Lately, I have noticed how often the DSM label is used in court in an attempt to either exonerate the person from assuming full responsibility for the crime of which they are accused or else to win sympathy from the court against the person with the label. In the past I have agreed with the general insanity defence, but am not at all convinced that parsing the insanity defence down to the specific “disorder” is a wise idea. In fact, the more I see this happening, the less I am convinced about the insanity defence. I see this being used more and more as an “out” for people who are not at all criminally insane or as a vehicle to convict the person you have a grievance against. Both sides are smart enough to know that the DSM carries the weight of “expert opinion.”

Since the more esoteric labels weren’t in existence much before the 1990s when pharma cemented the idea of the diseased brain in the public consciousness, it is axiomatic that their use in the courtroom has skyrocketed.

Last week-end’s Financial Times has an absolutely pathetic piece of journalism on Narcissistic Personality Disorder. Since the average reader of the Financial Times is supposedly a London investment banker, I feel this article was written more to titillate than to inform. The article begins with an anecdote about an enraged husband who threatens his wife with a gun when she decides to leave him. He backs off when she calls her father and later denied threatening her and the charges were dropped. At the divorce proceedings “a social services report diagnosed Rob with narcissistic personality disorder.” Why am I not surprised that the party seeking the divorce will try to pathologize the spouse’s behavior through “expert” testimony. The DSM is their friend in court.

The FT articles goes on at length about NFP as if it were a clinical disease (classified as a cluster B or “dramatic” disorder, as opposed to a cluster A “odd” disorder (paranoid and schizoid) and cluster C “anxious” disorders such as dependent disorders and OCD). It claims that NPD disorder is “diagnosed” when it it really apparent that there is no diagnosis, only “opinion.” The article demonstrates that even though “there is no laboratory test, no genetic predisposition, no specific types of people more susceptible than others,” a non-existent disease or disorder such as this will still stand up in a court of law. In my opinion, the social services report in the divorce case is tantamount to “hearsay.” Actually, much of the FT article struck me as hearsay evidence. We are supposed to believe the nasty things that someone else says about a husband, parent without our actually knowing them ourselves.

The author of the article writes while keeping a straight face “The disorder, formerly known as megalomania, affects 1 per cent of the population and up to 16 percent of the clinical population. It is not easily discernible to the untrained eye, partly because a degree of self-love is essentially healthy . . . . ” The article claims that this disorder is found frequently in the higher reaches of politics, finance and medicine, and, with no basis, claims that there is no cure!

Should this fuzzy labelling of a disorder that works well for many really have clout in a court of law? Should law abiding people who carry the label of schizophrenia and bipolar disorder object to their label being bandied about in a court of law to excuse someone else’s behavior? If these are phony diseases, as I firmly believe, then their presence should be struck from the court room, or certainly not carry the weight of “expert evidence.” Sensationalistic or lurid court cases where schizophrenia and other so-called disorders are invoked, condemn the vast majority of people with these labels who would no more kill someone, drive drunk or steal than the next person. They are stigmatized with the larger public courtesy of the DSM being allowed in the court of law.

“Expert evidence” in these cases claims to justify  that there is no other motivation for the behavior beyond the “disorder.”