Can we diagnose a suspect?

[Colin Roberts]

No sufferer of OCD would be able to tolerate any interruption of their ritual, and very likely would not leave, even under threat of discovery. Nothing else would matter but finishing what he meant to do.

Fallacy!

[lynn cates]

the crimes

Hello Scott.

"We can't even be sure of the nature of the crimes. Each one was different."

No argument here.

Cheers.
LC

[Scott Nelson]

4. We can't even be sure of the nature of the crimes. Each one was different.

[Errata]

Thank you, though I have to confess my intention was not to write beautifully. I think that quite a bit of this mystery is paradoxical. Building a case against a suspect without a shred of evidence. Compiling a victim pool when no two people agree on what the essential feature of a Ripper killing is. Diagnosing a suspect when it can't be done. Determining the veracity of witness with no fact to back them up. It is all fruitless endeavor, and yet it has value. Can we solve the case doing it? I have no idea. Probably not. But our research can add to the body of knowledge of the era. Our observations of behavior could be different enough to challenge what it is we are supposed to look for. We can educate people, even one at a time on issues that affect humanity today. We can elevate, we can reveal, we can turn things upside down, we can learn to think differently. Which to me is far more remarkable than solving a case, even one of such renown.

Through this one case we have the ability to learn about problems that still affect us. Poverty, prostitution, mental illness, domestic violence, all of it. And it is a hard person indeed who can come on this board and argue for justice for the "unfortunates" targeted by Jack, and then see a prostitute on the street of their city and dismiss them as some sort of oversexed addict. We know these women. They weren't "mere" whores. They were people. That changes us. Examining the lives and the behavior of the Whitechapel prostitutes is highly unlikely to lead to a break in the case. But knowing their lives leads to sympathy for anyone who shares their occupation. And I think a thorough knowledge of mental illness can do the same. Someone who knows schizophrenia is not going to back away in fear when they meet one. Someone who understands Bipolar will not sit idly by while people make fun of someone who suffers from it. And no one who even a little gets OCD will taunt someone with the disorder by purposefully triggering their rituals. And yes. A thorough understanding of what people in asylums or on the streets faced is unlikely to produce the killer. But it's not impossible. And more importantly, it lets people argue with knowledge about mental illness, and it creates compassion. This case is, for many, an intellectual exercise. But it can be uplifting if we treat all of the facets of this time period with respect, and strive to learn the truth. Not just their truth in 1888, but the truth now, and the truth that doesn't change.

Or to put it in a very simple way, any one of us on these boards can give a bunch of reason why a prostitute does not deserve scorn. But for the mentally ill, if I take away the option of responding that they do not deserve scorn because it isn't their fault they are sick, how many people can come up with another reason? I can think of 10. But I'm invested. I think everyone should be able to think of ten. Because I guarantee you that your perception of a what a mentally ill person can or cannot accomplish will change. And in a case that figures such people as Isenschmidt, Levy, Cohen, Kosminski, Druitt, it matters a great deal what they could or could not have accomplished.

Win/win I think. Understand the case, understand your fellow man.

[Mr Stu]

Beautifully written there, if I may say, and so correct on many levels.

[Errata]

Short answer?
God no. Not even a little.

And I admit, it drives me crazy when people whip out a section of the DSM-IV to assign a disease to someone who lived 130 years ago. There are three major problems to trying to categorize anyone from this remove.

First of all, we can't be sure of the symptoms. We don't know what was observed, what was assumed, what was reported. Mania in 1888 is not mania now. Same word, same general tone, but completely different meanings. And there is an aspect of mental illness that doesn't get a lot of discussion. A good portion of mental illness is cultural. Many symptoms are behaviors that are outside of the cultural norm. Some things remain the same. Cannibalism for instance. Not okay then, not okay now. Many do not. Women enjoying sex was thought to be a symptom of mental illness. Rape was not. Substance abuse was not. Non weapon oriented violence was not. Masturbation of any frequency was considered a symptom of mental illness, as was homosexuality (though lesbianism was legally a myth). It's all cultural, all dependent upon what was considered normal behavior at the time. So any symptom listed might simply be a natural expression, but because it was considered a symptom then, we assume that it refers to some kind of obsession or compulsive excess, when in reality it was perfectly normal.

