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Chapter 18: Mental Health and the Law Multiple Choice 1. The legal definition of insanity is a. not the same as the psychological definition of mental illness. b. essentially the same as the psychological definition of mental illness. c. a requirement that must be met prior to voluntary commitment. d. that a person who is insane is legally responsible for his or her actions. Answer: a. 2. Your textbook presents the case of John Hinckley, who, in 1981, tried to kill Ronald Reagan, the President of the United States. Hinckley had a history of odd behavior and was subsequently found not guilty by reason of insanity. As a result, a. Hinckley was released. b. federal laws regarding the burden of proof and the definition of insanity were changed. c. Hinckley was released but required to have a secret service agent with him at all times. d. Hinckley was confined to a mental hospital with no chance of release. Answer: b. 3. The legal concept of ________ reflects the idea that people act out of free will and are accountable for their actions when they violate the law. a. mens rea b. innocent until proven guilty c. criminal responsibility d. individual responsibility Answer: c. 4. One limitation placed on expert witnesses is that a. testimony can only be given by psychiatrists or medical doctors. b. only neutral witnesses can be used, and they must be appointed by the judge in a trial. c. expert testimony is limited to opinion based on established science. d. expert witnesses must not be paid. Answer: c. 5. In U.S. law, ________ is an exception to the concept of criminal responsibility. a. insanity b. mental illness c. determinism d. free will Answer: a. 6. American psychiatrist Thomas Szasz has taken the somewhat radical position that a. even people who commit serious crimes should not be imprisoned if they are suffering from a mental disorder. b. that everyone who commits a crime is mentally ill to some degree. c. even people who are seriously mentally ill should still be held responsible for their behavior. d. that all criminals should be allowed access to psychiatric treatment. Answer: c. 7. The mental disorder defense was codified in 1843, after _______ was found not guilty by reason of insanity. a. Freud b. Hinckley c. M’Naghten d. Conan-Doyle Answer: c. 8. Harry Jenkins has pled “not guilty by reason of insanity.” The state where Harry is being tried uses the M’Naghten test of insanity. What question will the judge use when instructing the jury on the basis of their decision in this case? a. Did the defendant know right from wrong? b. Did the defendant experience an irresistible impulse? c. Does the defendant have the burden of proving insanity? d. Did the defendant show behavior that was the product of mental illness? Answer: a. 9. What was the basis for the irresistible impulse test first used in the late nineteenth century? a. the legal assumption that everyone knows right from wrong b. the finding that the M'Naghten test was too broad c. the finding that even though some people intellectually know that their behavior is illegal, they still can't control their behavior d. the observation that some diagnoses are based on evidence of criminal behavior Answer: c. 10. A 1954 ruling by a Washington D.C. federal court in Durham v. United States broadened the insanity defense to say that an accused is not criminally responsible if his or her unlawful act was the product of mental disease or defect. This came to be known as the __________ test. a. mental illness b. D.C. c. Durham d. product Answer: d. 11. A defense attorney making use of the conditions of the American Law Institute model legislation on the insanity defense would have to provide evidence that her client a. was mentally ill at the time of his offense. b. lacked substantial capacity to appreciate the criminality [wrongfulness] of his offense. c. lacked a knowledge of the law that he is accused of due to his mental illness. d. demonstrated substantial capacity to control his actions. Answer: b. 12. A psychologist is hired by the defense in a case involving the issue of not guilty by reason of insanity. Based on changes resulting from the Hinckley case and the Insanity Defense Reform Act of 1984, it is likely that the thrust of the psychologist’s testimony would be in support of the defendant’s a. inability to stand trial due to her mental illness. b. inability to appreciate the nature and quality or wrongfulness of her behavior due to her mental illness. c. right to treatment versus imprisonment due to her mental illness. d. inability to discuss the nature of her offense with her attorney due to her mental illness. Answer: b. 13. What was the major change contained in the Insanity Defense Reform Act? a. The defense was required to prove insanity on the part of the defendant. b. The prosecution was now required to prove the defendant was not insane. c. The court took on the task of proving whether a mental illness existed or not. d. The definition of insanity was left up to the individual states. Answer: a. 14. In the United States, only about 1 percent of those charged with a crime attempt a defense of not