Schizophrenia | déchirement blog

Can’t a tea towel be both red and wet?

To answer this, I would have to see the tea towel in question.

It is entirely possible that the towel is indeed wet and red! Being wet does not change the fact that the tea towel could also red; similarly, nor does being red exclude the possibility that the tea towel is wet.

What’s all this talk about wet tea towels on a website devoted to educating people on personality disorders?

Lend me five minutes of your time and I’ll explain…

Most people can grasp the concept that a tea towel can be both red and wet, so why, when we see in the media, that someone has committed a heinous act such as murdering their own children, do we ask if someone is mad or bad, like they must be one or the other?

Just like the tea towel, ‘mad’ and ‘bad’ are not mutually exclusive. That is, it is possible for a person to be both mentally ill (ie ‘mad’) and have a comorbid (ie co-occurring) personality disorder (ie ‘bad’). In fact, many people with personality disorders also fulfil criteria for one or more mental health problem.

This does not mean, however, that they are ‘mad’, which is a common term to imply that an individual has a psychotic disorder, such as schizophrenia, that may at times render them otherwise not-in-control of themselves.

Having a mental health problem does not equal ‘madness’ per se. The vast majority of people who fit the criteria for a mental health problem (such as depression, social phobia, PTSD, anorexia, etc) would not be considered ‘mad’ by lay or professional standards, unless they were experiencing hallucinations or delusions that alter their perception of reality.

And, in case you were wondering, yes, it is possible for a person to be ‘bad’, which implies having a personality disorder, without suffering a comorbid mental health problem.

Hmm…perhaps I’m making this a little confusing. Traditionally, mental health problems such as mood and anxiety disorders (to name but a few) have been differentiated from personality disorders, which were considered to be ‘behavioural disorders’. With advances in neuroscience and personality disorder (PD) research, such a distinction is rapidly becoming outdated because PDs are increasingly considered to be genuine mental health conditions.

Even so, if we were to continue to distinguish between PDs and mental health conditions, PDs are far more represented in the global prison population than those traditionally labelled as ‘mad’.

Anders Breivik: Mad or Bad?

Mad, bad or both?

On July 22, 2011, Norwegian Anders Breivik killed 75 people, as a statement against Norway’s liberal immigration policies. He was a member of an extreme right wing group and a product of a dysfunctional childhood. But was he rational and deliberate, or just mad?

That’s the question the court will have to answer at the end of Breivik’s ten-week trial.

Competing views

In January 2012, two court-appointed psychiatric experts conducted extensive assessments of Breivik’s mental state. After 36 hours of interviews they handed down a 234-page report that concluded Breivik suffered from a paranoid schizophrenic disorder and was acting on his delusional beliefs.

But following appeals from lawyers representing the interests of victims, the court sought the opinion of two further mental health experts. Contrary to the past assessment, the second set of experts determined that Breivik was not psychotic, or severely mentally handicapped at the time of assessment, nor at the time of the offending.

All the experts agreed that Breivik was an extremely high recidivism risk. (Click here for article Source)

Interestingly, studies, such as the 1996 General Social Survey in the US, have found that many have a negative view of people with mental health problems and erroneously exaggerate the “threat” or “impairment” associated with the mentally ill. There is research to suggest that even when mental illness is controlled for within a population, low socioeconomic status is a better predictor of criminal offending behaviour.

Having worked in prison myself, the vast majority of the inmates I worked with had low-level literacy skills, minimal education, a history of abuse and neglect, and were raised in socially disadvantaged families and neighbourhoods. A very small percentage had some form of psychotic disorder…they were definitely the exception.

I have often heard people speculate that in order for a human being to commit an extreme atrocity, they must be ‘sick in the head’, believing that your average human being could not commit such an act. This is not true.

The vast majority of people who are sent to prison for terrible crimes are considered sane in the eyes of the law and psychiatry. Their personality pathology usually explains, though never justifies, their abhorrent behaviour meaning they are more likely ‘bad’.

The truth of the matter is that many offenders have antisocial personality disorder (ASPD, also known as psychopathy or sociopathy), avoidant personality disorder (AVPD), or borderline personality disorder (BPD) (or a combination of PDs). Whereas they may have a comorbid mental illness, it is unlikely to be a psychotic disorder such as schizophrenia that could possibly render them as ‘mad’ (even with a schizophrenia diagnosis, an individual may not be considered ‘mad’ or habitually out of touch with reality).

Hopefully this post adds some clarification to the confusion over how people who are technically sane are often the ‘bad’ ones to commit the most atrocious crimes.

Please Note: Whereas Cluster A personality disorders within the DSM-IV-TR are colloquially referred to as the ‘mad’ PDs, violence toward self and others is not included in the diagnostic criteria for this sub-group (ie Schizoid PD, Schizotypal PD and Paranoid PDs) nor are they commonly represented in the prison population. Violence toward self and others is in fact part of the diagnostic criteria for for ASPD and BPD; however, not everyone with BPD or ASPD commit offences or are violent toward themselves or others.