Nivoli Alessandra M A, Milia Paolo, Depalmas Cristiano, Nivoli Giancarlo, Biondi Massimo, Taras Giulia, Lorettu Liliana
Clinica Psichiatrica, Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli studi di Sassari, AOU-Sassari.
Dipartimento di Neuroscienze Umane, Sapienza Università di Roma.
Riv Psichiatr. 2020 Nov-Dec;55(6):33-39. doi: 10.1708/3504.34905.
The relationship between mental illness and violent behavior is a complex phenomenon. Scientific literature indicates that the presence of a mental disorder, even severe, is not sufficient, alone, to predict or motivate violent behavior, which seems to be more associated with other intermediate variables. The phenomenon of psychiatrization of violent behavior can be defined, from a psychiatric-forensic point of view, as the prejudicial and erroneous attribution to mental illness as a causal factor in relation to violent behavior. This phenomenon has consequences in psychiatric clinical practice, but also at the level of social stigmatization, management of organizational and economic resources, and the judicial system. In this paper, clinical criticalities related to the psychiatrization of violent behavior will be analyzed, including the need to differentiate clinical etiology and legal causality, predictability and avoidability, protective clinical factors and clinical risk factors, the limits of categorical psychiatric diagnosis, the need for specific victimological information, the criticalities of pharmacotherapy. Some forensic criticalities will also be analyzed, including errors in clinical and forensic methodology (psychiatrization of the symptom, prejudicial contamination, diagnostic overshadowing, legal causalization of protective and risk factors, the use of categorical diagnosis in the forensic field, the psychiatrization of non-pathological human experiences, the criminalization of the subject with mental disorder). In conclusion, it is highlighted that an individual can have a psychic disorder, even severe, but this disorder is not necessarily in a causal relationship with violent behavior. The lack of a causal relationship makes predictability of violent behavior difficult, even impossible depending on the case, both in the general population and in individuals with psychiatric disorders.
精神疾病与暴力行为之间的关系是一个复杂的现象。科学文献表明,即使是严重的精神障碍,仅凭其存在并不足以预测或引发暴力行为,暴力行为似乎更多地与其他中间变量相关。从精神病学 - 法医学的角度来看,暴力行为的精神病化现象可以定义为将精神疾病错误地归因于暴力行为的因果因素。这种现象不仅在精神病临床实践中有后果,在社会污名化、组织和经济资源管理以及司法系统层面也有影响。本文将分析与暴力行为精神病化相关的临床关键问题,包括区分临床病因和法律因果关系、可预测性和可避免性、保护性临床因素和临床风险因素、分类精神病诊断的局限性、获取特定受害者信息的必要性、药物治疗的关键问题。还将分析一些法医学关键问题,包括临床和法医学方法中的错误(症状的精神病化、偏见性污染、诊断遮蔽、保护性和风险因素的法律因果化、在法医学领域使用分类诊断、非病理性人类经历的精神病化、对患有精神障碍者的定罪)。总之,需要强调的是,一个人可能患有精神障碍,甚至是严重精神障碍,但这种障碍不一定与暴力行为存在因果关系。缺乏因果关系使得暴力行为的预测变得困难,在一般人群和患有精神障碍者中,根据具体情况甚至可能无法预测。