On November 7, the University of Utah S.J. Quinney College of Law hosted its annual Law Review Symposium, Legal Borders and Mental Disorders: The Challenge of Defining Mental Illness. The all-day event brought together nationally recognized experts in law and mental health to explore the difficulty of defining mental disorders, and the impact that this has on the law.
Questions explored at the symposium included: What counts as a mental disorder? Is it when your behavior is statistically unusual, when it impairs your functioning, or when others think it is antisocial? For clinical treatment and research, having reliable and discrete labels is critical, but how do these labels function in law? Should the law rely on the same diagnoses as psychiatrists do? Doesn’t the law value very different things?”
Participants in the symposium explored psychiatric diagnosis and its impact on criminal sentencing and civil commitment, education and health benefits, as well as how the system may change in the future. The current manual is called the Diagnostic and Statistical Manual (or, “DSM”) and is developed by the American Psychiatric Association for clinical use. The most recent version of the DSM was published in May of 2013, and marked the first substantial revision to the manual in over 30 years.
Symposium organizer Teneille Brown noted that to many judges and attorneys, a mental disorder is not “real” if it is not in the DSM, and in fact being diagnosed with a recognized DSM disorder is often a prerequisite for receiving legal entitlements and protections, such as disability determinations, health insurance coverage, or even mitigation at sentencing. Despite warnings in the manual itself that it should not be used for forensic purposes, the most recent authors of the manual welcomed input from legal consultants, recognizing that indeed, the DSM is often the only thing upon which courts rely. As Brown puts it, “Much hinges on the changes contained in this recent edition.”
The symposium keynote speaker was Professor Elyn Saks, Orrin B. Evans Professor of Law, Psychology, and Psychiatry and the Behavioral Sciences at the University of Southern California Gould School of Law. Her address can be viewed here: http://law.utah.edu/video/0_5q6np53g. The symposium began with Dr. Jan Terpstra, a member of the psychiatry faculty at the University, introducing participants to the history of the DSM and how it is used in clinical practice. The first legal session of the symposium featured Rebecca Johnson, a Ph.D candidate at Princeton, presenting her research on the factors affecting access to autism benefits and their interaction with changes in the DSM; and Professor Stacey Tovino, the Lincy Professor of Law and Lehman Professor of Law at UNLV, framing a comprehensive picture of how changes in diagnostic categories may affect legal qualification for health benefits. Next, Professor Sara Gordon, also from UNLV; Professor Michael Perlin, from New York Law School; and Nancy Haydt, a defense attorney specializing in representing defendants with mental disabilities, explored the role of psychiatric diagnoses in Civil Commitment and Sentencing. Finally, Professor Jennifer Bard, the Alvin Allison Professor of Law at Texas Tech University, and Professor Brown challenged the ethical and legal implications of revolutionizing what has come to be understood as the “psychiatric Bible.” These panels can be viewed here: http://www.law.utah.edu/event/law-review-symposium-2014-2/ .