Thursday, July 19, 2012

Are You Insane?

Scientifically--Yes! Psychology is a science!--insanity does not really exist, and neither does sanity. These are not actual psychological terms, although many people throw them about as if they are. The idea of insanity is a legal term. Even though it's not a true psychological concept, I will still try to explain it so that we can clear up this confusion and stop asking every psychologist or psychology major whether or not someone is insane.

Insanity is not actually a simple term to define. I am familiar with its use in the United States, so if you happen to know how it is observed in other countries, cultures, or legal systems, please leave a comment and educate me. I love learning!

In the United States, insanity is used solely as a defense in a court of law. It may be used in a civil case to determine whether or not a family member should be institutionalized for their (or, rather, the family's) own good. In this case, a judge takes testimony from psychological or psychiatric experts [a future blog post on psychologist vs. psychiatrist will be forth coming, I promise] on the mental state of the individual in question. There are no real set rules, that I know of (remember, I'm stepping a little outside my arena here, so please fill in my gaps, legal experts, if I miss something), to determine the requirements for institutionalization. Most judges in these cases will decide for themselves if the individual poses a harm to themselves or others, which is usually the primary concern when talking about removing someone's basic civil liberties due to a mental disorder.

I am sure that most people are more familiar with the use of insanity as a defense in a criminal case, thanks mostly to the popularization of this idea as a plot point in way too many television programs, movies, and novels. In reality, the idea of insanity is left up to a judge or a jury (depending upon the state and the offense) to determine. Each state in the United States has its own rules or criteria for determining whether an insanity defense is valid. These usually boil down to one of four basic rules. Some states use a combination of rules, some states have completely eliminated the defense all together, and some states allow a verdict of "guilty but insane" (never "not guilty by reason of insanity" in these states) in order to pass sentence. The four basic rules are as follows (paraphrased for simplicity; more information can be found at several other sites, including the Encyclopedia of Everyday Law and a 2006 article on the history and possible future of the insanity defense by Carol A. Rolf, JD).

The M'Naghten Rule:  Basically, the defendant, because of some mental or psychological defect, did not know that criminal act was in fact wrong--they could not distinguish between right and wrong--at the time the act was committed. That's the kicker there. By the M'Naghten rule, at least on the surface of things, you could be "sane", i.e. tell right from wrong, before stabbing your lover 50 times and "sane" after stabbing them 50 times (that's why you ran, after all), but while wielding the knife you had no concept of morality. It's no surprise that this test is difficult to prove and you can see how it actually led to defense attempts at the idea of "temporary insanity."

The Irresistible Impulse Test: In this instance, a defendant may or may not know the difference between right and wrong, but because of some mental disorder the defendant could not help themselves while committing the act. [BTW, psychologists rarely use the term "mental disease" any more, instead preferring to think of them as disorders.] The responsibility for the theft or murder or what have you lies at the feet of the disorder, not the person, based on this rule. They just couldn't help themselves because the disorder was ruling them. Unfortunately, this rule makes it easy to fake a disorder and, from my perspective, does not give the individual responsibility for their own actions. It's hard for me as a philosophical humanist to accept the idea that someone "just couldn't help themselves" when committing a crime. I can understand functioning under misinformation, such as when a hallucinating schizophrenic smacks a person that they thought was a giant mosquito, but the person still had the choice the smack that "giant mosquito" or to walk away from it.

The Durham Rule: This rule is overly simplistic, which might be why it is not really used (except in New Hampshire). It's so simple that it's really hard to paraphrase. Essentially, according to this rule, a defendant is not responsible for the crime if the crime was caused by a mental disease/defect. Again, it's tough to buy this argument, as it's giving the power of action to a condition. Conditions don't "do" anything besides exist. People "do" things; people are capable of actions. Defects and diseases are not. This rule did indicate that a medical diagnosis (the specific use of "disease or defect") was a necessary requirement, rather than evaluating one's cognitive abilities or more abstract mental state.

The Model Penal Code Test: This is a combination of the previous rules. A defendant may be seen as not responsible for the crime if they do not a) understand the right/wrong aspects of the act, or b) could not control their behavior at the time of the criminal act, as a result of a mental disease. So, someone would have to have a mental illness per a medical diagnosis and either lack the cognitive capacity to understand their actions or the will power to avoid the action.I'll let you fill in the gaps and loop holes on this one for yourself.

Well, that's a little insight into the legal definition of "insanity." Psychologists do not really use this term in any technical sense, as it's not one of ours. Insane has been used and abused by popular vernacular, thus many people seem to think it is a true psychological concept. The only time a psychologist or psychiatrist is involved in these cases is to question whether the individual exhibits symptoms of a mental disorder (disease or defect) and to judge the person's cognitive capacity for moral understanding. Okay, so maybe you're neither sane nor insane from a psychological standpoint. Can you be crazy? Once again, this is not a psychological term. Crazy is a popular or common word not used in scientific circles.

Crazy: mentally deranged, demented, insane; senseless, impractical, unsound; mad, foolish, foolhardy. Gee, based on the dictionary definition, this is an extremely versatile word. It's no wonder there is so much confusion and it gets thrown around so often. Demented is technically a mental state in which the brain does not function in full capacity--loss of memory, confusion, difficulties thinking or problem-solving, problems communicating or understanding--due to a biological deterioration of the brain itself. Mad is similar to insane in that it is more of a common usage term than a scientific term. As for the rest of the synonyms for crazy, many of them indicate a lower intelligence (see my earlier post on RETARDATION for more on that subject] rather than an inability to function. Most individuals suffering from (or living with, depending on your perspective) a mental disorder have normal intelligence levels.

So, do psychologists use any "real" terms to describe people with mental disorders? Absolutely. Psychologists look at abnormal behavior to determine one's mental health. Abnormal behavior is classified as having one or a combination of the following three criteria:
  1. The behavior represents a significant feeling of distress to the individual, i.e. the person is uncomfortable about the behavior and/or the results or consequences of the behavior, such as a person who washes their hands so often that the skin is usually scrubbed raw. They don't like the raw skin, but find it difficult to resist the impulse to constantly wash their hands.
  2. The behavior interferes with the daily activities of the individual. Daily activities include normal grooming, hygiene maintenance, work, play, socialization, etc. An example of a behavior that falls under this criteria would be keeping yourself locked in your house and never venturing outside because of a fear of something bad occurring once you leave your threshold. This would make it difficult to hold down a job or attend school.
  3. The behavior poses a danger to yourself or others. In most cases, individuals suffering from a mental disorder are more of a danger to themselves than to anyone else, primarily through self-neglect or anxieties that raise their stress levels. The exception would be the personality disorders. Unfortunately, stereotypes lead people to fear someone who is "seeing a shrink" so many people are reluctant to seek the therapy they need because they fear social ostracizing.
Are you nuts, crazy, or insane? If you are, a psychologist/psychiatrist won't officially tell you. Besides, you may just be a little weird and sometimes the people who call you mad just can't handle the unconventional. Sanity is possibly overrated anyway.