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Since mental illness has legal as well as medical aspects, it is the purpose of this thesis to consider one part of the relationship between the courts, the mentally ill person, and the state hospital. This part is concerned with the problem of how mentally ill persons are selected and committed by legal proceedings in the state of Texas for treatment in a mental hospital. This paper is concerned with the problem of how mentally ill persons are selected and committed by legal proceedings in the state of Texas for treatment in a mental hospital.

A comparison of the voluntary and involuntary patients at Dammasch State Hospital, Wilsonville, Oregon. A representative sample of cases over time, were chosen for the year 1976, 72 voluntary and 72 involuntary patients. One-hundred and twelve variables were coded onto sheets for each patient. The variables concerned marital status, job history, history of violent acts, present living situations and relationships, as well as drug history and diagnosis and treatment in the hospital. The data were coded onto cards and a computer analysis was done using Factor and Discriminant Function Analysis. It was hypothesized the populations of persons voluntarily admitted and involuntarily committed would be different in several ways. (A) The population of involuntarily committed persons would have more anti-social aggression in their histories. This hypothesis was partially supported by the data. The involuntarily committed had a significantly higher incidence of being under a current legal charge at the time of commitment. There was no significant difference between the two populations in the number of previous incarcerations or on 'violence committed within the family'. (B) Persons involuntarily committed would have significantly fewer relationships with persons in the community and fewer ties to persons they support financially or emotionally or that support them emotionally or financially. This hypothesis was partly supported by the data. The two populations were approximately equal on all the variables of relationship and living conditions except 'lives with mate'; for this variable the voluntary patients had a higher score. (C) Involuntarily committed persons would have less successful job histories. None of the items of the job history were significantly different in the two populations. (D) The involuntary population was more likely to have alcoholism as a secondary diagnosis. The voluntary population was more likely to have alcoholism as a primary diagnosis. This hypothesis was not clearly supported by the data. It was found that the voluntary population was more likely to abuse alcohol and the involuntary population was more likely to use alcohol. (E) The involuntary population was more likely to have experienced violence in their homes, while children. There were insufficient data in the hospital records concerning childhood to test this hypothesis. In the factor which contained the variable 'commitment' there were no elements of a history of dangerousness. The only significant correlation with commitment was 'prescription of phenothiazines in the hospital'; this result may point to the use of drugs as 'chemical restraints'. No other variable which indicated relationships, job history, social status, or dangerousness correlated significantly with commitment. These were the most important findings in the study.

published_or_final_version / Sociology / Master / Master of Social Sciences

Comment les acteurs qui évoluent dans le champ commun entre droit et psychiatrie choisissent-ils d’interner ou de soigner un patient contre son gré? Appliquent-ils simplement les dispositions légales supposées régir les interventions du champ, ou bien se réfèrent-ils à d’autres formes de normativité? Plus globalement, comment ces acteurs s’approprient-ils les normes et en quoi le choix normatif est-il lié au rôle des individus dans le lien social? Voici, très brièvement exposées, les questions auxquelles nous nous intéresserons dans cette thèse.Cette thèse vise deux objectifs distincts, mais complémentaires. Le premier, d’ordre théorique, s’attache à la compréhension sociologique du phénomène de pluralisme normatif tel qu’il se déploie dans le lien social, et plus particulièrement celle du rôle des individus dans la dynamique normative. Le second vise à mettre en perspective pluralisme normatif et droits de la personne dans le contexte particulier de la psychiatrie. À ce titre, nous avons choisi d’étudier le traitement juridique, clinique et social de l’internement et des soins psychiatrique. En effet, cet objet permet de mettre en évidence diverses tensions normatives latentes et constitue un support privilégié à la théorisation des rapports normatifs. / How do those working in the intersection between law and psychiatry make decisions to confine or treat patients against their will? Do they simply apply the legal provisions that are supposed to regulate such actions, or do they refer to other forms of normativity? More globally, how do such stakeholders adopt norms and how is the choice of norms related to individuals’ roles in the social fabric? These are, very briefly, the issues explored in this thesis.This thesis has two distinct, but complementary, objectives. The first is theoretical, and concerns the sociological understanding of the phenomenon of normative pluralism as it operates in the social fabric and more specifically of individuals’ roles in normative dynamics. The second objective is to place normative pluralism and human rights into perspective in the special context of psychiatry. For this, we have chosen to study legal, clinical and social approaches to confining patients and to psychiatric care. This brings to light various latent normative tensions, which proves useful when drawing up theories about normative relations.

