Abnormal Psychology in Contemporary Society

Our class only read part of chapter 17 of Butcher’s Abnormal Psychology: a section about inpatient mental health treatment in contemporary society and another about controversial legal issues and the mentally ill. 

Mental health treatment in contemporary society

In the late 19th century, mental hospitals were filled with patients. Many of these patients lived in a horrific environment that was unhealthy both physically and mentally. In those hospitals that had humane treatment of patients, there was a concern that patients would get “institutional syndrome” – in which people lost their ability to socialize and live independently because they had been in a mental hospital for so long. 

In the mid-to-late 20th century, a movement to deinstitutionalize the mentally ill gained momentum. It began in the 1950s and 60s, when antipsychotic drugs were developed. These medications made it possible for patients to leave hospitals and live independent lives. Later, a desire to rescue people from inhumane environments and to keep them from getting “institutional syndrome” accelerated the rate of deinstitutionalization. Another consideration in deinstitutionalization was the desire to decrease medical expenditures. As mentioned in my earlier post on Chapter 2deinstitutionalization was detrimental to many mentally ill people. One third of the homeless population is comprised of mentally ill people, and a horrifying number of the mentally ill are incarcerated with little to no mental health treatment (which, by the way, means that society is still doling out the bucks to pay for the housing of mentally ill). 

In contemporary American society, if a person is unable to care for himself, or if he is a danger to himself or others, he can be placed in a psychiatric hospital. Such a commitment can be voluntary, but if someone is considered a danger to himself or society and he refuses hospitalization, civil commitment procedures can be undertaken, and he can be confined involuntarily in a mental hospital. 

Such hospitals generally combine traditional forms of therapy with a constructive social environment. A study in 1977 by Gordon L. Paul and Robert L. Lentz compared the relative effectiveness of three treatment approaches. 

Milieu therapy, which focuses on providing the patient with a very clear idea of what the staff expectations are and providing feedback about compliance with those expectations, encouraging the patients to be active in their own treatment decisions, and providing social groups for support and “positive” peer pressure.

Social-learning, in which the patients learn socially acceptable behavior through a token economy (they get tokens when they behave well). With tokens, the patients can buy privileges. 

Traditional treatments, with pharmacotherapy, occupational therapy, and individual group therapy. For instance, a friend of mine was recently released from a mental health ward which had psychological therapy, psychiatry, yoga, prayer meetings, knitting classes, and all sorts of social groups. 

Paul and Lentz studied 28 schizophrenic patients for resocialization, learning new roles, and reducing bizarre behavior. From the social learning program, 90 percent of the patients remained in the community after release; compared to the 70 percent who’d had milieu therapy, and the less than 50 percent who’d had traditional therapy. I haven’t read it, but there’s a review of Paul and Lentz’s study available here

All of these programs seem like a positive change from the early 20th century, but in order to voluntarily get into one of these hospitals, the patient must have both resources and mindfulness of illness. In order to get involuntarily committed, the patient must have an advocate willing to report his danger. Most of the homeless do not have such advocates, and thus they slip between the cracks. 

Controversial legal issues and the mentally ill
In recent years news reports have sensationalized grizzly murders committed by sociopaths and psychotic people. In fact, one such grizzly murder was just discovered in the Twin Cities (where I live). It’s easy to say that if only the mental health system were better, we could prevent such tragedies. But how do you really know when someone is dangerous before they actually do anything? A mental health professional is authorized to make such a judgement call, though the dangerous person must first be seeing a mental health professional before any judgement can be made. And often a patient gives no hint of his violent thoughts. 

If the patient does give a hint of violent thoughts, the mental health worker (or even a priest during confession), has the duty to report the dangerous individual to the authorities, and in some states to warn the individual who has been threatened. 

One huge controversy about dangerous mentally ill people is the insanity defense (or not guilty by reason of insanity, NGRI). Someone can be successful with this plea if he is thought to not know right from wrong or if he was compelled irresistibly to perform the violent act. The defense attorney must obtain the testimony of a mental health professional who convincingly claims that the accused was insane at the time of the crime. 

