Stalking as a Variant of Domestic Violence

J. Leslie Kurt, MD

Much of what is presently known about in a domestic context has been depicted by the popular press, typically following a tragic outcome, and suggests that it is a problem of increasing dimensions. However, scientific litera- ture on this subject is quite limited. This article provides an overview of scientific data related to stalking and associated psychiatric syndromes, including eroto- mania. It reviews the current antistalking legislation and the National Institute of Justice Model Anti-Stalking Code. Four case studies of stalkers with psychotic disorders versus personality disorders are presented, and the differential diag- noses are discussed. The implications of diagnostic classification, with respect to criminal responsibility, are also discussed.

In November of 1992, the Chief Judge named David Purdy, a private investiga- of the State of New York, Sol Wachtler, tor, to obsewe the victim. In August of was arrested by federal agents and 1992 "Purdy" delivered a typed letter to charged with conspiracy to commit extor- Silverman's building that said, "it will tion and threatening to kidnap a child. cost you to get me out of your life." The charges emerged after an intensive In September of 1992 Judge Wachtler Federal Bureau of Investigation (FBI) directed the victim to establish another investigation uncovered a systematic, telephone line in her home and take out an highly convoluted and technically sophis- ad in the New York Times classified sec- ticated operation to extort money from tion advertising "Lost Texas Bulldog," Joy Silverman. with the new phone number, in order to According to Ms. Silverman, in April discuss blackmail terms. In the original of 1992 she began to receive obscene let- extortion demand, Wachtler indicated that ters, greeting cards, and joke cards. he had tape recorded and photographed Sometime later, a series of threatening intimate relations between Ms. Silverman phone calls began. As part of Judge and her married boyfriend and would Wachtler's campaign of harassment, he make this information public if she didn't also developed a fictional character comply with his wishes. Ultimately, Ms. Silverman received threats that her daughter would be kidnapped if she failed Dr. Kurt is assistant clinical professor of , Yale University, and on the staff of Yak Psychiatric In- to meet the demands specified. stitute, New Haven, CT. Address correspondence to: J. On September 19, 1992, Ms. Silverman Leslie Kurt, MD, Yale Psychiatric Institute, 184 Liberty Street, New Haven, CT 06.519. contacted FBI Director William Sessions

Bull Am Acad Psychiatry Law, Vol. 23, No. 2, 1995 21 9 Kurt and told him that she was being threat- Wachtler.' Scorned in one area, he simply ened and harassed by an unknown man. couldn't let go."4 The following day she met with several New Jersey FBI agents. Ms. Silverman Overview told them that she had had an affair with Over the last 20 years, domestic vio- Judge Wachtler after her marriage dis- lence has been recognized as a social solved and that he subsequently became problem of some magnitude. National enraged when she began seeing another surveys estimate that approximately two man. 1 million women are battered by their hus- In the months following arrest, there bands annually, although current esti- was some speculation that Wachtler's at- mates of prevalence probably fall short torneys would pursue an insanity defense, for a number of reasons, the most obvious citing his recently diagnosed bipolar dis- being under-reporting of incidents by order and prescription drug mi~use.~John victims. Conventional statistical analysis Money described Wachtler as "manifest- of criminal data also underestimates the ing advanced symptoms of the disease, actual incidence of domestic violence erotomania," and likened him to other when commonly associated, nonassault men and women suffering from this "dis- criminal charges such as breach of peace ease," who are "stricken with love-sick- and disorderly conduct are excluded from ness and obsessionally possessed by love re vie^.^ A substantial proportion of vic- ~nre~uited."~The prosecution posited that tims also demonstrate significant mor- his actions were simply those of a lover bidity.6 spurned. Analysis of FBI homicide data from On April 1, 1993 Judge Wachtler pled 1976 through 1985 by Mercy and Saltz- guilty to threatening to kidnap the daugh- man7 identified 16,595 spouse homicides ter of Joy Silverman. Under the plea representing 8.8 percent of all homicides bargain, a five-count indictment that in- reported. This study did not take into ac- cluded an extortion charge was dropped count homicides involving intimates how- by Federal prosecutors. In explaining ever. Further analysis of FBI homicide his actions to the court, Mr. Wachtler data from 1976 through 1987 by Keller- said that he "began a course of activity man and Mercy reveals that, although aimed at causing Ms. Silverman to women are at substantially lower risk for seek my help and protection. To do this homicide overall, almost 40 percent of fe- I hoped to put Ms. Silverman in fear male homicide victims were murdered by that her reputation would be ruined a spouse, intimate acquaintance, or family by publicizing her relationship with member. The authors note that there is David Samson." Of this, Michael often a pattern of escalating violence Chertoff, the Federal prosecutor re- prior to domestic homicide and that marked, "He confessed to carrying out a women are commonly murdered by their campaign of terror against a woman partners while in the process of leaving an whose only crime was she said, 'no, Sol abusive relationship.'