Thesis (Ph. D.)--University of Hawaii at Manoa, 1995. / Includes bibliographical references (leaves 166-178). / Microfiche. / xv, 178 leaves, bound ill. 29 cm

The story of the mentally ill is a tale which is filled with unpleasant facts. Only a very few persons have even a semblance of knowledge about mental deficiencies and those citizen unfortunates who have borne, or will travail, under the throes of such a mysterious affliction. Those people who do know the narrative of the "lunatic," too often are unwilling to reveal their expertise.Therefore, the purpose of this dissertation is to follow the history of those multitudes of mentally ill persons from primitive to contemporary times. One's attention will be focused upon the diagnosis and subsequent treatment of insanity in ancient Egypt and Greece, Europe during the Dark and Middle Ages, England prior to and during the adventures at empire, colonial America, Indiana prior to and after statehood, and specifically Delaware County, Indiana from 1869 through 1927.The research has shown that ages of abuse, restraints, banishment by popular consent from society, sequestration, and indifference toward the mindless in humanity have not explained the ambiguity of mental illness, dwindled man's apprehension regarding the mentally incapacitated, or put to rest his troublesome inner thoughts.In conclusion, little has changed. In contemporary times mankind tends to waver between throwing madness wholly out of perception and out of psyche, and complying with humanitarian impulses to heal the sick souls.It appears that the treatment of the mentally ill has gone full cycle. From remote but centralized places of containment in earliest times, the mentally ill were then supported rather ineffectively at county and local places in accordance with poor law regulations. Then came the advent of state-supported hospitals to replace the often despicable county and local poor farms and jails. But today the collapse of that whole system seems virtually ready to take place as funding becomes less adequate. The feeling is that the mentally ill can better be cared for at local levels. And so once again, the "unwanted" human cargo of concern will soon be back on the serpentine path to resume the life that just a little over a century ago was thought to be grossly inhumane.