Because it is very difficult to be acquitted as NGRI some people plea “guilty but mentally ill (GBMI).” With success of this plea, the convicted would be found guilty but placed in a mental institution instead of a prison. Many hope that this plea will decrease the number of patients who are found not guilty by reason of insanity, are confined to a mental institution, soon judged to be in recovery, and are unconditionally released into society. When a person is found guilty but mentally ill, he remains for his entire sentence in the mental institution. 

A third way that a mentally ill person can protect himself from unethical treatment is to claim incompetence to stand trial.  If a person is charged with a crime but is unable to understand the proceedings due to mental health, he can postpone the trial until they have recovered sufficiently to understand. Such people can be hospitalized until they are deemed competent. 

An interesting point that the authors brought up was about patients diagnosed with disassociative identity disorder, DID – formerly known as multiple personality disorder. If one personality commits a crime, is it ethical to punish all personalities? This is a question that first occurred to me several years ago while reading A Fractured Mind, by Robert B. Oxnam. Oxnam gave a few examples of when one personality did something “wrong,” and Oxnam implied that he, himself, was not guilty of those transgressions, because it was his other self that committed them. The two examples I remember are when one of his personalities cheated on his wife and when one of his personalities stole a bunch of stuff from a boating store. It peeved me that Oxnam thought it was ok to brush off those acts by saying “the other (bad) me did it.” But perhaps that is because I’m skeptical of true multiple personalities that are unaware of, and unable to control, the others’ actions. If it does exist, I’m sure it’s very, very rare. 

On the other hand, I do know someone who has disassociative episodes and was caught doing something illicit during an episode. But my friend has never blamed the “other” guy – he seems quite willing to step up and take the blame. Somehow that willingness to accept the blame makes him seem less culpable, in my eyes, than Oxnam.  

What do you think? Do you believe that people with DID can have completely separate identities that are unaware of, and unable to control, each others’ actions? Do you think the entire set of identities should be punished if one personality commits a crime?

This is a series of posts summarizing what I’m learning in my Abnormal Psychology course. Much of the information provided comes from reading my James N. Butcher’s textbook Abnormal Psychology. To read the other posts, follow these links: 

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness – Biology
Contemporary Viewpoints on Treating Mental Illness – Psychology
Frontline: New Asylums
Brave New Films: This is Crazy
Clinical Mental Health Diagnosis: Biological Assessment
Clinical Mental Health Diagnosis: Psychological Assessment
Does the DSM Encourage Overmedication?
Post Traumatic Stress Syndrome – The Basics
Panic Disorder
Obsessive Compulsive Disorder
Hoarding and Body Dysmorphic Disorders
Depression – an Overview
Personality Disorders – Clusters and Dimensions
Personality Disorders – Cluster A
Personality Disorders – Cluster B
Personality Disorders – Cluster C
Biological Effects of Stress on Your Body
Somatic Symptom and Related Disorders
Dissociative Disorders
Borderline Personality Disorder
Dialectical Behavioral Therapy
Paraphilic Disorders
Gender Dysphoria – Homosexuality and Transgender
Anxiety Disorders
Bipolar Disorder – The Basics
Suicide – An Overview


Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 17: Contemporary and Legal Issues in Abnormal Psychology. Abnormal Psychology, sixteenth edition (pp. 583-607). Pearson Education Inc.

Noughts and Crosses, by Malorie Blackman

Noughts and Crosses 

Written by by Malorie Blackman, Narrated by Syan Blake and Paul Chequer

Reason for Reading: Group read for my Social Justice February theme (which didn’t go so well this year due to a month of hospital runs….but things are looking more perky now!)

