Psychopathy/Psychopathic Personality/Dissocial Personality Disorder
Dear Tavistock and Portman NHS Foundation Trust,
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental Health Act) would be deemed as having Capacity?
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental Health Act) would be deemed mentally impaired?
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental Health Act) would be deemed as a severe or enduring mental illness?
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental Health Act) would be deemed as having mental illness?
Can you confirm if a Psychopath/Psychopathic personality/Dissocial Personality Disorder requires neurological assessment/investigation to determine the validity of a diagnosis?
Can you confirm if a Dissocial Personality Disorder is synonymous with Psychopathy?
Can you confirm if a Dissocial Personality Disorder is a disorder or disability of the mind as per the definitions of the 2007 Mental Health Act?
Can you confirm the status of a Dissocial Personality Disorder as a mental disorder prior to the 2007 Mental Health Act?
Can you confirm if a Dissocial Personality Disorder diagnosis prior to the 2007 Mental Health Act would be defined/synonymous as either of the following: Psychopath, Psychopathy, or a Psychopathic Personality Disorder?
Can you confirm if a Dissocial Personality Disorder is treatable, and if so, what methods of medical treatment are available?
Can you confirm the symptoms or manifestations of a Dissocial Personality Disorder and confirm how such is diagnosed, and by who?
Can you confirm if those who utilize either the DSM or ICD manual's to make a diagnosis are required to be appropriately qualified?
Can you confirm if those who utilize either the DSM or ICD manual's to make a diagnosis are required to be registered with an appropriate body: the British Psychological Society or Royal College of Psychiatry etc?
Yours faithfully,
Mr Clark
Thank you for contacting The Tavistock and Portman NHS Foundation Trust.
This is an automatic acknowledgement.
Your message has been received by our Freedom of Information team.
If you are requesting information under the Freedom of Information Act or
the Environmental Information Regulations, you will receive a response
within 20 working days.
If your message concerns an existing request for information, we will
respond accordingly.
If your message concerns another matter, your message will be passed to
the relevant team for processing
Please note, the Tavistock and Portman NHS Foundation Trust is a
specialist mental health trust which provides outpatient psychotherapy
services only. The Trust is not a hospital and does not provide acute
services. If your request relates to hospital or acute services, the
information you have requested may not be applicable to this Trust. If
this is the case, you are able to withdraw your request using the email
address [1][Tavistock and Portman NHS Foundation Trust request email]
Please visit our website for more
information: [2]https://tavistockandportman.nhs.uk/
Kind regards
The Freedom of Information Team
The Tavistock and Portman NHS Foundation Trust
Tavistock Centre
120 Belsize Lane
London NW3 5BA
References
Visible links
1. mailto:[Tavistock and Portman NHS Foundation Trust request email]
2. https://tavistockandportman.nhs.uk/
Dear Mr Clark,
Thank you for your email of 26 August 2020 below requesting information
under the Freedom of Information Act 2000 (the FOI Act).
It might be helpful to explain that the FOI Act provides a right of access
to recorded information held by public bodies. It does not provide a right
of access to any information, views or opinions of a public body where
they are not already recorded. Please clarify whether there are any
particular documents, recorded data or recorded information that you would
like to obtain and we will consider your request accordingly. To assist
you in refining your request, you may find it helpful to read the
[1]Information Commissioner’s guidance to the public about how to make
information requests.
Yours sincerely,
FOI Team
From: Kaleb <[FOI #687850 email]>
Sent: 26 August 2020 22:38
To: Freedom of Information Requests <[Tavistock and Portman NHS Foundation Trust request email]>
Subject: Freedom of Information request - Psychopathy/Psychopathic
Personality/Dissocial Personality Disorder
Dear Tavistock and Portman NHS Foundation Trust,
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental
Health Act) would be deemed as having Capacity?
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental
Health Act) would be deemed mentally impaired?
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental
Health Act) would be deemed as a severe or enduring mental illness?
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental
Health Act) would be deemed as having mental illness?
