BRIEF
COMMUNICATIONS
Forensic
Psychiatry:
Profiles
BY FRITZ A. HENN, PH.D., M.D., AND ROBERT H. VANDERPEARL,
The authors exatnined charged with sexual
MARIJAN M.D.
of Two HERJANIC,
records offenses
of239 individuals and referred by the courts to a forensic service . Defendants charged st’ith rape si’ere typical/v under 30 with histories of antisocial behavior that included other types of violence. Major mental illness si’as rare in this group. Child molesters in the sample were of no particular age, usually had no histor’ of violent behavior, and had a los’ incidence of ps)’chosis. The most common secondary diagnosis in both groups ss’as alcohol or drug abuse.
Types
of Sex
Offenders
M.D.,
statement was made. A book by Mohn and associates (2) on child molesters and exhibitionists provided a careful evaluation of these offenders. MacDonald (3) examined many aspects of nape. Thus, comparisons of different cohorts of sexual offenders have become possible, and the facts concerning sexual offenders can be established and made available not only to psychiatrists but to all concerned with these problems.
METHOD
reports an empirical examination of the characteristics of a group of defendants charged with sexual crimes and referred to the Malcolm Bliss Mental Health Center Forensic Service for psychiatric evaluation. The study was designed to answer two pnincipal questions: Are there distinguishing characteristics between groups of defendants charged with different sexual offenses? What role does psychiatric illness, particularly psychosis, play in sexual offenses? The resuits of our study of 239 defendants can be most clearly presented by reporting on the individuals charged with child molestation and rape. which were the most common charges against defendants admitted to the service. A wide variety of viewpoints has been brought to the study of sexual offenders. To some extent, this is due to the nature of the subject itself. Sexual offenses are, in pant, culturally determined and therefore value laden, and responses to them become imbedded in the legal framework. The legal responses to these offenses often reflect the fears on values of the culture rather than the characteristics ofthe offender. Because the offenses are related to cultural values, opinions are strong and facts are sometimes difficult to ascertain. As Guttmacher and Weihofen (1) stated over 20 years ago, “There is doubtless no subject on which we can obtain more definite opinions and less definite knowledge. However, there have been advances since that THIS
PAPER
‘ ‘
Presented Association,
at the 128th Anaheim,
annual Calif.
meeting ,
May
of the 5-9, 1975.
American
Psychiatric
Dr. Henn is Assistant Professor, Department of Psychiatry, State Psychopathic Hospital, University of Iowa, 500 Newton Rd., Iowa City, Iowa 52242. Dr. Herjanic is Assistant Superintendent and Dr. Vanderpearl is Director. Forensic Service, Malcolm Bliss Mental Health Center, St. Louis, Mo.
694
Am
J Psychiatry
133:6,
June
1976
We reviewed records of all defendants changed with sexual crimes and referred for evaluation to the Malcolm Bliss Mental Health Center Forensic Service, St. Louis, Mo., during the years 1952-1973. Out ofa total of 1,195 cases, 239 involved defendants changed with at least one sexual crime. These cases were reviewed and coded for demographic variables, diagnosis, crime, and outcome. Crimes represent the charges against the defendant on admission to the service, and diagnoses are those given in the report to the court. The Forensic Service is responsible for all patients neferned by court in the city of St. Louis and some patients (less than 10% of the total) from surrounding counties. In more than 90% ofthe cases, the defendant was admitted for a pretrial examination.
RESU
LTS
The cohort of charges of sexual rape and attempted 43 ofsodomy. We tion, since sodomy fenses. The other ism, were seen in fendants. Demographic
239 defendants had a total of 273 offenses. There were 69 changes of nape, I 16 of child molestation, and will focus on nape and child molestaconsists ofa variety ofdiffenent ofclasses ofoffense, such as exhibitiononly a small proportion of these de-
Variables
The demographic variable that most strikingly separated defendants changed with rape from those charged with child molestation was age. Those implicated in nape were much younger on the average.-. over 75% were under 30. Defendants involved in cases of child molestation were distributed over the entire age range-only 28% were under 30 and almost as
BRIEF
TABLE
1
Primary
Diagnoses
of 239
COMMUNICATIONS
Sexual Offenders
Principal Se xual Offense
Rape
and
Child
Attempted Rape (N=67) Primary
Diagnosis
Schizo-affectivedisorder Schizophrenia Affectivedisorder Antisocial personality Otherpersonalitydisorder
Drugand Organic
Molestation (N=111)
N
%
N
2 6 0 32 14
2.9 9.0 0.0 48.0 21.0
2 10 2 7 9
8 16
%
N
%
1.8 9.0 1.8 6.4 8.1
0 3 2 7 12
0.0 7.1 4.8 16.7 28.6
0 4 0 1 8
0.0 21.0 0.0 5.3 42.1
7.2 14.4
4 3 5 1 5
9.5 7.1 11.9 2.4 11.9
4 0 1 1 0
21.0 0.0 5.3 5.3 0.0
3
4.3
Mentalretardation
2.9 2.9
15
13.5
Other
0
0.0
34
30.6
Notill
6
9.0
8
7.2
were
oven
50.
