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THE CRIME OF NON-DIAGNOSIS
Most death row inmates, and many other criminals, are diagnosed as having "antisocial
personality disorder." But neurologist Jonathan Pincus argues that "the diagnosis of
antisocial personality is inappropriate for brain-damaged and/or psychotic individuals,
even for those who have committed antisocial acts."
Pincus charges that antisocial personality disorder "is not a proper medical diagnosis at
all," because it suggests that no physiological disease exists, and that the crimes which
have been committed should be judged morally and legally rather than medically. But
Pincus argues that brain damage "clearly characterizes the extremely violent," citing a
wide range of studies -- from PET and MRI scans to neurological and psychological
tests -- linking violent behavior to brain damage. In addition, he notes, treatments
including carbamazepine, propranalol, lithium, and hormonal therapy can often reduce
violent behavior in those labeled as antisocial.
Prosecutors favor a diagnosis of antisocial personality disorder, Pincus says, because it
leads to punishment rather than treatment. Noting that all of the death row inmates he
and his colleagues have examined have received this diagnosis, he says that "all... have
[also] suffered from a combination of other diagnosable neurologic and psychiatric
diseases." For such prisoners, Pincus says, "execution is not an acceptable treatment...
though restraint in a prison or hospital is."
Pincus calls on fellow physicians to adequately diagnose and treat the brain
dysfunctions of criminal patients, and to focus on reducing brain injury as a means of
lowering the number of violent criminals in society. "This is likely to be more successful
in reducing violence in America," he says, "than increasing the number of prison beds
or increasing the certainty and frequency of executions."
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"Neurologist's role in understanding violence," Jonathan H. Pincus, Archives of
Neurology, Vol. 50, August 1993, pp. 867-869. Address: Jonathan H. Pincus, Dept. of
Neurology, Georgetown University Hospital, 3800 Reservoir Rd. NW, Washington,
C.D. 20007-2197.
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