Table of contents
- Introduction
- An Overview of Dissociative Identity Disorder (DID)
- Theatment of DID in the Courtroom
- Criminal Justice Responsibility in Cases Involving DID
- Conclusion
Introduction
In the late 1970s, the American public was captivated by the controversial case of Billy Milligan, who made history by becoming the first individual in the United States to be found not guilty of several serious crimes, including kidnapping, armed robbery, and sexual assault, on the grounds of insanity. Milligan's unprecedented legal journey thrust him into the spotlight, with his face adorning magazine covers and newspaper front pages from the moment of his arrest and indictment. As his defense team prepared for trial, psychiatrists discovered that Milligan exhibited an astonishing twenty-four distinct personalities, an exceedingly rare and extreme case of multiple personality disorder. His defense argued that two of these personalities were responsible for the crimes, unbeknownst to Milligan himself. This landmark case marked the first successful use of an insanity defense based on a diagnosis of multiple personality disorder, raising challenging questions at the intersection of psychiatry and the legal system. The 1970s were a time when little attention was given to this disorder, making Milligan's case a catalyst for important discussions surrounding multiple personality disorder, its diagnosis, treatment, and its implications within the criminal justice system. This essay will explore the nature of multiple personality disorder, its diagnosis and treatment by psychiatrists, its relevance in the courtroom, and the responsibilities of the criminal justice system in handling cases involving this complex mental condition.
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'The Connection Between Dissociative Identity Disorder and Criminal Behavior'
An Overview of Dissociative Identity Disorder (DID)
Today, multiple personality disorder is more commonly referred to as Dissociative Identity Disorder (DID), as defined in the DSM-5 (American Psychiatric Association, 2013). DID is characterized by a disruption of identity, wherein an individual experiences two or more distinct personality states, often resulting from extreme trauma or abuse. Population studies conducted in Europe, North America, and Turkey have revealed that DID is a relatively prevalent psychiatric disorder, affecting approximately 1% to 3% of the general population.
Diagnosing Dissociative Identity Disorder can be a challenging endeavor. Psychiatrists may observe or patients may report the presence of various symptoms. These symptoms often include a sense of discontinuity in one's self-identity, marked by changes in behavior, emotions, memory, consciousness, perception, reality perception, sensorimotor functioning, and frequent lapses in the recollection of everyday events. These disturbances often lead to significant gaps in the memory of important personal information, creating a fragmented sense of self within the patient. While there are no specific laboratory tests for diagnosing DID, physicians may employ diagnostic tests such as X-rays, CT scans, or MRIs to rule out any physical illnesses or medication-related side effects. In the absence of physical ailments, patients are typically referred to a psychiatrist, psychologist, or psychiatric social worker for a comprehensive clinical interview aimed at gaining a thorough understanding of the patient's past experiences and current functioning.
The goals of treatment for DID are multi-faceted, with a focus on symptom reduction, ensuring the safety of both the patient and those around them, and facilitating the integration of the various personalities into a unified and well-functioning identity. Additionally, treatment endeavors to assist patients in safely processing traumatic memories while equipping them with new coping skills, life skills, and the ability to cultivate healthy relationships. The effectiveness of treatment hinges on factors such as the patient's cooperation, the nature of identifiable triggers, and the severity of their symptoms. Although various treatment modalities exist for DID, psychotherapy stands as the primary and most widely employed approach. It is important to note that there are no medications designed specifically for treating dissociative identity disorders themselves; however, patients with DID who also present symptoms of anxiety or depression may benefit from treatment with anti-anxiety or antidepressant medications. Patients with DID generally respond positively to treatment, but the process can be protracted and demanding. It typically begins with the empowerment and recognition of all personalities, facilitating their integration into a cohesive and fully functional whole.
Theatment of DID in the Courtroom
In the realm of criminal justice, the treatment of individuals with Dissociative Identity Disorder (DID) poses a complex challenge, often leading to diverse approaches within the legal system. Two distinct approaches have been observed. The first involves granting freedom with mandated periodic treatment for individuals found not guilty by reason of insanity due to DID, provided that the personality responsible for the criminal act was not the host personality, the individual's genuine self. In this scenario, experts evaluate the mental state of the involved personality, determining whether they were aware of their actions. The host personality may be deemed criminally insane if the personality in question lacked awareness of their actions during the criminal act, as exemplified by the case of Billy Milligan. The second approach involves imprisonment or involuntary commitment to a mental institution when an individual with DID is found guilty as charged. This outcome occurs when both the host personality and the alternate personalities collaboratively commit a crime, such as in the case of Thomas Lee Bonney, who was convicted of first-degree murder for the fatal shooting of his daughter.
Criminal Justice Responsibility in Cases Involving DID
However, I contend that the current insanity test, which focuses on whether the host personality was aware of or in control during the criminal act, is insufficient. DID represents a unique form of mental disorder, and individuals suffering from it may be unfairly deemed legally insane simply because they lacked consciousness during the commission of a crime, without implying that the host personality is inherently unstable. Courts must establish a distinct standard for applying the insanity defense to DID patients, one that deviates from the conventional criteria. Instead, legal responsibility should be determined based on whether any of the dissociated alter personalities were unaware of or did not participate in the crime. The court's determination should not be divorced from metaphysical questions of personal identity. In such cases, courts are obliged to ascertain which personality committed the crime and assess their responsibility before deliberating on whether punishment is warranted. Therefore, it is imperative to gain a comprehensive understanding of the nature of alter personalities, an understanding that can only be achieved when the patient themselves comprehends their distinct personalities. As previously emphasized, treatment plays a pivotal role in facilitating the safe recollection of traumatic memories, equipping individuals with DID with coping skills, and ultimately merging their disparate personalities into a unified and functional self.
While it is undeniable that there may be a guilty alter personality, the crucial question remains: What about the other innocent alter personalities? In criminal law, an individual's mental state is a critical element in determining their culpability for a crime. To be charged with a specific offense, there must be evidence demonstrating that the individual possessed the requisite mental state when committing the act, such as intentionality, knowledge, recklessness, or negligence. However, in the context of DID, an individual cannot possess an intentional mental state if they lack awareness of their actions. This underscores the dilemma that arises when considering the legal culpability of DID patients. While this approach may result in a guilty person avoiding punishment, the criminal justice system prioritizes the principle of not punishing innocent individuals over penalizing the guilty. This commitment stems from the belief, famously articulated by William Blackstone, that "it is better to let ten guilty people go free than to punish one innocent person." Consequently, the criminal justice system's fundamental commitment to preventing the punishment of innocent individuals necessitates a reluctance to hold individuals with DID fully responsible for their actions. Thus, experts evaluating insanity should meticulously examine all alter personalities, rather than focusing solely on the host personality or the personality in control at the time of the criminal act.
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Conclusion
Overall, Dissociative Identity Disorder presents a myriad of challenges that require the collaboration of both the legal and psychiatric fields to develop comprehensive approaches for addressing them. To achieve the goals of justice, societal security, and legal stability, the criminal justice system must aim to punish only those who bear genuine culpability. Simultaneously, it should prioritize providing individuals with DID the necessary treatment to reintegrate their fragmented selves into a single, independent identity, allowing them to regain a sense of wholeness and well-being.
