Module 9 Mental Disorder as a Defence

Objectives

 To have a basic understanding of dissociative identity disorder

 To have a basic understanding of dissociative amnesia
 To have a basic understanding of post traumatic stress disorder
 To have a basic understanding of what is meant by dangerous people
with severe personality disorder
 To be able to conduct research into dissociative identity disorder.

Introduction

A number of special mental disorders have been used to support a claim of

diminished responsibility or to free someone from criminal responsibility.

Dissociative identity disorder (Multiple personality disorder)

Dissociative identity disorder is a very rare psychological disorder in which a person

has two or more distinct personalities, each with its own thoughts, feelings, and
patterns of behaviour. The personalities often are direct opposites and dominate at
different times, with abrupt transitions triggered by distressful events or memories.
Each may be entirely unaware of the other but aware of unexplained gaps in
remembered time. In psychiatry the condition is known as dissociative identity
disorder, as distinct from schizophrenia which refers to the disintegration of the
personality. Schizophrenia is a psychotic disorder (or a group of disorders) marked
by severely impaired thinking, emotions, and behaviours. Schizophrenic patients are
typically unable to filter sensory stimuli and may have enhanced perceptions of
sounds, colours, and other features of their environment. Most schizophrenics, if
untreated, gradually withdraw from interactions with other people, and lose their
ability to take care of personal needs and grooming.

Multiple personality was first recognised and described by the French physician
Pierre Janet in the late 19th century (McKellar 1979). Public awareness of the
disorder increased in contemporary times after a case was the subject of the book
The Three Faces of Eve (Thigpen and Cleckley 1957).

The cause of multiple personality is not clearly understood, but the condition seems
almost invariably to be associated with severe physical abuse and neglect in
childhood (Lewis Herman 1994). It is believed that amnesia, the key to formation of
the separate personalities, occurs as a psychological barrier to seal off unbearably
painful experiences from consciousness. The disorder often occurs in childhood but
may not be recognised until much later. Social and psychological impairment ranges
from mild to severe. The primary treatment is psychotherapy to help the individual
integrate the separate personalities.

In a landmark trial in America, Billy Milligan, was a man tormented by twenty four
separate personalities battling for supremacy over his body. A battle that culminated
in his arrest after a series of three rapes carried out in 1977 at Ohio State University.
The evidence against him was overwhelming, handcuffs and weapons were found at
his flat, as well as the credit cards of victims, and he was identified from fingerprints
and photographs. Initially, he was diagnosed as having schizophrenia and when
tested he had an IQ of 68, such a low level of intelligence that he was considered
unfit to stand trial for his crimes. A psychiatrist, Dr Cornelia Wilbur, was called in and
diagnosed him as having dissociative identity disorder (multiple personality disorder).
Milligan pleaded not guilty on the grounds that one of his ‘alters’ Adalana, the
lesbian, had committed the crimes. He reported 24 different personalities, three of
whom were female, with nationalities that included Australian, British, and
Yugoslavian, and backgrounds ranging from criminal to weapons experts and lesbian
poets. Others, were felt to be undesirable and were suppressed by Arthur, the
dominant alter who decided who should be allowed to “hold the spot”.

Some of Billy Milligan’s alter egos included:

 Billy, a high school drop-out, aged 26, the core personality

 Arthur, a 22 year old, Englishman, rational and emotionless, he wore glasses
and read Arabic. A capitalist and an atheist, he dominated the other
personalities, except when the situation was dangerous when he decided who
would ‘come out’ and take the spot
 Ragan, aged 23, was Yugoslavian and could speak English only with a Slavic
accent. He had a drooping moustache. Ragan read Serbo-Croatian, did
drawings and was a karate and munitions expert with a criminal record. He
was a communist and an atheist. His role was to protect the others, and he
was the predominant personality when there was danger
 Allen, aged 18, was the only right-handed personality, he smoked cigarettes
and parted his hair on the side. Allen played the drums and was a
manipulative con-man
 Tommy, aged 16, played the saxophone, painted and was knowledgeable
about electronics. He was generally anti-social. An escapologist who
demonstrated his ability to escape from straight-jackets while on remand
 Christene was a 3yearold British girl who drew butterflies and flowers
 Adalana, aged 19, was a shy lesbian, who wrote poetry and liked cooking and
housework
 David was aged 8, he was small and highly sensitive. His job was to absorb
all the pain felt by the others.

