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Assessing the conduct of juveniles: diagnosis and delinquency, 1900–2013
Abstract
American child psychiatrists have long been interested in the problems of delinquent behaviour by juveniles. With the rise of specific psychiatric diagnoses in the 1960s and 1970s, delinquent behaviour was defined within the diagnosis of conduct disorder. Like all psychiatric diagnoses, this concept was shaped by particular historical actors in context and has been highly contingent on assumptions related to race, class and gender. The history of conduct disorder illustrates the tensions in child psychiatry between the expansive goals of the field and the often limited uses of its professional authority, as well as individual children as the target of intervention and their interactions in groups.
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There is much confusion now surrounding the diagnoses of Antisocial Personality Disorder and Psychopathy. Some individuals still refer to the two as the same diagnosis with different names, even though there is a consensus in the psychology field that the two are distinct disorders. Part of this confusion is likely to be the result of the overlap in the diagnostic criteria: both diagnoses are associated with a history of antisocial behavior. However, it is also very possible that this confusion in the literature is a result of consistent name and criteria changes for the "criminal personality" in the Diagnostic and Statistical Manual of Mental Disorders. To make sense of the confusion surrounding the two different diagnoses, the evolution of Antisocial Personality Disorder in the Diagnostic and Statistical Manual of Mental Disorders is examined in this paper.
The authors document the childhood neuropsychiatric and family characteristics of nine male subjects who were clinically evaluated as adolescents and were later arrested for murder. Those subjects are compared with 24 incarcerated delinquents who did not go on to commit violent offenses. The future murderers displayed a constellation of biopsychosocial characteristics that included psychotic symptoms, major neurological impairment, a psychotic first-degree relative, violent acts during childhood, and severe physical abuse. The authors relate this combination of factors to prediction of violence and discuss ethical issues that are involved in intervention to prevent violence.
The North Carolina Industrial School for Negro Girls was established in 1925 by the local branch of the National Federation of Colored Women’s Clubs. Also known as Efland Home, this institution, like others across the South, was designed to rehabilitate young black women “destined for pregnancy, prostitution, or prison.” The quasi-private reformatory negotiated its relationship with the state, receiving inconsistent and nominal funding for roughly a decade. By the mid-to-late 1930s, Efland Home functioned as a penal institution as the ideals of its clubwomen founders crumbled under financial and logistical pressures. State-sanctioned investigations and inquiries wrought mixed messages concerning the utility of the reformatory. During the last five years of its existence, Efland Home became a contested site of policing as matrons, superintendents, and others replaced rehabilitative ideologies with violence and (corporeal) punishment. To express their discontent, young women sentenced to the institution ran away in larger numbers and with greater frequency during these years, encountering local authorities in the process. The young women’s experiences thus reveal complex negotiations regarding the power of black clubwomen and the state to regulate black female adolescents’ behaviors.
The article by Pardini and Byrd1 in this issue of the Journal addresses the question of which childhood dispositional features predict chronic adult criminal behavior. The article focuses on three traits (interpersonal callousness, negative emotionality, and hyperactivity/impulsivity) that have been previously identified as factors associated with criminal offending. Because all three are comorbid with conduct disorder (CD), questions have arisen as to whether they independently predict criminal offending. Interpersonal callousness, which reflects deceitfulness, a manipulative tendency, and lack of empathy or guilt, has been found to be a predictor of criminal offending and the "with limited prosocial emotions" specifier was added to the DSM-5 CD diagnosis because of evidence that it predicts more severe criminal and delinquent outcomes even when the severity of CD is taken into account.2,3 Negative emotionality is composed of two separate constructs, dysregulated anger4 and fear and anxiety problems. Past research has been mixed regarding the association of these traits with criminal offending because of the comorbidity with CD; however, there has been evidence that fear/anxiety is protective against developing CD and engaging in offending behavior.5 Findings regarding the association between hyperactivity/impulsivity and criminal offending also have been mixed because of the comorbidity of hyperactivity/impulsivity with CD.6.
