Law and Mental Health: International Perspectives

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1

Law and Psychiatry in Holland: A Retrospective1

Michael Zeegers and Janny Krul-Steketee

Introduction

1.1 Two Centuries of Psychiatry and Criminal Law

1.2 The Psychiatric Patient in Civil Law

1.3 The Psychiatric Patient in Administrative Law

1.4 The Psychiatric Patient in Legislation on Mental Health

1.5 The Psychiatric Patient in Criminal Law

1.5.1 Principal Legal Regulations

1.5.2 Forensic Psychiatric Examination and Report

1.5.3 Psychiatry in Prison and in Rehabilitation

1.5.4 Psychiatric Aspects of Deviant Behavior

1.5.5 Sexual Offenses

1.5.6 Aggressive Criminality

1.5.7 Crimes Against Property

1.5.8 Crime and Addiction

1.5.9 Political Criminality

1.5.10 The Forensic-Psychiatric Hospitals

1.5.11 Clinical Psychotherapy for Seriously Disturbed Offenders

1.5.12 Problems Specific to Foreigners

1.6 Conflicts of Interest in Psychiatry

1.6.1 Aspects of Coercion

1.6.2 Critical Reactions

1.6.3 Complementary Concepts

INTRODUCTION

This survey of forensic psychiatry in the Netherlands will attempt to provide international readers with some insight into the most important literature in the area since the Second World War. The first portion of the chapter sets out a broad historical framework for the evolution of this professional specialty. Sections 1.1 through 1.4 deal with the four areas of law in which forensic psychiatry operates in the Netherlands: criminal law, civil, administrative, and law on the insane. Forensic psychiatry is a long-established discipline in Holland and many publications have appeared in all the pertinent sub-categories referred to. As it was considered necessary to pay more attention to criminal law, subsections 1.5.1 through 1.5.12 are limited in length. Subsections 1.6.1 through 1.6.3 discuss more general subjects: the problems of psychiatric force, the criticisms that have been focused upon in the Netherlands, and the relevant debates that have ensued.

¹The authors express their gratitude to all those who co-operated in this extensive project and to the Professor A.E.J. Modderman Institute at Leiden, which contributed generously to the cost of translation.

1.1

Two Centuries of Psychiatry and Criminal Law

Frans Koenraadt

ABSTRACT

This chapter aims at surveying the development of Dutch legislation and organisation in the field of forensic psychiatry, especially after World War II, with a brief historical review about the preceding period. In the Netherlands, psychiatric contributions to the theory and practice of penal jurisdiction date back to the beginning of the 19th century.

SOMMAIRE

Le présent chapitre constitue une étude de la psychiatrie légale aux Pays-Bas et de la législation en la matière, en particulier depuis la Deuxième guerre mondiale, avec une brève rétrospective historique. Aux Pays-Bas, la contribution de la psychiatrie à la théorie et la pratique du droit pénal remonte au début du XIXe siècle.

DEVELOPMENT

In Roman and Germanic law it was possible to refrain from punishing deluded criminals, or to punish them less severely. Before the 19th century, doctors in the Netherlands rarely advised the courts on the mental condition of suspects who might have been insane. Usually judges tried to form their own impressions of whether or not any mental aberration existed. Querido (1977) thought he had found the first indication of psychiatric expertise in court in a 1795 report on Harmen Alfkens (van Hall & van Hamelsveld, 1798). Faber and Krikke (1977) pointed to a number of psychiatric reports in Amsterdam in 1756, 1770 and 1780.

In 1795 the Netherlands came under French control. This did not mean that French legislation was introduced in the Netherlands immediately, but it did have a strong influence on legislation policies. In 1806 Holland became a more or less independent kingdom. The Crimineel Wetboek voor het Koninkrijk Holland (Criminal Code for the Kingdom of Holland) of 1809 contained a provision on responsibility which afforded the judge the possibility of holding the perpetrator of an offense either not responsible, completely responsible, or responsible to a lesser degree (Zeegers, 1981a).

After Holland was annexed to France in 1810, the Code Pénal replaced the Criminal Code in 1811. This Code Pénal remained in force in the Netherlands until 1886. It contained much less extensive provisions on nonresponsibility than the Criminal Code.

