Forensic Neuropsychopathology and Advanced Initiatives

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Experts continue to examine the complicated relationship between severe mental illnesses and criminality. To be clear, a severe psychiatric condition diagnosis does not automatically constitute a predisposition to violent or criminal behavior. Researchers have attempted to determine the actual relationship between the two. For instance, Halle et al. (2020) and Lu and Temple (2019) suggest there is no statistical significance between mental illness and crime, and no apparent correlation between mental health symptomologies and gun violence, respectively. Researchers such as Varshney et al. (2016) and Fisher and Liberman (2013) support that there are more negative perceptions and assumptions about the linkage between mental illness and criminality than actual reality. And Elbogen et al. (2016) have identified genetic, environmental, and dispositional factors that have been known to increase susceptibility to potential violence or criminal behavior, rather than mental illness.

We struggle to move past the notion that mental health conditions are linked to crime, especially as there have been increased mass shootings throughout the United States, with the perpetrator having a history of mental illness in most cases. Ghiasi et al. (2023) and Knoll and Annas (2016) purported that significant media attention highlights such atrocities and sensationalizes the perpetrators and their backgrounds, blurring the lines between criminality and mental health, especially when suspects' mental health history is heavily reported. Nonetheless, emerging research highlights that not only is there a clear relationship, but severe disorders with long-term effects have also been linked to criminal behavior and violence. According to Thornicroft (2020), “higher rates of violence perpetration have been identified among people with specific types of severe mental illness, particularly schizophrenia and bipolar disorders.”

My own recently published research identified posttraumatic stress disorder (PTSD), mild traumatic brain injury (mTBI), and depression comorbidities as the leading severe neuropsychopathologies diagnosed among military veterans exposed to combat and trauma, with PTSD and depression as the neuropsychopathological implicators of committing violent crimes (Chouraeshkenazi, 2023). My work also acknowledged that severe neuropsychopathological symptoms modify cortical areas of the brain—notably, altered frontal lobes and anterior prefrontal cortex regions, which can significantly impact cognitive functioning and potentially cause cognitive impairment. This is essential when understanding how cognitive impairment can transform one’s behavior, actions, and emotional and mental state, especially when considering competency and sanity.

Other researchers agree that there needs to be more evidence of this relationship, which requires more unprecedented analyses to provide definitive information. Nonetheless, there is a direct correlation (Chouraeshkenazi, 2023; Ghiasi et al., 2023; Dean et al., 2013) between long-term or severe mental illnesses (i.e., neuropsychopathologies) and criminal behavior that warrants mental health professionals to continue studying the causal link to improve mental healthcare practices. This will provide further diagnostic clarification of mental disorders and streamline treatment planning. Therefore, to improve advanced initiatives in clinical neuropsychology, forensic neuropsychopathology is the emerging discipline that can revolutionize clinical neuropsychology, medicine, and modern medical treatment.

Forensic Neuropsychopathology

Forensic neuropsychopathology merges forensic psychology and clinical neuropsychology to study mental health disorders in a legal context (Chouraeshkenazi, 2023). It is the study of how brain functioning (or cognitive performance) relates to criminal behavior. It involves assessing mental states for legal proceedings and addressing issues like competency and criminal responsibility. As the field continues to emerge, forensic neuropsychopathologists will work with forensic psychologists and other mental health and medical professionals to offer expert insights and evaluations within the legal system. This includes the civilian and military justice systems. The field's multidisciplinary approach aims to understand the interplay between neurological factors and criminal behavior within the context of forensic and neuropsychopathological evaluations.

The subspecialty focuses on the relationship between brain dysfunction and cognitive and criminal or deviant behavior. There are two essential components of forensic neuropsychopathology:

• It involves the assessment and evaluation of cognitive, behavioral, and emotional impairments caused by neurological or neuropsychological conditions such as brain injuries (e.g., traumatic brain injury), major or mild neurocognitive disorders (e.g., dementia, Alzheimer’s disease), or tumors (e.g., cancer) that may predispose one to criminal behavior.

• Licensed or specialized professionals in neuropsychology conduct neuropsychopathological evaluations, while medical professionals use brain imaging techniques to evaluate neurological dysfunction in criminal populations. This can detect disorders causing cognitive or behavioral impairment. Also, such evaluations and imaging can identify deficits that can be improved through specialized treatment.

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Findings can have crucial implications in legal settings for competency to stand trial, sanity/insanity evaluations, determining brain-based mitigating factors during sentencing, and identifying appropriate rehabilitation plans. Also, there is a focus on differential diagnosis to distinguish neurocognitive disorders that contribute to criminal behavior compared to malingering (i.e., faking symptomologies for secondary gain).

Improving Initiatives in Clinical Neuropsychology With Forensic Neuropsychopathology

The objective of forensic neuropsychopathology is to promote the connection of justice-involved persons with neurological or neuropsychological impairments with appropriate rehabilitation and related services to address the underlying neurocognitive deficits connected to behavior. Forensic neuropsychopathology involves a specialized neuropsychological evaluation of criminal offenders to provide brain-based perspectives on competencies and mental state and to guide case dispositions and planning of neurorehabilitation.

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Again, it is also critical to understand the various factors that may influence human behavior and criminality when mental health crises have upsurged the nation's hospitals and mental health facilities over the last three-plus decades. Metzl et al. (2021) expressed that a better understanding of this phenomenon is based on a four-part strategy, with researchers disregarding "lone wolf" theories; scruntinizing the association of violence, mental illness, and racial bias; better conceptualizing firearm access in relation to gun violence; and providing effective policies and interventions to reduce violence. Also, Appelbaum (2019) emphasized that many of us who are interested in better understanding the relationship between severe mental illness and criminality are conducting systematic reviews or meta-analyses. In addition, with an informational gap in this innovative field, pre-existing studies are becoming obsolete, leading to a recycling process of the same work with the same results; also, there are limited novel solutions and we have yet to present more to jumpstart the process of finding new data.

Therefore, it is vital to contribute more original and clinical research into forensic neuropsychopathology, the legal system, other psychiatric disciplines, and medicine to better understand this phenomenon; further, it is imperative to improve the multidisciplinary approach by working with medical providers, forensic neuropsychological mental health professionals, and justice administrative leadership to expand more knowledge within the criminal justice system and create modern initiatives within the field while requiring method standardization in research.