220 Bull Am Acad Psychiatry Law, Vol. 23, No. 2, 1995 Stalking and Domestic Violence

To date, stalking has not been described nearly half of the states had laws prohibit- in the literature as a form of domestic vio- ing some forms of harassment; however, lence." The only research data currently most of these statutes were very limited in available, to the best of my knowledge, is scope and few specifically prohibited that of ~ietz,"" who has studied stranger unauthorized touching with intent to stalking by investigating the pursuit of alarm, or following in public places. Fur- celebrities and politicians by mentally thermore, virtually all states treated ha- ill offenders. Thus, much of what is rassment as a misdemeanor, with fines presently known about stalking in a do- falling below $600 and maximum sen- mestic context has been depicted in the tences of less than seven months. Avail- popular press, typically following a tragic able civil remedies included injunctive re- outcome, and suggests that it is a problem lief, monetary compensation, and actions of increasing dimensions. In the domestic for defamation, trespass, assault, nui- arena, there is no doubt that some stalking sance, invasion of privacy, and intentional behavior represents a form of domestic infliction of emotional distress. These ac- violence and can be construed, at the very tions, however, require proof of specific least, as a type of interpersonal coercion, elements frequently absent in harassment as the Wachtler case illustrates. Motiva- scenarios and are expensive and time con- tion of the stalker is likely variable and suming. Even more critical, with the pos- multidetermined. Common wisdom sug- sible exception of injunctive relief, they gests that stalking behavior is generally provide no immediate protection to vic- employed following a separation or the tims and may ultimately be of no deter- dissolution of a relationship, but there is rent benefit whatever.12 little empirical data about its incidence, In the last few years state statutes have course, or resolution in the absence of a been developed to more specifically ad- disastrous denouement. dress harassment in the form of stalking. Until recently, legal remedies for stalk- Following the homicide of Rebecca Scha- ing have been grossly inadequate and, effer, in 1990, California became the first from a practical standpoint, largely un- state to enact a stalking law.+ In response available. Dietz, in a review of legal relief to other highly publicized cases, growing available to victims of obsessional harass- media attention, and expanding public ment in 1984, concluded that victims concern, as of November 1993, 48 states "often find comprehensive criminal reme- and the District of Columbia have insti- dies non-existent and civil remedies ex- tuted antistalking statutes. Two others, pensive and uncertain."12 At that time, Arizona and Maine, have revised harass- ment and terrorizing statutes, respec- tively, to make them applicable to stalking *For the purposes of this article, stalking is defined in current statutory language as "willful, malicious and re- situations. Approximately 11 states, Cali- peated following and harassing" in which a "credible threat, either expressed or implied" is made and places the victim "in reasonable fear of death or scrious bodily harm." TCal. Penal Code 5 646.9 (West 1995).

