Abnormal Psychology

Ethical and Legal Issues 721

Researchers are developing ways to ensure that patients who may be cognitively

impaired by a psychological disorder adequately understand the benefi ts and risks

of their participation in research. For instance, Wirshing and colleagues (2005) de-

veloped an educational video to increase awareness about informed consent among

patients with schizophrenia. Among other points, the video explained that partici-

pants can withdraw from the study at any time. Researchers continue to develop

and assess methods to ensure that participants give truly informed consent to par-

ticipate in research (Eyler, Mirzakhanian, & Jeste, 2005).

Key Concepts and Facts About Ethical Issues

• Each type of mental health professional works under his or her
  own discipline’s ethical code; all disciplines include in their ethi-
  cal code the principle of confi dentiality, which applies to infor-
  mation that patients share with mental health professionals.


• Although the clinician is bound by confidentiality, patients in
  couples therapy, family therapy, and group therapy are not. When
  a patient is a minor, the clinician may inform the parents about
  what the child has said; however, most clinicians discuss the
  limits of confi dentiality with a child old enough to understand.


• Because of HIPAA, the limits of confi dentiality have been rede-
  fi ned. Now limited information about a patient may be shared
  with the patient’s other health providers in order to facilitate
  treatment.


• Although laws protect confidentiality, confidentiality may
  be violated against a patient’s wishes when a clinician has

reasonable cause to (1) suspect abuse of children, the elderly,

or the disabled or (2) believe that a patient is likely to do signifi -

cant harm to himself or herself (including attempting suicide) or

a specifi ed other person.

• The legal counterpart of the ethical principle of confi dentiality
  is privileged communication—the protection of confi dential in-
  formation from disclosure during legal proceedings; however, in
  some circumstances, other people can decide whether the infor-
  mation about a patient should be disclosed.


• Patients who have impaired cognitive processes because of
  a psychological disorder (such as schizophrenia) may be able
  to provide informed consent to participate in research if they
  can understand what they are consenting to and can reason
  about it.

Criminal Actions and Insanity

After Andrew Goldstein pushed Kendra Webdale in front of the oncoming subway

train, other passengers detained him until the police arrived. When taken to the

police station, he explained in a signed statement why he pushed her: “I felt a sen-

sation like something was entering me like a ghost or a spirit or something like

that.... When I have the sensation that something is entering me, I get the urge to

push, shove, or sidekick’’ (Rohde, 1999b).

Goldstein then said he “watched in ‘horror’” as the train ran over Webdale,

after which he is reported to have turned to the man next to him, “raised his arms

in the air and said, ‘I don’t know’” (Rohde, 1999b). When police came, he told

them he was a “‘psychotic patient’ who had suffered a ‘psychotic attack’” (Rohde,

1999b) and asked to be taken to the hospital.

Goldstein was arraigned on the charge of second-degree murder and then, per-

haps because he seemed to be mentally ill or because of his long psychiatric history,

he was taken to a hospital rather than taken to jail. As we shall see, if someone

who allegedly committed a crime was mentally ill during or after the criminal act,

jail may not be the appropriate place for that person to be. Moreover, treatment—

rather than detention—may be an appropriate goal for such a defendant’s immedi-

ate future. In this section we review the legal and clinical issues that arise after a

crime has been committed by someone who is mentally ill.

As discussed in Chapter 1, the term insanity is a legal term and is not used in

DSM-IV-TR. The legal concept of insanity addresses the question of whether a per-

son was, at the time he or she committed a crime, criminally responsible—which