Can you confirm if a Psychopath/Psychopathic personality/Dissocial
Personality Disorder requires neurological assessment/investigation to
determine the validity of a diagnosis?
Can you confirm if a Dissocial Personality Disorder is synonymous with
Psychopathy?
Can you confirm if a Dissocial Personality Disorder is a disorder or
disability of the mind as per the definitions of the 2007 Mental Health
Act?
Can you confirm the status of a Dissocial Personality Disorder as a mental
disorder prior to the 2007 Mental Health Act?
Can you confirm if a Dissocial Personality Disorder diagnosis prior to the
2007 Mental Health Act would be defined/synonymous as either of the
following: Psychopath, Psychopathy, or a Psychopathic Personality
Disorder?
Can you confirm if a Dissocial Personality Disorder is treatable, and if
so, what methods of medical treatment are available?
Can you confirm the symptoms or manifestations of a Dissocial Personality
Disorder and confirm how such is diagnosed, and by who?
Can you confirm if those who utilize either the DSM or ICD manual's to
make a diagnosis are required to be appropriately qualified?
Can you confirm if those who utilize either the DSM or ICD manual's to
make a diagnosis are required to be registered with an appropriate body:
the British Psychological Society or Royal College of Psychiatry etc?
Yours faithfully,
Mr Clark
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References
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2. mailto:[FOI #687850 email]
3. mailto:[Tavistock and Portman NHS Foundation Trust request email]
4. https://www.whatdotheyknow.com/change_re...
5. https://www.whatdotheyknow.com/help/offi...
6. https://www.whatdotheyknow.com/help/ico-...
Dear Freedom of Information Requests,
The Tavistock and Portman NHS Foundation Trust assisted with contributing to the Home Office and Department of Health literature on the DSPD initiative, Psychopathy, Dissocial Personality Disorder and Anti-Social Personality Disorder, and there are plenty of examples to evidence this; questions about the present reality concerning either of the above should of course be directed at you, as you have clearly been promoting the varying ideologues and constructs, and it appears offering training relative to the Risk Assessment construct.
It appears that in accordance with published literature and legislation, for instance, an individual deemed a Psychopath or having any of the published DSM or ICD disorder's 'Dissocial Personality Disorder ICD, or Antisocial Personality Disorder DSM', would by definition of the claim, not have capacity, and would not be able to drive on UK roads, and in accordance with the applicable policies, would qualify for detention under the Mental Health Act; it also appears that there should be advocacy in place, although, if an individual has been brand as a Psychopath or having any of the published DSM or ICD disorder's by any number of people in clinical NHS settings, then it seems that there are instances whereby the individual can be defined as having a Psychopathic personality or having any of the published DSM or ICD disorder's, and yet prevented from having either advocacy, the Care Programme Approach, or any sort of support, and still have to experience the relevant restrictions on their liberty and circumstances such as their ability to drive on UK roads under the Road Traffic Act being prevented.
https://assets.publishing.service.gov.uk...
When can a person be detained under the MHA?
13.9 A patient may be admitted to hospital and detained for treatment under section 3 of the MHA if:
• they have a mental illness, severe mental impairment, psychopathic disorder or mental impairment (the MHA sets out definitions for these last three terms)
• their mental disorder is serious enough to need treatment in hospital
• treatment is needed for the person’s health or safety, or for the protection of other people – and it cannot be provided without detention under this section, and
• (if the person has a mental impairment or psychopathic disorder) treatment is likely to improve their condition or stop it getting worse
https://www.legislation.gov.uk/ukpga/197...
National Health Service Act 1977
1 Secretary of State’s duty as to health service.
(1)It is the Secretary of State’s duty to continue the promotion in England and Wales of a comprehensive health service designed to secure improvement—
(a)in the physical and mental health of the people of those countries, and
(b)in the prevention, diagnosis and treatment of illness,
and for that purpose to provide or secure the effective provision of services in accordance with this Act.
(2)The services so provided shall be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment, whenever passed.
https://www.centreformentalhealth.org.uk...
