Treatment of Illness that "Causes" Criminal Behavior

[Pretty POHA]

I'm currently writing a paper on Munchhausen syndrom by proxy (a.k.a. factitious illness by proxy) for my Psych of Violence & Agressions class for my undergrad.
I've come up with a moral dilemma that I'd be curious to know what you think of.

I've been fascinated by human behavior, which has driven me to work towards becoming a psychiatrist-- as I beleive that many mental illnesses are caused by physiological conditions that can be manipulated in many ways to help treat the afflicted individuals. My particular interest is forensic psychiatry-- I really want to work closely with criminals to treat them and rehabilitate if possible. (And study & research if rehabilitation isn't possible.)
So here's the problem:
I strongly believe that people who have committed child abuse should not have the priveledge of raising & bearing & spending time with children. Sounds pretty basic, right? Well it completely conflicts with my belief that mentally ill humans are treatable! Or does it?

I know there's no absolute right or wrong answer to this question, but I'm definitely interested in understanding how you all feel about this conflict. What are the caviats for the moral issue of treatment of persons that are ill enough to harm others, including children?
How does a psychiatrist generally view a person who has committed "absolute" crimes? Are there any absolutes?

Thanks for your thoughts!

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[Poety]

I'm currently writing a paper on Munchhausen syndrom by proxy (a.k.a. factitious illness by proxy) for my Psych of Violence & Agressions class for my undergrad.
I've come up with a moral dilemma that I'd be curious to know what you think of.

I've been fascinated by human behavior, which has driven me to work towards becoming a psychiatrist-- as I beleive that many mental illnesses are caused by physiological conditions that can be manipulated in many ways to help treat the afflicted individuals. My particular interest is forensic psychiatry-- I really want to work closely with criminals to treat them and rehabilitate if possible. (And study & research if rehabilitation isn't possible.)
So here's the problem:
I strongly believe that people who have committed child abuse should not have the priveledge of raising & bearing & spending time with children. Sounds pretty basic, right? Well it completely conflicts with my belief that mentally ill humans are treatable! Or does it?

I know there's no absolute right or wrong answer to this question, but I'm definitely interested in understanding how you all feel about this conflict. What are the caviats for the moral issue of treatment of persons that are ill enough to harm others, including children?
How does a psychiatrist generally view a person who has committed "absolute" crimes? Are there any absolutes?

Thanks for your thoughts!

I will probably be flamed for this but... any child molestor cannot be rehabbed because that is what they are sexually attracted to - children. It is as innate to them as being attracted to whichever sex you are attracted to - it cannot be changed or made to go away, therefore they should never be let out of jail and/or whatever program they are in. I feel VERY strongly about child abuse (which is why I could NEVER do forensics) as many of my friends have had their lives destroyed by these monsters - they prey on little kids, they do it because they can, and they don't care about the consequences because of their sex drive. I think anyone caught doing anything to a child needs to be... ok I'm stopping here

Flame away...

 

[mosche]

I will probably be flamed for this but... any child molestor cannot be rehabbed because that is what they are sexually attracted to - children. It is as innate to them as being attracted to whichever sex you are attracted to - it cannot be changed or made to go away, therefore they should never be let out of jail and/or whatever program they are in. I feel VERY strongly about child abuse (which is why I could NEVER do forensics) as many of my friends have had their lives destroyed by these monsters - they prey on little kids, they do it because they can, and they don't care about the consequences because of their sex drive. I think anyone caught doing anything to a child needs to be... ok I'm stopping here

Flame away...

WOW! Poety, you've got moxey!

 

[Poety]

WOW! Poety, you've got moxey!

alright what the heck is moxey and between you and Sazi I'm going nuts with these words ok?

 

[Hurricane]

alright what the heck is moxey and between you and Sazi I'm going nuts with these words ok?