guilty by reason of insanity (NGRI). Of those, approximately ________ percent are successful. a. 10 b. 15 c. 25 d. 55 Answer: c. 15. In most cases of a successful defense based on not guilty by reason of insanity, the defendant spends some time in a mental health facility after the verdict. The time spent in a mental health facility is a. generally shorter than a prison sentence would have been. b. somewhat longer than a prison sentence would have been. c. on average the same as a prison sentence would have been. d. significantly longer than a prison sentence would have been. Answer: c. 16. For more than eight years, Marilyn's husband has subjected her to physical and psychological abuse. As a result, she has been treated in the emergency room more than 10 times for a variety of injuries from bruises to broken bones. Each time she is abused, her husband begs for forgiveness. Finally, one night she takes his gun and shoots him as he is sleeping. She is charged with murder. Which of the following is a defense that has been used more often in cases like Marilyn’s? a. the battered woman syndrome b. temporary insanity c. guilty but mentally ill d. self-defense Answer: d. 17. Last year Leslie shot and killed her husband after years of abuse. She has rejected a plea bargain and is ready for trial. Her defense attorney is going to call experts on the battered woman syndrome. What question will the prosecution want to ask the experts on the battered woman syndrome? a. “Which DSM diagnosis best fits the defendant and her behavior?” b. “How can you distinguish dissociation from the battered woman syndrome?” c. “Why does the defendant have complete recall for the events surrounding the killing?” d. “How can someone who is suffering from learned helplessness bring herself to kill?” Answer: d. 18. Which of the following statements is true of research into the battered woman syndrome? a. Scientific evidence supporting the syndrome is weak to nonexistent. b. The researchers who discovered the syndrome are responsible for saving hundreds of lives. c. Scientific evidence supporting the syndrome has been growing over the past 25 years. d. Research shows that the syndrome depends on the presence of dissociation. Answer: a. 19. Another attempt to reform the insanity defense is known as a. not guilty due to mental illness. b. guilty but mentally ill. c. guilty but insane. d. not guilty due to mental mitigation. Answer: b. 20. In England, the M’Naghten rule a. still applies but is used in only a handful of cases every year. b. still applies and is used in a much greater percentage of cases than it is used in similar defenses in the United States. c. has been changed to “not criminally responsible due to mental illness” and is used very sparingly. d. has been changed to “not criminally responsible due to mental illness” and is attempted quite frequently, but not successfully. Answer: a. 21. ________ is defined this way: “The test must be whether he [the defendant] has sufficient present ability to consult with his attorney with a reasonable degree of rational understanding and a rational as well as factual understanding of proceedings against him.” a. Sanity b. Rationality c. Competence d. Innocence Answer: c. 22. Which of the following is most likely to result in an individual being ruled incompetent to stand trial? a. The accused is diagnosed with a psychotic disorder. b. The crime was so abhorrent that a trial is not necessary. c. The accused does not have enough money for a lawyer. d. The accused is unable to communicate with counsel because of brain damage. Answer: d. 23. At what stage of criminal proceedings may the issue of competence be raised? a. while the defendant is being read her/his Miranda Rights b. prior to the preliminary hearing c. prior to the sentencing phase of a trial d. at many stages in the legal process Answer: d. 24. If a defendant is determined to be incompetent, legal proceedings a. are suspended until they can be understood by the defendant. b. are suspended until the defendant is found competent, for up to the maximum length of a jail sentence he could receive if he is found guilty. c. continue, but the defendant is precluded from testifying in his/her own behalf. d. continue, but a lesser sentence is imposed than would be imposed for a competent defendant. Answer: a. 25. In all death penalty cases, ________ must be conducted, which include an assessment for mental disorders. a. judicial reviews b. mitigation evaluations c. compassionate reprieves d. psychiatric diagnoses Answer: b. 26. In the landmark case of Atkins v. Virginia (2002), the U.S. Supreme Court ruled—consistent with laws already in effect in many states—that a. schizophrenia is a mitigating factor that makes the death penalty unconstitutional. b. schizophrenia is not a mitigating factor that makes the death penalty unconstitutional. c. intellectual disability is a mitigating factor that makes the death penalty unconstitutional. d. intellectual disability is not a mitigating factor that makes the death penalty unconstitutional. Answer: c. 27. In Kansas v. Hendricks, the Supreme Court ruled the Kansas sexual predator law to be a. unconstitutional