Abstract
John Monahan’s The Clinical Prediction of Violent Behavior (1981) represents a critical moment in the development of modern risk assessment among mental health providers in the United States. Monahan made the case for short-term prediction in emergency contexts, shifting the focus from a determination of innate dangerousness to managing risky situations. While his original goal was to assist clinicians called upon by the legal system to assess a person’s dangerousness, risk assessment soon became part of daily practice in the post-deinstitutionalisation world. For psychiatrists, it resonated with the growing focus on risk factors as modifiable targets in healthcare. It was also part of the process by which the state reconfigured its approach to the management of disruptive individuals during the late twentieth-century turn toward neoliberalism. It remains unclear whether the benefit to public safety gained by risk assessment’s integration into mental healthcare outweighs its costs, particularly with respect to the time and energy necessary to help patients achieve a meaningful recovery.
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Notes
- 1.
John Monahan, The Clinical Prediction of Violent Behavior (Washington, DC: Government Printing Office, 1981).
- 2.
Author’s interview with John Monahan (11 May 2016); Monahan, “Predictions of Violence,” in The Roots of Modern Psychology and Law: A Narrative History, eds. Thomas Grisso and Stanley L. Brodsky (New York: Oxford University Press, 2018), 147–48.
- 3.
Charles Rosenberg, “The Crisis of Psychiatric Legitimacy: Reflections on Psychiatry, Medicine, and Public Policy,” in American Psychiatry: Past, Present, and Future, eds. George Kriegman, Robert D. Gardner, and D. Wilfred Abse (Charlottesville: University Press of Virginia, 1975), 135–48.
- 4.
Michael E. Staub, Madness Is Civilization: When the Diagnosis Was Social, 1948–1980 (Chicago: University of Chicago Press, 2011), 67–87. See also Matthew Gambino, “Erving Goffman’s Asylums and Institutional Culture in the Mid-Twentieth-Century United States,” Harvard Review of Psychiatry 21, no. 1 (2013): 52–57.
- 5.
Gerald N. Grob and Howard H. Goldman, The Dilemma of Federal Mental Health Policy: Radical Reform or Incremental Change? (New Brunswick, NJ: Rutgers University Press, 2006), 47–53.
- 6.
Gerald N. Grob, “The Attack of Psychiatric Legitimacy in the 1960s: Rhetoric and Reality,” Journal of the History of the Behavioral Sciences 47, no. 4 (2011): 407–9.
- 7.
Bruce J. Ennis and Thomas R. Litwack, “Psychiatry and the Presumption of Expertise: Flipping Coins in the Courtroom,” California Law Review 62, no. 3 (1974): 693–752.
- 8.
Judith Lynn Failer, Who Qualifies for Rights? Homelessness, Mental Illness, and Civil Commitment (Ithaca, NY: Cornell University Press, 2002), 71–87.
- 9.
Paul S. Appelbaum, Almost a Revolution: Mental Health Law and the Limits of Change (New York: Oxford University Press, 1994), 17–29. For the broader context of reform through litigation, see Murray Levine, The History and Politics of Community Mental Health (New York: Oxford University Press, 1981), 113–39.
- 10.
Julilly Kohler-Hausmann, Getting Tough: Welfare and Imprisonment in 1970s America (Princeton, NJ: Princeton University Press, 2017), 216–21, 231–49, 258–75; Ruth Wilson Gilmore, Golden Gulag: Prisons, Surplus, Crisis, and Opposition in Globalizing California (Berkeley: University of California Press, 2007), 88–90.
- 11.