The convergence of mental health and criminal justice policy, legislation, systems and practice Max Rutherford
The then Home Secretary, Jack Straw, had noted in the House of Commons that:
“We are talking about taking away the liberty of individuals who have not been convicted of a proportionate criminal offence. It is a very grave step to take. None of us should be under any illusions about that. It would be preposterous if we were to treat such a matter lightly” (Straw 1999).
Yours sincerely,
Mr Clark
Thank you for contacting The Tavistock and Portman NHS Foundation Trust.
This is an automatic acknowledgement.
Your message has been received by our Freedom of Information team.
If you are requesting information under the Freedom of Information Act or
the Environmental Information Regulations, you will receive a response
within 20 working days.
If your message concerns an existing request for information, we will
respond accordingly.
If your message concerns another matter, your message will be passed to
the relevant team for processing
Please note, the Tavistock and Portman NHS Foundation Trust is a
specialist mental health trust which provides outpatient psychotherapy
services only. The Trust is not a hospital and does not provide acute
services. If your request relates to hospital or acute services, the
information you have requested may not be applicable to this Trust. If
this is the case, you are able to withdraw your request using the email
address [1][Tavistock and Portman NHS Foundation Trust request email]
Please visit our website for more
information: [2]https://tavistockandportman.nhs.uk/
Kind regards
The Freedom of Information Team
The Tavistock and Portman NHS Foundation Trust
Tavistock Centre
120 Belsize Lane
London NW3 5BA
References
Visible links
1. mailto:[Tavistock and Portman NHS Foundation Trust request email]
2. https://tavistockandportman.nhs.uk/
Dear Kaleb
We have received your message below.
The Freedom of Information Act applies to official recorded information
that exists at the time of the request. Please can you clarify what
information you would like to be sent. If we hold the information we will
provide it, subject to any exemptions that may apply.
Kind regards
The FOI Team
[1][Tavistock and Portman NHS Foundation Trust request email]
From: Kaleb <[FOI #687850 email]>
Sent: 06 September 2020 12:34
To: Freedom of Information Requests <[Tavistock and Portman NHS Foundation Trust request email]>
Subject: Re: FOI response 20-21093 Psychopathy/Psychopathic
Personality/Dissocial Personality Disorder
Dear Freedom of Information Requests,
The Tavistock and Portman NHS Foundation Trust assisted with contributing
to the Home Office and Department of Health literature on the DSPD
initiative, Psychopathy, Dissocial Personality Disorder and Anti-Social
Personality Disorder, and there are plenty of examples to evidence this;
questions about the present reality concerning either of the above should
of course be directed at you, as you have clearly been promoting the
varying ideologues and constructs, and it appears offering training
relative to the Risk Assessment construct.
It appears that in accordance with published literature and legislation,
for instance, an individual deemed a Psychopath or having any of the
published DSM or ICD disorder's 'Dissocial Personality Disorder ICD, or
Antisocial Personality Disorder DSM', would by definition of the claim,
not have capacity, and would not be able to drive on UK roads, and in
accordance with the applicable policies, would qualify for detention under
the Mental Health Act; it also appears that there should be advocacy in
place, although, if an individual has been brand as a Psychopath or having
any of the published DSM or ICD disorder's by any number of people in
clinical NHS settings, then it seems that there are instances whereby the
individual can be defined as having a Psychopathic personality or having
any of the published DSM or ICD disorder's, and yet prevented from having
either advocacy, the Care Programme Approach, or any sort of support, and
still have to experience the relevant restrictions on their liberty and
circumstances such as their ability to drive on UK roads under the Road
Traffic Act being prevented.
[2]https://assets.publishing.service.gov.uk...
When can a person be detained under the MHA?
13.9 A patient may be admitted to hospital and detained for treatment
under section 3 of the MHA if:
• they have a mental illness, severe mental impairment, psychopathic
disorder or mental impairment (the MHA sets out definitions for these last
three terms)
• their mental disorder is serious enough to need treatment in hospital
• treatment is needed for the person’s health or safety, or for the
protection of other people – and it cannot be provided without detention
under this section, and
• (if the person has a mental impairment or psychopathic disorder)
treatment is likely to improve their condition or stop it getting worse
[3]https://www.legislation.gov.uk/ukpga/197...