because the continued confinement constituted “double jeopardy.” b. constitutional because the confinement did not constitute punishment. c. unconstitutional because the confinement was “cruel and unusual.” d. constitutional because the law punishes sexual predators. Answer: b. 28. The discovery of antipsychotic drugs in the 1950s paired with the _________ lead to mental patients being released from care. a. drop in the crime rate across the United States b. increase in the populations of mental health institutions c. increase in the number of mental patients now eligible for the death penalty d. the deinstitutionalization movement Answer: d. 29. U.S. law prohibits confining people for crimes they might commit in the future except in the case of a. civil commitment. b. mental health commitment. c. mental retardation. d. psychopaths. Answer: a. 30. The philosophy of parens patriae holds that the government has a humanitarian responsibility to a. care for society’s weaker members. b. keep the mentally ill from having children. c. reimburse family members who care for the mentally ill. d. protect society at large from the mentally ill. Answer: a. 31. The civil commitment of people who are dangerous to others is justified by a. the state’s authority to supervise minors and physically incapacitated adults. b. the state’s duty to protect public safety, health, and welfare. c. police powers belonging to the people. d. the need to care for mentally disordered people. Answer: b. 32. Most states provide for two types of civil commitment procedures: emergency and a. psychological. b. legal. c. procedural. d. formal. Answer: d. 33. Today, the emergency commitment procedures in most states allow an acutely disturbed individual to be confined to a. jail for a few days. b. a mental hospital for a few days. c. jail until the person agrees to be treated. d. a mental hospital until treatment is finished. Answer: b. 34. While the grounds for civil commitment vary from state to state, there is some commonality. Which of the following is one of the generally accepted grounds for involuntary hospitalization? a. ability to care for oneself b. having no friends or family c. dangerousness to others d. hearing voices Answer: c. 35. Approximately ___ percent of the mentally disturbed have no history of violence. a. 10 b. 20 c. 50 d. 90 Answer: d. 36. Which of the following individuals is more likely to commit acts of violence than the others? a. a man with schizophrenia b. a woman with major depression c. a man or woman with bipolar disorder d. a man or woman who abuses drugs and alcohol Answer: d. 37. Professional, clinical predictions that an individual patient will behave violently are correct approximately ________ percent of the time. a. 10 b. 25 c. 33 d. 50 Answer: c. 38. Dr. Davis has incorrectly hospitalized someone who is not dangerous. Dr. Eliot has incorrectly released someone from the hospital who is, in fact, still dangerous. Dr. Davis has made a ___________ error, while Dr. Eliot has made a __________ error. a. justifiable / unjustifiable b. unjustifiable / justifiable c. false positive / false negative d. false negative / false positive Answer: c. 39. When Supreme Court Justice Blackmun heard that the prediction of violence is wrong two out of three times, he concluded that predicting violence using a coin flip would be more accurate. Why was he wrong? a. The specificity of a coin flip is above 50 percent. b. The sensitivity of a coin flip is above 50 percent. c. The base rate of violence is much lower than 50 percent. d. The coin flip is random, not based on clinical judgment. Answer: c. 40. What is a base rate? a. how frequently an event occurs in a population b. the number of guesses made about the event c. the accuracy of predictions about the event in the past d. the amount of information available to make a prediction Answer: a. 41. The base rate of the actual occurrence of serious violence is ________ percent. a. 1 b. 3 c. 9 d. 27 Answer: b. 42. What is the general conclusion concerning making predictions of future violence? a. Clinical judgment is better than chance. b. Clinical judgment is equivalent to flipping coins. c. The number of false positives is unaffected by the base rate. d. Such predictions should be made by individuals with experience in police work. Answer: a. 43. The accuracy of predictions of violence is better when the focus is on a. violence against others. b. violence against oneself. c. imminent violence. d. violence that may occur over the long term. Answer: c. 44. Which of the following rights for mental patients was established by the Wyatt v. Stickney decision? a. standardized treatment plans b. adequate medication c. humane conditions d. treatment by medical doctors only Answer: c. 45. What is the most important issue about the patient’s right to be treated in the least restrictive environment alternative? a. Less restrictive environments are often not available. b. Treatment in these settings is usually prohibitively expensive. c. Insurance companies will not pay the expenses for alternative treatments. d. Treatment in a less restrictive environment is usually less effective. Answer: a. 