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Explorations in Criminal Psychopathology: Clinical Books and Media The authors use the fourth chapter to develop a set (p xiv). With these goals in mind, the volume is or- of principles for FMHA. They explore guidelines ganized in terms of clinical and psychodynamic con- and principles for FMHA from the literature, distill cepts, as opposed to specific diagnostic categories their findings, and derive 7 general principles of (such as psychosis or substance abuse) or medico- FMHA along with 31 other principles covering spe- legal matters, such as competence to stand trial, di- cific aspects of FMHA, ranging from preparing for minished capacity, and legal insanity. the FMHA to testifying. Although the standards de- The book is divided into three sections of five rived by the authors are aspirational, they also may be chapters each: “Disorders of Behavior,” “Disorders used to inform forensic mental health practice in of Thought,” and “Borderline and Psychotic Disor- various settings. ders.” In each section, the reader will find description The fifth and concluding chapter returns to ad- and analysis of unusual or uncommonly discussed dressing the best practices conceptualization and criminal forensic topics. The first section covers forms a segue to any of the other 19 books in the catathymic reactions, pathological gambling and its series. Overall, this volume on FMHA contains a vast relationship to crime, idiosyncratic alcohol intoxica- array of important information on the topic. The tion, organic brain dysfunction, and sadistic aggres- book captures the essence of FMHA in a readable sion. Section II reviews delusional misidentification fashion. For a forensic mental health trainee, it can syndromes, obsessional following (stalking), facti- serve as an invaluable guidepost to learning about tious disorder (including the by-proxy variant), mor- FMHA. For the seasoned forensic mental health cli- bid jealousy, and forensic aspects of pseudologia fan- nician, it provides a concise and cogent review of the tastica, or pathological lying. In Section III are topic. discussions of Ganser’s syndrome and other rare dis- Gregory B. Leong, MD sociative states, conduct disorder history in men with Patton State Hospital schizophrenia, dissociative identity disorder, post- San Bernardino, CA traumatic stress disorder (PTSD), and malingering. As this listing indicates, only a few chapters, such as Disclosures of financial or other potential conflicts of interest: None. those on PTSD and on the assessment of malinger- ing, cover ground that is likely to be familiar to many or most forensic practitioners. Some might wonder why a book devoted to exam- Explorations in Criminal ining psychodynamic processes and forensic “zebras” Psychopathology: Clinical is necessary or worthwhile. But anyone who has Syndromes With Forensic worked in forensic psychiatry for any length of time realizes that the complexities of human behavior can- Implications, Second Edition not always be easily explained simply by the applica- Edited by Louis B. Schlesinger. Springfield, IL: Charles C tion of a diagnostic label. Knowledge of psychody- Thomas Publisher, Ltd., 2007. 394 pp. $79.95 hardcover, namics can be of great value in assisting the forensic $55.95 paperback, $55.95 ebook. expert to make sense of the unconscious motivations and other antecedents for what may on the surface By design, Explorations in Criminal Psychopathology appear to be a bizarre or senseless crime. In certain differs from most books in the fields of forensic psy- cases, familiarity with psychodynamic mechanisms chiatry and forensic psychology. In the Introduction, allows the evaluator to provide a more complete pic- the Editor, Dr. Louis B. Schlesinger, describes the ture of the defendant’s psychological makeup, emo- book’s intent: “Practitioners . .need to have exper- tional reactions, and thought processes, as well as tise in a wide range of clinical conditions—beyond their relationship to the legal question(s) at hand, those covered in the Diagnostic and Statistical Man- especially for criminal defendants who have person- ual of Mental Disorders (DSM)—that relate to vari- ality disorders or clinically significant maladaptive ous forms of criminal conduct ” (p xiii). The Intro- personality traits, but whose perception of reality in duction’s final paragraph states: “The need for the traditional sense is found to be intact. forensic practitioners to understand. .the psy- In the past few decades, many psychiatry residency chodynamics of crime cannot be overemphasized” programs have de-emphasized the teaching of psy- Volume 40, Number 1, 2012 153 Books and Media chodynamic formulation. In a one-year forensic psy- prevents the experience of sadness. As with aggres- chiatry fellowship, there may be little time to explore sion in the context of a Capgras