Criminal - 
   Ability to stand trial
   Competency
   Sentencing
   Treatment of incarcerated criminals

One of the things that Forensic Mental Health Workers are trying to decide upon is competency. Someone could have been legally insane at the time of the crime. That does NOT mean that they are insane now. So the assessment looks at what was the mental health capacity in the
* past
* present - what is their mental health standing now? 
   Can s/he give testimony? 
   Stand trial? 
   Can this client understand what is going on? 
   Can they participate in their defense?

It's during the trial that the judge would decide the level of sanity during the crime. Only about 1% of cases attempts an insanity plea. 1 in 1,000 are considered insane.

An American judge talking to a lawyer.
(Photo credit: Wikipedia)
Guilty but Insane:

M'NAGHTEN RULE
If the defendant did not or could not understand what he or she was doing, or they knew it was wrong, at the time of the crime, they are considered not guilty by reason of insanity.

* Mens Rea - Guilty mind 
  VIDEOQUICK STUDY (7:48)
  You can't have a crime WITHOUT  mens rea and if you are
   criminally insane you CANNOT have mens rea and therefore you CANNOT
   be guilty

* Actus Reus volitional and conscious and/or omission to act. Ones mental
  state  can effect actus reus.
  Sleep walking disorder
  Car accident with stroke
  You don't owe the duty to go to someone's aid if they are imperil (unless by
   contract/law/or relationship)
  VIDEO QUICK STUDY (5:25) go to 1:30 to start.
  

Guilty but Mentally Ill:
After John Hinkley shot at Reagan the courts developed a new designation. Guilty but Mentally Ill happens when the suspect knew what he was doing was wrong BUT could not help or stop the actions because of his mental health status.

Diminished Capacity - you had the intent to commit the crime but had a mental reason for not being held completely responsible. VIDEO QUICK STUDY (:48)



See how this article influenced my plot lines in my novella MINE and my novel CHAOS IS COME AGAIN.




Thank you so much for stopping by. And thank you for your support. When you buy my books, you make it possible for me to continue to bring you helpful articles and keep ThrillWriting free and accessible to all.

10 comments:

  1. You provide terrific information, Fiona. Anyone who is writing a psychological mystery (like me), or a crime thriller should really read your work.

    Question: Would you say the DSM-5 is considered the 'bible" for clinicians on how to diagnose a patient? And if so, would it use the standard of classifying personality disorders into Cluster A/B/C?

    Thanks,

    eden

    ReplyDelete
  2. Hi Eden,

    Thanks for stopping by today. And thank you for the great questions; it shows you know a thing or two about psych.

    The DSM V is the newest iteration of the Diagnostic and Statistical Manual of Mental Disorders. It came out in May of this year. (ICD-10 is the WHO equivalent)

    In the DSM V they still use the A B Cs of personality disorders. A are odd and eccentric. B are dramatic/emotional/erratic. C are anxious and fearful (OCD falls into this category). In the DSM V there are some personality disorders that fall outside of the ABCs. Personality changes due to medical issues is an example.

    I hope this was helpful. I'm excited about your new literary work. If I can be of any help just DM me.

    Cheers ~ Fiona

    ReplyDelete
    Replies
    1. Thanks Fiona, for answering my question.

      Psychology has always interested me, (did my undergrad in it years ago), but never went further. Thank you for your offer to help. Really appreciate it, eden :)

      Delete
  3. For someone who has spent a career investigating individuals with assorted mental health impairments, I found your post excellent. Fiona, you provided great insight into the world of mental health and a valuable asset for writers.

    ReplyDelete
  4. Thanks, Mike!
    For my readers who don't know Mike, he's a former Secret Service Agent. Catch up with him at http://mikeroche.com/ where he posts wonderful and applicable articles. His books are on Amazon.

    ReplyDelete
  5. Thank you, Fiona, for a fascinating post. I read it through, then tried to paraphrase parts of it for my husband (even though he was watching football and wasn't really paying attention). I have no idea if I'll ever have a chance to use the things you wrote about (I write erotica) - but if I do ever have a mentally unstable character, I'll know where to come for clear, concise information! Thanks again,

    Evelyn (Gail Bridges from Twitter)

    ReplyDelete
  6. Hi Evelyn, I followed you back on Twitter - nice to connect! I'm so glad you found this article interesting - I can see how this might play out in erotica - how about a psychologist who is having an affair with a lawyer and when she writes the correct evaluation he rewards her with... hahaha!
    Cheers ~ Fiona

    ReplyDelete
  7. Fiona, you are a wealth of information. Thank you for writing such fascinating posts.

    ReplyDelete
  8. Thanks Elise! For my readers who don't know Elise Stokes, she is the author of the acclaimed Cassidy Jones Adventures that I highly recommend to my tween friends. Available on Amazon.

    ReplyDelete
  9. Hi Fiona,
    Thanks for such an interesting and informative post. It helped me understand one of the characters in my current WIP, and gave me a nice idea for a plot twist.

    ReplyDelete