In 1997, Billy Milligan was arrested and charged with
kidnapping, robbing and raping multiple women in Ohio, USA. He was the first
person to successfully use multiple personality disorder as an insanity defence
in the courtroom. The policemen reported evidence of him 'talking to different
people at different times' when he was arrested. One of the rape victims even
told the lead investigator that Milligan had a German accent, even though he
was born and raised in the United States. Another victim commented that 'He was
sometimes so nice to me, that I would consider dating him in a different
circumstance." All of these supporting evidence which pointed to his
dissociative identity led the judge to resolve the plea to insanity in his
favour. Even though this was a rare instance, the case of Billy Milligan raised
an essential question regarding the 'alter-in-control' insanity plea raised by
people with multiple personalities. They claim that since the
'alter-personality' was in charge of their behaviour during the offence, the
other 'innocent personalities' should not suffer the consequences and should be
set free. For hundreds of years, these claims have raised serious medico-legal
challenges for forensic psychiatrists, mental health clinicians, legal professionals,
the media, and the public. In this blog post, I will argue against the
prevailing criminal laws for people with multiple personality disorder.
Dissociative Identity
Disorders, also known as 'Multiple Personality Disorder' is a common mental
condition where two or more personality states are present in one individual.
Each of these personalities might have a distinct name, personal history and
characteristics. Recent studies and research has shown a high correlation
between crime and dissociative states of personality. A study that tracked 21
reported DID cases found that 47% of men and 35% of women reported engaging in
criminal activity, including 19% of men and 7% of women who committed homicide
(Farrell 2011). With such a high statistical correlation between crime and the
incidence of DID, it becomes imperative to have clearly set laws which define
punishments for people with multiple personalities.
However, this task is
monumental. This is mainly because the diagnosis of dissociative identity itself
is tricky. The DSM-4 does not state the symptoms of the disorder very clearly,
which leads to an invalid and unreliable diagnosis. The high comorbidity of
dissociative disorders with borderline personality disorders, depression,
anxiety and Post- Traumatic-Stress disorders (PTSD) makes the diagnosis more
complicated and confusing (Kluft 2010).
According to the section
84 of the Indian Penal Code, a legally insane person who is incapable of
knowing the nature and degree of the offence he committed cannot be held guilty
for it (Ramamurthy 2019). It is imperative to understand that the wording used
here is 'legally insane' and not 'medically insane' as it is inclusive other
psychiatric disorders like schizophrenia, paranoia, bipolarity or mania. However,
the question of the inclusion of dissociative personality disorder (DID) in
"legally insane" is highly debatable and controversial. Some experts
believe that only if the alter personality was in control of their actions and
behaviour at the time of the offence, then they can be classified as criminally
insane and won't be acquitted (Saks 1991). However, it is contentious and
challenging to determine if a person is in control of their behaviour if there
is so medical or scientific way to measure it. To this end, many courts
throughout the world have introduced specific insanity tests. If either one of
the personalities of the person with DID passes this test, then he/she can be
regarded as 'legally insane'. Even though these tests foster better validity of
the diagnosis, the question of how these insanity tests can be standardised
among different cultures remains unanswered.
It is equally important
to assess ethical and practical considerations which play along when people
with multiple personalities are held guilty and sent to prisons or other types
of correctional facilities. Such people fail to get the medications or medical
support they need and hence, their condition often deteriorates (British Medical Journal). The presence of risk factors like improper
nutrition available, social shame associated with prison, victimisation by
fellow inmates and isolation from friends and family often make the mental and
physical condition of a person worse. Even after their release, they must be
given social support and proper mental health services for them to function
normally and adjust back to their daily lives.
According to my
understanding of the disorder, I believe that psychiatrist's evaluation should
be primarily considered as this disorder has multiple biopsychosocial
consequences which a non-trained mental health professional may not be able to
understand. To this end, I would suggest the establishment of a psychiatric
evaluation committee which can recommend and psycho-educate the council on
matters which involve the prosecution of psychiatric patients. This committee
can be given advisory jurisdiction over the cases where the defendant raises
the insanity plea for any psychiatric disorders (which is not limited to DID).
Apart from advising on the status of the insanity plea, this committee could
also ensure the provision of additional support factors and adequate mental
health services for psychiatric patients who are sent to correctional
facilities.
Hence, it can be
reasonably concluded that the current legislature on criminal proceedings for
people with dissociative identity disorders needs to respect ethical
considerations as well as, serve justice to the society.
References
Farrell, H. M. (2011). Dissociative identity disorder: No
excuse for criminal activity. Current Psychiatry, 10(6),
33.
Kluft, R. P. (2010). Multiple personality
disorder'. Stress consequences: Mental, neuropsychological and
socioeconomic, 60.
Mentally Ill Offenders In Prison. (1985). British
Medical Journal (Clinical Research Edition), 290(6466),
447-447. Retrieved from www.jstor.org/stable/29518202
Ramamurthy, P., Chathoth, V., & Thilakan, P. (2019).
How does India decide insanity pleas? A review of high court judgments in the
past decade. Indian journal of psychological medicine, 41(2),
150.
Saks, E. R. (1991). Multiple personality disorder and
criminal responsibility. UC Davis L. Rev., 25, 383.
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