16 APRIL 2010
Severe personality disorder
The recent murderous attack on a church congregation by a naked man with a sword in the UK, widely reported in Ireland, once more raises the issue of the way the media shape or reflect the popular perception that the mentally ill are a threat from which the public is at risk. The fact is that is how people view them and this perception appears to be growing. For example, recently there appeared reports in the media that the Gardai trawled psychiatric hospitals in the Dublin area in the belief that the murderer, dubbed a "psychopath" in the media, of Raonaid Murray might be an outpatient (Allen, 1999). Whilst all avenues in a police investigation have to be pursued, the impact of such reports on public views is that it further enhances the sense that mentally ill people are more likely than most to be violent. Thus the recent survey conducted by the Royal College of Psychiatrists on the Irish public's knowledge of mental illness found that 57% strongly believed that people with schizophrenia are violent (Timmins, 1999).
In a number of countries in recent times, there have been one or two murderous incidents which, to the public mind, have seemed so incomprehensible that they have been dubbed "evil" and the word psychopath, which taps into a deep-rooted public anxiety about the mentally ill, has been attached to the murderers by the media. In the United Kingdom there was the murder of a mother and child by Michael Stone (BBC, 1999). In the United States the mass murder by two pupils of their schoolmates in Littleton, Colorado and "copycat" incidents that followed,(Wells, 1999). In Australia, the case of David Garry and his actions and threats of violence towards police officers (in this case resulting in the passage of a specific Act of Parliament specifically to contain him alone) (Williams, 1990). Finally, in Ireland we have the case of Brendan O'Donnell and his murder of a priest and mother and child. The professional disagreements as to whether or not such individuals are "mad" or "bad", usually a product of the adversarial legal process and reported in the media without qualification serve to increase the sense of public vulnerability.
A deep seated public fear attached to such terms as "psychopath" has been compounded by the revelation that a number of the perpetrators of these crimes were already known to the authorities and, more particularly had had contact at one time or another with psychiatric services. Such revelations combined with public fear have led to political pressure in a number of countries to introduce pre-emptive measures for the protection of the public.
At the centre of these policy developments is how to manage people suffering from what is variously labelled anti-social, psychopathic, severe or dis-social personality disorder. The behaviour of the minority of persons with severe personality disorder is often identified by the public as representative of the behaviour of all mentally ill people, and as such reinforces the vulnerability of mentally ill people to prejudice.
Severe personality disorder has been described as "a persistent disorder or disability of mind that results in abnormally aggressive or seriously irresponsible conduct of the person concerned". Such persons generally have an inability to relate to others and have difficulty learning from previous experience (Department of Health, 1983; Department of Health and Home Office, 1999). They find it difficult to form meaningful relationships, have a low tolerance of frustration, a marked proneness to blame others and a callous disregard for those around them. They often have a criminal history and are also likely to suffer from mental illness.
They generally have a history of childhood difficulties often consisting of an abusive and neglectful family background and poor educational attainment. Many were diagnosed during childhood as having a "conduct disorder". During adolescence they often demonstrate excessively indulgent behaviours involving substance and alcohol abuse, sexual precociousness and thrill seeking behaviours. Consequently they are likely to acquire a criminal record at an early age (Melia et al, 1999).
The average prevalence rate for severe personality disorder in the community found by a number studies stands at between 2-3% (Department of Health and The Home Office, 1999). However, prevalence is considerably higher in the prison population [ibid].
Despite the acceptance of the existence of the phenomenon of severe personality disorder, opinion is divided as to whether it can be categorised as a mental illness, what precisely constitutes the disorder and whether it is treatable (Ashworth Special Hospital Report of the Committee of Inquiry, 1999). The result of these factors is that psychiatrists in general are reluctant to assume responsibility for such individuals as a result of the apparent futility of intervention and the prospective fear of condemnation should these individuals offend violently.
JOHN S.G. WELLS
Wells, J.S.G. (2000). Editorial: The future of
dangerous severe personality disorder in Ireland. Irish Journal of
Applied Social Studies, 2, 2. pp. 32-52.
Allen, L .(1999). Raonaid: hunt for known psychopath. Sunday Tribune,19th September.
Timmins, E (1999) Psychiatrists warn of mental illness stigma.The Irish Times.
BBC, (1999) BBC World Service News, l9th July.
Wells, J. (1999). Murder and Madness in Ireland - Conference Paper Working with Vulnerable Populations. The Millennium Conference of the Isles Waterford Institute of Technology, Oct 21-22.
Williams, C. (1990). Psychopathy, mental illness and
preventive detention: issues arising from the David case Monash
University Law Review 16, 2. pp.161-183.
Department of Health, (1983). The Mental Health Act. London. HMSO.
Department of Health and Home Office, (1999). Managing Dangerous People with Severe Personality Disorder Proposals for Policy Development. London HMSO.
Melia, P., Moran, T., Mason, T. (1999) Triumvirate nursing for personality disordered patients: crossing the boundaries safely Journal of Psychiatric and Mental Health Nursing, 6. pp.15-20.
Ashworth Special Hospital Inquiry, (1999) Ashworth Special Hospital Report of the Committee of Inquiry. London HMSO.