One of the puzzles of psychiatry is the issue of how to psychatrically assess the patient who is in a correctional setting.

The difficulty is enhanced by the vague definition of the two diagnoses peculiar to the correctional population - Anti Social Personality disorder, and psychopathy.

The former is a diagnosis in the DSM IV, and the latter is not broadly accepted as a diagnosis by insurance companies.

This emphasizes one of the difficulties of correctional psychiatry.

The first difficulty is that the subject has no devoted group of psychiatrists.

This is in part a consequence of the stigma of the subject -- not too many psychaitrists wish to emphasize that this is a field deserving of scientific attention. But it is. A large portion of the public psychiatric population (patients who are reliant on public disbursements to cover the cost of care) are in prisons and jails.

Taking care of them psychiatrically is a not inconsiderable task.

Does an illegal act in and of itself consitute a psychiatric symptom ? It is hard to make the argument that it does, so the determination of the DSM IV that illegal acts are a sign of Anti Social Personality Disorder does not lead us to a psychaitric diagnosis that allows for accuracy in diagnosis.

In other words, a diagnostic criteria draws its validity from the capacity for improvement in resolution of diagnosis with better detection.

However, certainly, many illegal acts are evidence of loss of function. It is the specific loss of function which constitutes a sign of psychiatric illness. So it is how the crime comes to be commited that allows us to provide a diagnosis.

The relationship between crime and classic psychiatric illness, thus, remains to be delineated. One presumes that this would be one of the first tasks of any collegium of correctional psychiatrists.

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