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Taking Issue   |    
Sexual Predators and the Abuse of Psychiatry
Gary J. Maier, M.D.
Psychiatric Services 1999; doi:
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With the Kansas v. Hendricks decision in June 1997, the U.S. Supreme Court endorsed both the use of civil commitment to continue the confinement of sexual predators who had served time in the criminal justice system and the possibility that the proposed treatment could produce reliable change. (Effectiveness of treatment for sex offenders is reviewed beginning on page 349.) But the treatment of ego-dystonic sexual disorders has been problematic. Could the coerced treatment of criminal ego-syntonic sexual disorders be more successful? While the public generally supports confining sexual predators, what shouts for our attention is the question of whether sexual predators suffer from real mental disorders. Apparently one can get these disorders only at the end of a prison sentence. Calling criminal acts mental disorders is categorically fallacious. How is it that we have been co-opted into participating in this transparent process? Wasn't this the false promise of the old sexual psychopathy laws?

Yet psychiatrists and psychologists are championing guild-supported approaches to the prediction of dangerousness and to treatment options. The psychiatrists promote testosterone suppression and serotonin enhancement, while the psychologists advocate for cognitive-behavioral approaches. Typologies defining types of predators continue to proliferate, but these "diagnoses" are hardly compatible with the abnormal penile response patterns of predators as measured by the plethysmograph. The hope of research-oriented treatment designed for the ego-syntonic, sexually impulsive inmate coerced into treatment is matched only by the despairing fact that outcome studies for the (I must say it again) coerced inmate give no clear support to any treatment approach.

If the public doesn't want sexual predators released, it should promote truth in sentencing and life sentences. Unfortunately, society has made a dangerous turn to the right by using the legal and mental health systems to control undesirable persons in new special prison hospitals. Few inmates will be able to demonstrate they are ready for release because there can be no treatment for "willful" criminal acts.

The Russians abused psychiatry, creating politically motivated mental disorders—the disease of dissent and delusions of social reform—to control agitators and ideologues. Surely back-door predator laws will one day be viewed for what they are: the use of psychiatry by a fear-ridden society to continue to lock up people who have already paid their debt. Given this mentality, today it's predators who are locked up in the new prison hospitals, tomorrow it could be thieves, and after that it's anybody's guess.—

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