Search

The publication of the Government's two-part White Paper - Reforming The Mental Health Act- provides the opportunity to review and comment upon some of its main proposals against a background of current concerns with issues of public protection in mental health and criminal justice.

The character of Lady Macbeth has often been presented as evil and demonic. In this contribution, an attempt is made to show her in a somewhat different light; in doing so, some implications for forensic-psychiatric practice are suggested.‘Cann'st thou not minister to a mind diseas'd…?’(Macbeth, to his wife's physician: V:i: 40)1

This article describes briefly background material on personality disorders in general and the clinical condition of psychopathic disorder in particular. A selection of the main characteristics of psychopathic disorder are then described followed by some observations on etiology. The article concludes with a description of a survey of forensic/psychiatric professionals from whom opinion was sought regarding this phenomenon.

This article describes the legal and administrative framework for the supervision of potentially dangerous offender-patients in England and Wales and some of the practical problems involved in such supervision. The article is clinical rather than epidemiological and statistical in its orientation.

In response to an article in this journal by another contributor, a modest attempt is made in the present paper to put forward additional perspectives concerning the classification and aetiology of psychopathy. An attempt is made also to distinguish between ‘essential’ psychopathy and ordinary recidivist criminality. Finally, some observations are made concerning the question of treatment.

This paper examines the diversion of the mentally disordered offender against a background of the treatment of the mentally disordered in general. Some myths about incarceration are explored and the proposal is made that diversion is not a new idea. Finally, caution is expressed in the espousal of diversion in an uncritical fashion.

An attempt is made to define dangerous behaviour in a social and environmental context. Some ethical issues are discussed and guidelines are suggested for the assessment and management of dangerous or potentially dangerous offenders. The importance of the therapist ‘knowing himself’ is also stressed.

Aspects of possession are reviewed in historical, cultural and clinical contexts. Consideration is given to differential diagnosis and management. It is suggested that a multi-disciplinary approach is required for a condition that stands at the boundaries of psychiatry.

The implementation of the Mental Health Act, 1983 affords an opportunity to re-examine some of the background to the new legislation and to place it within a wider historical context of public and professional attitudes towards the mentally disordered. No attempt is made to chart these developments in detail, but sufficient source material is provided for those who wish to pursue the study of this important topic further.

The background to the Mental Health (Patients in the Community) Act, 1995 is reviewed briefly. Some problems concerning the Act's provisions for‘supervised discharge’ are then discussed. Some more general extrapolations follow concerning the problems of legislating for social and personal‘ills’.

Some aspects of the uncertain relationship between mental abnormality and criminality are considered. Comments are offered on the contextual framework for such a relationship, studies of penal and other populations and the relationship between some specific mental abnormalities and criminal behaviour. Some implications for management are identified.

Adult fire-raising (arson) is reviewed in brief historical text and some legal and statistical issues are discussed. A classification system is suggested followed by a brief discussion of motivation and management of this type of offender.

In psychology … and in chemistry as well-what we are really analysing are not substances, but properties … I understand not attributes inherent in substances, but simply relations manifested under certain standard conditions. (Burt, Frontiers ofthe Mind, 1940: 17-1 8)

The diversion of the mentally disordered from the criminal justice and penal systems needs to be seen against the background of the management of the mentally disordered in general and of mentally disordered offenders in particular. The implications of diversion are discussed with special reference to the future of prison and prison medical services. Some jurisprudential issues are raised for further debate.

This article explores briefly the use of classical and modern literature as an aid to understanding those mentally disordered offenders who not infrequently raise anxiety, and sometimes fear, in those charged with their management. Reference is made also to other media as aids in this process.Literature is the one place in any society, where, within the secrecy of our own heads, we can hear voices talking about everything in every possible way. (Salman Rushdie, unpublished lecture)

The rich opportunities that exist for presenting social work perspectives are utilized in the curriculum of a medical school in the United Kingdom

Some characteristics, drawn from a small sample of the series 'Pioneers in Forensic Psychiatry' and from a postal enquiry to thirty-seven UK consultant forensic psychiatrists are described; an attempt is made to provide a limited 'profile'.

