Treatment as Deterministic Chaos: A chaos theory perspective on the limitations of the treatment prognosis according to section 64 of the German Criminal Code

Abstract

According to section 64 of the German Criminal Code, substance dependent (violent) offenders may, under certain circumstances, be referred to custodial addiction treatment. For this to occur, the law requires that clinical experts predict the likelihood of positive treatment outcomes for each individual case. This has proved to be difficult and, as a consequence, nearly 50% of all custodial treatments for substance dependent patients are terminated prematurely. Empirical knowledge about prognostic factors is of a nomothetic type; these factors do not always help to predict the outcomes of individual cases. From a mathematical standpoint, psychotherapeutic processes may be regarded as complex, nonlinear, dynamic systems. These systems are sensitive to initial conditions, i.e., small differences in initial conditions yield widely divergent outcomes for such dynamical systems, rendering long-term prediction impossible in general. This behavior is known as deterministic chaos. Chaos theory has applications in several disciplines, including meteorology, sociology, physics, engineering, economics, biology, philosophy, and, recently, psychology. From this point of view, psychotherapeutic processes have been regarded as chaotic and unpredictable in as far as long-term individual outcomes are concerned. In contrast, section 64 of the German Criminal Code requires a long-term therapeutic prognosis to be made. The authors believe that, for theoretical reasons based on chaos theory, such deterministic requirements cannot be met. It is concluded that therapeutic sessions on a trial basis might help to clarify whether or not a patient will be able to successfully complete treatment.