Psychiatry Under the Influence investigates how the influence of pharmaceutical money and guild interests has corrupted the behavior of the American Psychiatric Association and academic psychiatry during the past 35 years. The book documents how the psychiatric establishment regularly misled the American public about what was known about the biology of mental disorders, the validity of psychiatric diagnoses, and the safety and efficacy of its drugs. It also looks at how these two corrupting influences encouraged the expansion of diagnostic boundaries and the creation of biased clinical practice guidelines. This corruption has led to significant social injury, and in particular, a societal lack of informed consent regarding the use of psychiatric drugs, and the pathologizing of normal behaviors in children and adults. The authorsargues that reforming psychiatry will require the neutralization of these two corrupting influences—pharmaceutical money and guild interests—and the establishment of multidisciplinary authority over the field of mental health.
In her insightful interdisciplinary history, physician and historian Mical Raz examines the interplay between psychiatric theory and social policy throughout the 1960s, ending with President Richard Nixon's 1971 veto of a bill that would have provided uni. © 2013 The University of North Carolina Press. All rights reserved.
Written by a leading scholar of juvenile justice, this book examines the social and legal changes that have transformed the juvenile court in the last three decades from a nominally rehabilitative welfare agency into a scaled-down criminal court for young offenders. It explores the complex relationship between race and youth crime to explain both the Supreme Court decisions to provide delinquents with procedural justice and the more recent political impetus to "get tough" on young offenders. This provocative book will be necessary reading for criminal and juvenile justice scholars, sociologists, legislators, and juvenile justice personnel.
Beginning with the Johnson administration, this article examines the development of the juvenile justice system and the subsequent criminalization of African American youth and the urban spaces they inhabited. Soon after Lyndon Johnson called for the “War on Crime” in 1965, federal officials merged the social welfare and law enforcement measures of the Great Society in new and innovative ways. The administration designed programs such as Youth Service Bureaus to reign in potential lawbreakers as well as offer assistance to troubled youth. As federal policymakers expanded the reach and resources of the Bureaus and other juvenile delinquency programs during the 1970s, they required youth employment initiatives, public schools, and grassroots organizations to partner with juvenile courts, police departments, and correctional facilities to receive funding. Following the enactment of the Juvenile Justice and Delinquency Prevention Act of 1974, however, the ongoing absorption of social service initiatives by crime control programs rapidly escalated. The legislation created a national justice system for young offenders and formally labeled all economically vulnerable youth “potentially criminal.” In an attempt to control future crime, the terms of the 1974 Act diffused crime control techniques into the everyday lives of black urban children, yielding new possibilities for supervision in public schools, housing projects, and within families on welfare. By the end of the 1970s, the United States had the highest youth incarceration rate of any industrialized nation as a result of this uniquely punitive approach to urban social programs.
The American Psychiatric Association published the third edition of its Diagnostic and Statistical Manual (DSM-III) in 1980. Unlike DSM-II, it included the listing “post-traumatic stress disorder” (PTSD). The PTSD diagnosis is the product of a concerted effort to reintroduce war neurosis into the official psychiatric nomenclature. This paper tells the sociological story of who put PTSD in DSM-III and how they did it.
Conclusions set forth in Serious and Violent Juvenile Offenders (1997) and other recent reports are remarkably similar to those that men and women on both side of the Atlantic had made a century ago: prevention is better than punishment; stable families are important; schools and communities must take a role in providing positive experiences for children and youth. The Revd William Byron Forbush, sociologist Charles Zueblin, philanthropist Louise de Koven Bowen and scores of other men and women also believed that ‘structured playground activities’ and after-school recreation programmes were important interventions. Chicago's Hull-House, which was inspired by Toynbee Hall, had developed extensive educational and recreational offerings for the youth of its community by the 1890s. Scores of settlement houses, which numbered over 200 by 1904, and other private endeavours directed their energies and resources to such programmes before the First World War.