Henry J. Steadman and Joseph J. Cocozza, Careers of the Criminally Insane: Excessive Social Control of Deviance (Lexington, MA: D. C. Heath, 1974). See also Harry L. Kozol, Richard J. Boucher, and Ralph F. Garofalo, “The Diagnosis and Treatment of Dangerousness,” Crime and Delinquency 18, no. 4 (1972): 371–92; Henry J. Steadman, “A New Look at Recidivism Among Patuxent Inmates,” Bulletin of the American Academy of Psychiatry and the Law 5, no. 2 (1977): 200–9; Joseph E. Jacoby and Terence P. Thornberry, The Criminally Insane: A Community Follow-up of Mentally Ill Offenders (Chicago, IL: University of Chicago Press, 1979); Cocozza and Steadman, “The Failure of Psychiatric Predictions of Dangerousness: Clear and Convincing Evidence,” Rutgers Law Review 29, no. 5 (1976): 1084–1101.
- 12.
“American Psychiatric Association Task Force on Clinical Aspects of the Violent Individual,” Clinical Aspects of the Violent Individual (Washington, DC: American Psychiatric Press, 1974); American Psychological Association Task Force on the Role of Psychology in the Criminal Justice System, “Report of the Task Force on the Role of Psychology in the Criminal Justice System,” American Psychologist 33, no. 12 (1978): 1099–1113. Monahan chaired the latter group.
- 13.
Alan A. Stone, “The Tarasoff Case and Some of Its Progeny: Suing Psychotherapists to Safeguard Society,” in Law, Psychiatry, and Morality: Essays and Analysis (Washington, DC: American Psychiatric Press, 1984), 161–64; Appelbaum, Almost a Revolution, 71–113.
- 14.
Marc F. Abramson, “The Criminalization of Mentally Disordered Behavior: Possible Side-Effects of a New Mental Health Law,” Hospital & Community Psychiatry 23, no. 4 (1972): 101–5.
- 15.
John Monahan, “The Psychiatrization of Criminal Behavior: A Reply,” Hospital & Community Psychiatry 24, no. 2 (1973): 105–7.
- 16.
John Monahan, “The Prevention of Violence,” in Community Mental Health and the Criminal Justice System, ed. John Monahan (New York: Pergamon Press, 1976), 13–34.
- 17.
Tarasoff v. Regents of the University of California, 551 P.2d 334 (Cal. 1976).
- 18.
Author’s interview with Monahan; Monahan, “Predictions of Violence,” 149. On Rosenhan’s classic experiment and its impact, see Staub, Madness Is Civilization, 178–79, 182–83, 186.
- 19.
John Monahan, “The Prediction of Violence,” in Violence and Criminal Justice, eds. Duncan Chappell and John Monahan (Lexington, MA: Lexington Books, 1975), 15–31; Monahan and Leslie Cummings, “The Prediction of Dangerousness as a Function of Its Perceived Consequences,” Journal of Criminal Justice 2, no. 3 (1974): 239–42; Monahan and Gilbert Geis, “Controlling ‘Dangerous’ People,” Annals of the American Academy of Political and Social Science 423, no. 1 (1976): 142–51; John Monahan and Gloria L. Hood, “Psychologically Disordered and Criminal Offenders: Perceptions of Their Volition and Responsibility,” Criminal Justice and Behavior 3, no. 2 (1976): 123–34; John Monahan, “John Stuart Mill on the Liberty of the Mentally Ill: An Historical Note,” American Journal of Psychiatry 134, no. 12 (1977): 1428–29.
- 20.
Monahan, “Predictions of Violence,” 148; John Monahan, “Dangerousness and Civil Commitment,” in Committee on the Judiciary, United States Senate, Reform of the Federal Criminal Laws (Washington, DC: Government Printing Office, 1974), 7083–93.
- 21.
Author’s interview with Monahan.
- 22.
Monahan, Clinical Prediction of Violent Behavior, v.
- 23.
Henry J. Steadman and Joseph P. Morrissey, “The Statistical Prediction of Violent Behavior: Measuring the Costs of a Public Protectionist Versus a Civil Libertarian Model,” Law and Human Behavior 5, no. 4 (1981): 263–74; Henry J. Steadman et al., “From Dangerousness to Risk Assessment: Implications for Appropriate Research Strategies,” in Mental Disorder and Crime, ed. Sheilagh Hodgins (Thousand Oaks, CA: Sage, 1993), 39–62.
