Poker Face in Mental Health Practice by Ansar Haroun

Author:Ansar Haroun
Language: eng
Format: epub
Publisher: W. W. Norton & Company

Volitional impairments have to do with one's self-control. “I did it, but I couldn't help myself” is the excuse given by the person suffering from volitional impairment. Examples of mental disorders that may contribute to such a condition include impulsivity disorders—either primary impulsivity disorders (such as intermittent explosive disorder) or impulsivity disorders that are part of some other disorder (such as attention deficit disorder).

In the U.S. legal system, the majority of States accept cognitive impairment as a basis of a mental excuse; only a few accept volitional impairments. This is partly because psychiatrists find it easy to assess the truth or falsity of a cognitive impairment but find it difficult to assess the truth or falsity of a volitional condition. In analyzing cognitive impairments, forensic evaluators generally are asked to specify whether the failure to understand applied to the nature of the act (“I didn't know I was killing her—I thought she was a doll and I was just playing with her”), the quality of the act (“I didn't know that putting a plastic bag over her head would kill her”), the wrongfulness of the act (“Yes, I killed her, but it was because she's an agent of the devil and God wanted me to kill her”), or some such combination. Excuses and justifications in more mainstream therapy settings generally fall into one of these categories as well.

Mental illness is probably the most common excuse or justification related to the actor, but there are also others. Sometimes people will offer epidemiological excuses—for example, an adolescent in therapy may say, “Yes, I admit I bullied that girl, but everyone else at school was bullying her too. Why should I get punished when I was just doing what everyone else was doing?” Another example is adultery—the adulterer may offer the excuse “everyone does it,” which means, therefore, that it is epidemiologically “normal.” The excuse is not “adultery is acceptable,” which would make the act epidemiologically normal, but rather that the actor's behavior is “normal,” conventional, or epidemiologically common irrespective of the morality of the act.

Similarly, some people may give cultural excuses. For example, throughout most First World countries, wife-beating is considered physical abuse that violates the law, ethics, and morals of society, but in other parts of the world it is viewed not only as acceptable but also as appropriate in certain circumstances.

Excuses and Justifications Related to the Act

One of the most common excuses in this category is to assert that the action was an accident or mistake. These two terms are often used interchangeably, but they are actually quite different. Accidents are defined as actions where there is an absence of intent, but a bad outcome. In contrast, mistakes involve the presence of intent and a bad outcome, but the bad outcome is the result of some error in information or in execution. Look at the following two examples.

In the first example, the distinction is clear. A client is referred for the evaluation and treatment of possible pyromania because there is a history of fire-setting.

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