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Crime, Punishment, and Mental IllnessReview - Crime, Punishment, and Mental Illness
Law and the Behavioral Sciences in Conflict
by Patricia E Erickson and Steven E Erickson
Rutgers University Press, 2008
Review by Tony O’Brien, RN, MPhil
Oct 21st 2008 (Volume 12, Issue 43)

In terms of their social treatment, crime and mental illness have never been far apart. Western societies have always struggled with the idea that madness might exculpate the person who commits a crime. The urge to punish is strong; leniency creates an anxiety that criminal behavior will get out of control and threaten society. In the institutional era each category of social deviance was given its own establishment: prisons for criminals and asylums for the mentally ill. In the era of community care one institution has all but vanished from the landscape while the other is swollen with refugees from the first. That is roughly the thesis of Crime, Punishment and Mental Illness. Law and the Behavioral Sciences in Conflict. It's an argument that needs attention, given the overwhelming evidence of rates of mental illness in prisons and the relative failure of society to provide a viable alternative to the asylum. Authors Patricia E Erickson and Steven E Erickson have done an impressive job in arguing this thesis. They have impressive credentials, one as a chair of a department of sociology, anthropology and criminal justice, the other as a forensic psychologist and attorney. Their aim is one of greater rapprochement between criminal law and behavioral science.

The book explores the problematic nexus of behavioral science and the law, and the effects of the failure to resolve the conflicts inherent in these competing disciplines. The problem is by no means new, but has been given new form in the early twenty-first century as increased risk consciousness reduces public tolerance for any semblance of threat to the social order. Crime, Punishment and Mental Illness is a valuable contribution to understanding how the apparent preference for punishment of the mentally ill as criminals came to be preferred over consignment to asylums. While the focus is on the United States, the debate about criminalization is an international one, and there is much that readers from other countries can take from Erickson and Erickson's analysis.

The book has seven chapters beginning with an introduction to the authors' social constructionist framework, followed by five separate chapters on different aspects of crime and mental illness, and concludes with a summary chapter reflecting on the significance of the issues. In the first chapter the problem of criminalization is characterized within a pattern of fluctuation between moral condemnation of the mentally ill and the urge to understand and offer succor. The authors return to this dichotomy in each chapter, showing how this characterization can be used as a lens of analysis. Throughout, the narrative is illustrated with extracts from case histories, beginning with the recent Virginia Tech murders, and drawing on many other high profile cases. In keeping with the social constructionist framework there is a good deal of historical background. Readers are encouraged to view the current problem of criminalization in its historical context, and this approach proves valuable in considering criminalization as a contingent phenomenon.

Other chapters explore issues of competency, the insanity defense, sex offenders, and juvenile offenders. Each of these chapters provides a useful historical overview before moving on to discussion of contemporary issues. The social constructionist framework proves very useful for this purpose as it shows how current problems while appearing in new guise, are in many respects the reworking of problems that have been addressed many times in the past, with differing results. To see insanity as the secularization of religious condemnation is to gain insight into a profound historical and philosophical shift, which to this day remains incomplete and contested. The discussion of competency is a helpful clarification of the relativity of this concept, and the political forces at work in its application. The case studies are carefully selected to show how media exposure influences public opinion, and the verdicts of juries. Similarly, issue of juvenile crime and mental illness have deep historical connections to concepts of autonomy and to constructions of childhood.

While I found Crime, Punishment and Mental Illness to provide a very clear and helpful analysis of an important social issue, there were some arguments that I felt could have been explored further. Erickson and Erickson argue that incidents such as the Virginia Tech murders are largely preventable although it is not altogether clear to me that this is so. Certainly, it is clear that Seung-Hui Cho had shown signs of mental illness, but it would require a very wide net indeed to closely monitor all individuals who give cause for concern about their mental health. Not examined in this book is the role of gun ownership, and the policing of access to weapons. This must surely be considered as one of a number of factors contributing to incidents such as Virginia Tech. But there is also a role for mental health services to intervene early in the course of mental illness, as there is evidence that the risk of violence is elevated early in the course of illness, especially in the absence of treatment. Arguments about criminalization or transcarceration are made in many jurisdictions, but as with Crime, Punishment and Mental Illness they often do not include detailed analysis of rates of mental illness in prisons prior to deinstitutionalization. They also don't allow for the increasingly broad diagnostic criteria in successive versions of the DSM, or for the increasing incidence of substance misuse. Erickson and Erickson  do refer to "Penrose's Law"; the theory that the populations of prisons and asylums fluctuate in inverse proportion to each other, but their reference here is a secondary one to a publication by E Fuller Torrey. The phenomenon of increasing rates of mental illness in prisons is certainly not an invention of researchers, but it does require a full understanding of the basis of comparisons over long time periods.

A more significant issue for me with this book was what seemed to be the assumption that "mental illness" refers to something relatively fixed and stable constructed differently within the legal and behavioral science models used as the authors' template of analysis. This is summed up in the statement that "the issue for us to understand is why we have chosen the prison rather than the mental hospital." (p. 49). For a book advancing a sociological theory of mental illness I found the relative absence of stigma interesting. Legal and behavioral science models of mental illness have common ground in conceptualizing people with mental illness as "other" and "different" and, arguably, constitute different models of exclusion. I felt there was more room to consider the role of stigma in the social construction of mental illness, and for considering whether the choice really was as stark as is presented here.

Of course it is easy, with the benefit of hindsight, to complain about what you would like to have seen discussed more. That should not detract from what is a highly accessible and informative analysis of a complex and pressing social issue. For such a broad topic, Crime, Punishment and Mental Illness is quite a small book, with around 200 pages of text. The authors have managed to summarize a wide range of research and analysis, and their discussion poses provocative questions for the future development of social, penal and health policy. It should prove a useful reader for mental health and legal professionals, especially for students pursing postgraduate studies. It is also accessible to a lay audience and would be a useful inclusion in libraries of health and criminal justice libraries.

© 2008 Tony O'Brien

Tony O'Brien, RN, MPhil, Senior Lecturer, Mental Health Nursing, University of Auckland, a.obrien@auckland.ac.nz


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