The Clinical School of Criminology

The clinical current answers a question the classical school could not ask and the cartographic school could not reach: what is wrong with this particular offender, and what can be done to him?

It is the strand of criminology that treats the offender as a case — as a person to be examined, diagnosed, classified, treated and, if possible, cured. Its natural home is the individual file, the interview and the report; its natural output is a prognosis. Everything modern that follows from that — the pre-sentence report, the psychiatric assessment, the indeterminate sentence, the treatment programme — descends from this current.

1. Physiognomy. The art of physiognomy claimed to enable its practitioners to judge character and disposition from the features of the face and the external forms of the body. It had been known since the seventeenth century, and J. C. Lavater's essays, published in 1792, purported to give it a scientific foundation.

2. Craniometry and phrenology. F. J. Gall and J. C. Spurzheim made similar claims in the early nineteenth century, this time focusing on the shape and contours of the human skull as an external index of character. By the 1830s physiognomy and phrenology had lost much of their scientific credibility and had become the obsession of a few enthusiastic publicists — but the quest to uncover the links between physical constitution and psychological character continued in a different and more important line of research.

3. Alienism and the asylum. The emergence of a network of private asylums in the eighteenth century produced a new quasi-medical specialism, at first called alienism and later known as psychological medicine or psychiatry. The writings of asylum managers about their patients — about their conduct, the antecedents of their madness, and the forms of treatment to which they responded — formed the basis of a major tradition of scientific investigation, and one which would subsequently be an important source of criminological data and ideas.

Two features of that new discipline mattered for criminology. It continued the attempt to link psychological characteristics to physical constitutions; and it had an intense focus upon the individual, a focus permitted and encouraged by the long-term confinement of asylum patients under the daily gaze of the alienist. What was developing was a new kind of empirical psychology, concentrating on pathological cases and their rational management; and because many of these cases involved criminal conduct, one offshoot was a diagnostic and prognostic literature claiming to give a scientific account of certain kinds of individual criminals.

4. The expansion after the Lunacy Acts. When the asylum network was expanded in the mid-nineteenth century to house the country's poor as well as the well-to-do, the new psychiatric profession had more and more to say about conditions such as moral imbecility, degeneracy and feeblemindedness, which were deemed prevalent among the populations dealt with by the poor-houses and the prisons. Consequently, when a science of the criminal began to develop in the last decades of the century, there already existed a tradition of work whose concerns ran in parallel with its own and from which it could draw support.

5. The clinical reception of Lombroso. The connection is not merely thematic. For about fifty years after the publication of L'Uomo Delinquente in 1876, the journals of the psychiatric profession were virtually the only ones in Britain which took a serious interest in Lombroso's project.

Criminality is a condition of the individual, susceptible of diagnosis and of treatment. Two theses follow from Lombroso's influence and run to the present day: that crime can be explained by reference to biological and inherited characteristics; and that crime is caused by a pathological or chemical abnormality which needs to be treated.

The clinical claim shows itself most clearly in the sentencing consequences it produces. Theories centred on the individual all suggest a cure based on adjustments to the individual — cures ranging from sterilization, in order to prevent crime in future generations, through to psychoanalysis. Because it takes time to cure or to help people, it becomes necessary to incarcerate them long enough to have the desired effect. In this way these theories influenced the lengths of prison sentences. That is the single most examinable consequence of the clinical current, and you should state it in those terms.

The clinical current's evidence is case material: individual histories, examinations, and observed responses to treatment. That is its strength, because it is the only body of evidence about particular offenders that anyone has; and it is its weakness, because case material cannot by itself establish that the condition observed causes the offending rather than accompanying it.

The specifically biological claims have fared badly. Where later writers grounded passivity and aggression in the different brains and hormones of men and women, the tests were done on animals, mainly rats: a predominance of oestrogens makes a rat's brain female, a predominance of androgens male, and a female injected early with androgens becomes aggressive and indistinguishable from a male. The extrapolation of any finding from rats or monkeys to humans is necessarily very risky, the hormonal links are complex, and they are always a mixture of biology and socialisation, so that it is very difficult to ascertain which has had the greater effect.

The clinical claim has nonetheless secured a foothold in law that no other criminological theory has. Menstruation has been used as a partial defence plea, and both menstruation and menopause have been accepted as factors that should reduce sentence. In the early 1980s premenstrual tension was successfully pleaded: in one case a murder charge was reduced to manslaughter on diminished responsibility, with a probationary sentence conditional on hormone treatment; in another, a woman charged with murder was convicted only of manslaughter on diminished responsibility with no custodial sentence and not even a requirement of hormonal treatment. And infanticide — where a mother kills her child within its first year as a result of post-natal depression or lactation — is the only sex-specific defence recognised in the criminal law.

• The neglect of social factors. These theories give little if any consideration to the role, status or socio-economic position of the person in society. That neglect has an immediate attraction for anyone wishing to retain the status quo, which helps explain the popularity of such theories among the better-off sections of the community.
• The sentence-lengthening consequence described above is not an accident but a structural feature: a theory whose remedy is treatment has no principled stopping point, because the sentence ends when the cure ends.
• The removal of choice. In the case of women in particular, the acceptance of medical pleas allows the continuation of the idea that women are incapable of controlling themselves and that their actions can be explained through medical reasoning. Widely used, the implication is that women should be treated for this sickness rather than punished. It removes the idea that they may choose criminality, or that it might be a rational decision arising out of a social, economic or political situation.
• The absence of a decisive test. No conclusive scientific tests have been found to establish what link, if any, psychological and physiological factors have with crime. Theories built on those ideas can be strongly attacked but cannot be wholly discounted; the only definite conclusion is that biological arguments have been largely discounted as major reasons for crime.

- On the schools question, this is your answer to Clinical School of Criminology: give the line of descent from physiognomy through phrenology to alienism and psychiatry, and then give the claim — criminality as a condition to be diagnosed and treated. - On penology, use it to explain the indeterminate sentence and the treatment order, and then use the criticism to explain why desert theorists object: the clinical view has often failed to recognise any general right not to be punished more than is proportionate, since it has been invoked in support of indeterminate sentences. - As the bridge to Freud, note that psychodynamic theory is the clinical current's most influential modern form, and that Freud differs from Lombroso on the crucial point: where Lombroso distinguished born criminals from other people, Freud saw everyone as a potential criminal, all human beings being born with amoral and antisocial instincts. - As the bridge to modern practice, note that cognitive behavioural treatment, the Risk-Needs-Responsibility model and the offence-focused programmes of the probation service are the clinical current still working, with a changed vocabulary. </content>