Cognitive Impairment and the Right to Vote: A Strategic Approach

Most democratic countries either limit or deny altogether voting rights for people with cognitive impairments or mental health conditions. Against this weight of legal and practical exclusion, disability advocacy and developments in international human rights law increasingly push in the direction of full voting rights for people with cognitive impairments. Particularly influential has been the adoption by the UN of the Convention on the Rights of Persons with Disabilities in 2007. Article 29 declares that states must ‘ensure that persons with disabilities can effectively and fully participate in political and public life on an equal basis with others, directly or through freely chosen representatives, including the right and opportunity for persons with disabilities to vote and be elected’. This article also argues for the right of all people to vote, including people with cognitive impairments, by adopting a uniquely strategic approach. Firstly, some of the strategic limitations of existing arguments in favour of extending the franchise are highlighted. Most such arguments are flawed because they run the risk of inviting disparaging philosophical commentary which compares disabled people to animals, or because they are based on implausible empirical claims, or because they inadvertently tie the case for voting rights for the disabled to other cases unlikely to ever enjoy widespread acceptance. This article, instead, justifies extending voting rights to all people with cognitive impairments based on a simple cost‐benefit analysis that avoids all of these problems.     

Regulating the Private Relations of Adults with Mental Disabilities: Old Laws,New Policies,Hollow Hopes

Recent legislative reforms have aimed to help people with mental disabilities pursue more “normal” lives. Yet, current laws regulating the mentally disableds' private relations continue to disenable them. Social scientists have asserted that people with mental disabilities vary widely in their individual competencies. Yet, laws tend to forgo an individualized approach to the mentally disabled in favor of broad restrictions on their rights to engage in sexual, marital, and parental relationships. Reviews of cases also show that when they challenge these restrictions, the mentally disabled tend to be required to demonstrate a higher level of morality and functioning than non-disabled. Reforming these restrictive legal rules requires an unlikely, but possible, concordance between social science and the law.     