delusion, obsessional psychodynamic subjects while learning the basics of followers frequently employ borderline defense mecha- the legal system, report writing, correctional mental nisms such as denial, splitting, and projective identifi- health, and so forth. This book, which includes con- cation, as well as idealization and, later, devaluation. cepts with which early-career forensic psychiatrists Similar analyses are found in other chapters. In are only vaguely familiar, should pique their curiosity each chapter, practical applications of the psycholog- and motivate them to learn more about how psy- ical explanations are covered in discussions of matters chodynamic theories of behavior may influence fo- such as epidemiology, risk assessment, treatment, rensic psychiatric practice. While the book does not and legal topics, such as insanity and sentencing attempt to provide a comprehensive review of psy- mitigation. Ultimately, the reader will gain an appre- chodynamic theories, the chapters that discuss these ciation of how identifying and understanding un- concepts generally do so in a clear and accessible conscious mental processes can translate into an ex- manner. planation of aberrant behavior that is useful in a Many chapters in the volume include illuminating forensic context. As mentioned previously, this is discussions of the unconscious mental processes and likely to be of particular relevance in regard to indi- motivations thought to drive certain types of crimi- viduals who do not have psychosis and who may appear nal conduct. A few examples serve to illustrate this relatively “normal” in the eyes of the legal system. theme. Chapter 1 reviews catathymia, the process by One evident weakness of the book is the outdated which an unresolved conflict, often centered on feel- nature of the research cited by several of the contrib- ings of sexual inadequacy, leads to violence toward a utors. This is the second edition; the first was pub- victim who is symbolically representative of the con- lished in 1996. Four of the 15 chapters include no flict and who therefore threatens the perpetrator’s references more recent than that date, and thus it psychological integration. The author explains that must be assumed that they were not updated for the the violent act resolves the emotional tension and second edition. One of these chapters describes three reestablishes internal equilibrium. references from 1984 as “current opinion” (p 71). The authors use the chapter on delusional mis- In another two chapters, the only post-1996 refer- identification to explain the hypothesized psycholog- ence is to the 2000 text revision to the fourth edition ical mechanisms underlying aggression in patients of the DSM. with Capgras syndrome, the belief that a person in A second weakness is Chapter 12, entitled “The one’s environment has been replaced by an identical- Consequences of Conduct Disorder for Males Who appearing impostor. Symptoms originate when an- Develop Schizophrenia: Associations With Crimi- ger toward another person is first defended against by nality, Aggressive Behavior, Substance Use, and Psy- denial. When this is not effective, splitting takes chiatric Services.” This chapter describes the results place, such that positive attributes are assigned to the of a single study examining the prevalence of premor- original identity and all negative attributes are as- bid conduct disorder in a group of men with schizo- signed to the impostor. Thus the delusional patient is phrenia or schizoaffective disorder. Although it is free to experience righteous anger toward the sup- interesting in its own right, it does not fit in partic- posed impostor without emotional conflicts. Subse- ularly well with the topics covered elsewhere in the quently, through projection and projective identifi- book. It does not discuss psychodynamic processes or cation, the patient attributes his own hostile impulses provide much in the way of practical information for to the misidentified object and comes to fear that use in the legal arena. person’s hostility and malevolent intent. Despite these problems, Explorations in Criminal In the chapter on obsessional following, we find a Psychopathology clearly would make an excellent ad- discussion of borderline personality organization in dition to the library of any forensic practitioner who the stalker. The obsessional following typically has its evaluates criminal defendants. origin in a pathological response to social isolation and social incompetence that challenges a narcissistic Joseph R. Simpson, MD, PhD fantasy of specialness. Feelings of shame and humil- Long Beach, CA iation are defended against with rage, which also Disclosures of financial or other potential conflicts of interest: None. 154 The Journal of the American Academy of Psychiatry and the Law.
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