- 24.
Author’s interview with Monahan.
- 25.
Nikolas Rose, “Governing Risky Individuals: The Role of Psychiatry in New Regimes of Control,” Psychiatry, Psychology, and the Law 5, no. 2 (1998): 179. See also Robert Castel, “From Dangerousness to Risk,” in The Foucault Effect: Studies in Governmentality, eds. Graham Burchell, Colin Gordon, and Peter Miller (Chicago, IL: University of Chicago Press, 1991), 177–95.
- 26.
Jeremy A. Greene, Prescribing by Numbers: Drugs and the Definition of Disease (Baltimore: Johns Hopkins University Press, 2007); Robert Aronowitz, Risky Medicine: Our Quest to Cure Fear and Uncertainty (Chicago: University of Chicago Press, 2015). See also William Rothstein, Public Health and the Risk Factor: A History of an Uneven Medical Revolution (Rochester, NY: Rochester University Press, 2003).
- 27.
The literature on neoliberalism is vast, but see e.g. Wendy Brown, Undoing the Demos: Neoliberalism’s Stealth Revolution (New York: Zone Books, 2015); David Harvey, A Brief History of Neoliberalism (New York: Oxford University Press, 2005); Daniel T. Rodgers, “The Uses and Abuses of ‘Neoliberalism,’” Dissent (Winter 2018), https://www.dissentmagazine.org/article/uses-and-abuses-neoliberalism-debate, accessed 22 January 2018. For another perspective on the intersection of neoliberalism and mental healthcare, see Joel T. Braslow, “The Manufacture of Recovery,” Annual Review of Clinical Psychology 9, no. 1 (2013): 781–809.
- 28.
Loïc Wacquant, Punishing the Poor: The Neoliberal Government of Social Insecurity (Durham, NC: Duke University Press, 2009).
- 29.
Anne E. Parsons, “Re-institutionalizing America: The Politics of Mental Health and Incarceration, 1945–1985” (Ph.D. dissertation, University of Illinois at Chicago, 2013).
- 30.
Steven Raphael and Michael A. Stoll, “Assessing the Contribution of the Deinstitutionalization of the Mentally Ill to Growth in the U.S. Incarceration Rate,” Journal of Legal Studies 42, no. 1 (2013): 187–222.
- 31.
Ulrich Beck, Risk Society: Towards a New Modernity (London: Sage, 1992); Anthony Giddens, The Consequences of Modernity (Stanford University Press, 1990); Anthony Giddens, Modernity and Self-Identity: Self and Society in the Late Modern Age (Stanford, CA: Stanford University Press, 1991); Anthony Giddens, “Risk and Responsibility,” Modern Law Review 62, no. 1 (1999): 1–10. See also Deborah Lupton, Risk (2nd ed.) (New York: Routledge, 2013); Pat Caplan, ed., Risk Revisited (London: Pluto Press, 2000).
- 32.
It is noteworthy that the rise of risk assessment has proceeded independently of violent crime rates, which climbed throughout the 1970s and 1980s before peaking in the early 1990s. Since then, rates have steadily declined, with no concomitant reduction in the role of risk management in mental healthcare. Uniform Crime Reporting Statistics, https://www.ucrdatatool.gov/, accessed 18 February 2018.
Acknowledgements
For helpful comments and feedback, the author would like to thank the participants in the Preventing Mental Illness conference on which this collection is based, as well as Mical Raz, Sam Scharff, David Herzberg and other attendees at the 2017 meeting of the American Association for the History of Medicine.
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Gambino, M. (2019). Risk Assessment in an Age of Neoliberalism: John Monahan’s The Clinical Prediction of Violent Behavior (1981). In: Kritsotaki, D., Long, V., Smith, M. (eds) Preventing Mental Illness. Mental Health in Historical Perspective. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-98699-9_8
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