National Health Service Act 1977
1 Secretary of State’s duty as to health service.
(1)It is the Secretary of State’s duty to continue the promotion in
England and Wales of a comprehensive health service designed to secure
improvement—
(a)in the physical and mental health of the people of those countries, and
(b)in the prevention, diagnosis and treatment of illness,
and for that purpose to provide or secure the effective provision of
services in accordance with this Act.
(2)The services so provided shall be free of charge except in so far as
the making and recovery of charges is expressly provided for by or under
any enactment, whenever passed.
[4]https://www.centreformentalhealth.org.uk...
The convergence of mental health and criminal justice policy, legislation,
systems and practice Max Rutherford
The then Home Secretary, Jack Straw, had noted in the House of Commons
that:
“We are talking about taking away the liberty of individuals who have not
been convicted of a proportionate criminal offence. It is a very grave
step to take. None of us should be under any illusions about that. It
would be preposterous if we were to treat such a matter lightly” (Straw
1999).
Yours sincerely,
Mr Clark
Dear Freedom of Information Requests,
You have been asked to answer the questions, you appear to keep obfuscating them with replies that otherwise ask me to clarify what information you would like to be sent, what you are requested to do, is address the questions in accordance with the FOIA and my right to ask these questions; they do not concern personal information, nor do they require opinions, these are questions based upon facts that have arisen as a consequence of understanding the Hare tools and risk assessment, and it would appear failings that are taking place whereby the system that has implemented these concepts have failed to consider the implications of introducing these ideas, and the impact such tools have upon those who have been subject to this ideology in clinical NHS, without one's prior consent, knowledge, or having had any opportunity to decline taking part in such matters:
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental Health Act) would be deemed as having Capacity?
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental Health Act) would be deemed mentally impaired?
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental Health Act) would be deemed as a severe or enduring mental illness?
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental Health Act) would be deemed as having mental illness?
Can you confirm if a Psychopath/Psychopathic personality/Dissocial Personality Disorder requires neurological assessment/investigation to determine the validity of a diagnosis?
Can you confirm if a Dissocial Personality Disorder is synonymous with Psychopathy?
Can you confirm if a Dissocial Personality Disorder is a disorder or disability of the mind as per the definitions of the 2007 Mental Health Act?
Can you confirm the status of a Dissocial Personality Disorder as a mental disorder prior to the 2007 Mental Health Act?
Can you confirm if a Dissocial Personality Disorder diagnosis prior to the 2007 Mental Health Act would be defined/synonymous as either of the following: Psychopath, Psychopathy, or a Psychopathic Personality Disorder?
Can you confirm if a Dissocial Personality Disorder is treatable, and if so, what methods of medical treatment are available?
Can you confirm the symptoms or manifestations of a Dissocial Personality Disorder and confirm how such is diagnosed, and by who?
Can you confirm if those who utilize either the DSM or ICD manual's to make a diagnosis are required to be appropriately qualified?
Can you confirm if those who utilize either the DSM or ICD manual's to make a diagnosis are required to be registered with an appropriate body: the British Psychological Society or Royal College of Psychiatry etc?
Yours faithfully,
Mr Clark
Thank you for contacting The Tavistock and Portman NHS Foundation Trust.
This is an automatic acknowledgement.
Your message has been received by our Freedom of Information team.
If you are requesting information under the Freedom of Information Act or
the Environmental Information Regulations, you will receive a response
within 20 working days.
If your message concerns an existing request for information, we will
respond accordingly.
If your message concerns another matter, your message will be passed to
the relevant team for processing
Please note, the Tavistock and Portman NHS Foundation Trust is a
specialist mental health trust which provides outpatient psychotherapy
services only. The Trust is not a hospital and does not provide acute
services. If your request relates to hospital or acute services, the
information you have requested may not be applicable to this Trust. If
this is the case, you are able to withdraw your request using the email
address [1][Tavistock and Portman NHS Foundation Trust request email]
Please visit our website for more
information: [2]https://tavistockandportman.nhs.uk/
Kind regards
The Freedom of Information Team
The Tavistock and Portman NHS Foundation Trust
Tavistock Centre
120 Belsize Lane
London NW3 5BA
References
Visible links
1. mailto:[Tavistock and Portman NHS Foundation Trust request email]
2. https://tavistockandportman.nhs.uk/
Dear Kaleb
The FOIA does not require public bodies to answer questions where this
would involve the creation of new information.