46. A mental patient involuntarily admitted to a mental hospital may refuse treatment if he or she a. can provide a good reason. b. is willing to post a bond. c. doesn’t agree that he or she is mentally ill d. is competent to give informed consent. Answer: d. 47. A newer, more assertive approach to treating patients who lack insight is court–ordered mandatory treatment in the community rather than in the hospital. This is known as a. deinstitutionalized commitment. b. outpatient treatment. c. community commitment. d. outpatient commitment. Answer: d. 48. While there may have been some benefits to the deinstitutionalization of mental patients, one serious problem that has resulted is reflected in the report of a 1986 study that found ________ percent of homeless individuals were in need of mental health services. a. 13 b. 31 c. 57 d. 90 Answer: b. 49. “Rotting with their rights on” refers to one problem with a. deinstitutionalization. b. institutionalization. c. community commitment. d. mandatory jail terms. Answer: a. 50. Individuals can use a legal procedure called ________ to list their preferences for treatment should they be found mentally ill in the future. a. sanity wills b. advance psychiatric directives c. treatment contracts d. community mental health directives Answer: b. 51. The deinstitutionalization movement was based on the philosophy that the mentally ill a. should be hospitalized if they are homeless. b. should be placed in private, not public, hospitals. c. need to be hospitalized under more humane conditions. d. can be better served in the community rather than in hospitals. Answer: d. 52. What is one of the reasons that deinstitutionalization has not worked as well as its proponents had hoped? a. Patients end up staying in the hospital for a longer period of time. b. There are not enough hospital beds. c. The needed numbers of Community Mental Health Centers were never built. d. There are no effective community-based treatment models. Answer: c. 53. In contrast to mental health law, virtually all of family law is based on the principal of a. protecting the community. b. parens patriae. c. the revolving door. d. deinstitutionalization. Answer: b. 54. Legal custody refers to a. where the child lives at which time. b. foster care placement of abused children. c. convincing a judge that one is a fit parent. d. how the parents will make decisions about their child’s life. Answer: d. 55. About ________ percent of children in the United States today will experience a divorce in their family. a. 10 b. 20 c. 40 d. 60 Answer: c. 56. A neutral third party who helps partners in divorce decisions is a(n) a. mediator. b. unbiased lawyer. c. facilitator. d. family counselor. Answer: a. 57. In 1962, Henry Kempe focused public attention on a family problem that had not previously received much attention. Kempe called the problem a. mentally disordered families. b. post traumatic stress disorder. c. the “refrigerator mother syndrome” d. the “battered child syndrome.” Answer: d. 58. The most commonly reported form of child abuse is ________, which places children at risk for physical or psychological harm by failing to provide basic and expected care. a. physical child abuse b. child neglect c. emotional abuse d. harm by omission Answer: b. 59. In reviewing hospital security tapes, several parents are observed trying to do physical harm to their children. These parents may be diagnosed with ________, a rare mental disorder in which parents fabricate or induce illness or injury in their children. a. child abuse syndrome b. schizophrenia c. psychopathy d. Munchausen-by-proxy syndrome Answer: d. 60. While the number of reports of child abuse have increased from around 669,000 in 1976 to well over 3 million in 2009, how many reports of abuse are found to be unsubstantiated? a. almost one half b. up to 25 percent c. practically none d. more than two-thirds Answer: d. 61. Each year, more than 100,000 children are placed in ________, where they live temporarily with another family. a. group homes b. short-term adoptions c. foster care d. protective custody Answer: c. 62. Children taken from their family homes can be adopted only if a. both parents are deceased. b. the parents are divorced. c. the child has been abused. d. parental rights have been terminated. Answer: d. 63. Two of the most common reasons for malpractice claims against mental health professionals are a. inappropriate use of medication and sexual harassment. b. inappropriate use of medication and negligent treatment. c. negligent treatment and involuntary hypnosis. d. sexual relations between therapist and client and financial fraud. Answer: b. 64. In Osheroff vs. Chestnut Lodge, Dr. Osheroff successfully sued Chestnut Lodge for a variety of reasons, including: a. failure to offer him informed consent about treatment alternatives. b. the refusal to allow him to prescribe off-label medications to his patients. c. that the hospital’s provided treatment was not consistent with the type of theoretical orientation it advertised. d. that he was subjected to electroshock therapy without his consent. Answer: a. 65. As a therapist, you are obliged to maintain