In articles by Thijssen (1830) and den Tex (1830) and in Moll’s (1825) textbook, the theory of monomania or partial insanity developed by the Frenchman Esquirol was well received. In his speech of 1837, Schroeder van der Kolk emphatically criticized the neglect of treatment of the insane in the Netherlands. In 1841 the first Lunacy Act came into force, regulating state control of the welfare of the insane.

In the first part of the 19th century, provisions for the welfare of the insane were altered considerably in several countries in Western Europe. Reforms in the Netherlands, however, were limited (Binneveld & Lieburg, 1978, 1979). The Act of 1841 made speedy admission to an institution possible. In 1825 there were 35 institutions in the Netherlands. By 1842 this number had decreased to 31 as a result of the new act and the Inspectorate installed by it. In 1850 there were 17 institutions left. These fewer asylums had to provide shelter for a much greater number of lunatics. It was not until the end of the 19th century that new institutions were built on any scale. They were established in the countryside. This meant that, in the Netherlands, too, the mentally disturbed were exiled to the geographical and social periphery of society (Binneveld, 1982). An increase in the capacity of the institutions was brought about through the private initiative of members of the Reformed Church and Catholics (see Moerings, 1983, for a description of this very Dutch phenomenon known as pillarisation). The welfare of the insane had become one of the areas in which the emancipation of these two pillars developed.

After 1850, medicine and psychiatry — the latter influenced especially by Ramaer (1879), who also advised the courts — developed and bloomed. Through his comments on state planning and his Psychiatrische Aantekeningen (Psychiatric Notes) of 1880, Ramaer exerted considerable influence on the Dutch Penal Code that came into force in the Netherlands in 1886 (see also MacDonald, 1885). At about the same time, on April 27, 1884, the second Lunatic Act replaced the first one of 1841. This new legislation was one of the factors which contributed to psychiatrists’ growing interest in psychiatric reports and in the treatment of mentally disturbed offenders.

The materialism that was having an important effect on science and thought at that time was also a decisive influence on attitudes about psychiatry and the administration of criminal justice. These attitudes enabled Lombroso’s ideas to flourish for a rather long period of time. Despite later skepticism and even refutation of these ideas, Aletrino (1902), Jelgersma (1894), and Jacobi (1898) were their advocates. Jelgersma also influenced the introduction of Sigmund Freud’s ideas in the Netherlands.

At the beginning of the 20th century much debate arose over offenders’ responsibility. Other arrangements became necessary because mentally disturbed offenders did not always remain in institutions long enough. Insane criminals and the criminally insane had to be interned for longer periods (van Geuns, 1899). Society also had to be better protected from disturbed offenders of diminished responsibility (Zeegers, 1981b).

A bill was introduced in 1911, but it was not until 1928 that the amended Penal Code allowed for the detainment of an offender at the government’s pleasure (Terbeschikkingstelling van de regering, hereafter TBR). de Ridder and de Vries (1984) have shown that there was no lack of debate on this legislation in specialist literature. In 1929 and shortly thereafter, several institutions for psychopaths were established. The number of TBR measures imposed increased rapidly, so rapidly that a so-called Stop-Act was brought into force in 1933 prohibiting TBR for crimes of property (with the exception of robbery with violence or threats, or blackmail). De Bois (1935) reported on the role of the psychiatric expert with regard to 80 offenders considered to be nonresponsible. From 1945 onward, the number of offenders subject to TBR increased rapidly, from less than 100 per year in 1945 to almost 400 in 1947 and 1948.

In the first half of the 20th century, S. van Mesdag (1930) and H. van der Hoeven were of great importance for forensic psychiatry in the Netherlands. Van der Hoeven’s textbook (1913) is an indication of that importance. Two forensic psychiatric clinics have been named after these pioneers, and F.S. Meijers gave his name to the association which specialized in special rehabilitation for mentally disturbed offenders from 1924 to 1974. In 1974, the Dr. F.S. Meijers Association was dissolved, after merging with a number of other rehabilitation associations (van der Kwast, 1974).