published_or_final_version / Sociology / Master / Master of Social Sciences

Afrikaans text / The purpose of this study was to retrospectively analyze a group of observation cases referred to a psychiatric institution through the criminal justice system by means of certain measuring instruments in order to determine on which grounds some of the cases were classified as criminals and others as state patients. The sample for the purposes of this investigation consisted of one hundred and forty-two cases referred to the Weskoppies hospital for psychiatric observation during 1988 to 1994. The measuring instruments were the South African Wechsler intelligence scale, the Rorschach projective technique and an information schedule which was used for the purpose of gathering biographical information and personal details of each particular case. The data collected through these instruments was statistically analyzed utilising frequencies and crosstabulations, chi-square tests, t-tests, correspondence analyses, factor analyses and regression analyses. The findings of this investigation revealed that crimes concerning personal relations and property crimes were more committed by criminals than state patients while crimes concerning communal life were encountered more amongst state patients than criminals. Non-person-directed crimes of violence were encountered proportionally more amongst state patients who had a history of substance abuse than in criminals with a similar history. State patients who had a history of substance abuse were proportionally more prosecuted on account of person-directed-crimes of violence than criminals with a similar history. The predictive measuring instrument developed by means of regression analysis indicated as important predictors three subtests of the South African Wechsler intelligence scale namely general information, digit-symbol substitution and picture arrangement as well as the variable "previous psychiatric treatment". The following recommendations were also made: The current endeavour to adapt the South African Wechsler intelligence scale for all population groups needs to be maintained and this adaptation should also be pursued in each country where the scale is used or was used in the past. It is advisable to draw up certain profiles of specific offenders by means of the Rorschach projective technique while the testing procedure should preferably be undertaken by the same researcher. Provision should be made that the accused be declared as state patients only on account of serious and violent crimes while the courts should have the right in appropriate cases to charge the accused with detention in accordance with chapter three of the Mental Health Act. The testimony of criminologists and psychologists should be added to the testimony of psychiatrists especially in cases of accountability or diminished accountability. The proposed predictive model may be further refined and adapted through the use of a larger, nation-wide sample resulting in the inclusion of a greater number of observation cases and variables. Due to the accelerating rate of revision associated with The DSM­ IV manual and the fact that its validity is questioned, ethically responsible psychiatrists, psychologists and criminologists are obligated to identify practices and procedures which threaten to misinform the legal system. / Die doel van hierdie studie was om aan die hand van bepaalde meetinstrumente retrospektief 'n groep observasiegevalle wat deur die regstelsel na 'n psigiatriese inrigting verwys is, te ontleed, sodat daar vasgestel kon word op watter gronde sekere van die gevalle as misdadigers en ander as staatspasiente geklassifiseer is. Die steekproef vir die doeleindes van hierdie ondersoek het bestaan uit honderd twee-en-veertig gevalle wat vanaf 1988 tot 1994 na Weskoppieshospitaal vir psigiatriese waarneming verwys is. Die meetinstrumente wat gebruik is, was die Suid-Afrikaanse Wechsler-intelligensieskaal, die Rorschach-projeksietegniek en 'n inligtingskedule wat biografiese inligting en persoonlike besonderhede van elke besondere geval ingewin het. Die gegewens wat uit hierdie meetinstrumente versamel is, is statisties verwerk met behulp van frekwensies en kruistabellerings, chi­ kwadraattoetse, t-toetse, korrespondensie-analises, faktoranalises en regressie-ontledings. Die bevindinge van die ondersoek het aan die lig gebring dat persoonverhoudings- en eiendomsmisdrywe meer deur misdadigers as staatspasiente gepleeg word, terwyl gemeenskapslewe misdrywe meer by staatspasiente as misdadigers voorgekom het. Nie-persoonsgerigte geweldsmisdrywe het verhoudingsgewys meer onder staatspasiente met 'n geskiedenis van substansmisbruik as by misdadigers met 'n soortgelyke geskiedenis voorgekom. Staatspasiente met 'n geskiedenis van substansmisbruik is ook verhoudingsgewys meer as misdadigers met 'n soortgelyke geskiedenis weens persoonsgerigte geweldsmisdrywe aangekla. Die voorspellingsmeetinstrument wat met behulp van die regressie ontledings ontwikkel is, het drie subtoetse van die Suid­ Afrikaanse Wechsler-intelligensieskaal naamlik algemene inligting, syfersimboolvervanging en prentrangskikking asook die veranderlike "vorige psigiatriese behandeling" as die belangrikste voorspellers uitgewys. Die volgende aanbevelings word ook hiermee gemaak: Daar moet volgehou word met die huidige poging om die Suid­ Afrikaanse Wechsler-intelligensieskaal vir alle bevolkingsgroepe in Suid-Afrika aan te pas asook met die aanpassing van die meetskaal vir elke land wat dit tans gebruik of in die verlede gebruik het. Dit is raadsaam om met behulp van die Rorschach projektiewe tegniek bepaalde profiele ten opsigte van spesifieke oortreders op te stel terwyl die toetsingsproses verkieslik deur dieselfde ondersoeker waargeneem word. Daar moet seker gemaak word dat beskuldigdes slegs in die geval van ernstige en gewelddadige misdade tot staatspasiente verklaar word, terwyl die howe die bevoegdheid kry om in geskikte gevalle te beveel dat beskuldigdes ingevolge Hoofstuk 3 van die Wet op Geestesgesondheid aangehou moet word. Die getuienis van kriminoloe en sielkundiges behoort bygevoeg te word by die van psigiaters en wel in gevalle waar toerekeningsvatbaarheid of verminderde toerekeningsvatbaarheid ter sprake is. Die voorgestelde voorspellingsmodel kan verder verfyn en aangepas word deurdat 'n groter, landwye steekproef van alle observasiegevalle getrek word wat uiteraard 'n groter aantal veranderlikes sal insluit. Weens die versnellingstempo van hersiening met betrekking tot die DSM-IV handleiding en die feit dat sy betroubaarheid bevraagteken word, word aanbeveel dat eties verantwoordelike gedrag aan die kant van psigiaters, sielkundiges en kriminoloe gevolg word sodat praktyke en prosedures wat die regstelsel kan benadeel, geidentifiseer kan word. / Criminology and Security Studies / D.Litt. et Phil. (Kriminologie)