A nasty soft drink, or when talking about a person: "spunk"

Wikipedia entry for moxie

I will probably be flamed for this but... any child molestor cannot be rehabbed because that is what they are sexually attracted to - children. It is as innate to them as being attracted to whichever sex you are attracted to - it cannot be changed or made to go away, therefore they should never be let out of jail and/or whatever program they are in. I feel VERY strongly about child abuse (which is why I could NEVER do forensics) as many of my friends have had their lives destroyed by these monsters - they prey on little kids, they do it because they can, and they don't care about the consequences because of their sex drive. I think anyone caught doing anything to a child needs to be... ok I'm stopping here

I haven't done any forensics, so I may be way off base here, but haven't a large percentage of child abusers been abused themselves? So they are both victims and perpetrators. I don't have the answer, but it seems sad to give up on them as a lost cause, locking them up and throwing away the key with no hope of trying to help them. As I said, I've never worked with child abusers personally, but I'd guess that they all don't want to be doing the things they do, but feel uncontrollable urges. So if one of these people wants help, you advocate telling them "sorry, there's no help for you?"

 

[Poety]

A nasty soft drink, or when talking about a person: "spunk"

Wikipedia entry for moxie


I haven't done any forensics, so I may be way off base here, but haven't a large percentage of child abusers been abused themselves? So they are both victims and perpetrators. I don't have the answer, but it seems sad to give up on them as a lost cause, locking them up and throwing away the key with no hope of trying to help them. As I said, I've never worked with child abusers personally, but I'd guess that they all don't want to be doing the things they do, but feel uncontrollable urges. So if one of these people wants help, you advocate telling them "sorry, there's no help for you?"

Me personally Hurricane? Yes. I don't believe they can be reformed, I believe they need constant moderation, constant supervision and should not be re-released into society. Yes many of them have been abused as children themselves, but from what I've been taught by a forensics attending is that they do not reform, this is their sexual preference, and it will happen again if they are given the proper opportunity.

I wouldn't say "sorry, theres no help for you" I think these people can benefit from an intensive program to help alleviate their own personal suffering from their guilt and despair over having these urges, (and I am not willing to do this therapy) but again, I don't think they can be reformed AT ALL - so I don't believe in letting them be free.

Theres multiple cases I've heard about that discussed how one psychiatrist felt they were reformed, let them back out, and they were repeat offenders - and if you just ask the police, they'll let you know how many times after prison release these people reoffend - its something ridiculous like 80% (that are CAUGHT) so - there are certain things I feel very strongly about and don't sway my argument an inch on, and this is one of them

I realize this is psych so many people may want to assist these individuals, but in all reality, I do believe there are some instances in which its best to protect society rather than make a bet on something that you're likely to lose on. I'm very anti-violence (to the point that I also believe that once you commit a certain degree of a violent crime you should not be let out of jail) and I don't find child molestors particularly fascinating to study so, there you go. those are my views, but i'm not forcing them on anyone else. I realize I have my own thoughts and ideas that may be very different from a lot of peoples - but oh well.

 

[Pretty POHA]

Thanks for your replies, everyone!
I think you have a valid point when you say that child abusers are not rehabilitatable-- I agree with you on SO many levels. This is a question that baffles me to no end, though. And unlike Poety, I DO have the fascination and I DO want to treat criminals, including child abusers... So that's why I appreciate everyone's thoughts on this topic--this is my future profession we're talking about!!
I also believe that in some cases with molestation or any sexual abuse-- perhaps it's a manifestation of OCD? For instance, a person that has obsessive thoughts about (fill in the blank) and then in order to calm the anxiety of the obsessive thoughts, "needs" to behave compulsively. And OCD is treatable, right? I mean there's obviously a very fine line here between treatability and lock them up and throw away the key-abilty. And as a taxpayer, I ABHOR that someone that horrible will be living for the rest of their life on my tax dollars... so I really want to see if there is a cure for such behavior...
So-- any other psychiatry-oriented people here that believe there are some mental illnesses that are not treatable? How do you justify this belief with your profession??
Thanks for the replies, again!