Brief comment is offered on Crichton's paper on the literary presentation of delusional jealousy as suggested in Othello. It is proposed that, if the Othello allusion is considered to be inappropriate, it might be wiser to describe the condition as the 'Leontes Syndrome'.

This article places risk assessment and management in criminal justice and mental health in brief historical context. It then considers concepts of risk and dangerousness, before examining the extent to which being 'wise after the event' may be helpful. Ways in which risk assessment and management might be improved and attempts to de-mystify the process are then discussed.

Some account is given of a small group of offender/patients defined as dangerous or potentially dangerous. Reasons are put forward in an attempt to explain an apparent reluctance to work with such clients and the unease that often occurs when so doing. It is suggested that an approach may be required to such offender/patients which differs in some respects from more traditional modes of treatment. Emphasis is placed upon the need for careful observation of material facts and events in the lives of such clients in addition to the careful observation of the manifestations of feelings and attitudes which may give premonition of dangerous or potentially dangerous behaviour

Criticism has recently been made of the assessment of practice in social work education. Whilst acknowledging that some of this may be well deserved, the writers of this article describe an attempt by staff at Leicester Universitys School of Social Work to make the assessment of fieldwork practice more rigorous.

The intention in this review is to examine a small selection of the literature on substance abuse and to assess to what extent it is a new phenomenon and a problem calling for legislative action. This intention accounts for the slightly capricious choice of title for the contribution.

Selected aspects of sexual offending are considered against a background of general observations about sexuality in contemporary society. It is suggested that sexual offending may appear in a variety of guises, that it is more realistic to talk about management than ‘cure’ and that success in management is highly dependent upon the professional's capacity to form a non-judgemental view and act with this constantly in mind.

Recent instruction from the Department of Health requires the institution of an independent inquiry into all cases of homicide committed by those who have been in contact with the psychiatric services. The background to this instruction is explored briefly within the context of more general concerns about violence and homicide, and the advantages and disadvantages of such inquiries are discussed.

The author enlarges upon and develops some observations upon the assessment of dangerousness which appeared in this journal a decade ago. In the present contribution, particular attention is paid to identifying the type of person at risk of committing further acts of serious personal harm to persons and or property and to the factors or circumstances that may be conducive to this. Finally, the author puts forward some views on why cues and clues may be missed and how these omissions might be overcome.‘Between the acting of a dreadful thing And the first motion, all the interim is Like a phantasma, or a hideous dream’Julius Caesar, Act II Scene 1.

Some aspects of the knowledge and skills required for dealing with the psychiatrically disordered offender in the community are identified; for this latter purpose, attention is focused specifically upon those who may have been adjudged to be dangerous in the past or who are thought likely to be dangerous in the future. It is suggested that a knowledge of the world's great literature provides a useful addition to clinical and academic teaching. The importance of team work and good communication is stressed as is the need for socio-forensic workers to identify their blind spots and defences.

The issue of diminishment of responsibility is discussed by a ‘layman’ both generally and more specifically in relation to the Sutcliffe case. Legal, psychiatric and social aspects are considered in the context of the present constraints of the law as are some proposals for reform.

The current concept of psychopathic disorder is reviewed against a short historical background. Aetiology is commented upon briefly and key characteristics described. Support is provided for the view that the concept has a degree of usefulness in clinical management provided it is viewed in a focused and restricted fashion.‘And thus I clothe my naked villainy … and seem A saint when most I play the devil.’Richard III(Act I. Sc.iii)

In this paper I shall consider the extent to which there are any substantial grounds for suggesting that there is a definite condition which some authorities have described as ‘clinical vampirism’. Such a condition, if indeed it can be said to exist, needs to be seen, not only against a background of various vampire myths and beliefs, but within the wider anthropological context of blood beliefs and rituals. Thus, in order to examine this topic we must be prepared to engage the subject matter of anthropology, mythology, folklore and demonology, as well as those disciplines that concern themselves more specifically with seriously pathological behaviour (such as forensic medicine, forensic pathology, forensic psychiatry and psychology).

The study reported upon here set out to investigate the degree to which the clinical concept of psychopathic disorder was shared between psychiatrists, psychologists and probation officers. Despite the small sample of respondents, it seems not unreasonable to conclude from the results reported below that the diagnosis of psychopathic disorder is still considered to be a useful one.