Bull Am Acad Psychiatry Law, Vol. 23, No. 2, 1995 Kurt fornia and Illinois among them, have re- stitutionally enforceable model that can vised and expanded existing antistalking serve as a guide in the development of legislation in 1993. California has added a further state legislation. civil remedy creating liability for the tort The results of this study were published of stalking, which allows for equitable by the NIJ in October of 1993.13 It recom- relief, not limited to an injunction, and mends that stalking be classified as a monetary compensation, including but felony offense and that penalties be estab- not limited to general, special, and puni- lished for stalking that reflect and are pro- tive damages.$ portionate to the seriousness of the crime. State code typically defines stalking as The NIJ study also suggests expansion of "willful, malicious and repeated follow- code language. Discarding the use of the ing and harassing of another person" by term "credible threat," which often re- an individual evidencing a pattern of con- quires a verbal or written threat, the study duct "who makes a credible threat, either recommends using the language "threats expressed or implied, with the intent to implied by conduct" within the context of place that person in reasonable fear of the offense. It also defines the intent ele- death or serious bodily harm." Misde- ment as conscious and purposeful activity meanor and felony classifications exist in that the defendant "knows or should know many states, although generally a first of- would cause fear in a person at whom the fense is punishable as a misdemeanor conduct is directed." Noting that stalking with a sentence of up to one year in jail. statutes criminalize behavior that could Repeat offenses in some states are punish- be construed as lawful, if fear were not in- able by sentences of three to five years. duced, the model code identifies "fear of Given the youth of these statutes, little in- bodily injury or death" as a critical ele- formation has accrued regarding enforce- ment in the charge, suggesting that an- ment, prosecution, average penalties, or noying or emotionally distressing conduct impact on recidivism. be punishable under harassment or intim- Nor has the constitutionality of such idation statutes. Further, it recommends statutes been challenged. The American that prohibited acts not be listed, because Civil Liberties Union (ACLU) has not some courts have ruled that such specifi- taken a formal position on the new anti- cation is exclusive and thus may allow the stalking statutes, but has basic concerns perpetrator to circumvent the law.13 about over breadth and vagueness. The Several federal bills are currently pend- ACLU supported a federal bill passed by ing. The Federal Stalking Prevention Act Congress in 1992, which directed the Na- of 1993 defines stalking as a pattern of tional Institute of Justice (NIJ) to conduct "conduct that involves an express or im- a one-year study of the various laws en- plied threat to kill or to inflict bodily in- acted by states in order to develop a con- jury that is made with the intent to place a person in fear and in a manner or context that causes that person to reasonably fear '~al.Civil Code S; 1708.7. bodily injury or death." This bill autho-

222 Bull Am Acad Psychiatry Law, Vol. 23, No. 2, 1995 Stalking and Domestic Violence rizes the Director of the Bureau of Justice sessed, criminally responsible for their Assistance to provide grants to states to actions? develop stalking prevention and reporting programs, and to reduce formula grants if Associated Psychiatric states are not compliant in implementing Syndromes stalking-related programs and procedures Stalking behavior has historically been as required by the national act. It also di- associated with erotomania (although rects the U.S. Sentencing Commission to anger rather than love may obviously moti- provide a longer sentence for second or vate some stalkers). This syndrome has subsequent offenses in circumstances in been recognized as a pathological form of which a protective order was in effect. It love since ancient times. Descriptions of it is applicable in situations in which an in- can be found in the writing of Hippocrates, dividual crosses state lines during or for Plutarch, Galen, and others.14 It did not ap- the commission of such an offense, uses pear in the psychiatric literature until the the U.S. mail, or commits the offense in 19th century, when it was described by Es- the special maritime and territorial juris- quirol in 1838 in Maladies ~enta1es.l~In diction of the United States. The Federal 1921 a disorder called "old maid's insan- Employee Antistalking Act of 1993 ity" was identified by the English psychia- would amend federal code to allow for trist Bernard Hart. Earlier the same year, criminal penalties and civil relief, includ- Kraepelin provided a detailed description ing punitive damages, in cases in which a of an identical syndrome, classifying it as a federal employee is stalked while en- grandiose subtype of , and the gaged in, or on account of, his official French psychiatrist de clerambault16 de- duties. fined erotomania in ks psychoses pas- Given the discord evoked by the sionelles. In addition to describing the fea- Wachtler case, and with the advent of tures of the syndrome, he characterized it new antistalking statutes and harsher as either pure or secondary. In the pure penalties for repeat offenses in some ju- form, onset is sudden and the disorder is risdictions, significant philosophical and limited to erotomanic features, whereas the diagnostic controversies are likely to secondary type has an insidious onset and evolve as domestic stalkers receive more represents only one aspect of a more perva- attention from forensic psychiatrists. In sive paranoid , most commonly these circumstances, the central ques- paranoid .16 All authors of tions are obvious. Does this obsessional the time considered it essentially a syn- behavior, in and of itself, constitute a drome of women, and that view has per- "disease" in the absence of a major men- sisted until recently.179'' Kraepelin noted tal disorder? Is "love sickness," coupled that the erotomanic "appear . . . with nondelusional, obsessional pursuit as the morbidly transformed expression of by a rejected intimate, a form of eroto- the natural emotions of the human heart," mania, as Dr. Money has suggested? And as "a kind of psychological compensation are such individuals, if by love pos- for the disappointments of life."l"egal