Persons with disabilities

In 1990, the United States Congress enacted legislation protecting the civil rights of persons with disabilities. The Americans with Disabilities Act (ADA) (1990) has been termed the most significant civil rights legislation since the 1960s (Rothstein, 1992/1994; see also Drimmer, 1993; Gostin & Beyer, 1993). The intent of the ADA is to provide “not only equal treatment [for persons with disabilities], but also equal opportunity” (Rothstein, 1992, p. 19, emphasis in original). The purpose of the ADA is not only to eliminate intentional discrimintion, but also to change “policies and practices that have a discriminatory impact” on persons with disabilities (p. 19). The ADA was implemented in the wake of decades of growing awareness of and responses to the numerous societal barriers confronted by persons with disabilities. The civil rights movement for persons with disabilities was spawned by grass roots movements (Scotch, 1984). Over time, this civil rights movement has been aided by behavioral science research as well as by legal actions (see, e.g., Scotch, 1984, 1988; see also Ainlay, Becker, & Coleman, 1986; Asch & Fine, 1988; Rothstein, 1992/1994; Shapiro, 1993). It is still too early to assess the ultimate success of the specific ADA legislation, much less the general disability-rights, advocacy movement. Nevertheless, as the articles in this special issue of Behavioral Sciences and the Law reflect, the behavioral-science-and-law community has much to contribute to the elimination of the marginalization of persons with disabilities in modern society. As shown in the articles in this issue, these efforts can include a) assessing progress in light of legislation and policy reforms, b) identifying on-going barriers, and c) offering ideas for different ways to conceptualize not only the problems, but also the solutions to problems confronting persons with disabilities. Ultimately, these and the other efforts being undertaken in the legal, social, and political arenas should help in the fight to fully integrate persons with disabilities into every part of the social fabric. The issue begins with two articles that report on empirical research. First, Professor Peter Blanck presents results from his longitudinal study of the ADA. Specifically, Professor Blanck has been examining employment integration and economic opportunity. His article summarizes the findings from his program of research: There are seven core findings, indicating both successes in employment (e.g., an increase of employment in integrated work settings) as well as continuing concerns (e.g., wage disparities as a function of gender; a leveling off of economic opportunities). The other empirical study is presented by Professor Delbert Rounds. Professor Rounds interviewed individuals with legal blindness in order to learn about their experiences of criminal victimization. One of only a handful of studies on the impact of crime on persons with disabilities, the research indicates that although individuals with legal blindness may not be victimized at rates different than sighted persons, the legally-blind appear to be vulnerable to specific kinds of victimization and their victimization experiences may differ from other crime victims' experiences. The remaining five articles assess different issues related to persons with disabilities. All draw, to some degree, on behavioral science research to argue for the elimination of barriers to persons with disabilities so that they can share the same social and legal rights and responsibilities as non-disabled persons. Professor Harlan Hahn offers a sociopolitical definition of disability. Instead of conceptualizing disability as a functional impairment, Professor Hahn advocates the use of a minority model that stresses attitudinal discrimination as the principal problem facing disabled persons. Professor Hahn suggests that the reconceptualization of disability could benefit persons with disabilities in both social scientific and legal contexts. For example, it would focus social scientific investigations on such issues as the concept of aesthetic anxiety. Research undertaken in light of the minority/attitudinal model, Professor Hahn argues, could have the same positive consequences in aiding persons with disabilities in their fight for legal and social equality as did social scientific research regarding race issues. Professor Michael Perlin presents a different twist on sociopolitical implications of disability issues. He shows how a seemingly “minor” decision by the United States Supreme Court in the mental disability case of Godinez v. Moran (establishing a unitary standard for the determinations of competence to stand trial, competence to plead guilty, and competence to waive counsel) had a substantial influence on the way in which the courts recently handled the high-visibility case of Colin Ferguson. Ferguson, a very bright but mentally disabled Black man, was the defendant charged with the murder of six people and the wounding of 19 others. Professor Perlin uses the filters of sanism and pretextuality to examine the Ferguson trial and to provide insight into how the American criminal justice system reacts to defendants with mental disabilities. Whereas Professor Perlin analyzed criminal law issues that disenabled persons with mental disabilities rather than enabled them, Professor Roger Levesque analyzes recent civil law reforms that have the same consequence. Professor Levesque's focus is on the way in which laws (statutes and case decisions) have intruded on the rights to engage in sexual, marital, and parental relationships. His analyses are very similar to Professor Perlin's in the demonstration of sanist and pretextual approaches to these issues taken by the law. Professor Levesque advocates that the law adopt the approach taken by many (but not all) social scientists — viz., the examination of behavior in context without preconceived, moralistic positions, resulting in individual assessments of competency — in order to provide a better understanding of rights and abilities for persons with mental disabilities, and, ultimately, an end to restrictive legal rules. Professor Donald Hantula and Ms. Noreen Reilly also focus on persons with mental disabilities. They contend that under the reasonable accommodation provisions of the ADA, persons with mental disabilities should and could have successful employment opportunities if only the social and managerial environments were to be modified. Professor Hantula and Ms. Reilly suggest the use of behavior analysis and performance management perspectives as bases for analyzing, developing, implementing, and evaluating reasonable accommodation for persons with mental disabilities. They also argue that the changes needed for persons with disabilities would actually benefit non-disabled employees as well. Finally, Dr. McCay Vernon, Dr. Lawrence Raifman, and Professor Sheldon Greenberg analyze the problems associated with providing Miranda Warnings to deaf suspects. They provide caselaw, empirical, and analytical evidence demonstrating that present law enforcement practices fail to inform deaf suspects of their legal rights, resulting in adverse consequences for both law enforcement and the suspects. Dr. Vernon and his colleagues identify techniques that not only promote an awareness of the problems, but also help to address the problems for criminal justice officials and for deaf suspects.     

The influence of the media on practice in mental health: a bricolage of a single case study

This paper has its genesis in the convergence of two individuals’ interests – one with a long-standing interest in representations of mental health and one with an interest in the use of bricolage as a research approach. These interests converged around the ways in which mental health care practitioners might react to and subsequently reflect on images of mental health they came across in the media. A bricolage was developed relating to newspaper coverage of a homicide carried out by someone with a mental health problem. The bricolage draws on the assumption that practitioners will have immediate reactions to material they come across, take a more considered overview of this material, and subsequently attempt to contextualize this reflection in terms of academic literature. The bricolage as presented mirrors this process for an experienced practitioner. Suggestions are made concerning the use of newspaper reports on mental health, to enable both novice and experienced practitioners to gain vicarious experience through reflection on these reports.     