REPORTING

During the 19th and 20th centuries a number of forensic psychiatric reports have been published as they were presented to the courts, with comments added in some cases. The discussion shall be limited here to a selection from these reports. van Deventer and Benders (1897) and Tellegen and Snijders (1900) reported cases of simulated insanity. There are also reports by Cowan (1899); Demmers (1898); Dobberke (1900); Heilbronner (1909); Jelgersma (1899); Ramaer (1879); Rutte (1910); Schneevoogt (1849); Schneevoogt and van Hees (1848); Tellegen, van der Hagen, and Jelgersma (1898); and Winkler and Jacobi (1898). Hulshoff Poll (1900) reported on the murder of four people, committed while the murderer was in an epileptic state of dreaming. An exceptional report by Jelgersma, van Deventer, and van Erp Taalman Kip (1910) concerns the examination of witnesses in the Papendrecht-case. (For further debate, see Jelgersma & van Erp Taalman Kip, 1911; Janse de Jonge, 1982.)

HISTORICAL RESEARCH

Van den Honert (1841) provided a historical view of the events surrounding the introduction of the first Lunacy Act in the Netherlands, describing the requirements that such legislation should meet. The psychiatrist Querido (1939) made an extensive study of general legislation on the insane and of both Lunacy Acts in particular. Many of his ideas are still of interest now (see Querido, 1970). The psychiatrist and jurist Mooy (1964) also examined the Lunacy Act. Hallema (1941) gave a summary of the way in which treatment of the insane and the prison system mingled in the 17th and 18th centuries.

Van Bemmelen and Wiersma (in Carp, 1941, 1956) dealt extensively with the history of forensic psychiatry. Wiersma (1969b) made an elaborate study of six murder cases that appeared in court between 1802 and 1885. After an extensive investigation of original sources, Beek (1969) reported on the role of insanity and the insane in medieval society. He dealt with legal matters in a separate chapter. Beek’s dissertation is one of the most important psychiatric documents in Dutch historical writing.

In addition to a historical survey, Bambang Oetomo (1970) undertook an investigation of rehabilitation in two psychiatric institutions, reaching the conclusion that rehabilitation exists only sporadically as an effective goal in medicine and treatment. Schut (1970) surveyed the development of institutional welfare for the mentally disturbed in the Netherlands.

Cahn (1970) discussed the importance of the State Asylum at Medemblik during the period 1884–1967. Van der Esch (1970) did the same with regard to the State Asylum at Woensel and the State Psychiatric Institution at Eindhoven during the period 1918–1968.

The state asylums described by Cahn and van der Esch were important for the treatment of insane criminals as well as the criminally insane. In an article on the district psychiatrist, van der Esch (1961) describes the development of the present function of the district psychiatrist. Peeters et al. (1980) based a historical study of changes in the nature and treatment of mental disease from 1885 to 1977 on a structured content analysis of 1,500 files on psychiatric patients.

In an extensive study, van der Esch (1980) deals with the history of state control of the insane (see also Vijselaar, 1983). Pieters (1981) wrote on the history of forensic psychiatry using research done in the archives of the State Asylum at Medemblik. A beautifully illustrated book by Vijselaar (1982b), showing life in a Dutch asylum around the turn of the century, was made possible by the working group Heritage Psychiatric Hospitals, formed in 1979 by the Dutch Center for Public Mental Health (Nederlands centrum Geestelijke volks-gezondheid, hereafter NcGv). An inventory by Vijselaar (1982a), compiled at the request of this working group, showed that there were valuable collections of historical photographs and objects in a number of psychiatric institutions. Over the past decade, some of these institutions have established exhibitions or museums. In 1982 and 1983 two national exhibitions were held simultaneously on the history of caring for the insane in the Netherlands, under the title Voor gek gehouden (Taken for a Fool).

More elaborate studies are to be found in the Commission for the History of Psychiatry and Public Mental Health (commissie geschiedenis van de psychiatrie en geestelijke gezondheidszorg) of the NcGv in Utrecht. The J.N. Ramaer library in Utrecht deserves mention here, for it has a valuable collection of old and contemporary writings (Lindeboom, 1982). Beyaert (1983) described recent developments in forensic psychiatry.