Bull Am Acad Psychiatry Law, Vol. 23, No. 2, 1995 223 Kurt has suggested that the delusions provide drome is more common than previously narcissistic gratification "when life cru- thought and not predominantly female. elly fails to do so."20 Taylor et a1.17 have described four cases The cardinal feature of the disorder as of male erotomania in a violent male of- originally described by Kraepelin and de fender population of 112. They observed Clerambault is the delusional belief, gen- a low level of aggression and note an in- erally held by a woman, that a man of verse relationship between this and the higher social station is secretly and madly firmness with which the central delu- in love with her.20,21 This man is typically sional belief is held. In other words, the someone that she has not met, or with stronger the erotomanic , the less whom she has had only fleeting contact. likely is dangerous behavior. Although Central to her elaborate belief system, this they conclude that this disorder may be a man acts as a silent caretaker, watching variant of the major functional psychoses, over her and communicating by extra- they suggest that it is useful, for the pur- ordinary means. The woman, in turn, is poses of management and prediction of eternally faithful and chaste. Curious as- behavior, to treat the disorder as a syn- sociated features include paradoxical con- drome akin to morbid jealousy. duct, in which the patient perceives all de- In an elegant paper, ~elo~~~conceptu- nials of love, no matter how adamant, as alizes the disorder in a very interesting ardent proof of love; and common sec- way. He hypothesizes that it exists in es- ondary delusional beliefs. For instance, it sentially two forms: he designates the first is not unusual for the patient to believe as classic, delusional erotomania and the that her "lover's" marriage is a mere pre- second as borderline erotomania. Border- tense or that he can never be truly happy line erotomania as defined by Meloy is a without her.20 nondelusional form of the syndrome in The syndrome tends to be chronic and which "an extreme disorder of attachment unremitting, although the object of love is apparent in the pursuit of, and in the po- may change. Treatment with antipsy- tential for violence toward, the unrequited chotic medication and forced separation love object." Central to his thesis is a dis- may lessen delusional intensity and pre- tinction between the actual relationship occupation however. and object relations. In delusional eroto- Although originally regarded as a rare mania, there has been no prior relation- disorder and one that was essentially pe- ship or only fleeting contact, whereas in culiar to women, recent data suggest oth- the nondelusional form, there has typi- envise.9. 17,18 Even though reports on this cally been a history of actual emotional syndrome are largely anecdotal, ~ietz,~in involvement of varying degree. Funda- an empirical study of communications mentally, the personality is organized at sent to celebrities and politicians, identi- the borderline level, and thus rejection by fied 35 erotomanic individuals, represent- the love object evokes abandonment fears ing 16 percent of the sample, who wrote and rage. It is Meloy's view, based on a to celebrities. He concluded that the syn- small clinical sample, that character traits

