Guilty by Reason of Insanity: A Psychiatrist Explores the Minds of Killers

by Dorothy Otnow Lewis

But something seems to happen to these children, or to their doctors, when the children reach about five foot, two inches in height. The very same children that the doctors saw as hyperactive, or brain damaged, or borderline psychotic when they were, say, four foot, nine inches, now look different. Diagnoses change. Schizophrenia, ADHD, and organic dysfunction of one sort or another turn into conduct disorder. (The term conduct disorder is relatively new. Years ago, when Jonathan and I trained, the term for the same set of behaviors was unsocialized aggressive reaction; such is progress.) A look at the children’s charts will reveal in an instant that their symptoms or behaviors have not changed, just their size. They still hallucinate occasionally, or can’t sit still, or feel persecuted. In fact, just about every psychiatric disorder of childhood can manifest itself as a behavior problem. No matter. That is why so many children who arrive at Long Lane with the diagnosis of conduct disorder once suffered from other potentially treatable disorders. Unfortunately, there is no specific treatment for conduct disorder. As time goes on, the diagnostic metamorphosis continues. Adolescence progresses and the children get even bigger. Now age dictates diagnosis. Eighteen is the magic number that transforms the diagnosis of conduct disorder into antisocial personality disorder, or what used to be called sociopathic personality. Once again, nothing much about the patients has changed—...