confidentiality because you have an ethical obligation not to reveal a patient’s private communication during therapy. What is an exception to this rule? a. hiding assets during a divorce b. anger toward others c. suspected illegal activity d. suspected cases of child abuse Answer: d. 66. Your client has just admitted to you that she intends to run her car into her ex-husband’s house, hopefully as he answers the door. As a result of which court decision are you now required to warn him of her intent? a. Megan b. California c. Tarasoff d. Mendonza Answer: c. 67. You are a psychotherapist practicing in San Francisco. You are concerned because a patient has just expressed a fairly detailed plan to kidnap, mutilate, and kill a coworker. Under California law, you have a duty to _______ the potential victim, which may include actions like hospitalizing the potentially dangerous patient. a. warn b. protect c. notify d. inform Answer: b. 68. A dilemma for mental health professionals involves whether they should tell their clients that they must break confidentiality in cases of a. child abuse. b. plans for divorce. c. repressed memories. d. tax evasion. Answer: a. 69. The legal case of Tarasoff v. Regents of the University of California (1976) established that therapists must a. refrain from having sex with their clients. b. report suspected cases of child abuse. c. notify police of a patient’s imminent suicide attempt. d. warn potential victims of a patient’s intent to harm them. Answer: d. 70. Subsequent California court decisions have extended the Tarasoff decision to the duty to a. warn. b. protect. c. inform. d. involve. Answer: b. Short Answer 71. The legal definition of insanity is not the same as the scientific definition of __________. Answer: mental illness 72. Criminal law assumes that human behavior is the product of __________. Answer: free will 73. Mental health professionals operate under an assumption of __________, the perspective that human behavior is determined by biological, psychological, and social forces. Answer: determinism 74. The 1843 M’Naghten decision was the beginning of the __________ defense in Western law. Answer: insanity 75. The __________ syndrome is a term coined by the psychologist Lenore Walker to describe her observations about the psychological effects of chronic abuse. Answer: battered woman 76. A defendant’s ability to understand the legal proceedings that are taking place against him and to participate in his own defense defines the concept of __________. Answer: competence 77. Using legal proceedings to confine an individual to a mental health facility against his will is known as _________ commitment. Answer: civil 78. The case of Lake v. Cameron established a patient’s right to treatment in ________ environment. Answer: the least restrictive 79. The question of a patient’s right and ability to refuse treatment often turns on the issue of __________. Answer: informed consent 80. A new legal device that addresses the issue of treatment for patients who lack insight yet who are eligible for release into the community is ________. Answer: outpatient commitment 81. The problematic process that removed mental patients from hospitals and placed them in the community was known as __________. Answer: deinstitutionalization 82. _________ involves the accidental or intentional infliction of harm to a child due to acts or omissions on the part of an adult responsible for the child’s care. Answer: Child abuse 83. ____________ is the ethical obligation not to reveal private communications that is basic to psychotherapy. Answer: Confidentiality Essay 84. Describe the various ways in which the legal system and the mental health professions interact, overlap, and, at times, find themselves in conflict. Answer: The legal system in the United States and the several mental health professions overlap and interact in a variety of ways. Both define behavior that is out of the ordinary, but in the legal professions, the term insanity tends to be used, and in the mental health professions, the term mental illness is used. The former is a legal term that has implications for a defendant. For example, in some cases an individual can commit a crime but be found “not guilty by reason of insanity” if his mental illness makes it impossible for him to appreciate the nature and quality of his act, to understand what is right and what is wrong. Even here there is overlap with the mental health professions because laws do not actually define what constitutes insanity; they leave it up to expert testimony by psychiatrists and/or clinical psychologists to present the information to a judge or jury. Even before a trial, the question of a defendant’s competence to stand trial can be raised. Actually the question of a defendant’s competence can be raised at any time: before trial, during trial, during sentencing, or as a result of sentencing. Again, mental health professionals are used to help make the determination of competence and in some cases to provide treatment mandated by the courts. An extreme form of conflict between the two fields in one in which the legal system wants to have mental health professionals