Are all lawbreakers emotionally ill? If so, should jails and penitentiaries be turned into mental hospitals? These were the principal questions occupying 3,000 psychiatrists in Atlantic City last week at the annual convention of the American Psychiatric Association. To no one's surprise, no consensus was reached. Extremists at both ends of the opinion spectrum remained unconvinced by heated arguments; in between were varying groups of gradualists and the unconvinced.
Washington's patriarchally bearded Dr.
Benjamin Karpman took one extreme position. His prediction: in 50 years the U.S.
will have no prisons—only psychiatric treatment centers for lawbreakers. "I am at odds with the legal profession and most of psychiatry," he conceded, "but they're all wrong. The question is simply, 'Is the accused sick or not?' You can't have mental illness and criminal responsibility in the same person at the same time." From the Snake Pit. Few psychiatrists lined up behind Dr. Karpman's banner.
From the vast snake pit of Manhattan's Bellevue Psychiatric Hospital, Drs. Emanuel Messinger and Benjamin Apfelberg reported that, of 57,000 lawbreakers ex amined over 25 years, a scant 5% had ordinary mental illnesses rated as treat able. Most of the rest were, in some de gree, what psychiatrists call psychopaths or sociopaths — individuals whose consciences are either lacking or inert, and who choose to do what they want when they want. These are notoriously the patients with whom psychiatry has the least success. And in many courts, psychopathy is excluded from the catalogue of mental illnesses that can justify an insanity plea.
Leading off for the opposition, Michi gan's Dr. Sidney Bolter tried to rip off "the mask of insanity" which, he said, has covered too many criminals. He scoffed at colleagues who "visualize a Utopian chain of hospitals and clinics devoted to the 'treatment' of every individual who breaks the law." Habitual offenders, Dr. Bolter argued, are psychopaths, and nothing can be done with them except keep them in penal institutions; in mental hospitals they are misfits and hamper the treatment of other patients. "Psychiatrists," said Dr.
Bolter, "are not looking at the problem realistically. It is about time we offered the courts some practical assistance, and not a lot of starry-eyed theories that allow too many clever patients escape hatches into a mental hospital." Flux & Finality. To many distinguished listeners, Dr. Bolter was simply an angry man. But all psychiatrists are in a dilemma over criminal law. Most of them cannot work well with the courts.
Used to having the last word themselves, they meet their match on the bench. And while the law insists on finality, it is itself in a confusing state of flux.