PsychPearls by Psychiatric Times

57: Treating ‘Morally Objectionable’ Patients

Sep 24, 2021

Dr. James L. Knoll IV, a forensic psychiatrist, discusses treating inmates and morally objectionable patients in the US criminal justice system. The topics explored in this podcast include social hierarchies in prisons contributing to psychiatric illnesses, high prevalence of bipolar disorder and schizophrenia among inmates, the challenges of treating patients in prisons vs jails, the role of mental health courts in improving care, and the difficulties of treating patients with psychopathy or antisocial personality disorders.

13:37

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Episode guests

James L. Knoll IV

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Quick takeaways

Morally objectionable patients in the criminal justice system require psychiatric care despite being shunned by other inmates and occupying the lowest social hierarchy within prison.

Correctional settings have a higher prevalence of psychiatric disorders like schizophrenia and bipolar disorder, which can be exacerbated or induced by the prison environment.

Deep dives

Understanding Morally Objectionable Patients

Morally objectionable patients, typically found in the criminal justice system, are individuals who elicit strong negative reactions due to their actions. These patients often occupy the lowest social hierarchy within prison, including sex offenders of children. Despite their objectionable nature, they receive psychiatric care as they are shunned by other inmates and require treatment for their mental illnesses.

Introduction

2min

Understanding the Social Hierarchy and Mental Illness in Corrections

2min

The Psychological Effects of Prison Environments on Inmates

4min

Understanding the Relationship Between Serious Mental Illness and the Correctional System

2min

Challenges and Treatment of Morally Objectionable Patients

3min

Psychiatrists are not strangers to difficult and even potentially dangerous patients, but James L. Knoll IV, MD, has made these populations one of his specialties. With decades of experience in forensic psychiatry, Knoll takes listeners deep into the US criminal justice system, where he treats both inmates suffering from detention-related psychiatric disorders and an especially challenging group that he has dubbed morally objectionable patients.

In this conversation, Psychiatric Times and Knoll cover:

1. What he means by the term morally objectionable patients.

2. How prisons’ strict social hierarchies can contribute to psychiatric illnesses.

3. The high prevalence of bipolar disorder and schizophrenia in corrections—and their potential causes.

4. The different challenges of treating patients in prisons vs jails.

5. Why inmates with psychiatric illnesses end up in the correctional system for longer than those without psychiatric illnesses.

6. The role of mental health courts in improving psychiatric care in the correctional system.

7. The challenges of treating patients who are high in psychopathy or have anti-social personality disorders.

This is the first half of the Psych Pearls podcast with Dr Knoll. Stay tuned for the second half later in the week.

Dr Knoll is professor of psychiatry and director of forensic psychiatry at SUNY Upstate Medical University in Syracuse, New York, and clinical director of Central New York Psychiatric Center in Marcy, New York. He is Emeritus Editor-in-Chief of the Psychiatric Times and President-elect of the American Academy of Psychiatry and the Law (2022-23).

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PsychPearls by Psychiatric Times

57: Treating ‘Morally Objectionable’ Patients

Episode guests

Podcast summary created with Snipd AI

Quick takeaways

Deep dives

Understanding Morally Objectionable Patients

Psychiatric Conditions in Correctional Settings

Unique Challenges and Treatment for Morally Objectionable Patients

Remember Everything You Learn from Podcasts