The
was
statistically
difference
in mean
age
of the
‘other’ category). This group, combined with those categorized as having no psychiatric illness, constitutes over a third ofall the child molesters seen. Other categories that contribute heavily to the diagnostic distnibution in this group include organic brain syndrome, mental retardation, and schizophrenia, which were found in almost two-fifths of the cohort changed with child molestation. Alcoholism and drug abuse were the predominant secondary diagnoses in both nape and child molestation constituting one-third of the secondany diagnoses for these two groups of defendants. We examined the influence of major psychiatric disorders in defendants charged with sexual crimes by looking at the incidence of schizophrenia and affective disorders among defendants changed with such offenses. Police records from the years 1961 through 1973 for all rapists and other sexual offenders (cxcluding offenses involving commercial vice) were obtamed. Unfortunately, child molestation was not kept as a separate category by the police. We then reviewed records of those in this group charged with nape and other sexual offenses who were seen on the Forensic Service between 1961 and 1973 for the presence of cithen illness. Since the Forensic Service is the only such service in St. Louis and receives more than 90% of its defendants from St. Louis City Courts, we assumed that the defendants with diagnoses of either schizophrenia on affective disorder would be in the group of defendants seen on the Forensic Service. This assumption is supported by the referral of a large proportion of defendants without severe psychiatric disorders, indicating a high index of suspicion of psychiatnic illness on the part of the count. This makes it unlikely that the courts would overlook a significant number of defendants with serious psychiatric problems. Further, a study of convicted felons in Missouri found little psychosis in the prison population (4). Schizophrenia, including cases of schizo-affective disorder, was found in 0.3% of all rapists (8 of 2657 cases) and 0.22% of other sexual offenders (I 1 of 4793 ‘
two
groups
Concurrent
significant
(p
COMMUNICATIONS
Forensic
Psychiatry:
Profiles
BY FRITZ A. HENN, PH.D., M.D., AND ROBERT H. VANDERPEARL,
The authors exatnined charged with sexual
MARIJAN M.D.
of Two HERJANIC,
records offenses
of239 individuals and referred by the courts to a forensic service . Defendants charged st’ith rape si’ere typical/v under 30 with histories of antisocial behavior that included other types of violence. Major mental illness si’as rare in this group. Child molesters in the sample were of no particular age, usually had no histor’ of violent behavior, and had a los’ incidence of ps)’chosis. The most common secondary diagnosis in both groups ss’as alcohol or drug abuse.
Types
of Sex
Offenders
M.D.,
statement was made. A book by Mohn and associates (2) on child molesters and exhibitionists provided a careful evaluation of these offenders. MacDonald (3) examined many aspects of nape. Thus, comparisons of different cohorts of sexual offenders have become possible, and the facts concerning sexual offenders can be established and made available not only to psychiatrists but to all concerned with these problems.
METHOD
reports an empirical examination of the characteristics of a group of defendants charged with sexual crimes and referred to the Malcolm Bliss Mental Health Center Forensic Service for psychiatric evaluation. The study was designed to answer two pnincipal questions: Are there distinguishing characteristics between groups of defendants charged with different sexual offenses? What role does psychiatric illness, particularly psychosis, play in sexual offenses? The resuits of our study of 239 defendants can be most clearly presented by reporting on the individuals charged with child molestation and rape. which were the most common charges against defendants admitted to the service. A wide variety of viewpoints has been brought to the study of sexual offenders. To some extent, this is due to the nature of the subject itself. Sexual offenses are, in pant, culturally determined and therefore value laden, and responses to them become imbedded in the legal framework. The legal responses to these offenses often reflect the fears on values of the culture rather than the characteristics ofthe offender. Because the offenses are related to cultural values, opinions are strong and facts are sometimes difficult to ascertain. As Guttmacher and Weihofen (1) stated over 20 years ago, “There is doubtless no subject on which we can obtain more definite opinions and less definite knowledge. However, there have been advances since that THIS
PAPER
‘ ‘
Presented Association,
at the 128th Anaheim,
annual Calif.
meeting ,
May
of the 5-9, 1975.