administer treatments so that a defendant can be temporarily competent for a death sentence to be imposed. Most mental health professionals see this as against their ethical codes. Mental health professionals are involved in divorce cases and determinations of custody. The extreme case here is where a parent is accused of being so incompetent at parenting that the court considers termination of her parental rights. Once again, mental health professionals will assess and present expert testimony that a judge or jury will use to make this determination. At time the legal profession oversees the mental health professions by hearing law suits against those professionals by clients who feel that they are the victims of neglect or wrong-doing at the hands of a mental health professional. All in all, there is very concerted and long-standing interaction between the two areas of activity. 85. Discuss the role of expert witnesses and the limitations placed on them by court rulings. Answer: There are three ways in which the law assumes that mental disorders may affect an individual’s ability to exercise his or her rights and responsibilities: (1) Defendants who are not guilty by reason of insanity are not criminally responsible for their actions; (2) Defendants who are incompetent to stand trial are unable to exercise their right to participate in their own defense; and (3) mental illness may be a mitigating factor that can lead to a less harsh sentence, or a harsher one. Since neither judges nor juries have expert psychological knowledge that allows them to make these decisions, mental health experts testify about these matters. One conflict between mental health and the law concerns the role of expert witnesses, specialists allowed to testify about matters of opinion (not just fact) that lie within their area of expertise. In Daubert v.Merrell Dow Pharmaceuticals (1993), the U.S. Supreme Court ruled that expert opinion must be based on an “... inference or assertion . . . derived by the scientific method,” and courts must determine “whether the reasoning or methodology underlying the testimony is scientifically valid and ... whether that reasoning or methodology can be applied to the facts in issue.” Since experts can and do interpret the same information in different ways, and lawyers “shop” for friendly experts who have a history of interpreting evidence in a way that will help their case. Lawyers expect challenges to their expert witnesses’ testimony, and they anticipate that experts for the opposing side will present conflicting testimony. One way to limit conflict, and hopefully improve expert testimony, is for courts to appoint neutral experts rather than having each side employ its own “hired gun.” 86. Compare and contrast the assumptions held by the legal system and those held by mental health professionals concerning the nature of the cause of human behavior. Answer: The legal system starts with the assumption that individuals are in possession of “free will,” that they have control over their behavior, and that they make choices and freely act on them. Thus, the law can hold people accountable for their actions. Mental health professionals tend to start from the assumption of “determinism,” that is, all human behavior is the result of complex interactions between genetics, biological factors, past experience, local conditions, social pressures, etc., and they recognize that sometimes, as the result of factors, such as brain tumors or social coercion, individuals actually can be made to behave against their will. The law does make one exception with regard to the assumption of free will in the “insanity” defense that recognizes that an individual can be suffering from a mental disorder that clouds his reason, perception, or judgment so much that it no longer makes any logical or legal sense to hold him fully responsible for his actions. At this point, the two definitions overlap, and a judge and/or jury needs to sort out the issue of responsibility. 87. Briefly outline the conditions inherent in the M’Naghten ruling for finding a defendant not guilty by reason of insanity, and then discuss the changes that have occurred in U.S. law that have modified the conditions for its successful application. Answer: The basic condition laid down in the M’Naghten ruling was that a defendant could be found not guilty by reason of insanity (NGRI) if suffering a “defect of reason” (mental disorder) that made it impossible for him to understand right from wrong. Subsequent developments first broadened and later narrowed the grounds for determining insanity. Parsons expanded it to include conditions in which the person might intellectually know that what he did was wrong, but he was overcome by an “irresistible impulse.” Durham introduced the product test, which suggested that if someone’s behavior was the product of a mental disorder or mental disease, they could be found NGRI. This ruling made no attempt to define either product or mental disease, and it led to circular reasoning: for instance, antisocial personality disorder is defined by criminal behavior, yet the same criminal behavior proved the perpetrator was insane. Durham