As ‘What do they know’ is specifically for FOI requests, if you would like
to email us using another email address, we will pass your correspondence
on to one of our services who may be able to direct you as to where you
can research the information you are looking for.
I am sorry that the FOI team cannot be of further assistance.
Kind regards
The FOI team
Tavistock & Portman NHS Trust
From: Kaleb <[FOI #687850 email]>
Sent: 07 September 2020 17:05
To: Freedom of Information Requests <[Tavistock and Portman NHS Foundation Trust request email]>
Subject: RE: FOI response 20-21093 Psychopathy/Psychopathic
Personality/Dissocial Personality Disorder
Dear Freedom of Information Requests,
You have been asked to answer the questions, you appear to keep
obfuscating them with replies that otherwise ask me to clarify what
information you would like to be sent, what you are requested to do, is
address the questions in accordance with the FOIA and my right to ask
these questions; they do not concern personal information, nor do they
require opinions, these are questions based upon facts that have arisen as
a consequence of understanding the Hare tools and risk assessment, and it
would appear failings that are taking place whereby the system that has
implemented these concepts have failed to consider the implications of
introducing these ideas, and the impact such tools have upon those who
have been subject to this ideology in clinical NHS, without one's prior
consent, knowledge, or having had any opportunity to decline taking part
in such matters:
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental
Health Act) would be deemed as having Capacity?
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental
Health Act) would be deemed mentally impaired?
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental
Health Act) would be deemed as a severe or enduring mental illness?
Can you confirm if a Psychopath/Psychopathic personality (pre 2007 Mental
Health Act) would be deemed as having mental illness?
Can you confirm if a Psychopath/Psychopathic personality/Dissocial
Personality Disorder requires neurological assessment/investigation to
determine the validity of a diagnosis?
Can you confirm if a Dissocial Personality Disorder is synonymous with
Psychopathy?
Can you confirm if a Dissocial Personality Disorder is a disorder or
disability of the mind as per the definitions of the 2007 Mental Health
Act?
Can you confirm the status of a Dissocial Personality Disorder as a mental
disorder prior to the 2007 Mental Health Act?
Can you confirm if a Dissocial Personality Disorder diagnosis prior to the
2007 Mental Health Act would be defined/synonymous as either of the
following: Psychopath, Psychopathy, or a Psychopathic Personality
Disorder?
Can you confirm if a Dissocial Personality Disorder is treatable, and if
so, what methods of medical treatment are available?
Can you confirm the symptoms or manifestations of a Dissocial Personality
Disorder and confirm how such is diagnosed, and by who?
Can you confirm if those who utilize either the DSM or ICD manual's to
make a diagnosis are required to be appropriately qualified?
Can you confirm if those who utilize either the DSM or ICD manual's to
make a diagnosis are required to be registered with an appropriate body:
the British Psychological Society or Royal College of Psychiatry etc?
Yours faithfully,
Mr Clark
Dear Freedom of Information Requests,
You are not being asked to create new information as you have claimed, this is pathetic. I am entitled to request that you provide the information that has been requested, I do not need to provide an email address, I have chosen to ask these questions on this public platform as they need to be answered.
Tavistock have been promoting the use of varying risk assessment instruments, the questions asked are able to be answered within the context of the role of Tavistock, I will have to report you to the ICO if you continue to abuse this request.
You are fully aware that within the context of the DSPD initiative and the Offender Personality Disorder Pathway these questions are answered in literature that has been published and relied upon by Tavistock, there are varying examples of this on the internet, I do not need to evidence every single factor when you are a substantial organisation that has been promoting these ideologues and the risk assessment culture.
