Volitional impairment and the sexually violent predator

This article discusses psychiatry's limited conceptualization of volitional capacity and its application to sexually violent predator laws by exploring two legal opinions critical to predator case law (Kansas v. Hendricks and Kansas v. Crane). The author reviewed pertinent psychiatric literature on impaired volition to identify potential contributions and limitations that psychiatry may offer the legal field. Assessment of the ego dystonic nature of impaired self-regulation, utilization of recent advances in self-assessment and laboratory evaluation of impulsive behavior, and dimensional categorization of a volitional capacity construct are recommended as an approach to the assessment and understanding of an inability to control concept. This paper concludes that elements of volition may be psychiatrically evaluated in a way that contributes to the Court's understanding of that capacity. However, further study is needed to operationally define volitional capacity and address issues of assessment validity and reliability.     

Legal rights and communicable disease: AIDS, the police power, and individual liberty

The policy debate over AIDS has focused on how to balance the rights of individuals who have the disease against the rights of the public. This paper examines the nature of both sets of rights by analyzing the development of public health law and its dominant visions today. The article argues that while once public health rights implied a vast reserve of community authority and obligation to prevent illness, today the rights of the public and those of individuals are seen as being in opposition. Public health jurisprudence now presupposes that illness is primarily a matter of individual concern. In this view, the science of medicine mediates the relationship between the individual and the public. This understanding of rights protects some of the interests of infected individuals, but is inadequate for addressing many of the major problems raised by the AIDS epidemic, particularly the spread of infection among the uninfected.     

Loathing the sinner, medicalizing the sin: why sexually violent predator statutes are unjust

In seventeen states, persons convicted of one or more sexually violent offenses may be involuntarily civilly committed at the end of their criminal terms if they suffer from a mental disorder that renders them likely to reoffend sexually. These statutes place the burden on states to show that the sex offender meets the United States Constitutional standard of dangerousness. The key to proving dangerousness is proof of a mental disorder. However, the United States Supreme Court recently found that the offender need not be mentally ill. He need only "suffer" from "mental abnormality" or "personality disorder" that affects his cognitive, emotional or volitional capacities such that he is highly likely to sexually reoffend. These statutes are expressions of disgust: a fear of contamination by persons who engage in sexual conduct that forces us to confront our dark impulses. We do not merely hate the sin; we hate the sinner, and we want the sinner to be removed from our presence. Moreover, the emotions these statutes express are the source of widespread moral panic not warranted by data about recidivism risk. Laws that express disgust are likely to result in the unjust treatment of sex offenders.     

Sexual psychopathy, public policy, and the liberal state

This article addresses several interrelated issues. It strives to situate a class of offenders within the liberal state. The disposition of this class allows an analysis of the tensions in liberal theory. It highlights the ways liberalism attributes individual responsibility for criminal behavior and captures the limits of those attributions. It also reveals liberalism's shift away from models of responsibility toward the social control of deviancy. The disposition of this class points toward the therapeutic mask involved in the social control model. Further, the disposition of this class may well serve as a model for isolating and demonizing other disfavored classes, including political dissenters.     

Mental health policy in the liberal state: the example of the United States

Mental health policy arises out of the interaction of many different variables. These include (but are not limited to) the composition of the population of persons with severe mental illnesses; the means of dealing with disease and dependency; concepts of the etiology and nature of mental disorders; the organization and ideology of psychiatry; funding mechanisms; and existing popular, political, cultural, and professional values. But an often neglected but crucial factor in shaping policy is the very structure of the American political system, which played a crucial role in shaping mental health policy. Rather than emphasizing the neo-liberal theory and its accompanying hostility toward "unsuccessful" people and disdain of welfare, this article suggests that an understanding of mental health policy in the latter half of the twentieth century is better served by an examination of what actually happened. Theory, however attractive, rarely can encompass the messy data of reality.     

Child abuse reporting trends: an unprecedented threat to confidentiality

Some recent interpretations of the child abuse laws are creating serious and unprecedented erosions of therapist/patient confidentiality. In contrast to the Tarasoff decisions and laws, the child abuse statutes introduced a new element of mandatory reporting which permits no discretionary alternatives and presents prospects of criminal penalties for failure to report. A recent development suggests a possible requirement for therapists to violate confidentiality for the sole purpose of punishing perpetrators. Overinterpretations of the laws by some child protective services have led to recommendations that long past child abuse must be reported, even when no current child is in danger. The California Attorney General's Office has issued a clarification stating that the child abuse statute refers to children and not to adults molested as children. A survey of forensic psychiatrists and psychologists shows that most perceived an ethical problem in reporting adults molested as children when no child is presently in danger, and the purpose of the report is solely for maximal legal self-protection. The survey indicates that fears induced by rigid and intimidating child abuse laws can influence therapists to act in ways most consider unethical. Recommendations are made for improving the current child abuse laws so that they accomplish their goals more effectively.     

Homicide-suicide and other violent deaths: an international comparison

Homicides followed by the suicide of the perpetrator constitute a serious form of interpersonal violence. Until now no study has directly compared homicide-suicides to other violent deaths from multiple countries, allowing for a better understanding of the nature of these violent acts. Using country-specific data, this study describes and compares the incidence and patterns of homicide-suicide as well as the relationship between homicide-suicide, homicide, suicide and domestic homicide in the Netherlands, Switzerland and the United States. The results indicate that cross-nationally, homicide-suicides are more likely than other types of lethal violence to involve a female victim, multiple victims, take place in a residential setting and to be committed by a firearm. Although homicide-suicides display many similarities across the different countries, differences exist regarding age and the use of firearms in the offence. This study indicates that homicides followed by suicides differ from both homicides and suicides in similar ways internationally. Cross-national differences in the availability of firearms may explain the international variation of homicide-suicide rates and patterns.     

Excepted substances: a comparison of Federal and state laws.

A state law has placed an obligation on the criminal investigation laboratories to screen and quantitate all preparations, both pharmaceutical and illicit, that fall under the provisions of "Excepted Substances." Without complete screens on these preparations, there is room for erroneous indictments as well as possible acquittals on technicalities.