Some of these personalities consented to take IQ tests, making it possible to

compare their scores. These ranged from a low level of intelligence exhibited by
David to superior intelligence exhibited by Allen.

Milligan claimed to have been abused as a child by his step-father, who threatened
to bury him alive if he talked about it to anyone. At one stage of the trial, his brother
was able to partially corroborate the allegations of abuse. Wasseem (2010) states
that clinical and research reports indicate that a history of physical and sexual abuse
in childhood is more common among adults who develop major mental illness than
previously suspected. Dissociation has also been linked specifically to childhood
physical neglect in patients diagnosed with schizophrenia. Various degrees of
dissociative disorders are recognised, ranging from passive disengagement and
withdrawal from the active environment to multiple personality disorder (MPD), a
severe dissociative disorder characterised by disturbances in both identity and
memory, and best understood as a post-traumatic, adaptive dissociative response to
the fear and pain of overwhelming trauma, most commonly abuse. Fully expressed
MPD is not often diagnosed as such in children, however, other forms of dissociative
disorders are not uncommon.

Milligan was given pre-trial treatment for a period of three months to partially fuse the
personalities, so that he would be fit to stand trial. He was found not guilty of rape
and kidnapping by reason of insanity and admitted to a psychiatric unit and was
eventually released in 1988 with his personality alleged to be fused.

Milligan was arrested in California for allegedly threatening a judge in 1996, but on
this occasion there was no claim of multiple personality disorder. In terms of legal
implications, Cave (2002) reports that Milligan was the first person in the USA to be
acquitted of a major crime because of an insanity plea based on multiple personality
disorder.

Ohio officials remain interested in Milligan because they want to tap into royalties
from a book "The Minds of Billy Milligan," which he co-wrote with Daniel Keyes.
They insist that Milligan should pay part of the $453,000 bill for his 11-year stay in
state mental hospitals. It seems that the attempt by Ohio officials to claim his assets,
triggered his troubles.

In Britain the former Member of Parliament, John Stonehouse, tried to escape his
responsibilities by running away. Stonehouse was Postmaster General, still in his
forties and with a droll sense of humour, he was known as a womaniser with a taste
for young Labour Party female workers. He had been conducting an affair with his
secretary, the young and much sought after, Sheila Buckley. Although his
parliamentary colleagues knew about the mistress, his devoted wife of 24 years
knew nothing of the affair.

The Labour Party lost power in the 1970 General Election and Stonehouse found
himself without a Shadow Cabinet post. Disappointed and bitter Stonehouse sets
himself the target of making £1,000,000 and in order to achieve this aim he set up an
array of businesses. As a former overseas development minister he was well
connected in the Third World and established an investment bank for Bangladeshis.
The affair with Sheila Buckley continued and he installed her in his Westminster flat.

By January 1974 things were beginning to go wrong for Stonehouse. One after
another of his companies began to get into trouble. He borrowed heavily to keep
afloat and to hide the financial mess that his companies were in. He embarked on a
course of false accounting, lying to his accountants and deceiving his partners. It
eventually became clear to Stonehouse that his crimes were going to be uncovered.
The Department of Trade and Industry started to take an interest in his business
dealings and several of his directors resigned.
Stonehouse set about plundering his companies, luring last minute investors and
diverting funds abroad. In mid-1974 he applied for two false passports in the name
of two dead men. He opened bank accounts in several countries using the false
names and siphoned money from his ailing companies into these accounts. He took
out a £125,000 insurance policy on his own life.

On a Miami beach he faked his own death by pretending to go for a swim and
leaving a pile of clothes on a beach. The police launched a massive search for him,
finally coming to the conclusion that he had drowned in the sea. Eventually
Stonehouse arrived in Australia and started to pour money into Melbourne banks.
By a quirk of fate it was about this time that Melbourne police received a request to
look out for Lord Lucan, who had beaten his children's nanny to death. They mistook
Stonehouse, who was not only English but same build and colouring as Lucan, and
followed him for several days. Stonehouse rented a luxury apartment and started to
build a network of contacts.