Afrikaans text / The purpose of this study was to retrospectively analyze a group of observation cases referred to a psychiatric institution through the criminal justice system by means of certain measuring instruments in order to determine on which grounds some of the cases were classified as criminals and others as state patients. The sample for the purposes of this investigation consisted of one hundred and forty-two cases referred to the Weskoppies hospital for psychiatric observation during 1988 to 1994. The measuring instruments were the South African Wechsler intelligence scale, the Rorschach projective technique and an information schedule which was used for the purpose of gathering biographical information and personal details of each particular case. The data collected through these instruments was statistically analyzed utilising frequencies and crosstabulations, chi-square tests, t-tests, correspondence analyses, factor analyses and regression analyses. The findings of this investigation revealed that crimes concerning personal relations and property crimes were more committed by criminals than state patients while crimes concerning communal life were encountered more amongst state patients than criminals. Non-person-directed crimes of violence were encountered proportionally more amongst state patients who had a history of substance abuse than in criminals with a similar history. State patients who had a history of substance abuse were proportionally more prosecuted on account of person-directed-crimes of violence than criminals with a similar history. The predictive measuring instrument developed by means of regression analysis indicated as important predictors three subtests of the South African Wechsler intelligence scale namely general information, digit-symbol substitution and picture arrangement as well as the variable "previous psychiatric treatment". The following recommendations were also made: The current endeavour to adapt the South African Wechsler intelligence scale for all population groups needs to be maintained and this adaptation should also be pursued in each country where the scale is used or was used in the past. It is advisable to draw up certain profiles of specific offenders by means of the Rorschach projective technique while the testing procedure should preferably be undertaken by the same researcher. Provision should be made that the accused be declared as state patients only on account of serious and violent crimes while the courts should have the right in appropriate cases to charge the accused with detention in accordance with chapter three of the Mental Health Act. The testimony of criminologists and psychologists should be added to the testimony of psychiatrists especially in cases of accountability or diminished accountability. The proposed predictive model may be further refined and adapted through the use of a larger, nation-wide sample resulting in the inclusion of a greater number of observation cases and variables. Due to the accelerating rate of revision associated with The DSM­ IV manual and the fact that its validity is questioned, ethically responsible psychiatrists, psychologists and criminologists are obligated to identify practices and procedures which threaten to misinform the legal system. / Die doel van hierdie studie was om aan die hand van bepaalde meetinstrumente retrospektief 'n groep observasiegevalle wat deur die regstelsel na 'n psigiatriese inrigting verwys is, te ontleed, sodat daar vasgestel kon word op watter gronde sekere van die gevalle as misdadigers en ander as staatspasiente geklassifiseer is. Die steekproef vir die doeleindes van hierdie ondersoek het bestaan uit honderd twee-en-veertig gevalle wat vanaf 1988 tot 1994 na Weskoppieshospitaal vir psigiatriese waarneming verwys is. Die meetinstrumente wat gebruik is, was die Suid-Afrikaanse Wechsler-intelligensieskaal, die Rorschach-projeksietegniek en 'n inligtingskedule wat biografiese inligting en persoonlike besonderhede van elke besondere geval ingewin het. Die gegewens wat uit hierdie meetinstrumente versamel is, is statisties verwerk met behulp van frekwensies en kruistabellerings, chi­ kwadraattoetse, t-toetse, korrespondensie-analises, faktoranalises en regressie-ontledings. Die bevindinge van die ondersoek het aan die lig gebring dat persoonverhoudings- en eiendomsmisdrywe meer deur misdadigers as staatspasiente gepleeg word, terwyl gemeenskapslewe misdrywe meer by staatspasiente as misdadigers voorgekom het. Nie-persoonsgerigte geweldsmisdrywe het verhoudingsgewys meer onder staatspasiente met 'n geskiedenis van substansmisbruik as by misdadigers met 'n soortgelyke geskiedenis voorgekom. Staatspasiente met 'n geskiedenis van substansmisbruik is ook verhoudingsgewys meer as misdadigers met 'n soortgelyke geskiedenis weens persoonsgerigte geweldsmisdrywe aangekla. Die voorspellingsmeetinstrument wat met behulp van die regressie ontledings ontwikkel is, het drie subtoetse van die Suid­ Afrikaanse Wechsler-intelligensieskaal naamlik algemene inligting, syfersimboolvervanging en prentrangskikking asook die veranderlike "vorige psigiatriese behandeling" as die belangrikste voorspellers uitgewys. Die volgende aanbevelings word ook hiermee gemaak: Daar moet volgehou word met die huidige poging om die Suid­ Afrikaanse Wechsler-intelligensieskaal vir alle bevolkingsgroepe in Suid-Afrika aan te pas asook met die aanpassing van die meetskaal vir elke land wat dit tans gebruik of in die verlede gebruik het. Dit is raadsaam om met behulp van die Rorschach projektiewe tegniek bepaalde profiele ten opsigte van spesifieke oortreders op te stel terwyl die toetsingsproses verkieslik deur dieselfde ondersoeker waargeneem word. Daar moet seker gemaak word dat beskuldigdes slegs in die geval van ernstige en gewelddadige misdade tot staatspasiente verklaar word, terwyl die howe die bevoegdheid kry om in geskikte gevalle te beveel dat beskuldigdes ingevolge Hoofstuk 3 van die Wet op Geestesgesondheid aangehou moet word. Die getuienis van kriminoloe en sielkundiges behoort bygevoeg te word by die van psigiaters en wel in gevalle waar toerekeningsvatbaarheid of verminderde toerekeningsvatbaarheid ter sprake is. Die voorgestelde voorspellingsmodel kan verder verfyn en aangepas word deurdat 'n groter, landwye steekproef van alle observasiegevalle getrek word wat uiteraard 'n groter aantal veranderlikes sal insluit. Weens die versnellingstempo van hersiening met betrekking tot die DSM-IV handleiding en die feit dat sy betroubaarheid bevraagteken word, word aanbeveel dat eties verantwoordelike gedrag aan die kant van psigiaters, sielkundiges en kriminoloe gevolg word sodat praktyke en prosedures wat die regstelsel kan benadeel, geidentifiseer kan word. / Criminology and Security Studies / D.Litt. et Phil. (Kriminologie)