I have been a long-time proponent of “splitting” diagnoses as opposed to “lumping” them together, which is why I originally coined the term, “TS+” – to remind people that some symptoms are not really due to Tourette’s Syndrome but to features of other co-morbid conditions that are also present. A news story out of Pennsylvania serves as a compelling reminder of why we need to “split” instead of “lump.” It also serves as a compelling reminder that defense strategies can contribute to negative public perceptions of a neurological or neuropsychiatric disorder.
Brian Bowling has a news report in the Pittsburgh Tribune-Review about a legal defense strategy that concerns me. As background: a man pleaded guilty to possession, receipt and transportation of child pornography. When the defense presented a forensic psychologist to argue for leniency in sentencing, the psychologist told the court that the defendant became attracted to underage girls and collected child pornography because (in part) Tourette’s Syndrome and his isolated childhood derailed the development of normal relationships with women. Having created the mis-impression that Tourette’s Syndrome might contribute to pedophilia, the defense compounded the problem even more by lumping hoarding or obsessive-compulsive behaviors with Tourette’s Syndrome:
Hardy amassed thousands of images and videos of child pornography, videotaped neighborhood children playing and stole girls’ panties from homes he visited, according to court documents. In online chats with other child pornography collectors, Hardy said “he would most like to rape 8-year-old girls but would rape any girls from 2 to 15 years of age,” court records show.
[The forensic psychologist] said Tourette syndrome causes people to obsessively collect or “hoard” things. That helps explains the 60 hard drives and other digital media police found when they searched Hardy’s home, she said.
“He collected more pornography than anyone could ever look at,” she said.
Is it any wonder people may be fearful of revealing their TS diagnosis when a court is being told by a psychologist that Tourette’s Syndrome caused or contributed to compulsive hoarding of pornography or pedophilia?
Perhaps the media report is not doing justice to the psychologist’s full testimony, but let me be clear: Tourette’s Syndrome does not cause people to become pedophiles. Nor does it cause them to become attracted to pornography or to hoard it. Many people with Tourette’s Syndrome have no obsessive-compulsive symptoms, and in this case, if the compulsive hoarding behavior was severe enough, it warranted a separate diagnosis of Obsessive-Compulsive Disorder. There is currently no separate diagnosis for hoarding, although it is under consideration for the DSM-5.
But here’s the bottom line of why such defense strategies should concern us all. Consider this response by Assistant U.S. Attorney Craig Haller:
If anything, the combination of Tourette syndrome and pedophilia makes Hardy more of a risk to society because it means he has less control over his impulses, Haller argued.
Defense attorneys advocate for their clients and will use whatever they have to try to get a reduced sentence, and I understand that. But mental health professionals testifying as expert witnesses have other ethical obligations, and with all due respect to the psychologist in this case, I think her testimony creates a misunderstanding about Tourette’s Syndrome. I can understand and see the value in pointing out that a child who had a difficult childhood or who was rejected because of TS might develop asocial or antisocial behaviors, but then the TS is still not the cause of the behavior — the cause is the family’s and society’s response to the TS. Argue that. Argue that the defendant has OCD and compulsively collected pornography, even though he may have known it was wrong and illegal. Argue that the client never got the treatment he should have gotten and that might have prevented these problems and that he’s not a hopeless cause. But don’t blame Tourette’s Syndrome for this defendant’s behavior. Pedophilia and compulsive collecting of pornography are neither symptoms of TS nor caused by TS.
If you know someone who is a hoarder, or are just curious about hoarding, you may wish to check out a new book by Randy Frost and Gail Steketee called Stuff: Compulsive Hoarding and the Meaning of Things. I haven’t had a chance to read it yet, but it’s gotten two glowing reviews in Salon and Flint Journal.