Lectures Forensic Psychopathology
Lecture 1
Why does psychiatry matter to criminal law?
○ Concept of “Not guilty by reason of insanity”: A defendant cannot be held responsible for criminal acts
if a serious psychiatric disorder played a causal role in the commission of his acts
○ In the Netherlands
▪ Article 39 of the Dutch Code of Criminal Law (Sr): If a defendant cannot be held responsible for
his acts because these acts were caused by a mental disorder, this person is not culpable. Such an
individual will not be punished but may be sent to a psychiatric institution for mandatory treatment
▪ TBS
o If a person is considered not responsible for his acts, he will (usually) be sent to a TBS
clinic (= forensic psychiatric hospital)
o If a person is considered diminished responsible for his acts, he will (usually) first have to
serve time in prison and then be sent to a TBS clinic
o In TBS clinics offenders with psychopathology undergo treatment to reduce their risk of
re-offending
o Note that a TBS order
Can only be imposed for serious offences
Is of indefinite duration, but every 2 years there is an evaluation to determine
whether or not the patient is not dangerous anymore and can return to society
○ Perpetrators with psychopathology?
▪ Breivik – Norway
▪ Thijs H.
Scientific psychiatry
○ About 135 years old: In 1889, German psychiatrist Emil Kraepelin published “Compendium der
Psychiatrie”
○ According to Kraepelin, psychiatry is a branch of medical science and should be investigated by
observation and experimentation like the other natural sciences
Psychiatric disorder/ psychopathology
○ Current definition: A clinically significant behavioral or psychological syndrome or pattern that occurs
in an individual and that is associated with present distress or disability or with a significant risk of
suffering death, pain, disability, or an important loss of freedom
Diagnosis and treatment of psychopathology
○ Psychiatrist: Physician who has received specialized training in psychiatry. Is allowed to prescribe
medications
○ Clinical psychologist: Psychologist who has received advanced training in the diagnosis and treatment
of psychopathology. Is (usually) not allowed to prescribe medications
Old distinction
○ Psychosis versus neurosis
○ Psychosis disrupts daily functioning to a large degree. Treated by psychiatrists with medications
○ Neurosis affects daily functioning, but does not disrupt this functioning. Usually treated by clinical
psychologists using psychotherapy
Diagnosis (classification)
○ Psychiatrists: interview
○ Psychologists: interviews and psychological tests
Criteria for psychiatric abnormality
○ Deviation from the general population is not necessarily a sign of abnormality
▪ For example if you are really smart, of empathic, that’s not yet an abnormality.
○ Incorrect perception or interpretation of reality often is a feature of a disorder, just as psychological
distress and/or counterproductive behavior
○ Dangerous behavior can be a sign of abnormality
, Prevalence
○ Psychopathology is not at all rare: About 40% of all Dutch people will, at one time of their life, develop
a serious psychiatric disorder
○ About 15-20% of the entire Dutch population suffered from a disorder during the last 12 months
○ Most common disorders: anxiety disorders and depressive disorders
Causes of psychopathology
○ Biological perspective
▪ A shortage or excess of neurotransmitters in the brain. For example, low levels of serotonin in
depression, or excessive levels of dopamine in schizophrenia
▪ Inside the brain: neurons (nerve cells)
o Electrically excitable cells in the nervous system that process and transmit information
o Are the primary functional units of the nervous system
o Neurotransmitters
Chemical compounds in the brain that are involved in the transmission of a signal
from one neuron to another neuron
Due to excess or shortage of neurotransmitters, some parts of the brain work “too
hard” or “not hard enough”
However, this is only one side of the story. In some disorders (e.g., phobias) there
is nothing wrong with the brain
○ Psychological perspective
▪ Learning theories: disorders are the result of conditioned responses
▪ Cognitive theories: faulty information processing and/or thinking patterns play a role in the
development/maintenance of a disorder
▪ Psychoanalytic theories (Freud): disorders are the result of unconscious motives that originate from
problems during developmental stages in early childhood
▪ Conditioning plays a part in the development of anxiety disorders (especially in phobias)
▪ Cognitive factors play a role in depression (e.g., depressed people can remember negative events
very well, but have difficulty recalling positive events)
▪ However: Hardly any evidence for psychoanalytic views on the origins of psychopathology
○ Biopsychosocial perspective
▪ Very popular among modern psychiatrists
▪ Development of schizophrenia
o Genetic predisposition plus stress during childhood/adolescence/early adulthood
o Also called: “diathesis stress model
o However, in some disorders (e.g. autism) psychological factors hardly play a role in the
development of symptoms
Classification of disorders
○ DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition)
▪ No diagnosis – you will need to know the cause of a disorder – but classification
▪ 5 axes
o Axis 1: Clinical disorders
Classic psychiatric disorders such as schizophrenia, anxiety disorders and
depressive disorders (disorders that were already described by Kraepelin)
DSM 4: Someone suffers from schizophrenia if over a period of 1 month s/he has
2 or more of the next symptoms: Delusions, Hallucinations, Disorganized speech,
Disorganized behavior, Negative symptoms (shortage of emotions and
motivation)
DSM 5: At least one of the 2 symptoms should be: Delusions, Hallucinations,
Disorganized speech
o Axis 2: Personality disorders and intellectual disability
These disorders are defined by experiences and behaviors that differ from
societal norms and expectations. Individuals diagnosed with a personality
disorder may experience difficulties in cognition, emotiveness, interpersonal
functioning or control of impulses
Lecture 1
Why does psychiatry matter to criminal law?
