Letters to the Editor
Lengthy Period of Incarceration as Personal Treatment Goal
Dear Editor:
I present a highly atypical case of a young male forensic patient who perpetrated 2 serious criminal code offences to ensure a maximal prison sentence.
Case Report
An 18-year-old, single male with a high school education was referred for a court-ordered psychological assessment to determine his fitness to stand trial and criminal responsibility for 2 sequential armed bank robberies. These robberies were carefully planned and perpetrated on the same day for the purpose of attaining a lengthy period of incarceration (ideally, between 4 and 12 years, according to the patient). The patient believed that incarceration would allow him to lead a stress-free and “interesting” existence and to enjoy the free services provided by prisons, such as schooling and gym activities. No clinical evidence supported either his lack of fitness for trial or his candidacy for a defence of “not criminally responsible on account of mental disorder” (NCRMD), and he was subsequently convicted and sentenced by a judge to less than 2 years in a provincial jail.
Physical assessments (that is, computerized transaxial tomography, ECG, urinalysis, hematology, and clinical chemistry testing) yielded no findings that could account for the patient’s behaviour. Collateral history revealed no prior contacts with the criminal justice system, no history of violence against either self or others, and a community perception of the patient as “a really good kid” and “the poster boy, baby sitting in the neighbourhood.”
However, the patient reported to the police that he had had “thoughts of harming and killing others” for as long as he could remember. He also reported to psychological examiners that he had experienced suicidal thoughts (for example, slashing or hanging) since age 4 years but had never made any attempts other than harmless self-injurious gestures. His overt mental status was unremarkable, although he verbally (and upon psychometric examination) endorsed every symptom of mental illness that was queried, while evidencing a dearth of remorse for the distress he had caused to both the victims of his crime and to his family. He expressed having negative feelings toward his family since age 6 years and currently wanting no contact with them; his parents held opposing perceptions regarding this issue.
Ample evidence of a malingered clinical presentation (1) was available. The patient articulately described continuous auditory hallucinations, although hallucinations are generally intermittent and usually (88%) associated with delusions (of which he displayed no evidence). The patient reported the presence of command hallucinations in stilted language (for example, voices telling him to exercise or walk), but the (usually) associated noncommand hallucinations (85%) and (or) delusions (75%) were absent. Although auditory hallucinations are most often (88%) perceived as originating outside the head, the patient stated the opposite. He displayed no evidence of distraction from voices during clinical interviews. Marked evasiveness was present; for example, the patient stated that it was “possible” that he was experiencing the various queried symptoms. Similarly, inconsistencies existed between patient-reported and clinically observed symptoms; for example, his concentration was good, although he reported that it was not. As he acquired knowledge, the patient also modified his personal history to agree with psycho- pathology indicators. However, psychotic provenances for such crimes as rape, robbery, and cheque forging have been found to be unusual. Finally, a psychometric examination with the Millon Clinical Multiaxial Inventory-III (MCMI-III) was consistent with malingering
Both hallmark and numerous related symptoms of borderline personality disorder (2,3) were also present. These included intense anger, inability to tolerate even minimal levels of stress, obsession with controlling relationships and termination of relationships that became close, a farrago of psychotic-like and other serious symptoms redolent of multiple diagnostic impressions, suicidal thoughts and gestures, excessive dependency, and undermining the realization of personal goals.
To my knowledge, this is the first description of a case of criminal behaviour motivated by the desire for a lengthy period of incarceration that was in turn engendered by the characteristics of a specific psychological disorder, namely, borderline personality disorder.
References
1. Resnick PJ. The detection of malingered psychosis. In: Rogers R, editor. Clinical assessment of malingering and deception: 2nd ed. New York: Guilford; 1997.
2. Millon T. Disorders of personality: DSM-IV and beyond, 2nd ed. New York: Jossey-Bass; 1995.
3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: 4th ed. Text revision. Washington (DC): APA; 2000.
Larry C Litman, PhD, CPsych, FACAPP, FPPR, FSMI, FICPP, FSICPP
London, Ontario
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