Sample Article Review Paper on How Often and How Consistently Do Symptoms Directly Precede Criminal Behavior Among Offenders With Mental Illness?

Theoretical Framework

The article proceeds on the hypothesis that in order to substantially reduce cases of
recidivism in instances of crimes connected to mental illness, there needs to be a separation
between those directly motivated by symptoms and those that are not directly motivated by
symptoms. By doing so, measure will not only be aimed at the symptoms of mental illness but
also at other factors that may contributed to criminal behavior among people with mental illness.
The article’s theoretical framework is structured into two questions: how often do
offenders actually commit crimes directly motivated by mental health symptoms? And how
consistently are symptoms of poor mental health linked to criminal behavior over time and
across incidences? In addressing the first question, the article first looks at legal definitions of
direct relationships. The M’Naghten rule, for example, require that subjects suffer from mental
illnesses that prevent them from being aware of the aspect of “right and wrong” in their actions.
According to the authors, this definition results in a narrow conception of mental illness. In
contrast, the American Law Institute’s definition is broader. It does not impose the requirement
of appreciation of right and wrong, but only requires the defendant to lack “substantial capacity.”
On the other hand, the Durham test broadly classifies criminal insanity as unlawful acts
stemming directly from mental defects. By addressing the reader’s attention to determined cases
however, the authors state that a majority of those found not guilty by reason of insanity were
suffering from schizophrenia and were apparently in various states of delusional psychosis at the
time of commission. Addressing the question of definition in the field of research, the authors

give as examples a number of studies in which the researchers particularly focus on psychosis as
an antecedent to criminal behavior. However, they argue that the result of such research indicates
that symptoms only precede criminal conduct in about 4%-5% for psychosis and 5% for other
symptoms. As a point of attention, the authors note a fundamental difficulty in differentiating
symptoms from normative traits. Drawing from a number of sources, the article states that
symptoms and traits often overlap, making it difficult to distinguish between true symptoms and
individuals’ personality traits. For example, anger may be a symptom of psychosis, PTSD or
mood disorders among others. However, anger is also a “fundamental and functional” human
emotion, which is in fact a common risk factor for violence among both general offenders and
clinical offenders (Gardner, Lidz, Mulvey, & Shaw, 1996). From this existing literature, the
authors then proceed to state their first hypothesis: that psychosis, bipolar disorder and
depression are the direct cause of criminal conduct in approximately 10% of cases (Peterson, 2014).
In answering the second question, the authors turn their attention to whether the
relationship between symptoms and criminal behavior is consistent within offenders or varies
over the person’s history. They however note and inherent difference in legal and policy
definitions, the former of which focuses on crimes while the latter focuses on people. The
authors rely on a number of studies, which establish that while theoretically speaking, defendants
acquitted by reason of insanity should not commit crimes that are not related to their symptoms,
that is not usually the case. In fact, general risk factors account for higher rates of recidivism
than clinical factors. As such, it can be assumed that even insanity defendants are exposed to
similar risk factors as normal offenders. This negates the assumption that symptoms are
consistently linked to criminal behavior over time. Because of the indeterminacy of the link

between symptoms and repetitive criminal behavior, the authors statistically examine the
distribution of links in order to find out whether “direct” and “indirect” classifications make
policy sense. From this literature the authors draw a second hypothesis: “the relationship
between symptoms and crimes will be consistent over time” (Peterson, 2014).
From the existing literature, the authors come to the conclusion that determining the
existence or nonexistence of a direct relationship between criminal behavior and mental health
symptoms is important. If such a link is established, then the implication for such a group of
offenders is that treatment of symptoms should reduce cases of recidivism. If research should
indicate an inconsistency however, then treating symptoms is likely to be of no consequence and
therefore other targets should be drawn up to reduce cases of recidivism among this group of


The authors use primary and secondary sources in order to establish their hypothesis and
complete the research as necessary. In using primary sources, the authors interviewed
participants with mental disorders in order to determine the relationship between symptoms and
criminal activity based on subjects’ past criminal records. The authors also reviewed records of
the participants’ psychiatric and criminal histories in order to corroborate primary diagnoses.
The secondary sources used included an extensive list of existing research as well as academic
reviews of the issues addressed within the article and legal records.


Peterson J.K., Skeem J., Kenealy P., Bray B. & Zvonkovic A. (2014). How Often and How
Consistently Do Symptoms Directly Precede Criminal Behavior Among Offenders With
Mental Illness? Law and Human Behavior, April 14, 2014. Advance online publication.
Retrieved from: (primary source)
Gardner W., Lidz C., Mulvey E., & Shaw E. (1996). A Comparison of Actuarial Methods for
Identifying Repetitively Violent Patients with Mental Illness. Law and Human Behavior,