Originally published by Rita Handrich.
One day he confided that he had been late for our treatment group because he couldn’t stop flushing the toilets on his ward. Later I asked him what he meant and he explained that when the State Legislature was in session and voting on bills, he felt he could also “vote” and perhaps sway their opinions. If he flushed the toilet at the right end of the group bathroom it was a vote for the Republican opinion and if he flushed a toilet at the left end of the group bathroom it was a vote for the Democrat perspective.
I asked him if the strategy worked and he grinned at me—“If I thought it worked, it would be a delusion and I am not delusional anymore. It’s just an over-valued belief at this point”. When I persisted by tilting my head and looking curious, he grinned more widely—“At this point, I can’t stop myself from doing it sometimes “just in case” but it only happens with bills that are really important”.
That lesson stuck with me so when I saw this article on the importance of defining the difference between a delusional belief and an over-valued idea—I knew it would end up as a blog post. It’s a good distinction to be aware of and perhaps especially important for those working on the criminal justice system.
First, a website story introduces today’s research article and includes a brief summary of the Norway killings (remember that one?) and the shooter’s rationale:
In the aftermath of violent acts such as mass shootings, many people assume mental illness is the cause. After studying the 2011 case of Norwegian mass murderer Anders Breivik, University of Missouri School of Medicine researchers are suggesting a new forensic term to classify non-psychotic behavior that leads to criminal acts of violence.
“When these types of tragedies occur, we question the reason behind them,” said Tahir Rahman, M.D., an assistant professor of psychiatry at the MU School of Medicine and lead author of the study. “Sometimes people think that violent actions must be the byproduct of psychotic mental illness, but this is not always the case. Our study of the Breivik case was meant to explain how extreme beliefs can be mistaken for psychosis, and to suggest a new legal term that clearly defines this behavior.”
Breivik, a Norwegian terrorist, killed 77 people on July 22, 2011, in a car bombing in Oslo and a mass shooting at a youth camp on the island of Utøya in Norway. Claiming to be a “Knights Templar” and a “savior of Christianity,” Breivik stated that the purpose of the attacks was to save Europe from multiculturalism.
In other words, when people commit violent acts (like mass murders), many others often assume mental illness was involved. For the most part, we are unable to imagine the rationale for such acts and so we explain it to ourselves by presuming the killer must be insane. So, if someone commits mass murders, the armchair observer often “diagnoses” the killer with mental illness and/or psychosis. While it may make intuitive sense (e.g., “No one in their right mind would do that….”), it is often, nonetheless, inaccurate.
That is where the forensic examiner enters the scene to see if the level of thought disturbance meets the legal bar for murder driven by delusions. The field of forensic evaluation is very complicated and there are specific rules about the height of the bar over which one must leap (in very technical terms) in order to be declared incompetent to stand trial or to be found competent to stand trial but ultimately tried and found not guilty by reason of insanity or guilty but mentally ill.
When a forensic evaluator adjudges a defendant not legally responsible for having performed an unthinkable act (such as killing one’s family, child, or a group of random strangers), there are generally delusional beliefs (e.g., “I thought my mother was the devil”) driving the behavior. And there are strict definitions for what constitutes a delusional belief (see the DSM-5 diagnostic manual’s criteria here). So today’s researchers use the example of that well-covered mass murder in Norway to explain the killings were not driven by delusional beliefs (the legal bar) but rather, by non-psychotic “extremely over-valued beliefs”.
They define that new term by quoting the work of another author (McHugh in 1998) and say that extreme over-valued beliefs are typically accompanied by fanaticism:
An extreme over-valued belief is one that is shared by others in a persons’s cultural, religious, or subcultural group. The belief is often relished, amplified, and defended by the possessor of the belief and should be differentiated from a delusion or obsession. The idea fulminates in the mind of the individual, growing more dominant over time, more refined, and more resistant to challenge. The individual has an intense emotional commitment to the belief and may carry out violent behavior in its service. It is usually associated with an abnormal personality.
So one with an extreme over-valued belief may still commit very violent acts “in service” of that belief but they would not meet criteria for psychosis and would clearly understand what they were doing was wrong. From a legal perspective, they would be potentially guilty and subject to punishment. The authors say that “the court ultimately had to draw a line” in the Norway case and concluded that the shooter’s beliefs were “neither bizarre or delusional” and noted “the evaluators who opined that he was not criminally responsible should have consulted experts on right-wing ideologies before concluding that his grandeur was culturally implausible”.
In short, having extremely weird or bizarre beliefs is not the same as being mentally incompetent. This is a distinction worth keeping in mind during election years…
The authors (three prominent psychiatrists) say that “extremely over-valued beliefs” are going to be rigidly held (like delusions) but will be non-delusional. They close with two uncommonly clear sentences summarizing why they see this contribution as important.
The fact that a defendant committed a crime because of a delusional belief is a common basis for an insanity defense. It is therefore critically important that forensic psychiatrists properly identify a defendant’s belief as either a delusion or as an extreme over-valued belief.
From a litigation advocacy perspective, the takeaway for the prosecutor is that if a person’s behavior is driven by delusions, they may be successfully treated with medication. There is no medication that will help with the intractable extreme over-valued beliefs. The defendant is thus a potential danger to society since these beliefs are just as intractable as psychotic delusions.
While the distinction is a good one of which to be aware—the reality is that juries may well see the organized, plotting, and planning (probably psychopathic) predator with the “extremely over-valued beliefs” as potentially more dangerous than the mentally ill individual whose delusions will stop driving behavior when properly medicated. It makes sense for forensic examiners to be capable of differentiating between delusions and over-valued beliefs but for the layperson juror—these are just “two very scary” defendants and it’s likely they will want them both locked up.
Rahman T, Resnick PJ, & Harry B (2016). Anders Breivik: Extreme Beliefs Mistaken for Psychosis. The Journal of the American Academy of Psychiatry and the Law, 44 (1), 28-35 PMID: 26944741
Related posts:
- “Belief Perseverance”: Correcting false information without inadvertently reinforcing it
- The better than average effect is even true in prison!
- Is it true that older jurors are more likely to convict?
Curated by Texas Bar Today. Follow us on Twitter @texasbartoday.
from Texas Bar Today http://ift.tt/28ILTZT
via Abogado Aly Website
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