I am very concerned that you are acting in a manner that lacks transparency, and that you are refusing to address what the public has a right to know.
Documents such as: https://pdfs.semanticscholar.org/4bc6/89... answer some of the questions, but this is not exactly an official answer so it is pertinent to ask Tavistock for the answers direct; to deny that you are capable of answering the questions is most concerning, it suggest a very unsettling picture.
Yours sincerely,
Mr Clark
Thank you for contacting The Tavistock and Portman NHS Foundation Trust.
This is an automatic acknowledgement.
Your message has been received by our Freedom of Information team.
If you are requesting information under the Freedom of Information Act or
the Environmental Information Regulations, you will receive a response
within 20 working days.
If your message concerns an existing request for information, we will
respond accordingly.
If your message concerns another matter, your message will be passed to
the relevant team for processing
Please note, the Tavistock and Portman NHS Foundation Trust is a
specialist mental health trust which provides outpatient psychotherapy
services only. The Trust is not a hospital and does not provide acute
services. If your request relates to hospital or acute services, the
information you have requested may not be applicable to this Trust. If
this is the case, you are able to withdraw your request using the email
address [1][Tavistock and Portman NHS Foundation Trust request email]
Please visit our website for more
information: [2]https://tavistockandportman.nhs.uk/
Kind regards
The Freedom of Information Team
The Tavistock and Portman NHS Foundation Trust
Tavistock Centre
120 Belsize Lane
London NW3 5BA
References
Visible links
1. mailto:[Tavistock and Portman NHS Foundation Trust request email]
2. https://tavistockandportman.nhs.uk/
Dear Tavistock and Portman NHS Foundation Trust,
Kate Moss and Herschel Prins also communicated in the paper Severe (Psychopathic) Personality Disorder: A review, numerous key aspects of the Psychopathy ideology. I wonder if Herschel Prins if he was alive today consider your response to my inquiries about this very important matter as being reasonable. Many lives have been negatively affected as a consequence of the introduction of actuarial risk assessment instruments, instruments that it appears are frequently being utilized in circumstances that they were not designed for, let alone lack norms and generalizability.
You have been asked to address the questions put to you as the answers would be available from what is known and held by Tavistock, I am simply asking that you provide transparency and integrity and that these matters are addressed.
https://www.researchgate.net/publication...
Severe (Psychopathic) Personality Disorder: A review
Manie sans delire (madness without delirium or delusion)
moral insanity
moral imbecility (defectiveness) Mental Deficiency Act 1913
(constitutional) psychopathic inferiority
‘neurotic character’
psychopathy
sociopathy (USA)
anti social personality disorder (DSMIV)
dissocial personality disorder (ICD10)
dangerous severe personality disorder (Home Office and Dept of Health, 1999).
Figure 1. From Pinel (1806) to the Home Office and Department of Health (1999)
The UK government is much concerned about ‘managing dangerous people with severe personality disorder’ and have set out various possibilities, the most disquieting being the apparent possibility of detaining someone on the basis of what it is felt they might do. Other weaknesses include the expectation that criminal justice and mental health professionals have foolproof skills in predicting future behaviour and its risks.
In our view, Professor John Gunn (1999) provides what is still a useful and critical summary of the work which may still need to be done.
‘In England and Wales we have an uphill struggle on our hands. We need to persuade our Home Office not to drop its interest (and we would add to this the Department of Health) and particularly [the] resource allocation for a needy, hitherto neglected group of patients, but at the same time to back away from new types of ... preventive detention laws and focus instead on the well-tried arrangements we already have. It is true that our prisons can do with more psychiatric resources, we have secure hospitals that also need more
resources ... we certainly do not need new and restrictive laws. The United Kingdom has many laws which can be used imaginatively if we have sufficient and appropriate staffs. Politicians, many of whom are lawyers, rush to legislate; we need to provide them with resources.’
Yours faithfully,
Mr Clark
Thank you for contacting The Tavistock and Portman NHS Foundation Trust.
This is an automatic acknowledgement.
Your message has been received by our Freedom of Information team.
