Michael Ragland: Throw away the keys

In Stanley Kubrick’s famous movie “A Clockwork Orange” (adapted from Anthony Burgess’ book with the same title) the story revolves around a violent criminal named Alex who, in order to be released from prison, agrees to an experimental treatment which is chemically induced and brought about by behavioral conditioning. All of Alex’s aggressive impulses are eliminated. In the end he tries to commit suicide and reverts back to his “old self”. The government, which sponsored the experimental research is keen on keeping its “mind control” and “threat” to “individual freedom” under wraps. It strikes an agreement with Alex. He will be “rewarded” by the state as long as he keeps his mouth shut to the media and others about what he went through. A Clockwork Orange was set in a future when crime was rampant in society. Part of the popularity of movies like “Death Wish” and vigilantism is society’s and the governments inability/unwillingness to protect society from violent criminals like Alex.

Regrettably, there is no known treatment/cure for those with antisocial personality disorder and for the foreseeable future there won’t be except to lock them up in prisons when they commit a crime.The clinical name for sociopathy/psychopathy is anti-social personality disorder and it  is listed in the psychiatric Diagnostic Statistical Manual. Some early signs of possible antisocial personality disorder include arson, cruelty to animals and bedwetting.There is currently no known treatments to “cure” such criminals  or to rehabilitate them. They have a genuine character pathology disorder. Surely, nobody can argue such individuals do not exist. So the question arises what should be done with such individuals?. Should we wait until they finish their sentence and are released so they can commit more crimes and revictimize society? That is currently the policy of our criminal justise system.

What follows is a suggestion for what should be done regarding those with antisocial personality disorder. It’s true this is putting a label on a person but just as there are those with schizophrenia, bipolar disorder and other mental illnesses .who we label (just as there are those we label with real physical diseases) there is a diagnosis for chronic anti-social behavior. It is still debated whether antisocial personality disorder is a mental illness but it is listed in the DSM. This op-ed argues antisocial personality disorder is a true pathological character disorder which is currently untreatable. These individuals can’t be rehabilitated. Is this statement “politically incorrect?

What should be done is that a parole board consisting of board certified forensic psychiatrists who can make determination/evaluation whether a particular inmate has antisocial personality disorder and if they are they should be civilly committed to a secure institution right before they have finished their sentences. The way the current system works today a criminal with antisocial personality disorder is sentenced to a number of years and then released. Why? So that they can commit more crimes and revictimize society?

I suggest we do with them what some states have done with sexually violent predators – release them from prison just before completion of their sentence and then civilly commit them indefinitely to a secure institution where society is protected such as the Virginia Center for Behavioral Rehabilitation. The term “rehabilitation” is something of a oxymoron as these particular individuals can’t be rehabilitated. It’s hard to accept that certain criminals can’t be rehabilitated and the high cost of keeping them indefinitely civilly committed but the social and economic costs of not doing this is much higher. This “idea” does not address what the causes of antisocial personality disorder are and the suggestion of indefinitely civilly committing such individuals may attract the criticism of civil libertarians but to just release those criminals who have antisocial personality disorder back into society so they can committ more crimes and revictimize society hardly seems wise.

A particular (standard) questionnaire could be supplied to the forensic board certified psychiatrists to afford some consistency e.g. aside from the forensic psychiatrist’s general evaluation there could be questions regarding self control, impulse control, questions regarding empathy and the understanding of other people’s suffering. Such a test would have to be complex and sophisticated so a potential individual with antisocial personality disorder would not be able to cheat/trick the questionnaire/evaluation and could be modeled after the Texas Medication Algorithm Project e.g. public mental health screening program. Refusal to answer the questionnaire or participate in an evaluation would automatically result in civil commitment to a secure facility indefinitely unless the individual was developmentally delayed..A process of appeal could include re-evaluation using different forensic psychiatrists (but randomly selected from a pool of participating psychiatrists) and challenging the decision made based on the psychiatric evaluation. This could be implemented anytime the political will is sufficiently strong to formulate and implement it.

It is not right that every day in America there are those with antisocial personality disorder released from prison to again break the law and revictimize society.

Letter from Michael Ragland/Triangle, Va.

Augusta Health Kris McMackin CPA
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