A Qualitative Investigation of Somali Immigrant Perceptions of Disability: Implications for Genetic Counseling

This study examined the potential utility of genetic counseling services for Somali immigrants by investigating their perceptions of disability. Five Somali women participated in structured interviews that assessed their perceptions of the nature, causes, and impact of disability, and care for persons with disabilities. Using a Heideggerian Hermeneutics qualitative method of analysis, six major themes emerged: (1) disability refers to both physical and mental conditions, with mental disability generally thought of first and as more severe; (2) in Somalia, the family cares for disabled family members, treating them as if they were normal (3) there are major cultural differences between Somalia and the United States in how persons with disabilities are treated; (4) caring for a person with a disability is stressful for the family; (5) Allah determines whether or not a child will be disabled, and this cannot be predicted or altered; and (6) family is the primary life focus, and therefore, risk of disability does not affect reproductive decisions. These themes suggest that traditional genetic counseling may have limited utility for Somali immigrants. We recommend several modifications to traditional genetic counseling for Somali patients that also may be useful for populations that have similar beliefs.     

湖北省智力残疾现状分析及预防对策

以湖北省第二次全国残疾人抽样调查的资料为依据,对智力残疾发生率、智力残疾等级、智力残疾的致残原因等现状进行分析。农村组智力残疾率明显高于城市组;三、四级智力残疾比率明显高于一、二级智力残疾比率;智力残疾的主要致残原因为遗传性疾病和脑疾病。说明智力残疾的康复任务仍很重,需要社会及政府的广泛重视。     

Some everyday life consequences of disability and bereavement for older adults

The study analyzed daily event differences between groups experiencing the major stressors of conjugal bereavement and physical disability, and analyzed the association of everyday events with self-reports of mental health for different groups across a 3-month time span. Monthly interviews were conducted with 61 recently conjugally bereaved, 62 recently physically disabled, and 123 matched-comparison older adults between the ages of 60 and 80. The purpose of these interviews was to obtain a comprehensive assessment of the monthly frequencies of everyday life events. Self-reports of mental health were obtained from paper-and-pencil measures filled out after each interview. Causal models were used to analyze the best-fitting structure of event/mental health relationships for the first 3 monthly interviews. Undesirable events showed uniformly adverse effects on mental health. Desirable events benefited the psychological well-being of the disabled the most and had no positive effects on the mental health of the bereaved. The bereaved also evidenced less stability over time than other groups in the frequency of small undesirable events.     

From status to contract: a future for mental health law

Given the many complex issues and interests involved it is hardly surprising that mental health is a controversial topic. The law has a critical role in protecting interests and balancing claims. But the law is a major part of the problem. Indeed analysis of its role in producing anti-therapeutic outcomes led to the development of therapeutic jurisprudence. And we keep changing the law; for example on 16 October, 1999 the British Government announced proposals for radical reform of the mental health laws of England and Wales which, in the current form, were heavily influenced by developments in the United States of America. A major problem, it is submitted, is that we do not have an agreed model of the law, upon which to develop an appropriate structure for the delivery of mental health services. Currently we emphasis 'status', which puts a premium upon drawing distinctions which it is difficult, if not unrealistic, to achieve in practice. Another approach would be to emphasize the centrality of the relationship between the patient, or client, and the inter-disciplinary team of people providing him or her with services. This approach, outlined and argued for in this article, would involve developing the law of contract.     

Disability and countertransference in group psychotherapy: connecting social oppression with the clinical frame

Psychoanalysis has paid limited attention to disability, and at times the approach has lacked political awareness. Over recent decades the international disability rights movement has argued that disabled people constitute an oppressed, systemically disadvantaged minority. Lately, a critical psychoanalytic view has connected disablist discrimination to universal unconscious conflicts evoked by impairment. Corresponding evocations emerge in the therapeutic frame, producing countertransference responses to the impaired body. Drawing on psychoanalytically oriented group psychotherapy with severely physically impaired adults, countertransference phenomena were studied in developing discussion on disability-related clinical work. The complex, uncertain role of psychoanalytic practice in combating oppression was also examined. Key issues include challenges to the traditional frame, the crossing of psychic boundaries, anxieties relating to not knowing, and the role of unconscious factors in marginalizing disabled experience.     

