The psychiatrist and the young lawyer stared gloomily into their warm beers, aga
ID: 3487128 • Letter: T
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The psychiatrist and the young lawyer stared gloomily into their warm beers, again considering the nightmarish farce confronting them. e guilt or innocence phaseof the case, part of the job they were used to, was over years ago and their patient/client was clearly guilty. At 21 years old, Charles Singleton had stabbed a store clerk to death and then went on to earn the dubious honor of being Arkansas’ senior resident on death row. At the time, he had been competent to stand trial, or, as the lawyer called it, “sane.” Now, at years old, his appeals exhausted, Singleton was back in the news again, but this time the issues were not so clear. Once the trial was over, the legal concept of “sane” had to be replaced with the medical/psychological concept of “mental illness.” e lawyer’s law books were of little help here. e definition of the client’s condition now depended upon the psychiatrist’s Diagnostic and Statistical Manual (DSM-IV).
Psychological diagnosis became important when, after years on death row, Singleton began showing
the symptoms of paranoid schizophrenia. is was a bizarre bit of good luck because in the Supreme Court had ruled that a person with severe mental illness could not be executed. Execution under these circumstances was considered cruel and unusual punishment. Consequently, in accordance with federal law, Singleton was removed from death row.
By the 1990s, however, antipsychotic medications had developed to the point that, when Singleton took them regularly, his symptoms were generally under control. When he began referring to himself as the “John the Baptist” or “the Pope and the Congress,” it was an indication that his dosage or the medication itself needed to be changed. After Singleton’s symptoms had abated for several months, a state judge declared
that the defendant was now sane and there was no reason that his execution should not move forward. Accordingly, the judge set an execution date.
Singleton may or may not have been mentally ill, but he certainly wasn’t stupid. He stopped taking his medication. People with schizophrenia frequently decide to stop their medication, even when execution is not one of the potential side effects. But, while a person is in prison, he or she has a federally mandated
“right to treatment.” is means that if a medical treatment would help the prisoner, the prison system is obliged to provide it. In this case, if the treatment could be argued to be in the best interest of the prisoner and the prison system, Singleton could be forced to submit to treatment without his consent.
Singleton’s lawyer felt his anger mounting as he described a conversation he had had that afternoon with the prosecuting attorney. “I said to him, ‘Come on, you can’t tell me that just because he is medicated, he’s sane! e symptoms aren’t obvious, but the illness is still there. Take away the medication and he’s back complaining that demons in his cell are stealing his thoughts. It’s an artificial sanity.’ So the prosecutor tells me, ‘If he doesn’t have symptoms, he’s sane. Get your psychiatrist to check his DSM-IV. If he doesn’t have delusions, hallucinations or a thought disorder, he doesn’t have schizophrenia. I can get a dozen psychiatrists to tell you that.’”
1. Discuss some accepted models of mental illness, i.e., psychological, biological, behavioral. How do these differ? What assumptions are being made?
2. How do these different models influence the treatment of people with mental disorders?
3. Tell the class the history of the present case. What does "right to treatment" entail for Singleton? Does Singleton have schizophrenia in your opinion?
4. What are the assumptions about mental illness held by Singleton's lawyer and the prosecutor? Support your answer with direct quotes from each lawyer.
5. Each lawyer appears to believe in a different model of mental illness. What model is each lawyer using to support his/her argument about how Singleton should be treated?
6. What is artificial sanity? Argue your own side of the case.
Explanation / Answer
Though several models of mental illness have been proposed, it is most ideal to adopt an eclectic approach while dealing with persons with mental illness.
Some of the widely accepted models include the following:
In the disease/biological model, a disorder affecting mental functioning is assumed to be a consequence of physical and chemical changes which take place primarily in the brain. Within such a model, the focus is on physical treatment methods, primarily consisting of drugs and ECT.
In the psychodynamic model, the patient’s unknown or unconscious feelings are assumed to have formed during critical times in their life, due to interpersonal relationships and have led to problematic thinking and behaviour. During treatment, a relationship builds up between the therapist and patient. The emotions that the patient attaches to the therapist are collectively known as ‘transference’, and those that the therapist attaches to the patient are collectively known as ‘counter transference’. By understanding these feelings, the patient may gain insight about future relationships.
In the behavioural model, mental disorder is assumed to be a result of the patient’s behaviour that has come about by a process of learning, or conditioning. Some learning, however, is maladaptive and behaviour therapy aims to reverse this learning (counter conditioning).
In the cognitive model, mental disorder is assumed as being a result of errors or biases in thinking; our view of the world is determined by our thinking, and dysfunctional thinking can lead to mental disorder. Cognitive behavioural therapy (CBT) aims to identify and correct ‘errors’ in thinking.
In the social model, mental disorder is assumed as being based on general theories of groups and caused by observable environmental factors and social forces. Therefore, treatment also primarily focusses on restoring the same.
Each of the models involve different content, structure and mechanisms, when it comes to the treatment aspect, as explained above.
In my opinion, Singleton may be having Residual Schizophrenia (please refer to DSM-IV-TR for the criteria) since the symptoms, though not fully-blown, seem to be present when he is off medication. ‘Right to treatment’ for Singleton entailed being forced to submit to treatment without his consent in the best interest of him and the prison system.
Assumption about mental illness held by Singleton’s lawyer: 'the illness may still be present though the symptoms are not obvious'. This may be reflective of the assumption of an eclectic approach towards mental illness, thereby placing emphasis on psychological and social factors that may be at play.
Assumption about mental illness held by Singleton’s prosecutor: the illness may be absent if the symptoms are not obvious/within the DSM criteria. This may be reflective of the assumption of a purely biological model, in which emphasis is placed solely on the symptoms.
Artificial sanity refers to rendering death row inmates competent for execution when they may not end up being so, upon thorough evidence-based inquiry.
In my opinion, Singleton may be diverted towards the mental health system, so that thorough psychosocial rehabilitation and access to reliable psychotropic medication may be ensured, before different stakeholders make the final decision.
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