The main point of this book is to contest the use of self-defeating personality disorder (SDPD) and late luteal phase dysphoric disorder (LLPDD) as diagnoses for women. Dr Caplan, a psychologist, feels that women who are labeled with these diagnoses are going to be damaged by the intervention. Accordingly, she wants to expose the decisionmaking process about who is "normal," as she feels that being knowledgeable about this background can help persons overcome the damage done to them when they are called "abnormal." It is the author's opinion that the constructing of the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV), of the American Psychiatric Association (APA) was a "disingenuous and dishonest process."Dr Caplan underscores most people's concern with being classified as "normal," and she appropriately notes that being labeled mentally "abnormal" causes countless people to have a poor self-image. She feels mental health professionals tend to overdiagnose rather than
This article provides an overview of the 1948 Round Table Session of the American Orthopsychiatric Association. The theme of the Session was on psychiatry and delinquency. Delinquency in extent, cost, immediate reactions, inner or external, upon the delinquent himself, or as a forerunner of much criminality is one of our formidable social problems. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
This article presents a symposium which attempts to cover another aspect of child behavior, which on the surface often looks not unlike the true psychopathic behavior except that the causation is known and the behavior is modifiable or correctible. An attempt was made to present a formulation of delinquency in terms of psychodynamics involved and the panel discussants presented cases that go far back into childhood and have been under observation for a number of years so that the results can be interpreted in terms of original causes. Suggestions were made for studying the delinquent through groups, by activity interview programs and by the organismic approach. Confinement is not considered a practical measure, the experience is likely to be traumatic, to be interpreted by the child as a final rejection. To conclude, participants and discussants who viewed the problem of juvenile delinquency from several varied and divergent viewpoints. There were people who emphasized the social and cultural aspects, while others emphasized the internal psychodynamic aspects; some who emphasized the purely physical factors, while others emphasized the deeper psychodynamic cases. In this way, it was enabled to learn the great variety of approaches presented by the problem of juvenile delinquency. Much is yet to be learned, but with the weaknesses inherent in many of these approaches already pointed out, we are enabled to arrange now for another symposium that will attempt to fill in the many missing points; and this will make for progress. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Recent research on juvenile criminal careers has documented a consistent drop in the prevalence of delinquent activity during late adolescence, but there are only a few limited investigations of the processes underlying this occurrence. The present report of retrospective interviews with a sample of recently “reformed” 15–20-year-old white males suggests directions for larger-scale and more rigorous research.
The policies advanced by the Juvenile Justice and Delinquency Prevention Act, while generally viewed as a success, are seen by some as a failure that may even abet juveniles in the commission of crime. After tracing the evolution of federal juvenile justice legislation and examining arrest and treatment data, the authors confront the criticisms aimed at the Act, and find reason for considerable optimism. Nationwide, the number, proportion, and rate of juvenile arrests have fallen more than the juvenile population, and many states appear to have made substantial progress in improving the processing and treatment of juveniles. The authors conclude that the Act is a continuing source of federal leadership for state innovation.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is one of the most influential and controversial terminological standards ever produced. As such, it continues to provide a valuable case study for sociologists of health and illness. In this article I take as my focus one particular DSM category: antisocial personality disorder (ASPD). The analysis charts the shifting understandings of personality disorders associated with antisocial behaviour in the DSM and in US psychiatry more broadly from 1950 to the present day. Memos, letters and minutes produced by the DSM-III committee and held in the American Psychiatric Association (APA) archives ground the discussion. Finally, the article explores more recent constructions of antisocial personality disorder and examines the anticipatory discourse pertaining to the rewriting of this category expected in the forthcoming DSM-5. In presenting an in-depth socio-historical narrative of the development - and potential future - of standards for pathological antisociality, this analysis casts new light on the ASPD construct. In particular, by considering it as a technology, I elaborate how processes of path dependency constrain innovation and how imaginaries of users and publics are implicated in the APA debates constitutive of this.
