One of the founding principles of any caring profession is to “do no harm.” Physically, we note the importance of a patient’s right to least restrictive treatment; mentally, we safeguard for adverse effects of whichever treatment option we choose to pursue; ethically, we hold the notion of doing no harm in high regard, alongside confidentiality and patient safety.
Despite all this, when mental illness and criminal activity coincide, the principle of doing no harm is often thrown to the wayside: the guiding principle is to first, incarcerate- harmful or not. Many mentally ill individuals are incarcerated without ever receiving serious treatment; as one 2014 study notes, “Approximately 20 percent of inmates in jails and 15 percent of inmates in state prisons have a serious mental illness. Based on the total number of inmates, this means that there are approximately 356,000 inmates with serious mental illness in jails and state prisons” (Torrey, Zdanowicz, Kennard et al.). In other cases, even acknowledging a patient’s mental health in a legal setting is seen as an “unwinnable” or risky tactic, one that could alienate them from juries (Reid, 2000). Most of us are familiar with these issues in forensic psychology.
And yet, there are also bizarre and troubling cases where mental illness isn’t ignored, but instead, invented as a result of treatment. Sometimes, this phenomenon can interact with the criminal justice system in unusual ways.
On page 234, our primary course text introduces a new term: iatrogenic, meaning “unintentionally caused by clinicians or practitioners themselves” (Bartol & Bartol, 2016). The term is generally used more broadly to describe any problem that arises as a result of a treatment. It was popularized in the field of biological sciences rather than behavioral ones, and stems from “Iatros” which means doctor or healer and “gennan,” which means “as a result” (Torrey, 2018). Therefore, the word literally means “as a result of a doctor.” It is used to describe everything from intentional malpractice to honest errors: any instance in which the founding principle of doing no harm has been ignored or unachieved while a patient is receiving care.
In our textbook, iatrogenic is used in reference to cases of DID (dissociative identity disorder) that are illegitimate- encouraged, perhaps unintentionally, by clinicians who are too suggestive with their diagnostic tools. Mistakenly believing that a patient has DID (or simply being overly sensitive to signs of this particular syndrome), a clinician may in fact guide them toward actually exhibiting symptoms that were not present beforehand.
This isn’t the only way that “false positives” can interact with the criminal justice system. Have you ever seen a television show in which a character suddenly remembers being the victim of a crime when they were a child? This popular plot device- seen recently in The Sinner (2017), for example- hinges on ‘recovered’ or ‘repressed’ memories: namely, the notion that traumatic events can result in dissociative amnesia, but that situationally-accessible memories may resurface one day with the right triggers.
Unfortunately, real-life cases that involve repressed memories aren’t so straightforward. The “Memory Wars” of the 1990s refers to the heated controversy surrounding the recovery of old memories, and whether or not these memories can be considered real (Patihis, Ho & Tingen, 2013). While some clinicians maintained their validity, other studies showed that you can implant fake “memories” via the power of suggestive interview techniques. When done on purpose, practitioners caused study participants to “remember” things which objectively never happened. When done on accident, the criminal justice repercussions can be significant.
One reason that the Memory Wars debate happened in the 1990s was as a reaction to the so-called ‘Satanic Panic’ of the 1980s, in which scores of childcare providers were accused (and sometimes convicted) of participating in religious sex cults that ritually abused young children. Eventually, these cases were dismissed and the whole episode was looked at largely as something similar to the prior Salem Witch Trials. And yet, the lives and careers of so many in the childcare industry were forever tarnished and destroyed.
When we think about doing no harm in the world of forensic psychology, it’s not enough to simply look at the negatives: the situations in which care was denied, or mental health issues were ignored (as in the case of mentally ill individuals who are incarcerated without treatment). We must also consider the false positives, in which suggestive forensic techniques can create problems that were never there to begin with. A false positive can lead to a false accusation, which in turn can lead to wrongful conviction.
Bartol, C. & Bartol, A. (2016). Criminal Behavior A Psychological Approach (11th ed.). Pearson.
Patihis, L., Ho, L. & Tingen, I. (2013). Are the “Memory Wars” Over? A Scientist-Practitioner
Gap in Beliefs About Repressed Memory. Retrieved from
Rousseau, D. (2018) Module 2 Lecture: What is Mental Illness? Accessed online December 5, 2018. https://learn.bu.edu
Torrey E. F., Zdanowicz M. T., Kennard A. D., et al. (November, 2014). How many individuals
with serious mental illness are in jails and prisons? Treatment Advocacy Center.
Torrey, T. (October 3, 2018). Iatrogenic Events During Medical Treatments: When something
meant to help causes a new illness or injury. Retrieved from