If you are requesting information under the Freedom of Information Act or
the Environmental Information Regulations, you will receive a response
within 20 working days.
If your message concerns an existing request for information, we will
respond accordingly.
If your message concerns another matter, your message will be passed to
the relevant team for processing
Please note, the Tavistock and Portman NHS Foundation Trust is a
specialist mental health trust which provides outpatient psychotherapy
services only. The Trust is not a hospital and does not provide acute
services. If your request relates to hospital or acute services, the
information you have requested may not be applicable to this Trust. If
this is the case, you are able to withdraw your request using the email
address [1][Tavistock and Portman NHS Foundation Trust request email]
Please visit our website for more
information: [2]https://tavistockandportman.nhs.uk/
Kind regards
The Freedom of Information Team
The Tavistock and Portman NHS Foundation Trust
Tavistock Centre
120 Belsize Lane
London NW3 5BA
References
Visible links
1. mailto:[Tavistock and Portman NHS Foundation Trust request email]
2. https://tavistockandportman.nhs.uk/
Dear Tavistock and Portman NHS Foundation Trust,
https://core.ac.uk/download/pdf/20076549...
Shapland, Susanna (2019) Defining the elephant : a history of psychopathy, 1891-1959. Doctoral thesis, Birkbeck, University of London.
More significantly, psychopathy has gained the reputation of a stigma diagnosis that acts as a barrier to treatment and an invitation to indefinite detention.10
10John Gunn, ‘Psychopathy: An Elusive Concept with Moral Overtones’ in Theodore Millon, Erik Simonsen, Morten Birket-Smith and Roger D. Davis (eds.), Psychopathy: Antisocial, Criminal, and Violent Behavior (The Guilford Press, New York, 1998), p.34; Jessica H. Lee, ‘The Treatment of Psychopathic and Antisocial Personality Disorders: A Review’, Risk Assessment, Management, and Audit Systems, (1999), p.25
However, the supposed dominance and ubiquity of this form of psychopathy is deceptive: there are dissenting voices challenging how psychopathy is currently used and understood. There are constant questions about the validity of the diagnosis and whether the PCL-R measures qualities that are testable and generalisable, and even if the Checklist itself has become the construct rather than the means of measurement.9 More significantly, psychopathy has gained the reputation of a stigma diagnosis that acts as a barrier to treatment and an invitation to indefinite detention.10This calls into question what the construct is reallyused to measure, how it is applied and the intentions of those utilising the diagnosis. While psychopathy has gained official acceptance in criminology as it is ‘relied on heavily when making release decisions in prison and forensic psychiatric settings’, John Gunn is one of many forensic psychiatrists who express concern at its continued use.11Gunn sees ‘psychopathic’ as shorthandfor ‘bad’: ‘“Oh he's just a psychopath” means “I don't like him; I regard him as a bad guy”’; the diagnosis ‘invites rejection’.12Michael Cavadino goes further, suggesting that we could easily substitute the term ‘psychopath’ for ‘bastard’, and might even gain something in the ‘honest expression of the essentially moral judgement and the dehumanising contempt with which we view ‘“psychopath”’.13The often unconscious presumption of badness is more than just a rejection of the psychopath as a patient, but of the psychopath as a person; the badness is seen as intrinsic and innate, rendering psychopathic patients supposedly harder to treat.
Being labelled as a psychopath is, therefore, ‘a real stroke of bad luck’, as carrying the diagnosis denies the recipient access to key psychiatric services on the grounds that they are essentially hopeless cases, and attempting to treat them would be a waste of time and resources.14 But is it really just a question of ‘bad luck’? ‘Psychopath’ is a diagnosis that has been used for decades as a label for the problematic elements in society, something that has been accentuated by its associations with APD. It is the answer to a question that has been asked for centuries, and around which the DSPD Programme was based: how to address and arrest crime. APD is ‘hopelessly confounded with criminality’, and the DSPD Programme operated on a similar principle that there was a relatively small number of people committing a disproportionately large amount of crime, identifiable by their disordered personalities.15
As forensic psychiatrist Conor Duggan points out when discussing the Programme, 'demonstrating that there is a functional (or evidential) link between the severe personality disorder and the dangerousness is a demanding criterionand one that hitherto has proved to be elusive’.16Once the purpose and medical application of the diagnoses are called into question, APD, DSPD and their ‘parent’ diagnosis, psychopathy, are reduced to being labels for people who have committed crimes that society finds problematic. They cease to become medical diagnoses and are reduced to value judgments, or at the least are ‘operational as opposed to diagnostic’.17The diagnosis becomes ‘both an explanation and a cause’, a means of labelling an offender based on their behaviour, but without explaining it or suggesting any course of treatment.18As crime is often the product of social and economic disadvantage, it suggests that the ‘bad luck’ of receiving this largely criminological diagnosis is the product of a lifetime of ‘bad luck’.
