Comment

For many years, there has often been a disconnect between behavioral science research and clinical practice. For example, during the past 50 years, researchers have debated the ability of MHPs to predict violence, while at the same time—in actual practice—clinicians have routinely been offering predictions and are often required to do so by law (Borum,

1996). This same disconnect has also existed in the area of psychotherapy research and psychotherapy practice, as noted in Chapter 7. Over the same time period, statistical studies have repetitively demonstrated (e.g., Morris, Turner, and Szykula, 1988) that psychotherapy is basically not very effective. But notwithstanding numerous validation studies that demonstrated how those on waiting lists (who did not receive psychotherapy) improved at the same rate as those in psychotherapy (Strupp, 1973), clinicians continued to practice, patients improved, and laws were passed to reimburse individuals for treatment. In fact, the pool of potential therapists (limited initially to psychiatrists) increased to include psychologists, social workers, and counselors, all obtaining insurance reimbursement for treatment that patients found effective but which researchers could not empirically validate.

With some distance, we now realize that the psychotherapy research was misleading because the wrong questions were being asked. General questions such as “Does psychotherapy work?” should probably have been replaced by more specific questions such as, “What type of therapies work best, with what types of patients, under what types of conditions?” The same issue applies to the problem of violence prediction. “Can we predict violence?” is the wrong question. The more appropriate one is “What types of predictions can we make, with what types of individuals, under what types of circumstances?” When these sorts of questions are asked, a prognostic statement can and should be offered.

A purely legal approach to the compulsive, repetitive, sexual murderer, or potential murderer will not only fail to prevent recidivism, but it will also fail to protect society or help the offender. Confinement is not always the most satisfactory (or possible) solution for prevention and public safety or for rehabilitation, treatment, and intervention. This is not to negate the importance of retribution, but the law rigidly applied often deals not with the offender but with the legal definition of the crime, which emphasizes the degree of intent. Thus, an individual who commits a crime with a high level of intent will, according to sentencing guidelines, very likely be incarcerated regardless of his personality structure, motivational dynamics, or dangerousness. On the other hand, a relatively minor assault might (legally) call for a shorter period of incarceration even if the offender was toying with strong gynocidal fantasies and a pressure to act. Such a person is potentially more dangerous than an individual who may have committed, for example, a homicide with a strong situational (and noncompulsive) element. Thus, the disposition of offenders—especially homicidal offenders—based solely on the crime rather than on prognostic possibilities actually creates a dangerous situation for the public.

Specialized forensic centers are desperately needed to provide evaluation and treatment of pathological murderers, sex murderers, and potential sex murderers. These programs should not be bogged down by bureaucratic and legalistic restrictions; instead, they should focus on research, study, and teaching (Arrigo and Purcell, 2001). Such settings should be connected to medical schools and graduate schools in psychology and criminology. This model would provide an excellent opportunity for practitioners to gain clinical experience with this population of offenders as well as to engage in research and provide training. In the long run, this would protect society from a subgroup of dangerous individuals whom we desperately need to study further.

Such an approach to the evaluation, treatment, and prevention of pathological murder would be well worth the effort. The serious scientific study of sex murder has been neglected. Our government devotes vast resources to the apprehension, legal disposition, incarceration, and punishment of such offenders. However, it expends little effort on prevention, treatment, or the scientific study of the problem. Friends and relatives of the victims demand retribution, which serves a restorative psychological function as well as one of justice. But there is no reason why the punishment of sex murderers cannot also involve a concerted effort to learn more about them.