Fraud, deception, and thieves

Dishonesty and deception are mundane and ubiquitous elements of human behaviour. Various forms are also categorized as criminal offences in the codes or statutes of all organized societies. In criminological terms, fraud, deception, and theft are forms of stealing, in other words dishonestly depriving others of goods or services. However, deception and fraudulent misrepresentation play a much wider role in human behaviour and interactions. This chapter will first consider briefly the broader picture, before considering in detail psychiatric aspects of stealing.

Cognitive disorders, epilepsy, ADHD, and offending

‘Cognitive disorders’ is a broad and heterogeneous diagnostic category, which includes different disorders, each with a distinct aetiology. They affect individuals in different ways depending on the age in which they occur. The term may be applied to a child, who has experienced perinatal trauma as well as to an older person with a beginning dementia of the Alzheimer type. The scientific literature on offenders with cognitive disorders is sparse. Most authors in forensic psychiatry do not systematically differentiate between the diagnostic subcategories and tend to use broad terms, such as organic disorder, organic psychosis, organic brain syndrome, neuropsychological deficit, dementia, mental handicap, mental retardation to include a number of different disorders in their studies. The number of patients with any kind of brain disorder in forensic hospitals and institutions is comparatively small and ranges from 1 to 10 per cent of all forensic inpatients. The same numbers apply for individuals assessed for criminal responsibility or risk of reoffending. Compared to major mental disorders like schizophrenia or affective disorders or to personality disorders, patients with cognitive disorders account for only a small proportion of individuals seen by forensic psychiatrists. Subdividing this group any further would be statistically irrelevant. The way forensic psychiatry and the law deals with offenders suffering from organic brain disorders is rather derived from case reports and convention than from empirical knowledge.

Psychosocial causes of offending

Offending is part of a larger syndrome of antisocial behaviour that arises in childhood and tends to persist into adulthood. There seems to be continuity over time, since the antisocial child tends to become the antisocial teenager and then the antisocial adult, just as the antisocial adult then tends to produce another antisocial child. The main focus of this chapter is on types of antisocial behaviour classified as criminal offences, rather than on types classified for example as conduct disorder or antisocial personality disorder. In an attempt to identify causes, this chapter reviews risk factors that influence the development of criminal careers. Literally thousands of variables differentiate significantly between official offenders and non-offenders and correlate significantly with reports of offending behaviour by young people. In this chapter, it is only possible to review briefly some of the most important risk factors for offending: individual difference factors such as high impulsivity and low intelligence, family influences such as poor child rearing and criminal parents, and social influences: socio-economic deprivation, peer, school, community, and situational factors. I will be very selective in focussing on some of the more important and replicable findings obtained in some of the more methodologically adequate studies: especially prospective longitudinal follow-up studies of large community samples, with information from several data sources (e.g. the child, the parent, the teacher, official records) to maximize validity. The emphasis is on offending by males; most research on offending has concentrated on males, because they commit most of the serious predatory and violent offences. The review is limited to research carried out in the United Kingdom, the United States, and similar Western industrialized democracies. More extensive book length reviews of antisocial behaviour and offending are available elsewhere.

Residential care for social reasons

Residential care for the young is an elusive object of study. Provided in the past by establishments as diverse as workhouses, orphanages, and reformatories, it has no clear definition marking its boundaries with foster care or boarding education; at the same time it variously aims to shelter, classify, control, and reform and it has no agreed theory or body of values. The need for residential care, and the difficulties of providing it, vary with time and place; the issues it raises are quite different in Romania than they are in California, or were in Victorian England. Given this diversity, any discussion of residential care needs to outline the context within which it was written. In the case of this chapter the context is provided by current British social policy. Although the focus is on residential care provided to young people by Children's Services in England for social reasons, the conclusions drawn are applicable to the rest of the United Kingdom. The issues raised by this provision have similarities in other parts of the developed world, in virtually all of which the use of residential care is declining. This chapter is written against the background of this decline. Its aims are as follows: ♦ to describe the current characteristics of residential child care in England, and by extension in Great Britain ♦ to outline the problems that have led to its numerical decline ♦ to identify practices that should overcome or reduce these problems ♦ to discuss the role that residential care might play in future.

