Papers by Susanna Radovic
MAD, SAD or BAD? Nedslag i svensk rättspsykiatrisk forskning -en festskrift till Anders Forsmans 70-årsdag
International Journal of Law and Psychiatry, 2022
This paper clarifies the conceptual space of discussion of legal insanity by considering the virt... more This paper clarifies the conceptual space of discussion of legal insanity by considering the virtues of the 'medical model' model that has been used in Norway for almost a century. The medical model identifies insanity exclusively with mental disorder, and especially with psychosis, without any requirement that the disorder causally influenced the commission of the crime. We explore the medical model from a transdisciplinary perspective and show how it can be utilised to systematise and reconsider the central philosophical, legal and medical premises involved in the insanity debate. A key concern is how recent transdiagnostic and dimensional approaches to psychosis can illuminate the law's understanding of insanity and its relation to mental disorder. The authors eventually raise the question whether the medical model can be reconstructed into a unified insanity model that is valid across the related disciplinary perspectives, and that moves beyond current insanity models.
Remissvar från Göteborgs universitet till betänkandet SOU 2012:17 Psykiatrin och lagen
Insiktsförmåga och uppsåt - en jämförande studie av begreppens funktion i rättspsykiatriska utlåtanden och domar
New Journal of European Criminal Law, 2020
This article provides a discussion about criminal insanity regulation in Norway, Sweden and the N... more This article provides a discussion about criminal insanity regulation in Norway, Sweden and the Netherlands, with a focus on the roles of legislators, judges and experts in the concretisation of the legal meaning of criminal insanity. The authors recognise that these three countries reflect different ideal type rule constructions that are interesting to study comparatively. The article addresses the following overall questions: To what extent and in what way do the different rule constructions also involve different views on the roles of legislators, judges and experts? And in case of competing models, which is the better solution? To investigate and eventually answer these questions, the authors analyse the content and legislative considerations of the relevant rules, how these rules are applied and understood by judges and experts, and how different understandings of insanity, of legislators, judges and experts, depend on each other. The authors show how the different rule constru...
Psychiatry, Psychology and Law, 2020
Previous research indicates that insight is frequently used but rarely defined in mental health p... more Previous research indicates that insight is frequently used but rarely defined in mental health proceedings. This article examines how participants in Swedish administrative court proceedings use the concept of insight when discussing decisions regarding involuntary psychiatric care. Open-ended qualitative interviews were conducted with professional mental health court participants. The results show that lack of insight is used by the informants as an argument for all three legal criteria for involuntary psychiatric care in Sweden, as well as the criterion for release from forensic psychiatric care. It is concluded that there are troublesome legal and ethical implications of courts relying on a poorly defined concept such as insight in their rulings.
Frontiers in Psychiatry, 2020
Background: Pharmacological treatment is of great importance in forensic psychiatry, and the vast... more Background: Pharmacological treatment is of great importance in forensic psychiatry, and the vast majority of patients are treated with antipsychotic agents. There are several systematic differences between general and forensic psychiatric patients, e.g. severe violent behavior, the amount of comorbidity, such as personality disorders and/or substance abuse. Based on that, it is reasonable to suspect that effects of pharmacological treatments also may differ. The objective of this systematic review was to investigate the effects of pharmacological interventions for patients within forensic psychiatry. Methods: The systematic review protocol was pre-registered in PROSPERO (CRD42017075308). Six databases were used for literature search on January 11, 2018. Controlled trials from forensic psychiatric care reporting on the effects of antipsychotic agents, mood stabilizers, benzodiazepines, antidepressants, as well as pharmacological agents used for the treatment of addiction or ADHD, were included. Two authors independently reviewed the studies, evaluated risk of bias and assessed certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). The literature search resulted in 1783 records (titles and abstracts) out of which 10 studies were included. Most of the studies included were retrospective and nonrandomized. Five of them focused on treatment with clozapine and the remaining five on other antipsychotics or mood stabilizers. Five studies with a high risk of bias indicated positive effects of clozapine on time from treatment start to discharge, crime-free time, time from discharge to readmission, improved clinical functioning, and reduction in aggressive behavior. Psychotic symptoms after treatment were more pronounced in
On the Abolition and Reintroduction of Legal Insanity in Sweden We would like to thank The Swedish National Board of Forensic Medicine for partly financing the empirical study described in this chapter, and Marianne Kristiansson, Peter Andiné and Olof Svensson for sharing their medical and psycho...