After a couple of weeks Stonehouse travelled to Copenhagen where he spent a

weekend with Shiela Buckley. The Australian police who were still keeping him
under observation lost him in Copenhagen. Still believing him to be Lucan they took
the decision to arrest him before he could escape again. On Christmas Eve 1974
Stonehouse was arrested by the Melbourne Police and he confessed to his real
identity. He was extradited from Australia and tried at the Old Bailey on 21 charges
of fraud, theft, forgery, conspiracy to defraud, causing a false police investigation and
wasting police time.

Stonehouse claimed that in Miami he broke away from the Stonehouse burdens and
was reborn as Joe Markham. It was as Markham that Stonehouse travelled to
Australia and then to Copenhagen and then back to Australia via Moscow and
Singapore. It was then that a third “alter”, Clive Mildoon took over. Stonehouse
pleaded not guilty by reason of insanity and secured the services of five psychiatrists
to support his insanity defence, among them were the leading forensic psychologist,
Dr. Lionel Haward (McKellar 1979) and Dr. Ronald Laing. In this case Stonehouse
was found to be sane, guilty and sentenced to seven years imprisonment.

Amnesia

This disorder is characterised by a blocking out of critical personal information.

Dissociative amnesia, unlike other types of amnesia, does not result from other
medical trauma, such as a blow to the head. The predominant disturbance is one or
more episodes of inability to recall important personal information, usually of a
traumatic or stressful nature, that is too extensive to be explained by ordinary
forgetfulness.

The disturbance does not occur exclusively during the course of dissociative identity
disorder, dissociative fugue, post traumatic stress disorder, acute stress disorder or
somatisation disorder and is not due to the direct physiological effects of a substance
such as prescribed medication or illegally obtained substances or to a neurological or
other general medical condition.
The symptoms cause clinically significant distress or impairment in social,
occupational, or other areas of functioning. Localised amnesia is present in an
individual who has no memory of specific events that took place, usually traumatic.
The loss of memory is localised within a specific window of time. For example, a
survivor of a car wreck who has no memory of the experience until two days later is
experiencing localised amnesia.

Dissociative amnesia has several subtypes:

 Selective amnesia: happens when a person can recall only small parts of
events that took place in a defined period of time. For example, an abuse
victim may recall only some parts of the series of events around his or her
abuse
 Generalised amnesia: is diagnosed when a person's amnesia encompasses
their entire life
 Continuous amnesia: occurs when the individual has no memory for events
beginning from a certain point in the past continuing up to the present
 Systematised amnesia: is characterised by a loss of memory for a specific
category of information. A person with this disorder might, for example, be
missing all memories about one specific family member
 Dissociative fugue: is a rare disorder. An individual with dissociative fugue
suddenly and unexpectedly takes physical leave of his surroundings and sets
off on a journey of some kind. These journeys can last hours, or even several
days or months. Individuals experiencing a dissociative fugue have travelled
over thousands of miles. An individual in a fugue state is unaware of or
confused about his identity, and in some cases will assume a new identity
(although this is the exception). Dissociative fugue is a sudden, unplanned
excursion away from ones planned itinerary accompanied by either memory
loss or confusion about, loss of, or assumption of a new identity. McKellar
(1997) suggests that John Stonehouse may have been suffering from
dissociative fugue in Miami when he suddenly became Joe Markham. The
passports obtained by Stonehouse suggest a degree of planning which is not
normally encountered in this condition.

Ioannou and Greenall (2008) suggest that in general the courts have not been
receptive to amnesia as a valid condition in either the identity defence or as a
condition that promotes incompetence to stand trial. There will always be a
suspicion that the defendant may be faking the memory loss. Claims of amnesia are
made in a substantial proportion of homicide trials and whilst it is easy for a person
to say that they cannot remember committing the offence, it is difficult for a
psychologist to determine the truthfulness of such a claim.

Post traumatic stress disorder

Post traumatic stress disorder (PTSD) is a psychological and physical condition that
is caused by very frightening or distressing events. It occurs in up to 30% of people
who experience traumatic events. Events known to precipitate PTSD include:
  military combat
 serious road accidents
 terrorist attacks
 natural or man-made disasters
 being held hostage
 violent deaths
 violent personal assaults, such as sexual assault, mugging or robbery.

