Emotionally Triggered Involuntary Violent Behaviour Not Attributed to a Mental Disorder: Conceptual Criteria and Their Reliability
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Emotionally Triggered Involuntary Violent Behaviour not Attributed to a Mental Disorder: Conceptual Criteria and Their Reliability Pierre Mauritz Joubert Submitted in partial fulfilment of the requirements for the degree Doctor of Philosophy (Psychiatry) Supervisor: Prof C.W. Van Staden Department of Psychiatry School of Medicine Faculty of Health Sciences University of Pretoria July 2014 Acknowledgments I would not have been able to do this thesis on my own. People and institutions were involved who made it possible for me to complete the thesis. I dearly thank the following: Prof. C.W. Van Staden, my supervisor. He was a teacher, guide, and supporter during this endeavour. I am grateful that I could make use of his invaluable expertise and knowledge. Prof. J.L. Roos, Head of the Department of Psychiatry. His support as Head of Department made possible a space in which the research could be done. What he made available is broader than can be described. It included, but is not limited to, a motivation for a total of seven months study leave (which I took in periods) that proved very necessary to complete the thesis. The Faculty of Health Sciences of the University of Pretoria for allowing the doctoral thesis, approving a bursary to support it, for the use of its information resources, and allowing for study leave with remuneration. Ms. M.A. Mabena, Chief Executive Officer of Weskoppies Hospital. She ultimately made the study leave, which I had to take to complete the thesis, possible. Dr. G.P. Grobler, who was willing to act as Independent Evaluator for the five précis. The study participants: you know who you are. I appreciate your time, effort, and constructive criticism. My colleagues at Weskoppies Hospital, who supported me by lessening the official work-load from time to time and for standing in for my duties while I was on study leave. I also thank colleagues for their participation in the study and for their useful comments to me after their participation. A special word of thanks My wife, Dr. M.J. Jakuszko-Joubert, who was a friend and colleague during the years I worked on the thesis. Her love and support was invaluable. Ms. M. Lee, the information specialist of the Medical Library, who helped me find books and documents relevant to my research. I owe her even greater thanks for showing me additional ways of obtaining online documents through the University of Pretoria and assisting me with the correct abbreviations of journals. Ms. S. Gillmore, an information specialist of the Law Library, who helped me find cases of possible relevance to the study. Ms. L. Viljoen, also an information specialist of the Law Library, who helped me find cases of possible relevance to the study. Ms. J. Jordaan, the research consultant of the Departments of Statistics, who checked the data and operators of Part 2 of the study with me. Dr. L. Fletcher, the statistician of the Department of Statistics, who guided me through the statistical analysis of the data of Part 2 of the study. Mr. S. James, the departmental administrator, who showed me how to create an appropriate data sheet in Microsoft Excel for Part 2 of the study. My daughter, Ms. C.M. Joubert, who studied hard during her final year at school, thereby helping by setting my mind at ease. Last, but not least, my parents, the late Mr. G.M. Joubert and Mrs. L.N. Joubert who encouraged in me a desire to learn and study from a young age. i Contents List of Tables v Abstract 1 Chapter 1: Introduction and Overview 2 Background and Relevance 3 Overview of the Study 5 Chapter 2: Emotionally Triggered Involuntary Violent Behaviour and Automatism 8 Automatism: an Unclear Concept 10 Chapter 3: Methodology of the study of Emotionally Triggered Involuntary Violent Behaviour 13 Part 1: The Conceptual Component of the Study 13 Part 2: The Reliability Component of the Study 23 Chapter 4: Violent Behaviour in ‘ETIVB’ 37 Violent Behaviour in „ETIVB‟ is Defined by the Consequences of Physical Injury or Physical Damage 37 Violent Behaviour in „ETIVB‟ is Observable 39 The Features of Behaviour in ETIVB can be Described 40 Chapter 5: What Counts as ‘Emotionally Triggered’ in ‘ETIVB’? 42 How Emotions are Related to Stimuli in „ETIVB‟ 42 How Emotions are Related to Socio-Cultural Context in „ETIVB‟ 45 How Stimuli, Emotions and Behaviour are Related in „ETIVB‟ 47 Chapter 6: What is ‘Involuntary’ in ‘ETIVB’? 