The second problem is that diagnosing a patient is not simply a matter of Opening the DSM-IV and picking what fits. It is one part science, one part art, and one part sheer luck. Anyone who has been through the mental health evaluation process knows that they will pick up about seven or eight different diagnoses along the way. A lot of things look like a lot of other things. I have been tested for autism nine times. I'm not autistic. My brain works differently, either because it just does, or because I was medicated before puberty and my brain rewired. I was in the running for major depressive disorder, childhood onset bipolar II, anoxia related brain damage, childhood onset schizophrenia, attention deficit disorder, and temporal lobe epilepsy for about 10 years. It wasn't until I was through puberty that they could get accurate scans of my brain to rule some of them out. And after than it was just total guesswork. They treated me for everything I remotely qualified for until they found something that worked, which was Lithium, a bipolar medication. But generally, the decision was based on a very strict interpretation of Bipolar, which states that you only ever need one manic episode to qualify. And I had one. Just one. No doctor upon a single meeting or even having my entire file would have diagnosed me Bipolar. It took years. I have a very atypical presentation. But it is Bipolar. One part blind luck.

Lastly, the only hope we have of a diagnosis for someone we can't observe is a classic presentation. And of course, about half of the people with mental illnesses do not present classical symptoms to their disease. People think "oh delusions. That's Schizophrenia". No. It could be, that's classic. But it could be Bipolar, Mania, PTSD, Anxiety disorders, Substance abuse, OCD, body dysmorphia, Depression, about 12 others. And I can think of about six other causes of delusions that have nothing to do with mental illness. That can happen to anyone. But even with classical presentation, most people don't what symptoms have to be present, or what symptoms have to be absent in order to make an accurate assessment. Delusions and hallucinations without cognitive processing issues is probably not Schizophrenia, no matter how much it looks like Schizophrenia. It is a structural disorder, and a Schizophrenics brain is collapsing on itself. If there is no cognitive deterioration, it's something else. If a person is prevented from doing some ritualized action, like hand washing, and they don't absolutely freak out, it's not OCD. It's just a habit. If a person describes themselves as being intensely sad, they probably aren't depressed. Depression feels like a fog, everything is dull and lifeless, the world is an uninteresting shade of gray. It's the memory of feeling that makes depressed people sad. We weep over it the way someone mourns a lost limb. But we always return to tired, disinterested, unmotivated. Not sad.

So we can't diagnose these people. Should we even try?
Maybe.

In a lot of ways, it matters. A schizophrenic has a timeline that is different from other mental illnesses. It's cyclical, with people coming in and out of delusion. But most importantly, over time they lose executive function. During times of stress, a Schizophrenic is more likely to become less functional, same with OCD, or someone who is depressed. But stress boosts mania, triggers the hyper awareness of PTSD, causes Bipolar people to rapid cycle, giving them more chances to become in fact very alert. Hallucinations can be ignored. It s much harder to fight a delusion. Certain mental illnesses lend themselves better to violence. Some prohibit organized behavior. Some even severely limit life expectancy.

I have said on any number of occasions that I don't think Jack the Ripper was schizophrenic. So for me, identifying a Schizophrenic suspect would take him out of the running. Severe OCD is also an unlikely candidate. No sufferer of OCD would be able to tolerate any interruption of their ritual, and very likely would not leave, even under threat of discovery. Nothing else would matter but finishing what he meant to do.

Me, I can sling around diagnoses all day long. I was a psych major, I've had to work with psychological assessments and profiles for most of my working life, and seeing a shrink for 30 years doesn't hurt. And there are other who have worked in the field who are on this site who have made very coherent assessments of various individuals. I think it's a useful debate. And I think that it's a debate that anyone can join in on, as long as they are willing to learn. I'm not always right. I know some stuff, but I don't know everything. I've been corrected any number of times on any number of subjects. I'm willing to be guided, and I'm willing to let the voices of greater experience shape my opinion. I hope that other will allow me to impart my knowledge.

Basically, I know mental illness. Intimately. And I'm fine. But it doesn't work they way a lot of people think it works. And if you are going to understand a possibly mentally ill suspect or killer, you have to understand the symptoms, possibly the disease, and you have to understand how it works. It's not Jekyll and Hyde. It's not like being wasted. It's not Toon Town (who doesn't love a Roger Rabbit reference?) It's complicated, and it's simple. Binary and infinitely complex. Life altering and a footnote. The brain is a strange and wonderful creation. When it works it's a thing of beauty. When it doesn't, there is also a kind of beauty. If you can put yourself in the shoes of someone with a mental illness, you can see the obstacles that need to be removed, the conditions that have to apply, and the vastly complicated array of emotions that goes with it. It can't be written off as abnormal. It's a different way of being, and they are ways that not only deserve respect, but empathy. If you call someone Schizophrenic, you have to be willing to feel sorrow at the loss of control, wonder at the way personality is expressed even in delusion, respect for moving through one world while living in another. In other words, if you are going to label someone as something that society deems ugly, be willing and able to see the beauty. Because it's always there.