The Dilemma of the Sexual Offender

The Dilemma of the Sexual Offender, another publication in the American Series in Behavioral Science and Law, is a thoughtful and at times controversial examination of sexual offending, the individuals who engage in it, and public policy responses. In addition to the psychiatric and legal questions familiar to forensic psychiatrists, Palermo and Farkas have tackled head-on some of the moral aspects of sexual offending that are often foremost in the minds of the public but are typically awarded scant attention by researchers and clinicians. The book is intended to be a guide for psychiatrists, forensic mental health professionals, attorneys, criminologists, and policy analysts, and it is full of useful information presented in an accessible format. The first edition of the book was published more than 10 years ago by the same authors; the current edition contains updated research findings and additional chapters on topics such as cyber-offending, child-molesting among the clergy, and erotic and sadistic psychopathy. The authors are accomplished authorities in the area of sexual offending and sex offender laws and policies.

At the outset, the authors state that they hope their book will promote a more reasoned consideration of the consequences of sex offender legislation and help inspire new directions for treatment with the goal of preventing sexual victimization. To that end, they make liberal use of psychodynamic theory to understand sexually offensive behavior and the individuals who engage in it. Although their discussions of the psychodynamics of sexual offenders (often enhanced by case examples) is a welcome departure from the dry recitation of research findings often noted in publications related to this area, some of the discussions may be difficult to follow for those not well versed in psychoanalytic vocabulary. Although Palermo and Farkas maintain an empathic approach toward both offenders and victims throughout the book, they do not mince words. They are clear in their opinion that the current state of affairs with respect to how we understand sexual offenders, as well as how we treat and manage them, is inadequate.

The book is organized into 13 chapters. The first two, “Women in Society” and “Is Evil Real?,” offer a refutation of the mantra that rape is about power, not sex, and present a nuanced discussion of sexuality, aggression, and men's ambivalence toward women throughout history. Chapter 3, “Deviant Sexuality,” contains much pithy psychoanalytic discussion and covers a wide swath, including pedophilia, incest, necrophilia, elderly offenders, and juveniles. There has been burgeoning research over the past decade in the area of deviant sexual arousal, and a more detailed discussion of research findings would have been helpful. There is only a cursory discussion of juvenile sexual offending. Also, the authors appear to exaggerate juvenile sexual recidivism and do not mention studies that indicate that most individuals who sexually offend as youths do not continue to offend in adulthood, nor do the authors mention research that attempts to drill down on risk factors that may differentiate juvenile sex offenders from non–sex-offending delinquents.

Chapter 4, “Rape and Rapists,” contains an excellent review of typologies. Chapter 5, “The Sexual Sadistic Psychopath,” provides an interesting discussion of object relations in the development of psychopathy. Chapter 6, “Lust Murderers,” briefly reviews some of the research, which is minimal, on serial killers and typologies and discusses several well-known serial killers, such as Jeffrey Dahmer and Ted Bundy. A case in which Palermo served as an expert witness is reviewed. Chapter 7, “The Relationship of Mental Illness to Sexual Offending,” reviews the connection between mental illness and violence, but little attention is paid to the role of substance use in sexual offending. Throughout the chapter, much attention is paid to the fantasy life of offenders, citing the available literature. Case examples pepper the text by way of illustration.

Chapter 8, devoted to “Victims of Sexual Abuse and Their Victimizers,” discusses the dynamics involved between victim and offender and presents research findings. Cyber-offending is covered in Chapter 9, which provides an overview of the Internet and child pornography, sexual tourism, the typologies of Internet sex offenders, and law enforcement responses. The authors acknowledge the paucity of research on sexually offending women in Chapter 10, “Female Sex Offenders and Clergy Child Sex Offenders.” Although they point out that sexual abuse by clergy is not restricted to one faith, their focus is exclusively on Catholic priests. The chapter could have profited from a more balanced discussion of child abuse among clergy of all religions.

Chapter 11 on treatment very briefly describes the variety of psychopharmacological therapies, as well as other modalities. The evolution of sex offender laws and the basis for “a recurrent history of special provisions” is the subject of Chapter 12. It provides an excellent summary of the evolution of society's approach to sex offenders from the sexual psychopath statutes to current laws. In Chapter 13, the authors call for more research into the impact and efficacy of the laws with respect to reducing recidivism, noting that extant research has not indicated a compelling positive effect on first-time sex offending or recidivism.

This book is provocative and intellectually stimulating. It provides an excellent overview of sexual offending for novices. Seasoned practitioners will appreciate the novel three-dimensional perspective that the authors deliver, as well as their attempt to explore some of the thornier questions surrounding the area of sexual offending.

• © 2014 American Academy of Psychiatry and the Law