The history of psychiatry is often portrayed through the metaphor of a pendulum, the profession swinging back and forth between a concern with psyche and soma. Recent work critiquing the pendulum metaphor, however, suggests that it does not account for the complexity of psychiatry. This article explores the metaphor through an analysis of the changing aetiological accounts of personality disorders associated with antisocial behaviour advanced in the American Journal of Psychiatry from 1950 onwards. It is argued that the social, scientific and economic factors which help shape overarching professional trends in psychiatry only partly structure personality disorder discourse. If the pendulum swings, therefore, not all psychiatrists move with it.
In a timely contribution to current debates over the psychology of boys and the construction of their social lives, On My Honor explores the folk customs of adolescent males in the Boy Scouts of America during a summer encampment in California's Sierra Nevada. Drawing on more than twenty years of research and extensive visits and interviews with members of the troop, Mechling uncovers the key rituals and play events through which the Boy Scouts shapes boys into men. He describes the campfire songs, initiation rites, games, and activities that are used to mold the Scouts into responsible adults. The themes of honor and character alternate in this new study as we witness troop leaders offering examples in structure, discipline, and guidance, and teaching scouts the difficult balance between freedom and self-control. What results is a probing look into the inner lives of boys in our culture and their rocky transition into manhood. On My Honor provides a provocative, sometimes shocking glimpse into the sexual awakening and moral development of young men coming to grips with their nascent desires, their innate aggressions, their inclination toward peer pressure and violence, and their social acculturation. On My Honor ultimately shows how the Boy Scouts of America continues to edify and mentor young men against the backdrop of controversies over freedom of religious expression, homosexuality, and the proposed inclusion of female members. While the organization's bureaucracy has taken an unyielding stance against gay men and atheists, real live Scouts are often more open to plurality than we might assume. In their embrace of tolerance, acceptance, and understanding, troop leaders at the local level have the power to shape boys into emotionally mature men.
In clinical practice the authors observed that many of the delinquent children of psychiatrically impaired and/or criminal parents had remarkably adverse health histories. To test their clinical impression they systematically compared the medical histories of 20 delinquent children with criminal parents and 85 delinquent children with less obviously maladapted parents. They found a strong association between paternal criminality and serious medical problems in these delinquent children. On the basis of this finding the authors suggest that the behavioral manifestations resulting from such physical illness or neglect, although they appear genetic in nature, may reflect the physical and psychological consequences of parental neglect and/or battering.
This study compares the neuropsychiatric, intellectual, and educational status of extremely violent and less violent incarcerated boys. The more violent children were more likely to demonstrate psychotic symptomatology (paranoid ideation and rambling, illogical associations) and to have major and minor neurological abnormalities. They were also more likely to have experienced and witnessed extreme physical abuse. The contribution of these factors to violent delinquency is discussed and implications for therapeutic intervention are suggested.
The authors studies the hospital records of 109 delinquent children and a matched comparison group of 109 nondelinquent children. The number, reasons for, and timing of hospital contacts significantly differentiated the delinquent from the nondelinquent children; perinatal difficulties did not. The authors hypothesize that an interaction of developmental factors and parental inadequacies accounts for the clustering of hospital contacts before age 4 and between ages 14 and 16 in the delinquent sample. They discuss the implications of their findings for prevention.
Clinical and epidemiological evidence is presented indicating that many more black delinquent children and their families fail to receive needed psychiatric and medical services than do white delinquents. Explanations and implications of the reluctance or inability of white mental health professionals to diagnose serious psychopathology in the black delinquent population are explored.
The authors compared the psychiatric symptoms, socioeconomic status, family structure, family size, and occurrence of treated parental mental illness in 136 children referred to a juvenile court and 82 children referred to a child guidance clinic. The prevalence of psychiatric and organic symptoms and treated parental psychopathology in both groups of children did not differ significantly. Juvenile court clinic children, however, tended to come from larger families and to lack a biological mother in the home. The authors explore explanations for the routing of sick children to the juvenile court rather than to a treatment facility.
