[Pio1980]

Originally Posted by Ike Bana

Mental health isn't like most other medical practice. No scans can show pathology, only levels of brain activity, which only tells you that some areas are running really "hot." No blood tests or pee tests provide diagnostic information. No x-rays to show what's "broken." The diagnoses are clinical evaluations of symptoms with decision trees where "yes" or "no" answers to questions direct the clinician to the next set of Y or N questions, etc., etc. We spend considerable time in supervision and group clinical consultation working on honing our diagnostic skills. So...what have I learned, and what are my clinical opinions on this subject?

OK...here goes. In my humble clinical opinion the only people who can be considered not responsible for their actions are suffering from psychosis so severe that they are totally unable to differentiate actual right from wrong. They may be suffering from delusions such as "command hallucinations", where a higher power or some mystical manifestation is instructing them to take certain action that a stable person would normally reject as dangerous to self or others. They literally don't know it's wrong. They are no more responsible for driving their car into a group of people at a bus stop because the voices instructed them to, than is the driver who suffers a seizure, goes unconscious and drives their car into a group of people at a bus stop. They have disturbances of thought process, not mood or emotion.

The difficulty is always determining if they're faking it, or actually delusional. How that is done is not my area of expertise. I'm better with disorders of character and personality. Those who have emotional disturbances and accompanying behavioral problems. Histrionic, narcissistic, borderline, anti-social personalities. In cases like Holmes, sociopathic personalities. No empathy, no concern for the rights and feeling of others. They know right from wrong...they're just pissed off over their own miserable existence and don't care.

There's one other specifically disturbing condition called reactive attachment disorder that causes a similar but significantly more severe lack of empathy and ability to have reasonable human interaction. It complicated and related to missing attachment experience in infancy and early childhood. If anybody is interested, it's pretty fascinating but would take just too much time try to explain here. But you can always google around to get some information on it. Those who have it are pretty much impossible to deal with, and often extremely dangerous.

But I've rambled long enough and the smart phone is about to go dead.

Thnx for the insight.

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