PROFESSIONALIZATION

The courts formed their own impressions of an offender’s mental aberrations before 1800; subsequently, the medical practitioner was gradually admitted to criminal trials to advise on suspected insanity. In 1827 Schroeder van der Kolk became a professor of anatomy and physiology in Utrecht. He was the first to teach psychiatry in the Netherlands and also presented reports to the court as a forensic-psychiatric expert (Goldstein, 1840). The Journal for Legal Medicine and Psychiatry (Tijdschrift voor Gerechtelijke Geneeskunde en Psychiatrie) was established in the mid-19th century. Several forensic psychiatric reports appeared in psychiatric and neurological journals at the turn of the century.

Two so-called schools of thought are worth mentioning with regard to forensic psychiatry in the Netherlands: the Groningen School and the Utrecht School (on the latter, see Leauté, 1959). D. Wiersma (1943, 1950) wrote on the ideas of the Groningen School. At the end of the 19th and the beginning of the 20th centuries, E.D. Wiersma and G. Heijmans, representatives of the Groningen School, conducted research on the heredity of mental characteristics in general, and temperament and character in particular. Their work on temperament is best known. Heijmans distinguished three basic characteristics of temperament: activity, emotionality, and the secondary function, all three of which could possibly appear in different combinations. From the late 1940s to the early 1960s, criminal jurist Pompe, (forensic) psychiatrist Baan, and criminologist Kempe cooperated closely at the University of Utrecht. The aim of their common project has been described by Moedikdo (1976) as treating the delinquent as a fellow-human being, that is, taking the individuality of the offender into account in the administration of criminal justice. Baan greatly stimulated the development of forensic psychiatry. Thanks to his activities, a number of important institutions were established in Utrecht: the Psychiatrische Observatiekliniek van het Gevangeniswezen (a psychiatric observation clinic for the prison system, now the Pieter Baan Centre) in 1949 (see Baan, 1950, 1955); the Selectie Instituut voor Terbeschikking van de Regeringsgestelden (Institute for Selection of Offenders Detained at the Government’s Pleasure) in 1951; and the Dr. H. van der Hoeven Clinic in 1954. Extensive research on the population of the psychiatric observation clinic is of historical importance (Pompe & Kempe, 1962).

Waller (1984) briefly compared reports by the Pieter Baan Centre in 1950 and 1979. He came to the conclusion that reporting had become increasingly more extensive, more detailed, and more empirical and that the person’s version of the story who was being observed was gradually disappearing into the background.

At present there are extraordinary professors in forensic psychiatry at six universities in the Netherlands. At Leiden, Tilburg, Nijmegen, Groningen, Utrecht, and Amsterdam (Free University) such professors have been appointed to the Faculty of Law. At the University of Groningen, the chair is also a member of the Faculty of Medicine. There are of course also many connections with the field of social psychiatry (Esser, 1971).

The Dutch Association for Psychiatry, to which a section of forensic psychiatry also belongs, dates from 1871.

In some cases, psychiatrists and other behavioral experts also have a judicial task as members of the special chamber of the court of justice in Arnhem, to which an offender may appeal against decisions not to allow or to repeal conditional release (see de Smit, 1983).

Forensic psychology in the Netherlands has never amounted to much. At the beginning of the 20th century, psychological experts were brought into criminal trials, but usually only to help evaluate the trustworthiness of a witness. This, however, did not happen often, a remarkable difference from forensic psychology in West Germany where representatives of that discipline were and still are often consulted in court. At present, two working groups function within the Netherlands’ professional association for psychologists, het Nederlands Instituut voor Psychologen (Netherlands Institute for Psychologists), namely, the working group on forensic psychology and the working group of prison psychologists.

