"There is a clear-cut difference between mental disorders and
psychopathic disorders in German law and forensic psychiatry," said
Henning Sass, M.D., at the 2009 APA annual meeting in San Francisco in May."
The concept of responsibility must be kept close to psychopathology or
there is a danger of extending the concept of irresponsibility too
Responsibility is not just a matter of science but also of society's values
and what it will tolerate, said Sass, medical director and chair of the board
of directors at University Hospital of the University of Technology in
Neither German nor U.S. law considers psychopathology an argument for
diminished responsibility in criminal cases, said both Henning Sass, M.D.,
(left) of the University of Technology in Aachen, Germany, and Alan Felthous,
M.D., of St. Louis University in St. Louis, Mo. The two shared the Manfred S.
Guttmacher Award for co-editing the International Handbook on Psychopathic
Disorders and the Law.
Credit: Ellen Dallager
Sass was awarded the Manfred S. Guttmacher Award jointly with Alan
Felthous, M.D., director of forensic psychiatry and a professor in the
Department of Neurology and Psychiatry at St. Louis University. The award is
given jointly by APA and the American Academy of Psychiatry and the Law for an
outstanding contribution to forensic psychiatry
Sass and Felthous discussed the issue of psychopathic disorders and
criminal responsibility in a combined lecture at the annual meeting.
Sass observed that while there were many universal aspects of forensic
psychiatry, there were also distinctive national patterns. In Germany, the
psychiatric expert is appointed and paid for by the court or the public
prosecutor but serves as a neutral expert. He or she is neither for nor
against one party in a legal proceeding, and everything the expert discovers
or determines is reported in court, whether it favors the defense or
The accused are deemed to have a lower level of responsibility if they are
diagnosed with psychosis, mental retardation, a severe disturbance of
consciousness, or some other mental abnormality, said Sass. He pointed out
that these were legal and not psychiatric terms.
Factors weighing against the assumption of diminished responsibility
include evidence of calculation, preparation for the crime, controlling the
criminal activity, or having the capacity to choose other behavior.
Psychopathology is not considered an argument for diminished
Criminal responsibility in the United States' judicial system begins with
normative public-policy standards, which are sometimes said to be shaped by
popular folk psychology, said Felthous.
"There's some truth in that, in actuality, but it's not good
enough," he said. "These standards should be informed by science,
but science shouldn't determine the policy. Other interests must be weighed
and considered, and cannot be resolved by science."
In U.S. law, psychopathic disorders and personality disorders are not
considered mitigating, he said.
In both Germany and the United States defendants with psychopathic
disorders are not involuntarily committed for treatment. For one thing,
studies on the effectiveness of treatment for these individuals are
inconclusive, so commitment would be unlikely to benefit either the patient or
public safety. Also, commitment would medicalize a problem that should be
dealt with by the criminal justice system, Felthous noted.
"It is easy to overgeneralize, however," said Felthous."
We must think about subtypes of psychopathic disorders, treatable
comorbidities, and the role of aggression."
He noted four types of aggression: impulsive, which combines emotion
without thought; spontaneous, with neither emotion nor thought; compulsive,
performed with both thought and emotion; and premeditated, involving thought
without emotion. The last of these is most closely associated with
psychopathy, he said.
What can be done with such defendants?
"We should exclude psychopathic disorders both as a reason for
long-term civil commitment and as a mental disorder for the insanity
defense," he said.
More research is needed into the origins and treatment of psychopathic
disorders and into ways to prevent them.
"Psychopathic disorders are universal, but each country has its own
history and legal principles" regarding how the disorders are addressed
in the legal system, he concluded. "So it would help to compare
different approaches and thus provide a broader perspective as we grapple with
the question of what to do with [defendants who have] psychopathic