By design, Explorations in Criminal Psychopathology differs from most books in the fields of forensic psychiatry and forensic psychology. In the Introduction, the Editor, Dr. Louis B. Schlesinger, describes the book's intent: “Practitioners …need to have expertise in a wide range of clinical conditions—beyond those covered in the Diagnostic and Statistical Manual of Mental Disorders (DSM)—that relate to various forms of criminal conduct ” (p xiii). The Introduction's final paragraph states: “The need for forensic practitioners to understand…the psychodynamics of crime cannot be overemphasized” (p xiv). With these goals in mind, the volume is organized in terms of clinical and psychodynamic concepts, as opposed to specific diagnostic categories (such as psychosis or substance abuse) or medico-legal matters, such as competence to stand trial, diminished capacity, and legal insanity.
The book is divided into three sections of five chapters each: “Disorders of Behavior,” “Disorders of Thought,” and “Borderline and Psychotic Disorders.” In each section, the reader will find description and analysis of unusual or uncommonly discussed criminal forensic topics. The first section covers catathymic reactions, pathological gambling and its relationship to crime, idiosyncratic alcohol intoxication, organic brain dysfunction, and sadistic aggression. Section II reviews delusional misidentification syndromes, obsessional following (stalking), factitious disorder (including the by-proxy variant), morbid jealousy, and forensic aspects of pseudologia fantastica, or pathological lying. In Section III are discussions of Ganser's syndrome and other rare dissociative states, conduct disorder history in men with schizophrenia, dissociative identity disorder, post-traumatic stress disorder (PTSD), and malingering. As this listing indicates, only a few chapters, such as those on PTSD and on the assessment of malingering, cover ground that is likely to be familiar to many or most forensic practitioners.
Some might wonder why a book devoted to examining psychodynamic processes and forensic “zebras” is necessary or worthwhile. But anyone who has worked in forensic psychiatry for any length of time realizes that the complexities of human behavior cannot always be easily explained simply by the application of a diagnostic label. Knowledge of psychodynamics can be of great value in assisting the forensic expert to make sense of the unconscious motivations and other antecedents for what may on the surface appear to be a bizarre or senseless crime. In certain cases, familiarity with psychodynamic mechanisms allows the evaluator to provide a more complete picture of the defendant's psychological makeup, emotional reactions, and thought processes, as well as their relationship to the legal question(s) at hand, especially for criminal defendants who have personality disorders or clinically significant maladaptive personality traits, but whose perception of reality in the traditional sense is found to be intact.
In the past few decades, many psychiatry residency programs have de-emphasized the teaching of psychodynamic formulation. In a one-year forensic psychiatry fellowship, there may be little time to explore psychodynamic subjects while learning the basics of the legal system, report writing, correctional mental health, and so forth. This book, which includes concepts with which early-career forensic psychiatrists are only vaguely familiar, should pique their curiosity and motivate them to learn more about how psychodynamic theories of behavior may influence forensic psychiatric practice. While the book does not attempt to provide a comprehensive review of psychodynamic theories, the chapters that discuss these concepts generally do so in a clear and accessible manner.
Many chapters in the volume include illuminating discussions of the unconscious mental processes and motivations thought to drive certain types of criminal conduct. A few examples serve to illustrate this theme. Chapter 1 reviews catathymia, the process by which an unresolved conflict, often centered on feelings of sexual inadequacy, leads to violence toward a victim who is symbolically representative of the conflict and who therefore threatens the perpetrator's psychological integration. The author explains that the violent act resolves the emotional tension and reestablishes internal equilibrium.
The authors use the chapter on delusional misidentification to explain the hypothesized psychological mechanisms underlying aggression in patients with Capgras syndrome, the belief that a person in one's environment has been replaced by an identical-appearing impostor. Symptoms originate when anger toward another person is first defended against by denial. When this is not effective, splitting takes place, such that positive attributes are assigned to the original identity and all negative attributes are assigned to the impostor. Thus the delusional patient is free to experience righteous anger toward the supposed impostor without emotional conflicts. Subsequently, through projection and projective identification, the patient attributes his own hostile impulses to the misidentified object and comes to fear that person's hostility and malevolent intent.
In the chapter on obsessional following, we find a discussion of borderline personality organization in the stalker. The obsessional following typically has its origin in a pathological response to social isolation and social incompetence that challenges a narcissistic fantasy of specialness. Feelings of shame and humiliation are defended against with rage, which also prevents the experience of sadness. As with aggression in the context of a Capgras delusion, obsessional followers frequently employ borderline defense mechanisms such as denial, splitting, and projective identification, as well as idealization and, later, devaluation.
Similar analyses are found in other chapters. In each chapter, practical applications of the psychological explanations are covered in discussions of matters such as epidemiology, risk assessment, treatment, and legal topics, such as insanity and sentencing mitigation. Ultimately, the reader will gain an appreciation of how identifying and understanding unconscious mental processes can translate into an explanation of aberrant behavior that is useful in a forensic context. As mentioned previously, this is likely to be of particular relevance in regard to individuals who do not have psychosis and who may appear relatively “normal” in the eyes of the legal system.
One evident weakness of the book is the outdated nature of the research cited by several of the contributors. This is the second edition; the first was published in 1996. Four of the 15 chapters include no references more recent than that date, and thus it must be assumed that they were not updated for the second edition. One of these chapters describes three references from 1984 as “current opinion” (p 71). In another two chapters, the only post-1996 reference is to the 2000 text revision to the fourth edition of the DSM.
A second weakness is Chapter 12, entitled “The Consequences of Conduct Disorder for Males Who Develop Schizophrenia: Associations With Criminality, Aggressive Behavior, Substance Use, and Psychiatric Services.” This chapter describes the results of a single study examining the prevalence of premorbid conduct disorder in a group of men with schizophrenia or schizoaffective disorder. Although it is interesting in its own right, it does not fit in particularly well with the topics covered elsewhere in the book. It does not discuss psychodynamic processes or provide much in the way of practical information for use in the legal arena.
Despite these problems, Explorations in Criminal Psychopathology clearly would make an excellent addition to the library of any forensic practitioner who evaluates criminal defendants.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2012 American Academy of Psychiatry and the Law