was overruled in 1972 and replaced by the Insanity Defense Reform Act of 1984 in which an individual can be found NGRI if he suffers from a mental disorder and, as a result of that disorder, can’t comprehend the nature and quality of his actions. This combines concepts from the M’Naghten case with the idea of irresistible impulses, stating: A person is not responsible for criminal conduct if, at the time of such conduct and as a result of mental disease or defect, he lacks substantial capacity either to appreciate the criminality [wrongfulness] of his conduct or to conform his conduct to the requirements of the law. 88. How does Lenore Walker's concept of the battered woman syndrome explain why it is so hard for a battered woman to leave an abusive relationship? Answer: According to Lenore Walker, chronic abuse has psychological effects on victims, which she called the “battered woman syndrome.” Walker postulates a “cycle of violence,” that includes three stages: (1) a tension-building phase leading up to violence; (2) the battering incident itself; and (3) a stage of loving contrition, during which the batterer apologizes and attempts to make amends. Second, Walker asserts that the abused woman is prevented from leaving the relationship by learned helplessness. This implies that the battered woman expects to be beaten repeatedly but is immobilized and unable to leave the relationship. 89. Discuss the conditions that need to be met in order for an individual to be found “competent to stand trial.” Answer: Many more people are institutionalized because of findings of incompetence than because of insanity rulings. Competence is a defendant’s ability to understand the legal proceedings that are taking place against him and to participate in his own defense. The U.S. Supreme Court defined competence this way: "The test must be whether he [the defendant] has sufficient present ability to consult with his attorney with a reasonable degree of rational understanding and a rational as well as factual understanding of proceedings against him." Competence refers to the defendant’s current mental state and the defendant's ability to understand criminal proceedings. The defendant must show legal understanding, legal reasoning, and legal appreciation. 90. What are the two broad rationales for the government’s power to put people into psychiatric hospitals against their will, through civil commitment procedures? Answer: U.S. law has two broad rationales for involuntary hospitalization, which hinge on the government’s responsibility to protect those who cannot protect themselves, as well as to protect the public at large. The concept of parens patriae (“state as parent”) refers to the government’s humanitarian responsibility to care for its weaker members. Under parens patriae authority, civil commitment may be justified when the mentally disturbed are either dangerous to themselves or unable to care for themselves. Police power refers to the government’s responsibility to protect the public safety, health, and welfare. This concept means that civil commitment is used to confine those who present a danger to others. 91. A public policy official reads that the rates of violence are five times higher among people with serious mental illness than they are among the general population. Based on this evidence, the public policy official recommends legislation that would allow those with serious mental illness to be detained preventatively to keep them from committing violent offences. What is the scientific evidence that suggests that such a policy is not justified? Answer: The actual risk of violence is much lower than publicly perceived. Ninety percent of mentally ill people have no history of violence. Furthermore, while current psychotic symptoms predict violence, past psychotic episodes do not predict future violence. While the percentage of violent behavior among those with mental illness is higher than it is among the general population, those statistics include those who abuse alcohol or drugs. Substance abuse increases the likelihood of violence for both the mentally ill and the general population. Finally, other factors, such as poverty, also increase the risk for violence, and our society would consider it a violation of civil liberties to detain someone simply for being poor. Except in certain extreme cases, this policy would not be justified. 92. Discuss three rights mental patients have in the United States with regard to treatment and how they are sometimes contradictory. Answer: Mentally ill patients in the United States are considered to have three important rights: the right to treatment, the right to treatment in the least restrictive alternative environment, and the right to refuse treatment. The right to treatment was codified in the Wyatt decision, which expanded the individual’s right to treatment by trained staff, under humane conditions, with individualized treatment plans. Mentally ill patients cannot simply be warehoused; they must receive treatment. The right to treatment in the least restrictive alternative environment is an attempt to balance paternalistic and libertarian concerns. The state provides