49 An Inability to Exercise „Control‟ or „Choice‟ as Necessary Qualities of „ETIVB‟ 50 „Involuntary‟ in Terms of „Cannot Be Helped‟, Willing, Unconscious Behaviour, and Memory 54 Comparing „Involuntary‟ in „ETIVB‟ with Other Forms of Involuntariness 56 Chapter 7: Recognising ‘ETIVB’ 61 Recognising „Violent Behaviour‟ in „ETIVB‟ 61 Recognising „Emotionally Triggered‟ in „ETIVB‟ 62 Recognising „Involuntary‟ in „ETIVB‟ 64 Indications of Having „Control‟ and „Choice‟ 70 Chapter 8: Formatting Criteria for the ETIVB-Instrument 73 The ETIVB-Instrument 73 Recording of whether Criteria Are Met or Not Met 79 Addendum B to Chapter 8 82 Addendum B to Chapter 8 88 Chapter 9: ‘ETIVB’ Attributed to Mental Disorder and Alike 90 Addendum A to Chapter 9 93 ii Chapter 10: Case Demonstration: Assessing Two Cases with the ETIVB-Instrument 95 Applying the ETIVB-Instrument to Sanders and Jacaranda 94.2 95 Attributive Considerations of ETIVB 104 Applying the ETIVB-Instrument to S v Campher 105 Chapter 11: Results of Assessing Study Cases with the ETIVB-Instrument 114 Results 114 Discussion 116 Chapter 12: Validity of the ETIVB -Criteria 127 Content Validity of the ETIVB-Instrument 127 Construct Validity of the ETIVB-Instrument 128 Face Validity of the ETIVB-Instrument 131 Chapter 13: Results of the Reliability Study 134 Demographic Data of Study Participants 137 Study Results 138 Discussion 159 Chapter 14: Summary and the Way Forward 173 The Way Forward 174 Testing the ETIVB-Instrument with a Larger Sample of Participants 180 Conclusion 180 Addendum A to Chapter 14 181 Addendum B to Chapter 14 184 Addendum C to Chapter 14 185 References 195 iii List of Tables Table 1: List of Study Cases and Whether Psychiatric Evidence was Given. 43 Table 2: Case with One Candidate Behaviour that Qualifies as ‘ETIVB’. 131 Table 3: Cases with One Candidate Behaviour that Does not Qualify as ‘ETIVB’. 132 Table 4: Cases with Multiple Candidate Behaviours that Do Not Qualify as ‘ETIVB’. 133 Table 5: Cases with One Candidate Behaviour with the ETIVB-Outcome Being Uncertain. 134 Table 6: Cases with Multiple Candidate Behaviours with the ETIVB-Outcome Being Uncertain. 135 Table 7: Ratings of Attributive Considerations in Sanders and Jacaranda 94.2. 135 Table 8: Study Cases for which the ETIVB-Criteria Were Not Met Compared with Court Verdict. 140 Table 9: Demographic Data for Participants Who are Qualified Psychiatrists. 146 Table 10: Demographic Data for Participants Who are Psychiatrists-in-training. 147 Table 11: Criterion Ratings of Sanders. 148 Table 12: Criterion Ratings of Dhlamini. 149 Table 13: Criterion Ratings of Mahlinza. 150 Table 14: Criterion Ratings of Gesualdo. 151 Table 15: Criterion Ratings of Campher. 152 Table 16: Uncorrected and Corrected I-Criteria Ratings by Case and Participant. 153 Table 17: Frequency of Criteria Ratings in Sanders Regarding the Requirements of ‘ETIVB’ Being Satisfied (n=25). 154 Table 18: Frequency of Criteria Ratings in Dhlamini Regarding the Requirements of ‘ETIVB’ Being Satisfied (n=25). 155 Table 19: Frequency of Criteria Ratings in Mahlinza Regarding the Requirements of ‘ETIVB’ Being Satisfied (n=25). 156 Table 20: Frequency of Criteria Ratings in Gesualdo Regarding the Requirements of ‘ETIVB’ Being Satisfied (n=25). 157 Table 21: Frequency of Criteria Ratings in Campher Regarding the Requirements of ‘ETIVB’ Being Satisfied (n=25). 158 Table 22: Frequency of Criteria Ratings in All Study Cases Combined Regarding the Requirements of ‘ETIVB’ Being Satisfied (n=125). 159 Table 23: Total Observed Agreement Uncorrected for Chance and Modified Fleiss’ kappa by Criteria Unit and Study Case. 160 Table 24: Degree of Agreement between Participants as Calculated by the Modified Fleiss’ kappa by Criterion Unit and Study Case. 161 Table 25: Derived Variable Values of Campher. 162 Table 26: Derived Variable Values of Dhlamini. 163 Table 27: Derived Variable Values of Mahlinza. 164 Table 28: Derived Variable Values of Gesualdo. 165 Table 29: Derived Variable Values of Sanders. 166 Table 30: Frequencies of Outcomes of Derived Variables by Case (n=25). 167 Table 31: Completion of Attributive Consideration of ETIVB in Cases where ETIVB-Criteria were Considered Satisfied 181 iv Abstract Emotionally triggered involuntary violent behaviour not attributed to a mental disorder: conceptual criteria and their reliability. This study conceptualised emotionally triggered involuntary violent behaviour (ETIVB), developed criteria for the identification of ETIVB, and examined their validity and reliability. South Africa criminal courts allow for a defence called “non-pathological criminal incapacity”. It refers inter alia to extreme emotional arousal triggering involuntary violent behaviour. This is usually called an “emotional storm” or a so-called “psychological blow automatism”. Psychiatrists are often called to give expert testimony in this regard, but there is no conceptual clarity or criteria upon which to base it. This difficulty is compounded by the requirement set by the criminal courts that the behaviour may not be attributed to a mental disorder (in this thesis the terms mental disorder and mental illness are used interchangeably). The first advance in obtaining clarity was afforded by focusing on the behaviour as distinct from 1) legal and jurisprudential considerations as well as 2) whether the behaviour is (not) attributed to mental disorder. The subsequent research questions driving the study were, “what counts as ETIVB?” In particular, what counts respectively as „emotional triggered‟, „involuntary‟, „violent‟, and „behaviour‟.