PTSD may also occur in any other

situation where a person feels
extreme fear, horror or helplessness.
However, it does not usually develop
after situations that are upsetting,
such as divorces, job losses or
failing exams. A person suffering
with PTSD often relives the
traumatic event through nightmares
and flashbacks. They may also
have problems concentrating and
sleeping, and feel isolated and
detached. These symptoms are
often persistent and severe enough
to have a significant impact on a
person’s day-to-day life.

The term ‘post-traumatic stress

disorder’ was first used after the Vietnam War. In 1980, PTSD officially became
recognised as a mental health condition when it was included in the Diagnostic and
Statistical Manual of Mental Disorders, which was developed by the American
Psychiatric Association (APA).

A successful PTSD defence usually result in a verdict of diminished responsibility

rather than of a verdict of not guilty by reason of insanity.

Dangerous and severe personality disorder

The government first introduced this term in a consultation paper (Home Office and
Department of Health 1999), which suggested ways to detain and treat a small
minority of personality disordered offenders who pose a significant threat to others
and themselves. Cases such as that of Michael Stone, who attacked Josie Russell
and murdered her mother and sister in 1996, acted as a catalyst for the introduction
of the concept of Dangerous People with Severe Personality Disorders. Stone
committed the crimes several years after his personality disorder had been deemed
to be untreatable (Ioannou and Greenall2008).

The Dangerous People with Severe Personality Disorder Programme brings

together the Ministry of Justice (originally part of the Home Office), the Department of
Health, Her Majesty’s Prison Service and the National Health Service to deliver new
mental health services for people who are or have previously been considered
dangerous as a result of severe personality disorder(s).

The main objectives of the pilot programme are:

 Improved public protection

 Provision of new treatment services improving mental health outcomes and
reducing risk, and
 Understanding of what works in treatment and management of those who
meet DSPD criteria.
The underpinning philosophy of the DSPD Programme is that public protection will
be best served by addressing the mental health needs of a previously neglected
group.

The pilot services cover England and Wales. In addition to the 300 high secure
places for men, the programme also provides:

 75 medium secure and community places with community teams

 A pilot service for women
 A research and development programme (Ministry of Justice 2010)
 Personality disorders have often been used as a defence in court.
Suggested reading

Herman, J.L. (1994) Trauma and Recovery London: Pandora

Keyes, D. (1981) The Minds of Billy Milligan New York: Random House
Health, NOMS and the Ministry of Justice available online @
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/21737
0/early-years-dspd-programme-research-summary.pdf

Sizemore, C. C. (1989) A Mind of My Own New York: Greene Communications

Wasseem, M. (2010) “Child Abuse & Neglect, Dissociative Identity Disorder” in e-
medicine available on lone@ emedicine.medscape.com/article/916186-overview

Bibliography

Casey, J.F. Wilson, L. (1993) The Flock London:Abacus

Cave, S. (2002) “Multiple personality disorder (MPD)” in Classification and Diagnosis
of Psychological Abnormality. New York: Taylor & Francis
Herman, J.L. (1994) Trauma and Recovery London: Pandora
Ioannu, M. Greenwall, P.V. “Mental Disorder and Crime” in D. Canter (ed) Criminal
Psychology Hodder Education: London
Keyes, D. (1981) The Minds of Billy Millingan New York: Random House
Larmore, K. Ludwig, A.M. Cain, R.L. (1977) “Multiple Personalities, an Objective
Case Study” in British Journal of Psychiatry 1977 131 (pp 35-40)
Mayer, R. (1988) Through Divided Minds New York: Doubleday
McKellar, P. (1979) Mindsplit Guildford: J.M. Dent & Sons Ltd
Ministry of Justice (2010) DPSD Programme: A joint initiative between the
Department of Health, NOMS and the Ministry of Justice available online @
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/21737
0/early-years-dspd-programme-research-summary.pdf

Sizemore, C. C. (1989) A Mind of My Own New York: Greene Communications

Szasz, T. (2010) “The Therapeutic State ~ Anti-Coercion Is Not Anti-Psychiatry" in
Freeman Foundation for Economic Education May 2008 Vol 58 Issue: 4.
Thigpen, C.H. Cleckley H.M. (1957) The Three Faces of Eve New York: McGraw Hill
Wasseem, M. (2010) “Child Abuse & Neglect, Dissociative Identity Disorder” in e-
medicine available on lone@ emedicine.medscape.com/article/916186-overview