Criminal or Insane?

Are all lawbreakers emotionally ill? If so, should jails and penitentiaries be turned into mental hospitals? These were the principal questions occupying 3,000 psychiatrists in Atlantic City last week at the annual convention of the American Psychiatric Association. To no one's surprise, no consensus was reached. Extremists at both ends of the opinion spectrum remained unconvinced by heated arguments; in between were varying groups of gradualists and the unconvinced.

Washington's patriarchally bearded Dr.

Benjamin Karpman took one extreme position. His prediction: in 50 years the U.S.

will have no prisons--only psychiatric treatment centers for lawbreakers. "I am at odds with the legal profession and most of psychiatry," he conceded, "but they're all wrong. The question is simply, 'Is the accused sick or not?' You can't have mental illness and criminal responsibility in the same person at the same time." From the Snake Pit. Few psychiatrists lined up behind Dr. Karpman's banner.

From the vast snake pit of Manhattan's Bellevue Psychiatric Hospital, Drs. Emanuel Messinger and Benjamin Apfelberg reported that, of 57,000 lawbreakers ex amined over 25 years, a scant 5% had ordinary mental illnesses rated as treat able. Most of the rest were, in some de gree, what psychiatrists call psychopaths or sociopaths -- individuals whose consciences are either lacking or inert, and who choose to do what they want when they want. These are notoriously the patients with whom psychiatry has the least success. And in many courts, psychopathy is excluded from the catalogue of mental illnesses that can justify an insanity plea.

Leading off for the opposition, Michi gan's Dr. Sidney Bolter tried to rip off "the mask of insanity" which, he said, has covered too many criminals. He scoffed at colleagues who "visualize a Utopian chain of hospitals and clinics devoted to the 'treatment' of every individual who breaks the law." Habitual offenders, Dr. Bolter argued, are psychopaths, and nothing can be done with them except keep them in penal institutions; in mental hospitals they are misfits and hamper the treatment of other patients. "Psychiatrists," said Dr.

Bolter, "are not looking at the problem realistically. It is about time we offered the courts some practical assistance, and not a lot of starry-eyed theories that allow too many clever patients escape hatches into a mental hospital." Flux & Finality. To many distinguished listeners, Dr. Bolter was simply an angry man. But all psychiatrists are in a dilemma over criminal law. Most of them cannot work well with the courts.

Used to having the last word themselves, they meet their match on the bench. And while the law insists on finality, it is itself in a confusing state of flux.

Since 1843 most British and U.S. courts have followed the M'Xaghten Rule: an accused is "sane" (a legal rather than a psychiatric term), and therefore responsible for his criminal acts, unless at the time of the crime he did not know what he was doing or did not know that it was wrong. But since 1954 the law and psychiatry have been wrestling with an attempt by the U.S. Court of Appeals in the District of Columbia to liberalize the definition of "sanity" as a measure of criminal responsibility. Under this court's Durham Rule,* an accused is not responsible, and therefore not required to stand trial, if at the time of his crime he was suffering from a "diseased or defective mental condition" and the crime was a "product" of this condition.

Though the Durham Rule was designed to bring the law in line with modern psychiatric thinking, it proved as disturbing to many psychiatrists as to lawyers. Baltimore's famed Forensic Psychiatrist Manfred S. Guttmacher last week offered an explanation. The rule's broad implications, he said, presage a socio-psychiatric revolution as sweeping as that of 1792. when Philippe Pinel struck the chains from the mentally ill in Paris asylums. Many of his colleagues. Dr. Guttmacher intimated, fear a change because of their own deficiencies.

Labels Are Not Enough. The Durham court has held that "unexplained medical labels--schizophrenia, paranoia, psychosis, neurosis, psychopathy--are not enough." The psychiatrist called as an expert witness must explain also the development of the disease and how it affected the accused's behavior. This. Dr. Guttmacher said politely, is "a challenge which, I fear, few psychiatrists are equipped to meet." Encouraging progress was reported from California, where San Francisco's Dr. Bernard Diamond has helped to change the administration of justice by winning acceptance in the courts of the principle of "diminished responsibility." This is a grey shade between M'Naghten's black and white, leaves judges more latitude. As one of the two psychiatrists on a new ten-man state commission on "problems of insanity relating to criminal offenses," Dr. Diamond said he will propose that diminished responsibility be put into law. Then, after sentencing, a special board, with plenty of psychiatric help, should decide where each convicted offender should be kept and what treatment he should get. All sentences should be indeterminate.

Such a compromise course seemed the only way out for the psychiatrists. Wisconsin's Dr. Seymour L. Halleck complained that extremists like Washington's Karpman who say "there are no criminals, only the insane" are making it "more difficult for the rest of us who want to make practical progress gradually."

*Named (as was the M'Xaghten Rule) for the defendant in the case: Monte Durham, a smalltime robber and housebreaker.

This file is automatically generated by a robot program, so reader's discretion is required.