Legal Insanity and the Brain : Science, Law and European Courts
Mordiska sjölejon och marsianer – Om falska föreställningar och straffansvar
Idees Fixes a Festschrift Dedicated to Christian Bennet on the Occasion of His 60th Birthday, 2014
International Journal of Law and Psychiatry, 2015
Public Health Ethics, 2015
The vision of legendary criminologist Cesare Lombroso to use scientific theories of individual ca... more The vision of legendary criminologist Cesare Lombroso to use scientific theories of individual causes of crime as a basis for screening and prevention programmes targeting individuals at risk for future criminal behaviour has resurfaced, following advances in genetics, neuroscience and psychiatric epidemiology. This article analyses this idea and maps its ethical implications from a public health ethical standpoint. Twenty-seven variants of the new Lombrosian vision of forensic screening and prevention are distinguished, and some scientific and technical limitations are noted. Some lures, biases and structural factors, making the application of the Lombrosian idea likely in spite of weak evidence are pointed out and noted as a specific type of ethical aspect. Many classic and complex ethical challenges for health screening programmes are shown to apply to the identified variants and the choice between them, albeit with peculiar and often provoking variations. These variations are shown to actualize an underlying theoretical conundrum in need of further study, pertaining to the relationship between public health ethics and the ethics and values of criminal law policy.
Frontiers in Psychology, 2014
Mental health and international crimes
Criminological Approaches to International Criminal Law, 2014
This volume is one of the few books to explain in-depth the international crimes behind the scene... more This volume is one of the few books to explain in-depth the international crimes behind the scenes of substantive or procedural law. The contributors place a particular focus on what motivates participation in international crime, how perpetrators, witnesses and victims see their predicament and how international crimes should be investigated at local and international level, with an emphasis on context. The book engages these questions with a broad interdisciplinary approach that is accessible to both lawyers and non-lawyers alike. It discusses international crime through the lens of anthropology, neuroscience, psychology, state crime theory and information systems theory and draws upon relevant investigative experience from experts in international and domestic law prosecutions.
Investigating Depersonalization
Philosophy, Psychiatry, & Psychology, 2002
ABSTRACT Philosophy, Psychiatry, & Psychology 9.3 (2002) 287-288 The comments offered by ... more ABSTRACT Philosophy, Psychiatry, & Psychology 9.3 (2002) 287-288 The comments offered by Morris and Modigh in this issue give us an opportunity to clarify some of the views and topics discussed in our paper. One of Morris' objections is that we on some occasions characterize depersonalization complaints in a way that indicate delusion. Although one of the criteria of depersonalization syndrome is intact reality testing (APA 2000), it is nevertheless the case that patients with depersonalization complaints may at the same time be delusional, a fact that Modigh also points out: "The border between unreality feelings with largely intact reality-testing ability and psychotic disorders with grossly disturbed reality-testing is, however, not absolute and patients with psychotic disorders may of course experience feelings of unreality or depersonalization." Morris is also critical of the idea that feelings of unreality in the quasi-sensory sense (or in sense [a3]) may tempt patients to doubt the reality of the items experienced as unreal. We suggest that the experience of the self or the world as unreal may actually give rise to an impulse to believe that the self or the world does not exist. This, however, need not imply that a person who has such a belief is delusional. For example, consider the following cases, which include patients with intense unreality feelings but who exhibit largely intact reality testing. One of Sierra and Berrios' (2000) patients says: "I have to touch myself to make sure that I have a body and a real existence." Lindqvist (1966, p. 171) describes two cases of the "mirror syndrome," which he recognizes as a typical behavior seen in cases of severe depersonalization. The patients want to confirm that they are real by looking in a mirror. Such cases strongly indicate that a person with otherwise intact reality testing can be so overwhelmed by feelings of unreality that he or she can come to doubt his or her own existence. The reason we do not want to call this state delusional is that the patient constantly tries to compare the experience of reality with some other mark of reality (e.g., by using a mirror), thus indicating that, on a higher cognitive level, he or she still understands that his or her belief may be incorrect. The image in the mirror works as an assurance that the fear of not existing is, after all, just a fear. Merleau-Ponty's (1962) description of Stratton's inverting spectacles experiment is indeed relevant to our analysis. The experiment seems to indicate that the feeling of unreality corresponds to the degree of unfamiliarity with seeing the world upside down. Stratton's subjects report that after a couple of days objects still appear inverted but less unreal than they did before. This seems to suggest that unreal in this circumstance approximates not normal. An inverted world is after some time accepted as normal. (See also note 3 in our paper.) Let us conclude with a few comments on an important methodological issue. Our methodological approach is not equivalent with a classical ordinary language approach because our main concern is language use in psychiatric contexts. A classical ordinary language analysis aims to explicate how terms actually are used in everyday language; our primary concern is to try to understand the phenomenology underlying descriptions of felt unreality given by patients suffering from depersonalization. However, we do start by looking at the terms from an everyday angle, but this only gives us a coarse approximation of what the depersonalization patient may mean by such expressions. The strange and unpleasant phenomenology of the condition in combination with the variety of characteristic expressions make it likely that the role of unreal in connection with depersonalization complaints is quite different from its use in everyday language. When a person undergoes a depersonalization episode for the first time, he or she encounters a quite new and perhaps unexpected phenomenological reality. When the person attempts to describe these perplexing feelings he or she, naturally, uses terms found in everyday language, but the changed situation requires extensions of previous uses. Therefore, we think that the value of a classical ordinary language approach is quite limited in a psychiatric context. For...