American
Psychiatric
Dr. Henn is Assistant Professor, Department of Psychiatry, State Psychopathic Hospital, University of Iowa, 500 Newton Rd., Iowa City, Iowa 52242. Dr. Herjanic is Assistant Superintendent and Dr. Vanderpearl is Director. Forensic Service, Malcolm Bliss Mental Health Center, St. Louis, Mo.
694
Am
J Psychiatry
133:6,
June
1976
We reviewed records of all defendants changed with sexual crimes and referred for evaluation to the Malcolm Bliss Mental Health Center Forensic Service, St. Louis, Mo., during the years 1952-1973. Out ofa total of 1,195 cases, 239 involved defendants changed with at least one sexual crime. These cases were reviewed and coded for demographic variables, diagnosis, crime, and outcome. Crimes represent the charges against the defendant on admission to the service, and diagnoses are those given in the report to the court. The Forensic Service is responsible for all patients neferned by court in the city of St. Louis and some patients (less than 10% of the total) from surrounding counties. In more than 90% ofthe cases, the defendant was admitted for a pretrial examination.
RESU
LTS
The cohort of charges of sexual rape and attempted 43 ofsodomy. We tion, since sodomy fenses. The other ism, were seen in fendants. Demographic
239 defendants had a total of 273 offenses. There were 69 changes of nape, I 16 of child molestation, and will focus on nape and child molestaconsists ofa variety ofdiffenent ofclasses ofoffense, such as exhibitiononly a small proportion of these de-
Variables
The demographic variable that most strikingly separated defendants changed with rape from those charged with child molestation was age. Those implicated in nape were much younger on the average.-. over 75% were under 30. Defendants involved in cases of child molestation were distributed over the entire age range-only 28% were under 30 and almost as
BRIEF
TABLE
1
Primary
Diagnoses
of 239
COMMUNICATIONS
Sexual Offenders
Principal Se xual Offense
Rape
and
Child
Attempted Rape (N=67) Primary
Diagnosis
Schizo-affectivedisorder Schizophrenia Affectivedisorder Antisocial personality Otherpersonalitydisorder
Drugand Organic
Molestation (N=111)
N
%
N
2 6 0 32 14
2.9 9.0 0.0 48.0 21.0
2 10 2 7 9
8 16
%
N
%
1.8 9.0 1.8 6.4 8.1
0 3 2 7 12
0.0 7.1 4.8 16.7 28.6
0 4 0 1 8
0.0 21.0 0.0 5.3 42.1
7.2 14.4
4 3 5 1 5
9.5 7.1 11.9 2.4 11.9
4 0 1 1 0
21.0 0.0 5.3 5.3 0.0
3
4.3
Mentalretardation
2.9 2.9
15
13.5
Other
0
0.0
34
30.6
Notill
6
9.0
8
7.2
were
oven
50.
The
was
statistically
difference
in mean
age
of the
‘other’ category). This group, combined with those categorized as having no psychiatric illness, constitutes over a third ofall the child molesters seen. Other categories that contribute heavily to the diagnostic distnibution in this group include organic brain syndrome, mental retardation, and schizophrenia, which were found in almost two-fifths of the cohort changed with child molestation. Alcoholism and drug abuse were the predominant secondary diagnoses in both nape and child molestation constituting one-third of the secondany diagnoses for these two groups of defendants. We examined the influence of major psychiatric disorders in defendants charged with sexual crimes by looking at the incidence of schizophrenia and affective disorders among defendants changed with such offenses. Police records from the years 1961 through 1973 for all rapists and other sexual offenders (cxcluding offenses involving commercial vice) were obtamed. Unfortunately, child molestation was not kept as a separate category by the police. We then reviewed records of those in this group charged with nape and other sexual offenses who were seen on the Forensic Service between 1961 and 1973 for the presence of cithen illness. Since the Forensic Service is the only such service in St. Louis and receives more than 90% of its defendants from St. Louis City Courts, we assumed that the defendants with diagnoses of either schizophrenia on affective disorder would be in the group of defendants seen on the Forensic Service. This assumption is supported by the referral of a large proportion of defendants without severe psychiatric disorders, indicating a high index of suspicion of psychiatnic illness on the part of the count. This makes it unlikely that the courts would overlook a significant number of defendants with serious psychiatric problems. Further, a study of convicted felons in Missouri found little psychosis in the prison population (4). Schizophrenia, including cases of schizo-affective disorder, was found in 0.3% of all rapists (8 of 2657 cases) and 0.22% of other sexual offenders (I 1 of 4793 ‘
two
groups
Concurrent
significant
(p