Cognitive behaviour therapies for children and families

Cognitive behaviour therapy (CBT) is derived from both behavioural and cognitive theories. Using concepts such as operant conditioning and reinforcement, behavioural theories treat behaviour as explicable without recourse to description of mental activity. In contrast, mental activity is central to all concepts derived from cognitive psychology. Both sets of theories have been of value in explaining psychological disorders and, in the design of interventions they have proved an effective combination. Central to that part of cognitive theory that is relevant to CBT is the concept of ‘schemas’, first described in detail by Jean Piaget. A schema is a mental ‘structure for screening, coding, and evaluating impinging stimuli’. The origin of mental schemas lies in the pre-verbal phase when material is encoded in non-verbal images that, as the child's language develops, gradually become verbally labelled. They form part of a dynamic system interacting with an individual child's physiology, emotional functioning, and behaviour with their operation depending on the social context in which the child is living. There are similarities but also differences between schemas and related concepts in psychoanalysis, such as Freudian ‘complexes’ and Kleinian ‘positions’. Schemas can be seen as organized around anything in the child's world, especially objects, beliefs, or emotions. They develop from past experience. The processing of new information in relation to such schemas can usefully be seen as involving the evaluation of discrepancies between information that is received and information that is expected. If there is a discrepancy, (the information not corresponding with that expected), then during the coding process information may be distorted so that it no longer creates discomfort, or, more adaptively, it may be incorporated into a modified schema.

Children's speech and language difficulties

Speech and language difficulties have a significant impact on the lives of children and their families. This chapter will give an overview of the types of speech and language difficulties children present with and how these are generally classified and diagnosed. Specific Language Impairment (SLI) and speech and language difficulties associated with child psychiatric disorder, specifically disorders of attention and selective mutism will be a focus. The life course of children with speech and language impairments will be described through childhood, adolescence, and adult life. Current management approaches will be presented and evaluated and strategies for effective communication considered.

Obsessive–compulsive disorder and tics in children and adolescents

Paediatric OCD is the disorder, in child psychiatry, whose clinical picture most closely resembles its adult counterpart. Despite a relative diversity, the symptom pool is remarkably finite, and very similar to that seen in older individuals. Prevalence, comorbidity, and response to behavioural and drug treatment also appear similar across the lifespan. For tic disorders, there is continuity between child and adult presentations, but the disease is much more prone to resolve spontaneously, or to be less disruptive in adulthood. Both OCD and tics occur more often in males than in females, and are likely to be linked to an array of neurobiological abnormalities, many of which remain to be understood. Invaluable benefits can now be obtained from available behavioural and pharmacological treatments, but complete remission remains uncertain and long-term management may be required. Thus, the treatment of OCD and tics in children and adolescents remains a clinical challenge. It requires careful assessment of the targeted symptoms and, in many cases, comorbidity; attention to the quality of the child's functioning at home and with peers; use of specific CBT interventions, which are not readily available (or accessible) in all communities; patience and caution in the choice and adjustment of medication; and vigilance in watching potential side effects. Given the possible chronicity of OCD and/or tic disorders, and their changing patterns in severity and impact over the childhood and adolescent years, optimal treatment generally requires a long-term ongoing relationship with the child and family. Current conceptualizations of OCD and tic disorders have been shaped by advances in systems neuroscience and functional in vivo neuroimaging. Continued success in these areas should lead to the targetting of specific brain circuits for more intensive research. This should include testing novel pharmacological agents, tracking treatment response using neuroimaging techniques, and possibly investigating circuit-based therapies using deep-brain stimulation for refractory cases. The identification of the PANDAS subgroup of patients, with an abrupt onset and dramatic exacerbations, certainly brings new insights into the pathophysiology of OCD and tic disorders, and may lead to new assessment and treatment strategies. The increasing evidence for susceptibility genes in OCD and tic disorders will also doubtless point to new therapeutic directions. Furthermore, it is likely that many of the empirical findings used in research on paediatric OCD and tic disorders will be relevant to a better understanding of both normal development, and other disorders of childhood onset.