Callum McGregor and Sephy Hadley have been best friends for as long as they remember. But recently their feelings for each other have begun to develop into something…stronger. Unfortunately, Sephy is a member of the dark-skinned upper class of Cross, and Callum is a pale-skinned, low-class Nought. The teens’ romantic problems intensify when Callum’s family gets caught up in a terrorist liberation organization that Sephy’s father (a politician) has sworn to stamp out. Sephy and Callum must learn to love each other in a tumultuous world of hatred. Does this scream out “star-crossed lover” to you? But soft, what light through yonder window breaks? (I got the same Romeo and Juliet vibe from Warm Bodies, which I just finished reading. I think it’s fun when the cosmic net of connected concepts captures me.) 

I’ve heard fantastic things about this book, but I wasn’t as impressed as I thought I’d be. Maybe it’s just because I wasn’t in the mood to read depressing race-relations books (and they’re all a bit depressing, aren’t they?), but this book wasn’t a slap in the face of my preconceived notions.  It was just another book about racism, much like a book written about a white girl and teenaged member of the Black Panthers. The whole skin-color switcharoo seemed like an unnecessary literary device to me. Now, don’t get me wrong, I’m not saying it was a bad book…I was just expecting more amazingness, that’s all. It was a tragically-sweet love story about a very important issue – racism, and the ease with which we can be swept away by other people’s causes. But I think the book would have been more powerful if she’d focused on  the realism of the story instead of trying to build a new world that was simply too similar to our own to justify the effort of creation.  

What do other people think? I imagine there are people out there who think the skin-color switcharoo added to the story? If so, please let us know. 🙂

Congo Dawn, by Jeanette Windle

Congo Dawn, by Jeanette Windle

Reason for Reading: This is my first (and feature) book for the 2013 Social Justice Theme Read. An ARC was provided by the publisher/author in exchange for an honest review. 


When Robin Duncan takes on a security/translator contract in Democratic Republic of Congo, she doesn’t expect all of her old wounds to open. Then she meets a man that she hoped to never see again, and she is reminded not only of her disappointment in humanity but also of the senseless death of her brother. Duncan must struggle inwardly with these issues while she maintains military efficiency in her team’s efforts to capture a deadly insurgent leader. Soon, she learns that not all is as it seems – sometimes, good seems evil and evil seems good. Sometimes well-intentioned people can become monsters while fighting monsters. 

Most Christian Suspense I’ve read is fairly fluffy, so I was surprised (and impressed) with the meatiness of this plot. I found the intensity of the mercenary action against the insurgency convincing. Often, I found myself unable to put the book down for suspense. The romantic tension was delicious, and added emotional depth to the characters without distracting from the suspense plot. And, of course, I always find stories about social justice medical personnel heartwarming. I also learned a lot about the Democratic Republic of Congo while reading this book. Windle has done a lot of research to back up all aspects of her plot – and it really shines through.

The only con would be a con ONLY to people who specifically avoid Christian Fiction. At one point, the suspense is, well, suspended by a philosophical discussion about why God allows bad things to happen to good people. This discussion would be interesting to any reader of Christian Fiction (i.e. the target audience), and the philosophy is demonstrated in the story by action. For those of you who generally avoid Christian Fiction because you feel it is “preachy,” I recommend that you give this book a try anyway. Yes, there is that short section, but the rest of the book is all philosophy-demonstrated-by-action. 

Overall, I really enjoyed this book. I am eager to read more of Windle’s works now that I’ve had this taste. 🙂 

Iron House, by John Hart

2012 Book 5: Iron House, by John Hart (1/9/2012)

Iron House is a beautifully written mystery/suspense novel that delves into the psychological effects of a childhood of violence and abuse. Michael is an orphan who, after running away from a violent scene at an orphanage, grows up to be an enforcer for a powerful mobster. When he falls in love with a beautiful waitress and retires from organized crime, he is suddenly thrown into a violent mystery leading him to explore things he had left behind. Despite my need to suspend disbelief a few times (and to frown upon a few clichés), I feel that Hart kept up the action (and mystery) throughout the book, making for an engaging read. This is an excellent book for people who enjoy mystery/thrillers (assuming they don’t mind violence). I gave the book 3.5/5 stars…it lost points for violence and small clichés.