Dr Mark Burgin BM BCh (oxon) MRCGP considers how immunising against guilty thoughts using the biopsychosocial model improves outcomes in criminal cases.
Mens rea is a central part of criminal law but Nick Ross at the RCGP conference explained that that guilty minds are a cultural phenomenon.
He explained that a guilty mind spreads from person to person as a thought or belief system that breaking the law is permitted or even mandatory in given circumstances.
Those accused of crimes frequently share their beliefs with their families, social groups and the area that they grew up in, so they form a cultural group.
Cultural groups that believe in honour will typically have more extreme responses than those that believe in the rule of law and they engage in more violent crime.
Understanding the way that an accused person thinks is critical to effective engagement with the legal system and avoidance of punitive responses.
The guilty mind as an infection
A child growing up in a high crime area will learn rules from their parents and friends and even experiences with the authorities that will shape their beliefs.
These beliefs are thoughts or explanations that permeate the cultural group like a virus and mutate at times becoming more virulent and causing flare ups of crime.
Typical beliefs are ‘you cannot trust the police’ ‘kill or be killed’ ‘if I am treated badly I should punish them’ ‘cannabis has benefits for health’.
Children are particularly susceptible and once infected with an idea can become unable to fight it off leading to maladaptive behaviours.
These maladaptive behaviours then cause a reinforcing response from the authorities and the society increasing the behaviour and giving evidence for the belief’s truth.
Guilt in the Justice system
When investigating a crime the police will find that many of the suspects have a guilty mind (rather than feeling guilty for doing the crime) and may be spoiled for choice.
The solicitor defending an accused may find their work is undermined by strongly held beliefs which appear to suggest that they did the crime, even when they were innocent.
There is no general policy to identify cultural viruses either in troubled communities or within the prison population and treatment is more miss than hit.
As a doctor I focus on whether a person has an unhelpful thought system rather than whether they are guilty of this particular crime.
This is a pragmatic approach because many past crimes go undetected and the risk of future crimes is increased by having a guilty mind.
Doctors are taught to have a neutral view of illness and not to blame the patient for having the illness and concentrate on finding solutions to the patient’s problems.
Treating the infection
As a doctor who assesses prisoners I have been surprised how many times after years or even decades the prisoner retains their guilty mind beliefs.
Therapeutic approaches based upon improving communication, increasing empathy for others, ABC (antecedent, behaviour and consequence) have had limited success.
Much of the work in prisons is treating the effects by releasing tension and reducing the isolation, alienation, and stress of prison life.
Fundamental change can only occur if the infection is identified and treated, treating the symptoms can lead to temporary improvements but recurs under stress.
True and long-term improvements only occur when the thought causing the problem is identified and an appropriate treatment is given.
The biopsychosocial model (BPSM) allows the doctor to identify the thought and provide simple options to the belief without challenging their culture.
The idea of a cultural virus that spreads crime like an infection was popularised by Nick Ross and the theory explains why many therapies for prisoners are found ineffective in preventing reoffending.
The GP using the biopsychosocial model (BPSM) has the potential to transform the lives of those at risk of or convicted of crimes.
The work is simple and typically takes an hour or two and does not cause significant stress making the intervention likely to be cost effective and acceptable.
Solicitors should be aware of this therapy and its potential to improve the chance of a successful outcome at any stage of the justice system pathway.
Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.
Dr. Burgin can be contacted firstname.lastname@example.org and 0845 331 3304 website drmarkburgin.co.uk
Nick Ross 2013 Crime, how to solve it and why almost everything we’re told is wrong