Prevention of mental disorder in childhood and other public health issues

Enormous progress has been made in recognizing the scope of mental health problems for children around the world, and in developing the theoretical framework needed to address decreasing this burden in a systematic fashion. Technological advances in neuroimaging, genetics, and computational biology are providing the tools to start describing the biological processes underlying the complex course of development, and have renewed appreciation of the role of the environment in determining how a genetic heritage is expressed. However, rapid technological change is also altering the environment of children and their families at an unprecedented rate, and what kinds of challenges to public health these changes may present is not yet fully understood. What is becoming clear is that as technological advances increase the range of available health care treatments, along with the potential cost, the choices for societies between spending limited resources on treatment or prevention will have to become increasingly deliberate. A substantial body of work has demonstrated that prevention in mental health can be effective, but those who would benefit the most from preventive interventions are often not those with the political or economic resources to make them a priority. While the potential interventions to prevent mental health disorders in children are constrained by the knowledge and resources available, what is actually done depends upon the social and political values of individual communities and nations. It is to be hoped that as our understanding of these disorders grows, public policies to prevent the development of mental health disorders in children will become as commonplace a responsibility for modern societies as the provision of clean drinking water.

Suicide and deliberate self-harm in elderly people

Although in some countries suicide rates in young males have risen dramatically in the last decade or so, suicide in old age is important because rates in older people, especially those over 74, are still proportionately higher in most countries of the world where reasonably reliable statistics can be obtained. For example, in 2004 in Lithuania where suicide incidence is currently the highest, the overall rate in males per 100 000 total population was 70.1, but in men over 74 the rate was 80.2. In the United States, where suicide is neither especially common nor rare, in 2002 the overall rate for males per 100 000 total population was 17.9, but 40.7 in men over 74. Rates for older women are nearly always much lower than for their male counterparts. A second reason for the importance of suicide in old age is that the proportion of older people in the population is rising worldwide. Indeed, the increase in developing countries is likely to be even greater than in developed countries. Although rates vary from year to year and birth cohort to cohort, it is highly likely that unless suicide prevention becomes a great deal more effective than at present, more and more older people will kill themselves in the coming years. As with younger people, completed suicide in old age may be seen as part of a continuum from suicidal thinking through deliberate self-harm (which does not lead to death), to completed suicide. An added component within this continuum for older people is that of ‘indirect self-destructive behaviour’, such as refusal to eat and drink or ‘turning one's face to the wall’ which is clearly intended to hasten death. Finally, although this section does not deal with euthanasia and related issues, assisted suicide in people with terminal illness such Alzheimer's disease and cancer may also be seen as part of the suicide continuum.

Sociology of normal ageing

Research on the sociology of normal ageing has focused on understanding the paradigms of ‘successful ageing’. In an apparent reaction to ‘disengagement theory’ which proposed that to withdraw from roles and relationships in old age was normal, a new conceptual framework was developed in the late 1960s and 1970s which attempted to explain how individuals adapted to the constraints of ageing and old age. This has been variously measured in terms of good health, high levels of physical and mental functioning, and active engagement with one's social and physical environment. While post-modernism and critical gerontology have attempted to refocus the debate, the emphasis of most research and writing has remained within the framework of understanding, explaining, and even facilitating, ‘success’ in old age. There is also a body of research which recognizes the importance of the life course perspective, and that throughout an individual's life, he or she is faced with continuities and discontinuities which have to be negotiated and resolved. Old age is but part of this life-long process. Changes which occur in later life, such as retirement and widowhood, will lead to discontinuities in roles and relationships, other aspects of our lives will undergo little change allowing continuity. Alongside this, perspectives from anthropology, history and the social constructionist school of thought have also been recently influential. This chapter will discuss concepts of age, generation, and cohort. It will consider the contribution of the life course approach to understanding ageing, and the manner in which other perspectives, such as social constructionism, narrative psychology and anthropology, have contributed to the sociology of normal ageing.