Comment

The chronic catathymic process has been recognized as a clinical entity for almost a century; however, its usefulness in both forensic and clinical practice has been greatly undervalued. Not only can the catathymic process inform forensic practitioners in cases of extreme violence such as homicide, but it can also inform nonforensic clinicians (Schlesinger, 2002b) in cases of stalking, suicide, and even self-mutilation (Greilsheimer and Groves, 1979; Simpson, 1973). Perhaps because catathymia is not listed in the latest edition of the

Figure 6.3 Deep depression is obvious in drawings by a man who killed his entire family.

diagnostic manual or perhaps because it is a psychodynamic construct (which may not be easily understood), its applicability has been relatively limited.

In some instances, the catathymic process is incorrectly applied to cases of interpersonal violence involving symptoms of brooding, depression, and a conflicted relationship with the victim. Schlesinger (1996b) discussed the differential diagnosis of the catathymic process and argued “not all explosions of violence directed against the partner, in a long term conflictual relationship, are necessarily catathymic reactions. Many primary psychiatric conditions may also result in explosive/homicidal behavior” (p. 131), as well as simply anger and jealousy. The catathymic process has also been incorrectly used as an explanation for serial murder (Garrison, 1996) and to explain other forms of behavior such as male battering (Dutton, 1998).

Both acute and chronic catathymic processes can also be useful in courtroom proceedings as a supplement to a traditional DSM diagnosis, especially in cases where the offender’s motive is unclear. Catathymia is not meant to replace a diagnosis but rather to accompany it. A clinical diagnosis is a description of symptoms. The catathymic process helps explain the individual’s behavior. Neither a diagnosis nor a psychodynamic explanation can directly satisfy the requirements of a legal standard; however, various disorders, conditions, and syndromes that relate to the loss of control are always of interest to the court. And as noted in Chapter 5, a catathymic homicide in its pure form may be relatively rare, but features or elements of the process can be found in many cases.

An insanity plea is usually rejected by the jury in chronic catathymic homicides, essentially for three reasons: (1) there is often no clear-cut psychosis, a necessary condition to establish mental disease; (2) the jury does not fully appreciate the frequently accompanying dissociative state; and (3) the jury often considers obsessive rumination to be the equivalent of premeditation. Nevertheless, a clear explanation of the catathymic process can enable jury members to gain additional insight into the complexity and depth of many such cases. Sentencing options, capacity for rehabilitation, and the potential for repetition if the underlying complex is not adequately addressed are additional issues of importance to the court.

The devastating consequences of a catathymic homicide underscore the need to develop effective risk-assessment strategies. Recognition of the clinical manifestations of the process helps to identify individuals at risk, particularly when a person reveals a belief that a violent act is a solution to an internal conflict. Practitioners, therefore, should routinely question their patients regarding homicidal thoughts with the same level of conscientious detail they use in assessing thoughts of suicide. Those found to be at risk need immediate intervention and treatment, including the option of hospitalization (possibly involuntary). Meloy (2010) notes that in cases of catathymic homicide, “the act is inexplicable by those who investigate it, and the prior absence of any violence completely obliterates the usual phenomenological explanations for intentional killing” (p. 1395). Nesca and Kincel (2000) believe that individuals in the incubation phase of the catathymic process can be effectively treated by “an aggressive focus on mood stabilization and relationship issues” (p. 52). They found pharmaceuticals as well as individual and conjoint psychotherapy to be of help. In addition, these authors stress the need for consultation with a forensic specialist who has expertise in this type of clinical syndrome.

Many suicidal threats often mask homicidal risk, while those who make homicidal threats often wind up committing suicide (MacDonald, 1968; Pokorny, 1966; Rhine and Mayerson, 1973). Thus, both types of threats, no matter how indirect, require careful assessment. The uncovering of catathymic ideation is always a foreboding sign that needs to be recognized and properly treated in an attempt to prevent tragedy. The effectiveness of restraining orders and antistalking laws is, at this point, unclear. Such measures hold promise, however, if a potential offender can be identified and referred for mandatory assessment and treatment rather than just handled legally without any mental health intervention. But the first step in prevention is the recognition of risk.