The Psychiatrisch-Juridisch Gezelschap (Psychiatric-Legal Association) fulfills an important function as a platform for debate among the various disciplines. Experts from other areas, such as psychologists and sociologists, are also involved in the association. Its reports are an important source of information on the development of forensic psychiatry in this century. On the occasion of its 75th anniversary in 1982, the chairman pointed to the changes that attitudes toward psychiatrists have undergone in the course of the century. At one time the psychiatrist was drawn into criminal law to protect the mentally disturbed offender from the authority of the court. Now there would seem to be a need for protection from the psychiatrist. In other words, the need for psychiatric influences to restrain the application of criminal justice at the beginning of the century seems to have become a need for legal measures to restrain the psychiatrist. It is not only the task of the psychiatrist as advisor which has expanded in the course of the century; forensic psychiatry now also pays more attention to aspects of treatment.

Intensive contacts have certainly improved mutual understanding between jurists and psychiatrists. In forensic psychiatry, too, more emphasis has been placed on social factors in recent years. The judiciary has followed this development, and expects more from a report than a mere clinical diagnosis, a situation which is perhaps specific to the Dutch context. Data on family relationships, circumstances at work, and so forth must not be lacking in forensic-psychiatric reports.

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1.2

The Psychiatric Patient in Civil Law

J.G. Schnitzler

ABSTRACT

Psychiatrists report in civil cases regarding guardianship by reason of mental disorders which, either permanently or periodically, make a person unable to look after his interests.A less far-reaching measure has been possible since 1982 — the so-called protective administration for adults. In this case the person does not become legally incapable, as is the case in guardianship; only his property, in whole or in part, is placed under administration. There are further legal provisions as to marriage, parental power, guardianship of minors, and last will and testament, in which psychiatric advise may be requested.

SOMMAIRE

Les psychiatres sont appelés à témoigner dans des affaires civiles de tutelle où la maladie mentale, soit permanente, soit temporaire, empêche la personne défendre ses propres intérêts.Depuis 1982, il existe une mesure beaucoupmoins radicale, à savoir le placement sous tutelle administrative pour les adultes. Dans ce cas-là, la personne n’est pas frappée d’incapacité au sens juridique, comme dans le cas de la tutelle traditionnelle; seuls ses biens sont placés en totalité ou partiellement, sous la protection de l’Etat.La loi prévoit d’autres cas où le psychiatre intervient éventuellement, à savoir les questions de mariage, d’autorité parentale, de tutelle de mineurs et de testaments.

There are a number of provisions in Dutch civil law that concern the mentally disturbed. The most important of these will be discussed here. Civil law is governed by the Civil Code, which dates from 1838 and is divided into a number of books. Some decades ago a total revision of the Civil Code was begun, including a revision of the classification in books. As yet, only a small part of the revised code has come into effect. This includes the laws of persons, family, and guardianship, which are all governed by Book 1 of the new Civil Code. Although other books have been completed, they have not yet come into effect.

In the administration of civil law, a psychiatric expert may be requested to conduct an examination and subsequently advise the court. Such a request may be made either by the court itself – by way of a court order – or by one of the parties in litigation. The psychiatrist who performs the examination may be an independent professional, or may be attached to a general psychiatric hospital, the psychiatric department of a general hospital, or the Social Psychiatric Services (at present known as RIAGG: regionaal instituut voor ambulante geestelijke gezondheidszorg – regional institute for ambulant mental health welfare). In recent years there has been a tendency in the Netherlands to produce the advice of a psychiatrist in civil cases more often than in the past.

GUARDIANSHIP

The provisions governing guardianship (interdiction) are to be found in Title 16 of Book 1 of the new Civil Code, sections 378–391. Other parts of Dutch legislation also contain provisions for those placed under guardianship. Section 378, Book 1 of the Civil Code is especially important. It stipulates that

a major may be placed under guardianship (interdicted) by a district court:

a. because of a mental disturbance which renders the disturbed person, either permanently or periodically, unable or only partly able to look after his own interests properly;

b. because of prodigality;

c. because of habitual abuse of alcohol [with certain consequences detailed in the section itself].

Book 1 of the new Civil Code, which was introduced in 1970, no longer contains a fourth ground for guardianship named by the old code, namely weakness of ability, a ground that only the person to be placed under guardianship could appeal. A psychiatric expert will be concerned only with the ground for guardianship contained in section 378(a): This is the only place where a mental disturbance that could prevent or hinder a person from looking after his own interests properly is