Mental Disorders in Children and Parents in Family Law Proceedings: Cases on Child Protection Matters Versus Child Custody and Visitation Issues

Psychologists can contribute considerably to decision making in family law proceedings. The mental health of the parents and the children forms an important factor in psychological evaluation. It is the overall aim of this study to specifically examine the occurrence of mental disorders in evaluated family members in cases of termination of parental rights as opposed to cases of child custody and visitation rights. This data are based on 297 psychological evaluations completed between 2008 and 2012 at an evaluator association in Bremen, Germany. In this retrospective content analysis, evaluation reports were examined for indications of mental disorders in children, mothers and fathers. The data were assessed in bivariate analyses and logistic regression models. A total rate above 39 % indicates a comparatively high exposure to mental disorders of children and adolescents in this sample. A mental disorder of the mother and a mental disorder of the father occur significantly more often in cases of termination of parental rights than in cases of child custody/visitation rights. Children and adolescents who showed aggressive-dissocial behavior and aggressive-oppositional behavior were significantly more likely to be evaluated in legal issues of termination of parental rights as opposed to child custody/visitation rights. Restrictions in parental mental health and parenting capacity should be carefully weighed against restrictions in the mental health of the children and their developmental needs when conducting psychological evaluation.     

Effects of disability and bereavement on the mental health and recovery of older adults

We investigated the role of two major stressors, recent disability and conjugal bereavement, in older adults' self-reports of mental health and recovery from stress. A sample of 246 older adults between the ages of 60-80 was interviewed monthly for 3 months by trained elderly interviewers; Month-10 interview data were also analyzed. Control subjects, who were not experiencing the stressors, were carefully selected from a sample of adults matched on age, sex, and socioeconomic status. Dependent variables were psychological distress and psychological well-being, each with component subscales. The disabled group evidenced significantly lower positive well-being and significantly greater distress than did the other groups. Bereaved subjects demonstrated high levels of depression compared with the disabled subjects, but showed less anxiety. Bereaved subjects showed recovery on several indicators of mental health, but disabled subjects continued to show considerable psychological upset in comparison with the other groups.     

Islamic law and human rights: A contribution to an ongoing debate

In this essay the author criticizes two opposite approaches to the relationship between Islam and human rights: the incriminating and the apologetic approach. They are either anachronistic in that they judge the rules of classical Islamic jurisprudence by present‐day standards, or they entirely ignore its heritage. The author attempts instead to develop a new approach whereby classical Islamic jurisprudence is analyzed in its historical context. In order to examine whether Islam recognized a notion of fundamental rights, the author first tries to establish to what extent the notion of legal equality is recognized in Islamic law. Secondly, he examines two hierarchical legal relationships, viz. that between master and slave and that between husband and wife, in order to find which basic and inalienable rights Islamic law assigns to the weaker party in these relationships. His conclusion is that classical Islamic law offers points of departure for the development of a modern theory of human rights rooted in Islamic notions.>     

残疾儿童心理健康对家长亲职压力的影响:有调节的中介效应

为探讨残疾儿童心理健康与家长亲职压力的关系,揭示亲社会行为在残疾儿童情绪行为问题与家长亲职压力之间的中介作用,以及问题影响程度的调节效应,本研究采用短式亲职压力量表、长处和困难问卷分别对199名残疾儿童及其家长进行问卷调查,结果发现：（1）残疾儿童情绪行为问题对家长的亲职压力有显著的正向预测作用;（2）亲社会行为在残疾儿童情绪行为问题与亲职压力之间起着部分中介的作用;（3）问题影响程度能够调节该中介效应,当问题影响程度越小时,中介效应越显著。可见,亲社会行为能够缓冲残疾儿童情绪行为问题对家长亲职压力的负向影响,并且问题影响程度越小,这种缓冲作用越明显。     

On Christ and Healing: Eiesland,Tillich, and Disability Theology

Abstract : The existentialist interpretation of the biblical texts offered by Protestant theologian Paul Tillich is deeply problematic in its treatment of disability, especially mental illness. Theologian Nancy Eiesland argues against a conflation of sin and illness, and proposes the symbol of the disabled God as a source for a liberation theology of disability. Reading the biblical texts existentially, as Tillich suggests, can advance Eiesland's Christology, while her critique of Christian teaching on disability offers a correction for Tillich.     