Prompted by the clinical recognition of serious psychopathology in both delinquent children and their parents, we report an epidemiological study of the possible association of delinquency, parental psychiatric treatment and/or hospitalization, and parental criminality. We also examine questions of assortative mating among psychiatrically impaired and criminally involved parents of delinquents. Findings suggest that delinquency, children's psychopathology, parental psychiatric impairment, and parental criminality may be different manifestations of an entire family's severe adaptational problems. Whether the psychiatric or criminal justice systems become involved may depend primarily on which system is impinged upon at a given time.
The use of the diagnosis "sociopathy" and its synonyms hinders the search for other kinds of symptomatology, the recognition of which might lead to appropriate therapeutic intervention. The authors therefore suggest that the terms "sociopathic personality," "antisocial personality," and "acting out aggressive reaction of childhood or adolescence" be eliminated as primary diagnoses from the psychiatric nomenclature for children or adolescents. Two case reports are presented to emphasize the damage these diagnoses can cause.
The author traces the history of psychiatric nosology in the United States from its origins in the early nineteenth century to the introduction of DSM-I in 1952. Until World War I, psychiatrists were not interested in systematic classification, although they were concerned with diagnosis. The first official nosology, adopted in 1918, reflected the need to collect mental hospital data. The federal Bureau of the Census had a role in the development of this nosology in that it required such data. The publication of DSM-I marked an internal transformation that mirrored the growing dominance of psychodynamic and psychoanalytic psychiatry and the relative weakness of the biological tradition. This transformation occurred largely as a result of the lessons learned by psychiatrists during World War II. The author's basic argument is that nosology reflected not only psychiatric ideology but also other, external determinants at any given point in time.
The results of a follow-up study of 95 formerly incarcerated delinquents are reported. Adult F.B.I. and state police records were used. All but six of the subjects had adult criminal records. The average number of adult offenses was 11.58. Juvenile violence alone did not distinguish well between those who would and would not go on to adult violent crime. Seventy-seven percent of the more violent juveniles and 61% of the less violent juveniles committed adult aggressive offenses. The interaction of intrinsic vulnerabilities (cognitive, psychiatric, and neurological) and a history of abuse and/or family violence was a better predictor of adult violent crime.
Supported by grants from the Ford Foundation and the Kenworthy- Swift Foundation
Psychiatric disturbance, and its relationship to delinquent behavior, was investigated in 71 incarcerated seriously delinquent adolescents (40 male, 31 female) using structured diagnostic instruments (SADA-DSM-III) and a definition of delinquency based on adjudicated felonies. A wide range of psychopathology was identified, with all subjects receiving multiple psychiatric diagnoses. Substance abuse/alcoholism, borderline personality disorder, and major/minor affective disorders were the most common diagnoses. Measures associated with severity of delinquency and adult antisocial outcome were most clearly associated with borderline personality disorder and substance/alcohol abuse. Results are discussed with regard to future studies and treatment implications.
Psychiatrically hospitalized adolescents from city and voluntary services who had been diagnosed as having conduct disorder were compared with psychiatrically hospitalized adolescents who had never been so diagnosed. There were no significant symptomatic differences. The major factor distinguishing adolescents ever diagnosed as having conduct disorder was violence, regardless of other symptoms. The most common discharge diagnosis of those who had formerly been diagnosed as having conduct disorder was schizophrenia. However, even violence did not distinguish those discharged with a diagnosis of conduct disorder from those whose diagnoses were subsequently changed. With its focus on manifest behaviors and its lack of clear exclusionary criteria, the conduct disorder diagnosis obfuscates other potentially treatable neuropsychiatric disorders.
The psychopathology of 29 delinquent and 25 nondelinquent psychiatrically hospitalized adolescent boys was similarly severe. Similar proportions had hallucinations, delusions, learning disabilities, and evidence of neurological impairment, and over half in each group had been diagnosed as being psychotic. Fire-setting, enuresis, and cruelty to animals did not distinguish the two groups. Significantly more of the delinquents had been psychiatrically hospitalized previously, and significantly more of the delinquents had engaged in violently aggressive acts. The household composition of both groups was similar, but more mothers of delinquents than of nondelinquents had been psychiatrically hospitalized. The authors discuss the issue of the treatment of psychiatrically ill violent adolescents.