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Book Review   |    
Psychopathology and Violent Crime
Harold Carmel, M.D.
Psychiatric Services 1999; doi:
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edited by Andrew E. Skodol, M.D.; Washington, D.C., American Psychiatric Press, 1998, 156 pages, $26, softcover

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This book is a good survey of what we know, as of a year or two ago, about the relation between psychiatric disorders and criminal violence, a rapidly evolving field of study. Of the five chapters, two report interesting individual research projects, two provide competent literature reviews, and one analyzes policy concerns.

After briefly reviewing the literature on the relationship between personality disorders and criminal violence, Jeremy Coid reports his study of 260 persons in maximum-security hospitals and prisons in England. His findings draw attention to the importance of borderline personality disorder in this population. Using the Structured Clinical Interview for DSM-III Axis II Disorders, he diagnosed borderline disorder in 69 percent of his sample—more frequently than antisocial personality disorder (55 percent), narcissistic personality disorder (48 percent), and paranoid personality disorder (47 percent).

Michael Stone has read 297 biographies of murderers—certainly a most exceptional undertaking for a psychiatrist. Based on this material, along with his extensive clinical experience, he argues that "narcissistic and antisocial/psychopathic traits blend together to form a personality configuration that is so common as to be almost ubiquitous among murderers of almost every type."

Beck and Wencel "review [the] extraordinary recent outpouring of research on the relationship between violent crime and Axis I psychopathology… document[ing] a significant development in the intellectual history of psychiatry. In a brief time, no more than 5 to 7 years… the received wisdom of a generation that held that crime and mental disorder were unrelated has been rejected."

Coccaro and McNamee review the biology of aggression, from the perspective that "most data support the idea that impulsive violent criminal behavior has significant biological underpinnings that might lead to a rationale for pharmacologic treatment." But they go beyond the science to a policy interest: "It is possible that our growing biological understanding of impulsive aggression will lead to a reconceptualization regarding the process of jury verdicts and sentencing in the case of impulsive violent crime." This view is reminiscent of mid-century psychiatric thinking that, after contemplating the problems of criminal justice, promised much more than psychiatry could deliver.

Paul Appelbaum expertly reviews legal views of mental disorder and crime and the history of exculpation on the basis of mental disease. In his view, "The most potent agent of change in legal approaches to crime is likely to result from the ability of the mental health professions to treat criminal behavior effectively.… But I am skeptical, given the current state of knowledge, that biological research into the roots of criminal behavior has anything meaningful to say to the law at present, and I doubt that it will influence the law in the foreseeable future."

I should note that minor editing errors were scattered throughout this book. Aside from that, Psychopathology and Violent Crime is useful, particularly to trainees and forensic clinicians; other clinicians will find the volume of general interest.

Dr. Carmel is clinical director of John Umstead Hospital in Butner, North Carolina.

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