○ Concept of “Not guilty by reason of insanity”: A defendant cannot be held responsible for criminal acts
if a serious psychiatric disorder played a causal role in the commission of his acts
○ In the Netherlands
▪ Article 39 of the Dutch Code of Criminal Law (Sr): If a defendant cannot be held responsible for
his acts because these acts were caused by a mental disorder, this person is not culpable. Such an
individual will not be punished but may be sent to a psychiatric institution for mandatory treatment
▪ TBS
o If a person is considered not responsible for his acts, he will (usually) be sent to a TBS
clinic (= forensic psychiatric hospital)
o If a person is considered diminished responsible for his acts, he will (usually) first have to
serve time in prison and then be sent to a TBS clinic
o In TBS clinics offenders with psychopathology undergo treatment to reduce their risk of
re-offending
o Note that a TBS order
Can only be imposed for serious offences
Is of indefinite duration, but every 2 years there is an evaluation to determine
whether or not the patient is not dangerous anymore and can return to society
○ Perpetrators with psychopathology?
▪ Breivik – Norway
▪ Thijs H.
Scientific psychiatry
○ About 135 years old: In 1889, German psychiatrist Emil Kraepelin published “Compendium der
Psychiatrie”
○ According to Kraepelin, psychiatry is a branch of medical science and should be investigated by
observation and experimentation like the other natural sciences
Psychiatric disorder/ psychopathology
○ Current definition: A clinically significant behavioral or psychological syndrome or pattern that occurs
in an individual and that is associated with present distress or disability or with a significant risk of
suffering death, pain, disability, or an important loss of freedom
Diagnosis and treatment of psychopathology
○ Psychiatrist: Physician who has received specialized training in psychiatry. Is allowed to prescribe
medications
○ Clinical psychologist: Psychologist who has received advanced training in the diagnosis and treatment
of psychopathology. Is (usually) not allowed to prescribe medications
Old distinction
○ Psychosis versus neurosis
○ Psychosis disrupts daily functioning to a large degree. Treated by psychiatrists with medications
○ Neurosis affects daily functioning, but does not disrupt this functioning. Usually treated by clinical
psychologists using psychotherapy
Diagnosis (classification)
○ Psychiatrists: interview
○ Psychologists: interviews and psychological tests
Criteria for psychiatric abnormality
○ Deviation from the general population is not necessarily a sign of abnormality
▪ For example if you are really smart, of empathic, that’s not yet an abnormality.
○ Incorrect perception or interpretation of reality often is a feature of a disorder, just as psychological
distress and/or counterproductive behavior
○ Dangerous behavior can be a sign of abnormality
, Prevalence
○ Psychopathology is not at all rare: About 40% of all Dutch people will, at one time of their life, develop
a serious psychiatric disorder
○ About 15-20% of the entire Dutch population suffered from a disorder during the last 12 months
○ Most common disorders: anxiety disorders and depressive disorders
Causes of psychopathology
○ Biological perspective
▪ A shortage or excess of neurotransmitters in the brain. For example, low levels of serotonin in
depression, or excessive levels of dopamine in schizophrenia
▪ Inside the brain: neurons (nerve cells)
o Electrically excitable cells in the nervous system that process and transmit information
o Are the primary functional units of the nervous system
o Neurotransmitters
Chemical compounds in the brain that are involved in the transmission of a signal
from one neuron to another neuron
Due to excess or shortage of neurotransmitters, some parts of the brain work “too
hard” or “not hard enough”
However, this is only one side of the story. In some disorders (e.g., phobias) there
is nothing wrong with the brain
○ Psychological perspective
▪ Learning theories: disorders are the result of conditioned responses
▪ Cognitive theories: faulty information processing and/or thinking patterns play a role in the
development/maintenance of a disorder
▪ Psychoanalytic theories (Freud): disorders are the result of unconscious motives that originate from
problems during developmental stages in early childhood
▪ Conditioning plays a part in the development of anxiety disorders (especially in phobias)
▪ Cognitive factors play a role in depression (e.g., depressed people can remember negative events
very well, but have difficulty recalling positive events)
▪ However: Hardly any evidence for psychoanalytic views on the origins of psychopathology
○ Biopsychosocial perspective
▪ Very popular among modern psychiatrists
▪ Development of schizophrenia
o Genetic predisposition plus stress during childhood/adolescence/early adulthood
o Also called: “diathesis stress model
o However, in some disorders (e.g. autism) psychological factors hardly play a role in the
development of symptoms
Classification of disorders
○ DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition)
▪ No diagnosis – you will need to know the cause of a disorder – but classification
▪ 5 axes
o Axis 1: Clinical disorders
Classic psychiatric disorders such as schizophrenia, anxiety disorders and
depressive disorders (disorders that were already described by Kraepelin)
DSM 4: Someone suffers from schizophrenia if over a period of 1 month s/he has
2 or more of the next symptoms: Delusions, Hallucinations, Disorganized speech,
Disorganized behavior, Negative symptoms (shortage of emotions and
motivation)
DSM 5: At least one of the 2 symptoms should be: Delusions, Hallucinations,
Disorganized speech
o Axis 2: Personality disorders and intellectual disability
These disorders are defined by experiences and behaviors that differ from
societal norms and expectations. Individuals diagnosed with a personality
disorder may experience difficulties in cognition, emotiveness, interpersonal
functioning or control of impulses