Representing disability in charity promotions

Social psychological research in relation to charity advertising in the area of disability has attempted to distinguish between ‘positive’ and ‘negative’ images and the way in which these are related to their fundraising potential. In the light of the critique of charity advertising offered by a number of disability theorists, it is suggested that this perspective would be enhanced by consideration of the attitudes of disabled people to charity advertisements. A study is reported that compares the attitudes of disabled and non‐disabled people to two charity advertisements. Differences between these two groups are reported and in the light of the nature of these it is suggested that what are considered to constitute ‘positive images’ is unlikely to be consensual. Copyright © 1999 John Wiley & Sons, Ltd.     

Personality prior to disability determines adaptation: agreeable individuals recover lost life satisfaction faster and more completely

Personality traits prior to the onset of illness or disability may influence how well an individual psychologically adjusts after the illness or disability has occurred. Previous research has shown that after the onset of a disability, people initially experience sharp drops in life satisfaction, and the ability to regain lost life satisfaction is at best partial. However, such research has not investigated the role of individual differences in adaptation to disability. We suggest that predisability personality determines the speed and extent of adaptation. We analyzed measures of personality traits in a sample of 11,680 individuals, 307 of whom became disabled over a 4-year period. We show that although becoming disabled has a severe impact on life satisfaction, this effect is significantly moderated by predisability personality. After 4 years of disability, moderately agreeable individuals had levels of life satisfaction 0.32 standard deviations higher than those of moderately disagreeable individuals. Agreeable individuals adapt more quickly and fully to disability; disagreeable individuals may need additional support to adapt.     

The Purchase of Fruitfulness: Assisted Conception and Reproductive Disability in a Seventeenth-Century Comedy

The relationships between socioeconomic and biogenetic reproduction are always socially constructed but not always acknowledged. These relationships are examined as they apply to an instance of infertility and assisted reproduction presented in a seventeenth-century English play, Thomas Middleton's 1613 comedy, A Chaste Maid in Cheapside. Middleton's satirization of the effects of secrecy on the category of reproductive disability is analyzed and its applicability to our own time considered. The discussion is in four parts, focusing on: the attribution of disabled status to one member of the couple, the wife; the use of this attribution to protect the husband's reputation for sexual and reproductive health; the concealment of the nature of assisted reproduction; and the interests of the child conceived with such assistance.     

Attitudes toward genetic counseling and prenatal diagnosis among a group of individuals with physical disabilities

Few studies have been published on the attitudes of people with physical disabilities toward genetic counseling and prenatal diagnosis. Articles in the lay press and social science literature on this topic, mainly written by disability rights activists and advocates, imply opposition to prenatal diagnosis and the field of clinical genetics by the physically disabled population. In this study, 15 adults with physical disabilities were interviewed regarding their attitudes toward genetic counseling and prenatal diagnosis. Genetic counseling and prenatal diagnosis were generally viewed favorably by this sample of the disability community. Only a small percentage of the sample perceived genetics to be eugenic. Implications for genetic counseling and future research are discussed.     

Human rights and correctional clinical practice

The formulation of human rights theory and policies represents an ethical advance and promises to supply a framework for resolving ethnic, social, and individual conflicts. Ethics is essentially a means for coordinating the conflicting interests of peoples and nations and human rights provide a strong foundation to do this in multiple domains. Our aim in this paper is to apply a human rights perspective, in association with a justifying theory and set of goods, to the correctional arena. First, we discuss the definition of human rights, their proper analysis and justification. We then apply the results of our discussion to the assessment, treatment, and monitoring of offenders. Finally, we consider the policy, research, and intervention implications of a human rights perspective for correctional practitioners.     

Some problems in forensic assessment

The establishing of facts in criminal cases calls for the marshalling of evidence, from every angle and without bias, in strict compliance with the law. The findings of the court in respect of criminal accountability must likewise be established beyond doubt; probability is inadequate as a basis for conviction. The highest degree is inadequate as a basis for conviction. The highest degree of forensic competence in matters psychiatric and psychological must be assured. Expert opinion must proceed from an evaluation of the accused person's capacity to distinguish between right and wrong, taking account of the nature of the offense. Part of this evaluation consists in the determination of the combined effect of the principal determining factors. Greater depth of knowledge is required respecting the part played by alcohol in the capacity to distinguish right from wrong compared with impulse, mental deficiency, grave abnormal development, etc. In the interests of securing a sound judgment of criminal accountability, further research is desirable into the complexus of determining factors, for example, into the multifunctional contribution of deranged physiological structures and processes which take a mental and/or psychopathological course.