Feelings of Unreality: A Conceptual and Phenomenological Analysis of the Language of Depersonalization
Philosophy, Psychiatry, & Psychology, 2002
Further, we focus on the two dominating criteria found in the literature on depersonalization, th... more Further, we focus on the two dominating criteria found in the literature on depersonalization, the feelings of unreality and the so-called as-if character. Two different uses of the phrase "I feel unreal" are made explicit in order to avoid conflation. The as-if element, which usually ...
A philosophical view on concepts in psychiatry
International Journal of Law and Psychiatry, 2010
This essay first outlines a philosophical theory of concepts and then applies it to two areas of ... more This essay first outlines a philosophical theory of concepts and then applies it to two areas of relevance to psychiatrists, especially forensic psychiatrists. In the philosophical theory, the respective roles of verbal and non-verbal definitions are illuminated, and the importance of the phenomenon of division of semantic labour is stressed. It is pointed out that vagueness and ambiguity of a term often result when the term is used for several practical purposes at the same time. Such multi-purpose uses of terms may explain both the current problems associated with the Swedish forensic-psychiatric concept of a severe mental disorder and some of the shortcomings of DSM-IV.
Accountability and psychiatric disorders: How do forensic psychiatric professionals think?
International Journal of Law and Psychiatry, 2009
Swedish penal law does not exculpate on the grounds of diminished accountability; persons judged ... more Swedish penal law does not exculpate on the grounds of diminished accountability; persons judged to suffer from severe mental disorder are sentenced to forensic psychiatric care instead of prison. Re-introduction of accountability as a condition for legal responsibility has been advocated, not least by forensic psychiatric professionals. To investigate how professionals in forensic psychiatry would assess degree of accountability based on psychiatric diagnoses and case vignettes, 30 psychiatrists, 30 psychologists, 45 nurses, and 45 ward attendants from five forensic psychiatric clinics were interviewed. They were asked (i) to judge to which degree (on a dimensional scale from 1 to 5) each of 12 psychiatric diagnoses might affect accountability, (ii) to assess accountability from five case vignettes, and (iii) to list further factors they regarded as relevant for their assessment of accountability. All informants accepted to provide a dimensional assessment of accountability on this basis and consistently found most types of mental disorders to reduce accountability, especially psychotic disorders and dementia. Other factors thought to be relevant were substance abuse, social network, personality traits, social stress, and level of education.
International Journal of Law and Psychiatry, 2009
Legal research in Sweden has traditionally focused on a systematization of the legal rules and th... more Legal research in Sweden has traditionally focused on a systematization of the legal rules and their practical application, while the task of studying the effects of the application of the laws has been handed over to other branches of the social sciences. In contrast, new legal theories focusing on proactive and therapeutic dimensions in law have gained increasing attention in the international arena. These approaches may be better suited for evaluating legislation governing compulsory psychiatric care. Theoretical discussions and studies of causal mechanisms underlying criminal behaviour, as well as the implementation and value of instruments for predicting behaviour, are relevant to contemporary criminological research. Criminal behaviour varies across different groups of perpetrators, and the causes can be sought in the interplay between the individual and social factors. Multi-disciplinary efforts, integrating research from forensic psychiatry, psychology, sociology, and criminology, would be beneficial in leading to a better understanding of the causes underlying criminal behaviour.
International Journal of Law and Psychiatry, 2009
Explanations for violent behaviour—An interview study among forensic in-patients
International Journal of Law and Psychiatry, 2014
The alleged relation between mental disorder and violent criminal behaviour has been investigated... more The alleged relation between mental disorder and violent criminal behaviour has been investigated mainly from an epidemiological perspective. Population-based registry studies have shown that violence occurs more frequently among people with mental disorders, like schizophrenia and bipolar disorder, compared with control subjects, but that the increased risk is largely mediated by drug abuse and socio-economic deprivation. The aim of this study was to explore how patients who have committed violent or sexual crimes and have been sentenced to forensic psychiatric care by a Swedish court of law construed their criminal actions in terms of causes. Forty-six participants from six different Swedish forensic psychiatric clinics were included in the study. A semi-structured interview study was conducted and the data was analysed using a thematic analysis. A large group of the participants did not believe that the mental disorder played any role in the criminal events. Contributing causes that were mentioned were drug abuse and social factors.
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Papers by Susanna Radovic