The Alfred Hitchcock movie, Psycho , certainly colored the word with the feeling that it implies someone we should be afraid of — someone who is out of control emotionally or mentally. Indeed, both psychopaths and psychotic people might pose danger at times, though at completely different levels.
Psychosis is a general umbrella term for a wide variety of disorders. Also referred to as psychotic disorders or psychoses, these disorders typically involve losing touch with reality, manifested by delusions and hallucinations. Delusional thinking often occurs in psychotic people; this consists of believing that people are out to harm you or are plotting against you. Schizophrenia — along with brief psychotic disorder, delusional disorder, and others — is considered a form of psychotic disorder.
People with bipolar disorder, depression, or other mental illnesses can often show psychotic symptoms in the DSM-5, bipolar disorder is actually listed as a bridge between psychotic disorders and depressive disorders. But as with many mental illnesses, psychosis can often be a fluid category and definition, with aspects of it manifested in people who are psychopathic, sociopathic, bipolar, or depressed.
Psychotic individuals suffer from serious mental disorders that require proper care and treatment, and anti-psychotic medications as well as cognitive behavioral therapy can help mitigate these effects.
While some bad people such as serial killers have psychotic episodes… the vast majority of psychotic individuals are not immoral. In fact, many people who are psychosis-prone contribute positively to society. But, the greater the psychopathy, the poorer the prognosis with hospital treatment and, therefore, the weaker the treatment becomes as a justification for hospitalization. The issue is not simply a debate between the conflicting justifications of public protection and effective treatment.
Regardless of whether a patient is psychopathically disturbed, traditional justification for discharge is that the patient has achieved optimal benefits from hospitalization. A minimal justification, favoring cost containment, is that the crisis or acute condition that precipitated hospitalization has subsided to the extent that the patient no longer presents a significant risk of harming himself or others in the near future.
A compromising justification between these options is substantial reduction in the probability that rehospitalization will be necessary soon. Many would advocate a laissez-faire approach to persons with psychopathic disorders. If they do not appear to be suffering and motivated, attempts to treat these patients might be wasted efforts. Civil commitment is inappropriate because the disorder does not cognitively disturb their ability to consent. In Foucha v Louisiana , 11 a psychopathically disordered insanity acquittee had to be released from involuntary hospitalization because, even if dangerous, he lacked a mental illness for which continued hospitalization would be justified.
If, however, a person with psychopathy violates criminal law, he is subject to punishment, including imprisonment, just as any other person. Incarceration to punish the person and protect society is preferred over treatment and civil commitment. Criminal intervention is reactive, not proactive, and retributive justice is blind to whether the person has a personality disorder. Involuntary hospital commitment is most easily justified when the unwilling patient has a mental disorder that deprives him or her of the capacity to consent, is amenable to psychiatric treatment, and creates a serious risk of harm to himself or others.
Psychopathy alone statistically elevates the risk of harm to others but does not result in incapacity to consent and is not generally considered responsive to standard psychiatric treatments.
In Zinermon v Burch, 12 the US Supreme Court noted that Burch was voluntarily admitted to a hospital and no attempt was made to ascertain whether he was competent to sign the voluntary admission forms. This and the resultant deprivation of liberty was sufficient to state a claim in Federal Court.
Of course, those with psychopathy alone should be competent to voluntarily agree to hospitalization. The US Supreme Court's Burch decision 12 notwithstanding, many patients have historically been and many continue to be hospitalized voluntarily and involuntarily without having been found legally incompetent to make treatment decisions.
Those who are hospitalized involuntarily show a wide range of decisional capabilities. Most committed patients eventually benefit from treatment sufficiently to qualify for hospital discharge. Depending on jurisdictional law, some persons with developmental disabilities and sexual offenders are subject to long confinement with little to suggest the possibility of recovery as a result of treatment. Historically, persons with mental illnesses were sometimes committed for life, before the advent of effective psychotropic medicine.
Whether the patient is likely to respond to inpatient treatment is an important consideration for civil commitment, but amenability to treatment per se is not necessarily dispositive. To address the risk of personal violence or harm to others, 3 qualities must be assessed: the seriousness of the risk, its likelihood, and its proximity in time.
If violence is about to occur, its seriousness need not be extremely catastrophic to justify intervention. When the risk is secondary to psychotic agitation associated with schizophrenia, the application of these 3 considerations: treatment decision capacity, treatment amenability, and risk-is straightforward for purposes of addressing the overall appropriateness and specific jurisdictional legal criteria for involuntary hospitalization.
For the remitting patient with schizophrenia who is also psychopathic, the matter becomes more complicated. If he is no longer considered high risk, the patient may not qualify for involuntary hospitalization. However, if the patient with schizophrenia is also psychopathic, psychopathy cannot be overlooked because psychopathy may increase the risk of present and future aggression more than schizophrenia alone.
Joyal and colleagues 14 suggest that many index crimes, even when perpetrated by patients with schizophrenia, are actually driven by aspects of their disordered personality.
Any significant aggression during active psychosis can reasonably be attributed to the psychosis for purposes of justifying civil commitment, even if the exact causal mechanism cannot be demonstrated and psychopathy may have contributed.
Mostly, this is because of a harmful image portrayed by the media regarding psychosis and psychopathy. Psychosis is a set of symptoms which can spread across various mental health disorders, which are labeled as psychotic disorders. Antipsychotic medications, for example, are often prescribed to people who have such conditions.
Psychopathy is another distinct mental illness in which one is completely detached from moral reality. The two are different and understanding the difference is critical to ending misconception, advocating against false presentations in the media, and helping a loved one who might be struggling with a severe mental illness. The news and media often confuse the two terms psychopath and psychotic, but they are very different, and the distinction is rather important.
A psychotic person is not, by definition, a danger to himself or society. However, if that person thinks that he is being told to kill or harm others, then he will become a danger when he acts upon those delusions. In court, he or she will likely be found criminally insane and not responsible for his or her actions due to this delusional state.
Delusional Disorder is an example of a psychotic disorder. For instance, they may believe that a famous celebrity is in love with them, even though they have never met that celebrity. Psychotic noun: a person with psychosis. Adjective: suffering from psychosis : A danger to society?
What do you think now that you know?
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