 

[Manochikitsak]

So-- any other psychiatry-oriented people here that believe there are some mental illnesses that are not treatable? How do you justify this belief with your profession??
Thanks for the replies, again!

As in any other medical speciality, there are conditions in Pscyhiatry which may not be treatable fully but can be managed to a limited degree. For example, small cell lung ca has a very bad prognosis. Full blown AIDS has a very bad prognosis. So, all u can u do in these cases is take a deep breath and go on with it. The difference lies in the fact that Child abuse has consequences for the society and other illnesses have main consequences for the individual.

With the logic u use, one could also argue that why treat a guy with AIDS and use the tax $$$. Why treat the guy with lung ca and use the tax $$$? Why have hospice and federally funded nursing home care for millions of elderly people?

So, if u consider a certain condition a disease, consider it like any other disease.

But for me the issue goes much further. We as Psychiatrists should not be encouraging a trend where horrible crimes like child abuse are given the tag of a mental illness. It is a horrible crime and should remain as such.

 

[Poety]

But for me the issue goes much further. We as Psychiatrists should not be encouraging a trend where horrible crimes like child abuse are given the tag of a mental illness. It is a horrible crime and should remain as such.

This is a phenomenal post and perspective - said much more eloquently than I did but states my sentiment quite nicely -

 

[Pretty POHA]

As in any other medical speciality, there are conditions in Pscyhiatry which may not be treatable fully but can be managed to a limited degree. For example, small cell lung ca has a very bad prognosis. Full blown AIDS has a very bad prognosis. So, all u can u do in these cases is take a deep breath and go on with it. The difference lies in the fact that Child abuse has consequences for the society and other illnesses have main consequences for the individual.

But for me the issue goes much further. We as Psychiatrists should not be encouraging a trend where horrible crimes like child abuse are given the tag of a mental illness. It is a horrible crime and should remain as such.

Thank you for your thoughts on this! I'd love to hear more!
I've recently learned that one of the only mental illnesses that is not treatable is sociopathy. (This disorder fails to respond to treatment.) Is this true?
Crimes are committed by people that are either mentally healthy or unhealthy. You probably would agree that many of the most hellacious crimes are committed by mentally unhealthy people. No? I mean, there are obviously crimes that are committed by mentally healthy people-- and these people are just bad people, right? But isn't it true that many crimes are committed by people who just aren't "right", i.e. rape, infanticide, child abuse?
Am I making a mistake of believing that some criminality, even of the most horrible nature, is a manifestation of mental disease?

A specific example:
The DSM-IV calls Munchausen Syndrom by Proxy a mental affliction-- but perpetrators are generally loving mothers that hurt their children for the attention... It's true that the behavior observed is literally child abuse. And it's true that most cases of MSbP do not result in the child being reunited with the perpetrating mother. However, there are several cases where the family is treated as a whole, and eventually it is safe for the child to be reunited with the person who at one time caused such horrific harm to her own child.
This is a specific example of why I'm curious to know about the treatability issues I'm presenting... (although I'm looking for a more wide-spread answer that can adress other forms of child abuse, rape, or criminal behavior that is "caused" by some mental affliction...)

 

[Manochikitsak]

This is a phenomenal post and perspective - said much more eloquently than I did but states my sentiment quite nicely

Thanks

Thank you for your thoughts on this! I'd love to hear more!

Well, you are touching an issue much broader than one that can be discussed on a forum like this.... but still....I think that the separation of the child from the perpetarating mother is basically a form of treatment as well as having them live together after appropirate family counselling. This would vary on case to case basis, depending upon circumstances and reasons for abuse....Of course, in many cases reason may not be valid at all and separation may be the sole resolution.

Just had another thought.....extreme forms of criminal behavior i.e. sexual child abuse, rape can have an analogy with a severely ulcerated and infected diabetic foot which has to be amputated to prevent further consequences.

Would any of the more experienced people in Psychiatry care to offer more thoughts?