Two recent events have led me down an unusual path in my thinking.
First, I had the opportunity a few weeks ago to read The Stranger, often considered to be Albert Camus' masterpiece of Absurdism. This brief book—easily read in two or three hours—is viewed as Camus' explanation of the meaningless of life.
In brief, the narrator and protagonist, Meursault, is accused of killing an Arab on the beach in Algeria. The second part of the book takes place entirely during Meursault's detention and trial. During the trial, he is portrayed by the prosecution as having “no feelings” and “no remorse,” and he is given the death penalty.
Camus' point in this sequence is that life has no meaning, and it is “absurd” to try to find any meaning. Ironically, his very thesis regarding the pointlessness of existence has led generations of students to study and debate the meaning of his work.
Throughout the book, Meursault is depicted by his own words and his own thoughts as an emotionless, detached man, disconnected from what those around him view as important decisions and values. Thus, when his mother dies at the opening of the book, he focuses more on the intolerable heat than on any grief he may (or may not) have for her passing.
As I read this book, increasingly I became convinced that Meursault appears to have had Asperger's syndrome. That this disorder was unknown at the time may have been the reason for his being convicted for who he was, and less for what he did.
This should not similarly absolve us of making this same error.
The second recent event is the approval of the next iteration of the psychiatric Diagnostic and Statistical Manual, which will be known as DSM-5, which includes one change that may make it more difficult for clinicians and legal professionals to properly identify individuals with Asperger's syndrome.
Asperger's is often considered a high functioning form of—and in the new DSM-5 will be formally subsumed under—autism. There are similarities in the two diagnoses that support their combined classification, but I believe the differences are especially important for those of us working in criminal justice.
When an individual commits a crime, he is on trial for what he did. At sentencing, of course, who he is becomes the issue when considering aggravating and mitigating factors. In the case of Meursault, it is clear that the court viewed his cold, emotionless, detached nature as evidence of an antisocial or sociopathic nature.
I believe that the court missed the bigger picture that those of us who read the book—and therefore are inside Meursault's mind—can see clearly.
Newer clinicians—trained in the DSM-5 era—will be less likely to be able to discern such cases because of the new diagnostic scheme. I frankly disagree with the APA's position that “[t]he proposed criteria will lead to more accurate diagnosis.”
Time will tell, but we in criminal justice have a long way to go.
Asperger's and other forms of autism may look superficially like antisocial personality disorder, but these are very different problems and should be treated differently by the criminal justice system. While the Bureau of Justice Statistics has some data on the victimization of people with these disorders, there is no data that I could find as to the criminalization of people who have difficulties navigating their social environments due to these disorders.
This undoubtedly is based on inadequate diagnosis by the clinicians and legal personnel involved in these cases as they are adjudicated, and later as they serve their sentences.
It is time to change this, and I fear that the recent alteration to the diagnostic scheme will make this more, and not less, difficult for us.
Postscript: As I was finalizing this essay, I learned of the tragedy in Connecticut, in which an individual who may have had a disorder such as those I have been discussing killed a number of small children and their teachers and other school professionals.
My point in this essay is not to render any diagnosis of Mr. Lanza—something I believe to be inappropriate and unethical.
That said, if Mr. Lanza did have autism or Asperger's, and if his problems went unrecognized and untreated, it underscores my bigger public policy point: proper diagnosis is essential to receiving appropriate care, and I hope that the APA's new approach does not muddy the waters in which we must swim.
Erik Roskes, a regular blogger for The Crime Report, is a forensic psychiatrist and serves on the teaching faculty in the Psychiatry Department at the University of Maryland School of Medicine. The opinions expressed are those of the author only, and do not represent those of any of Dr. Roskes' employers or consultees, including the Maryland Department of Health and Mental Hygiene. He welcomes readers' comments. Dr. Roskes' website is http://mysite.verizon.net/eroskes.