July 6 juillet 8:30 – 12:15
(extended session)
Room NCDH–201
Chair:
Volker Dittmann
, University of Basel
Discussant: Gerard J. Werckle
, California Department
of Corrections
The evaluation of 78 expert reports on sexual delinquents that were made since 1991 in the forensic psychiatric department of the Psychiatric University Hospital of Basel show that in 10 cases schizophrenic or schizoaffective disorders were diagnosed. In another case no expert report made since the diagnosis of schizophrenia occurred during hospitalisation. Another patient with a schizoaffective disorder showed sexually deviant thoughts and behavior during treatment. In our investigation we considered, in particular, the possibility of the presence of a disorder regarding sexual preference in addition to the psychotic disorder. First results will be presented.
According to current opinion, the classification of sexual
offenders is crucial to risk assessment. In a retrospective study of 73 reports
on sexual offenders, we examined whether, in addition to criteria-based
assessment, the application of the HCR/SVR and a taxonomic classification could
provide further relevant prognostic information. The study involved 73 reports
from the past 10 years from the forensic department of the psychiatric
university hospital: 37
cases were accused of aggressive sexual assault, 34 of pedosexuality and 3 of
exhibition. The diagnostic categories (ICD-10) included seven cases of substance
dependence, eight cases of schizophrenia, one case of affective disorder, one
case of reactive disorder, one case of behavior disturbance, 42 cases of
personality disorders, 15 cases of altered sexual preference and two cases of
mental retardation.
A 50-year old man accused of sexual acts involving two boys
was referred to us for forensic-psychiatric assessment. Coming from a
disharmonious family background the offender had shown marked behavioral
problems and persistent delinquency and had been placed, at age five, in various
educational and correctional facilities, in one of which he was reportedly
physically mistreated and sexually abused. From the age of 18, he repeatedly
committed sexual acts involving boys, in some cases also resorting to force. He
frequented homosexual circles and committed larceny. Several treatment attempts
with Cyproteron failed due to poor compliance. At 28 year of age, after a
renewed bout of delinquency involving sexual acts with boys, he abruptly decided to
submit to surgical castration. From then on he embarked on a successful professional career,
quickly working his way up to sales manager of a large company and starting a
successful travel agency.
At 43, he convinced a doctor under some pretext to prescribe androgens
which, were regularly administered only seven years later. A few months after
androgen administration, a relapse occurred. Comment:
The castration of this man occurred in 1976, and was one of the last performed
in Switzerland on forensic-psychiatric grounds. In this case, it is remarkable
castration resolved not only the sexual delinquenc,y but also the antisocial
behavior. We
discuss the import of castration of sexual offenders in Switzerland and its
effect on the case at presented.
The discussion about the appropriate legal and practical dealings with sexual offenders has been brought to the public eye since the early 90’s through several spectacular cases in this and also in other European countries. Extensive reports by the mass media concerning the offenders, the court cases that followed and the diverse political discussions gave the public the opinion that sexual offenders, especially child molesters, are basically violent offenders who are driven by instinct and have a high risk of relapse. In contrast, the discussion about juvenile sex offenders is rather controversial. Some classify sex offences among juveniles as careless, awkward lapses that occur within normal sexual development. Others, however, regard sexual crimes during adolescence as the first sign of a highly deviant, dangerous criminal potential. Consequently there are considerable differences in dealing with such aberrant behavior among adolescents. Taking these views into consideration, we are interested in both the extent of the offenceand in the biographical and criminal development of the juvenile. Our study investigated the forensic histories and the types of sexual offences committed by juveniles who received orders to appear in front of the juvenile court between 1995 to 1999, in the Canton of Zürich. Based on the offenders’ records, we examined their family and educational background, the presence of any specific life events, as well as any outstanding family or personal developments. Our study further highlighted the offenders’ psychopathological problems, the demographic markers, the characteristics concerning the victims, the type and extent of the legal and therapeutic interventions and the characteristics of their social network.
The lecturer presents two case reports:
Firstly a young man with Klinefelter-Syndrome who showed behavioral problems since his early childhood. In his adolescence, he placed newspaper advertisements to get jobs as a babysitter. He had sexual intercourse with two of these children (ie, mutual fellatio), and played games while using diapers.
The second case is a twenty-eight year old computer specialist who almost became addicted to the internet, searching for web sites under the keyword “diaper”. In addition to these activities, he formed a bondage-like relationship with an elderly aunt, who was expected to wrap him in diapers. He was eventually convicted of having played such games with her two children.
In the theoretical part, the author presents several types of deviant sexual behaviors in the context of paedophilia. He finally outlines a hypothesis concerning the genesis of these disorders, although the entire neurobiological basis of psychosexual infantilism is not yet clarified.
The Psychiatric and Psychological Service of the Department
of Justice in Zurich is a specialized forensic center, providing a lot of
outpatient services in the area of justice: The wide range of therapeutic
treatments allows us to offer, for example, specialized prevention programs or,
as a basic coverage, psychiatric services in the prisons. Making
risk-assessments available to the prosecutors and the system of correctional
services, organizing trainings for interested colleagues, and contributing to
scientific questions that are relevant to the practice , are some of the
additional professional activities undertaken by the service. To understand the
potential of the Zurich-Model it is necessary to note that service
representatives are responsible for the management functions of the justice
system. This means that psychiatrists take responsibility for the development of
the whole justice system, permiting a close cooperative relationship between
psychiatry professionals and the justice system. The primary goal of the entire
legal concept is to prevent relapse by focusing on many organizational levels.
This includes differentiation (special arrangements for specific kinds of
offenders, or problems inside and outside the penitentiary), systematic
interdisciplinary cooperation, specialization (e.g., risk assessment and
preventive therapy programs).These working conditions create an intensive
interdisciplinary culture of working together, making practical solutions to
problems possible, that in other situations could not be attained. The Zurich-Model will be presented in the
lecture, the philosophy of treatment programs will be described and a new
approach for risk-assessment will be introduced.
One of the Zurich projects comprises a highly intensive specialized program for sexual and violent offenders at canton Zurich’s largest penitentiary. Prison staff here work closely with therapy personnel. The author, one of the therapists, will present the program results to date and pay special attention to therapy aspects with regard to offenders with personalitiy disorders. This presentation will show the possibilities that were opened up through close interdisciplinary teamwork, which is structurally anchored in the overall justice organization.
This presentation deals with 88 sex-offenders who were sentenced by the court to compulsory outpatient treatment and sent to our forensic outpatient service during the period of April 1992 to March 1998. 66 of these sex offenders had been released from prison, 22 from high security hospitals for mentally ill offenders. The committed offences ranged from sexually motivated homicide to paedophilic violence. The majority of the offenders had a psychiatric diagnosis (e.g. personality disorder, schizophrenia, paedophile sexual identity).
68 offenders received psychiatric and/or psychotherapeutic treatment, as established by our treatment unit. 20 offenders required no therapeutic offer.
We investigated relapse rates, using the criminal records of March 1999, with a mean follow-up time period of 4.2 years after the index assessment at out unit.
We will present our concept and costs for treatment of our service. We compared treatment costs of 66 sex-offenders kept in prison, and of 22 offenders kept in high security hospitals, to the treatment cost of the same risk set of our unit. We contrasted the treatment costs and the costs following relapse.
The results show, that our outpatient treatment is more effective and economic in relation to no treatment after release.
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