mandatory care, but restricts individual liberties as little as possible. Unfortunately, community care centers that are less restrictive than hospitals are not always available. The most recent right is the right to refuse treatment. Several courts and state legislatures have concluded that mental health patients have the right to refuse treatment under certain conditions, although this right is on increasingly shaky ground. If a patient is competent to give informed consent, treatment can be refused. If the patient is incompetent, an independent guardian offers a substituted judgment based on what the patient would choose if he or she was competent (but this is not necessarily what is in the patient’s best interest). Courts have ruled that a patient can be medicated involuntarily to reduce dangerous behavior, so the third right is limited in these cases. 93. Discuss how outpatient or community commitment meets some of the concerns of over paternalism and addresses some of the needs created by deinstitutionalization. Answer: When patients were released from mental hospitals because of deinstitutionalization, many had mental health needs that were not met, and large numbers became homeless and indigent. The libertarian values behind deinstitutionalization came into question in the 1990s as concerns arose around (1) treating severely disturbed patients who lack insight into their conditions and (2) protecting the public from the violently mentally ill. Outpatient commitment is mandatory, court-ordered treatment, such as therapy or medication, that takes place in the community rather than through institutionalization. Outpatient commitment orders must be based on the same legal standards as inpatient commitment, i.e. dangerousness and (in some states) inability to care for self. Outpatient treatment of sufficient length reduces the rate of subsequent hospitalization; thus, the coercive procedure can help the seriously mentally ill to receive help in a less restrictive environment 94. List and define the types of custody at issue in child custody cases. Answer: Legal terminology differs by state, but child custody involves two issues. (1) Physical custody means where children will live at what times. (2) Legal custody means how the parents will make decisions about their children’s lives. The term “sole custody” means that one parent has both physical and legal custody of the children. In “joint custody,” both parents have legal or physical custody or both. 95. Discuss the value of divorce mediation in child custody disputes. Answer: Leaving the decision of child custody in a divorce settlement to the judge is problematic because what is in the child’s best interest is only vaguely defined in the law. Many mental health and legal experts believe they serve children and the legal system better if they help settle custody disputes outside of court. In divorce mediation, parents meet with a neutral third party, who may be a mental health or legal professional, who helps them to identify, negotiate, and ultimately resolve their disputes. Mediators adopt a cooperative approach to dispute resolution, treating separated parents as parents rather than as legal adversaries. Mediation reduces custody hearings, helps parents reach decisions more quickly, and is viewed more favorable than litigation by parents. One randomized trial found that five to six hours of mediation causes nonresidential parents to remain far more involved in their children’s lives and work together better 12 years later. Many states now require mediation as a more “family friendly” forum for dispute resolution. 96. Describe the disorder of Munchausen-by-proxy. Answer: Munchausen-by-proxy is a rare but potentially very harmful, even deadly, form of child abuse. In this syndrome, a parent feigns, exaggerates, or induces an illness in a child. This can range from fabrication of symptoms to causing severe harm, such as illness or injury. Video recordings have captured parents attempting suffocation, trying to break a child’s arm, and attempting to poison a child with disinfectant. Even more alarming is the fact that many of these children had siblings who had died suddenly and unexpectedly. 97. Discuss the circumstances in which a therapist would be obliged to break confidentiality regarding a patient. Answer: Confidentiality is an ethical obligation that is basic to psychotherapy in order to establish and maintain trust with patients. However, there are cases when confidentiality must be broken. Confidentiality must be broken when a patient is dangerous to himself or to others; a therapist has the duty to warn or protect potential victims. In particular, cases of suspected child abuse or when the patient has threatened to harm someone override confidentiality. The Tarasoff case established the duty to warn in California; subsequent cases expanded this to the duty to protect, which can involve protective actions like hospitalizing the potentially dangerous patient. Test Bank for Abnormal Psychology Thomas F. Oltmanns, Robert E. Emery 9780205997947, 9780205970742, 9780134899053, 9780134531830, 9780205965090

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