Should we diagnose perpetrators of abuse and violence with mental disorders?
What Would Jess Say?
Thank you to the person who asked me to write about what I would say to people who support the psychiatric diagnoses of perpetrators of serious violent crime such as rape, abuse, and assault.
I’ve had my own journey of this topic, on which I have completely changed my own views. Years ago, I would have agreed with and supported the argument that people who commit serious violent crime must have some sort of mental health issue or psychiatric disorder.
I remember thinking that for people to be able to commit acts like this, there must be something different or wrong with them. I remember thinking that there must be something we could find about them and then diagnose, and ‘treat’ it, and eventually help them to be better people.
Writing in the present day, I’m not so sure that is true. I’m also interested in why we are so likely to diagnose perpetrators, and what purpose it serves - for them, and for everyone else in society.
What function does the diagnosis have?
My first feeling of discomfort around this topic came from a case in which a young, successful, handsome, popular man was charged with making child abuse images of him abusing his infant daughter. He uploaded them and shared them with groups of paedophiles. He had also downloaded thousands of images of other babies.
When it came to the trial, his defence barrister argued that he not only committed the crimes due to ‘depression’ but that he should be spared prison because he had ‘anxiety’. I was baffled.
Depression doesn’t cause sex offending.
His barrister argued that he was in a loveless (read: sexless) marriage and it had made him very sad. He said that the offending was part of his depression. I was shocked to hear that. Sex offending was not a part of anyone’s depression. It’s an excuse, a convenient mask, but it is not a part of low mood. It felt like the barrister was twisting what depression was, and how powerful it could be, to suggest that it turned their defendant from a successful happy guy into a depraved child abuser.
I remember thinking, ‘But surely, everyone in that courtroom knows that isn’t true?’
I also couldn’t understand why him having anxiety would prevent justice being served. He was clearly a risk to children, and to the public. But it worked a treat, he was positioned as a great guy who was struggling with anxiety and depression, and whilst he was found guilty for the offences, he was spared a custodial sentence. Instead, he was given a package of support around his ‘depression’.
As time went on, I saw more and more cases like this. Men who had abused, raped, attacked, robbed, assaulted, and controlled their victims were positioned as mentally ill or struggling with their mental health. I worked in a prison during my PhD too, and learned that the majority of all men in the prison were given personality disorders within weeks of being there. The Institute for Psychiatry estimates that at least 50% of all people in prison have a mental disorder (MHF, 2019).
I met a man who had no criminal record and had never been known to any authority services. During his first night of a long sentence in prison, he tried to end his life. He had been imprisoned for accidentally killing a child in his vehicle when he wasn’t paying attention to the road. His actions, and the public trial, had led to his family losing everything (his income, the house they lived in, their partner, and father etc) and he was in shock.
It was the psychiatrist’s opinion that he must have an undiagnosed personality disorder, and that he needed medication. When I challenged this and said that his desperation seemed like a normal reaction to me, and he probably needed time to let it all sink in, I was laughed at. They were certain he had a personality disorder and they hadn’t even met him. They agreed with other professionals that he was mentally ill, and planned to prescribe him medication the next day.
Examples like these, and many others over the years, changed the way I thought about the diagnosis of perpetrators of serious crime. What was it really for?
Men who had abused their partners and children were using psychiatric diagnosis to ‘explain’ their offending.
Men who were sent to prison were being diagnosed with mental health issues as soon as they got there.
Men doing long stints in prison were being diagnosed with psychiatric disorders as if prison is a normal environment for anyone to live in, and as if that assessment would be objective and scientific.
What Would Jess Say?
I think what this comes down to, is a prevalent global discomfort with humans making horrible choices to harm and abuse others. As a society, we seem incapable of acknowledging that some people want to harm and abuse others, they want control over them, they want to oppress and bully others. This doesn’t make them mentally ill. This doesn’t signal a personality disorder. Even in the DSMV, there are no mental illnesses or disorders that contain offending or abusing as a symptom or a consequence.
We often don’t like the simple, basic answers to societal and human problems - but we do like the abstract theories and over-complicated labels. We won’t accept that people are different. We search for reasons and issues. Some people, ever since the beginning of time, enjoy violence and harm, but instead of acknowledging this, we prefer to suggest disorders, illnesses, and problems with the mind.
Psychologically, it is much easier to distance ourselves from these people by labelling them as disordered. We can convince ourselves that we are different from them, and would never commit crimes like that, because we are of ‘sound’ mind. We tell ourselves that they must be mentally ill, psychopaths, disordered or evil.
People say things like, ‘No one in their right mind would treat someone like that!’
This fascinates me. Violence and abuse is celebrated in society, is it not? Films. Music. Wars. History. Books. Social media. Video games. We literally thrive off violence and abuse. And for those of us who don’t thrive off it, and hate constant depictions of violence and abuse around us, we have no choice but to be surrounded by it. So why would it be a mental disorder to act it out in real life? Haven’t we groomed society to be violent?
Doesn’t it strike anyone else as odd that we have multi-million dollar industries encouraging violence and abuse of humanity - but then when people do it, we suggest they are mentally ill?
And what about the obvious fact that the vast majority of millions of people with mental health diagnoses don’t offend or become violent at all?
Further, my concern is the way that these disorders and diagnoses start to excuse and minimise violence and abuse committed by people who know exactly what they are doing and why.
Why was the man at the beginning of my article able to defend his thousands of abusive actions to infants by saying he was depressed? Why was he spared prison because he had anxiety? Why did any of that matter?
This is certainly something that worries me. And it worries me for the women and girls being abused by men like this.
Many women who are currently in, or have been in, abusive and violent relationships with men have been convinced by others (or the perpetrator, himself) that he only does it to them because he has mental health issues. That he is the true victim. The one who needs to support.
This creates a level of expected empathy for the perpetrator, where even his own victim is supposed to be forgiving and understanding every time he loses his temper and smashes the living room up.
People around the couple expect the woman to be patient, or even to love him harder to ‘fix him’. As if being more submissive and more loving will cure his ‘illness’ so he stops abusing her.
‘It’s not his fault, he has mental health issues.’
No. I’m sorry. But no.
Abusive behaviour from a perpetrator is not caused by mental health issues, disorders, or diagnoses. It is always a choice. It is something they want to do, and they had capacity to choose not to do.
That might be uncomfortable and contentious, but do we really think that these perpetrators have no choice? That they have some illness or disorder that causes them to abuse their partners and children, but not their boss at work?
The final thing I want to say to this point is that I’ve seen more and more women on social media ‘diagnosing’ their exes and perpetrators with psychiatric disorders and personality disorders. They talk about their exes in terms of ‘NPD’ and ‘BPD’ and label them ‘psychopaths’ without realising that all they are doing is giving credence and support to the abusive behaviours by ascribing a psychiatric label to a violent and abusive person.
To those women specifically:
I know it might feel validating to give them a label, or to explain or describe their behaviours as if they have a disorder. It might feel like you finally found the ‘reason’ why they did that to you. I know it might even make you feel less angry towards them, because you can reframe it as an illness they couldn’t control.
But your perpetrator is not mentally ill. They don’t need a label or an illness to be horrible people. You don’t need to care about them. You don’t need to look after them or feel guilty. You don’t need to fix them. You don’t need to forgive them.
They didn’t harm you because they are ill. They didn’t harm you because they were struggling, or not coping. They didn’t harm you because they had a rough childhood. They are adults, choosing to behave like this because ultimately, they get something they want from it.
I wonder what would happen if we stopped diagnosing perpetrators of abuse and violence with mental disorders, and instead focussed on their choices, motivations, and the way society rewards their actions?