If those diagnosed with psychopathy have been a lifetime in the making, the awkward reality is that the construct itself is the product of decades of conjecture and shifting boundaries, of uncertainty and accusations of being a wastebasket diagnosis. Although the PCL-R is seen as largely rehabilitating the diagnosis, it is clear that the diagnosis required rehabilitation: it has been widely contested since its introduction, and attempts to understand its aetiology have been consistent only in their lack of consensus.19 Just a glance through the history of its different incarnations shows this, as ‘constitutional psychopathic inferiority’ became ‘psychopathic states’ and ‘psychopathic personality’, with some detours to sociopathy, APD and DSPD along the way. Gunn sees this constant rebranding as distracting from the main issues surrounding the diagnosis, suggesting that it is ‘a bit like that of the "privy," the "water closet," the "lavatory," the "toilet," or the "restroom": If we change the name, it will not seem so horrid and embarrassing'. He further observes that the ‘privy’ exists, but psychopathic disorder does not: we are simply finding new names for the same reified condition.20
Psychopathy is not alone in being seen as a diagnosis that is ‘horrid and embarrassing’, but it is singular in the lack of interest in diminishing this stigma. Charities such as Mind and Rethink Mental Illness work hard to end mental health discrimination more broadly, mostnotably in their joint campaign, ‘Time to Change’, and in the ‘Changing Minds’ campaign of the Royal College of Psychiatrists.21This battle has perhaps been fought hardest in the case of schizophrenia, once considered ‘the epitome of risky madness’, a view exacerbated by the intersection of the ‘Care in the Community’ policy with a tabloid panic concerning the perceived proliferation of murders perpetrated by schizophrenics.22Indeed, damaging stories in The Sun newspaper are referenced as a direct cause of increased stigma surrounding the condition, and one of the catalysts for the launch of Rethink’s ‘Schizophrenia Awareness Week’ in 2013.23However, there is a noticeable lack of concern or activity regarding the stigma attached to psychopathy, or personality disorders generally. Psychopaths are absent from the campaigns, implying that psychopathy is a diagnosis that is denied parity with other mental illnesses, in terms of both resources and understanding: psychopaths are still perceived as people to be avoided, reviled and removed from the public gaze.
This is partly due to psychopathy’s historical occupation of the space between psychosis and sanity, meaning that it does not fit with conceptions or perceptions of mental illness. In contrast, schizophrenia in particular is intrinsically linked with popular conceptions of mental illness: ‘Someone who is suffering from Schizophrenia’ has been the most popular way of describing a person who is mentally ill in Mind’s Attitudes to Mental Illness report, since the question was first asked in 2003.24 It is likely that psychopathy’s strong link to criminality, mainly due to the significant component of antisocial behaviours specified in the diagnostic criteria, holds it apart from conditions such as schizophrenia or bipolar disorder in both psychiatric classification and public opinion. Indeed, personality disorders have been identified as a ‘samizdat topic’ even within the psychiatric profession, ‘written about in code, discussed in quiet corners between professionals when they could not be overheard’, and those diagnosed with a personality disorder are generally considered to be ‘the disliked patient’, and treated as such.25 Psychopaths and the personality disordered more generally are often defacto excluded from this group of the mentally ill who are now being emancipated and heard: exiled by very traditional narratives of worthlessness and badness.
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