224 Bull Am Acad Psychiatry Law, Vol. 23, No. 2, 1995 Stalking and Domestic Violence of the narcissistic, histrionic, antisocial, uncover a significant relationship. Given or paranoid type are invariably present, the characterologic vulnerabilities of this solely or in some combination, in the non- group, particularly those with borderline delusional subtype. He also notes that a and antisocial traits and obsessionality, major psychosis, affective disorder, or or- stalking behavior and other acts of vio- ganic frequently coexists lence would not be surprising findings. with the classical form of de Cleram- bault's syndrome. These observations are Case Examples consistent with my clinical experience The case histories that follow illustrate with a small sample of forensic patients the variety of psychopathology and the charged with stalking-related offenses. clinical complexities and subtleties inher- As the pathognomonic feature of eroto- ent in these situations. They also serve mania is the delusional belief that one is to highlight common features and critical passionately loved, is it meaningful or distinctions between erotomanic and non- parsimonious to add a nondelusional sub- erotomanic individuals who obsessively type to this diagnostic category? Other pursue an object of "love." forms of pathological or obsessional These individuals, all male, presented "love" are commonly observed in clinical for competence to stand trial evaluations practice and, although aberrant, may or after incurring a variety of criminal may not reflect a major psychiatric disor- charges that resulted from stalking behav- der. For instance, current research on the ior. Each had evidenced a pattern of re- personality characteristics of male batter- peated following and harassment, al- ers reveals significant character pathol- though this was much more prominent in ogy, particularly of the borderline and three of the four. Two demonstrated obvi- antisocial types. Hamberger and Hast- ous signs of de Clerambault's syndrome. ings23, 24 report that 85 percent of their The remaining two individuals presented sample of male batterers met Millon Clin- with prominent signs of Axis I1 pathol- ical Multiaxial Inventory criteria for ogy, although an Axis I disorder could not personality disorder. Borderline, passive- be ruled out, given the limitations of the aggressive, schizoid, and antisocial diag- examination. noses were the most prevalent. In a study In all cases the victims were fearful of done by Else et aL2%sing the Minnesota contact with the perpetrators. It is also Multiphasic Personality Inventory, abusers noteworthy that, in three of the four cases, demonstrated significant elevations on the protective orders had been violated on nu- borderline and antisocial subscales only, merous occasions. as well as poor problem-solving skills. Case 1 Mr. A is a 62-year-old, white Although there are presently no data male who was charged with numerous available regarding the incidence of stalk- counts of breach of peace, harassment, ing behavior among men who habitually criminal trespass, and disorderly conduct. engage in domestic violence, it is likely Additional charges included second and that forthcoming research in this area will first degree stalking, failure to comply

Bull Am Acad Psychiatry Law, Vol. 23, No. 2, 1995 225 Kurt with fingerprinting, and multiple counts ium. Past medical history was remarkable of failure to appear. All criminal charges for peripheral vascular disease. arose from events related to the pursuit of Case 2 Mr. B is a single, 27-year-old, a nurse he met while he was a patient in a white college graduate, who was charged convalescent home several months earlier. with threatening, criminal trespass, and Following his discharge, he made re- interfering with a police officer. These peated attempts to contact her, by phone charges arose from an incident in which and in person, over a period of six he went to the home of a young woman months. On a number of occasions he re- whom he believed was in love with him turned to the nursing home and went to and threatened to kill her. He had met her her residence, even attempting to kiss her several years before at work and had gone on one occasion. In addition to maintain- on a group outing with her in the remote ing the delusional belief that the woman past. Despite an understanding that the loved him, Mr. A emphatically asserted young woman had not responded favor- that she was his wife. Despite his aware- ably to his overtures, and that an actual re- ness that the woman in question was mar- lationship had not materialized, Mr. B be- ried, Mr. A repeatedly described how she lieved a special, spiritual one had evolved magically became his wife when he gave over time. her a watch. On mental status examination, Mr. B On mental status examination, Mr. A presented as a thin, attractive, well presented as a tall, poorly nourished, di- groomed, healthy-appearing young man sheveled, elderly, white male who ap- who initially seemed lucid and articulate. peared older than his stated age with His speech became increasingly pres- physical stigmata of alcoholism. Attitude sured as the interview proceeded. His toward the examiner was overly familiar, thinking became markedly disorganized jocular, and hypersexual. Speech was and overly elaborate with flight of ideas rapid, pressured, perseverative, and ram- and frank delusional content. He also en- bling. Thinking was frankly disorganized, dorsed auditory and visual , frequently to the point of incoherence. ideas of reference, and prominent ideas of Grandiose and erotomanic delusions were influence. Grandiose and supernatural noted. Affect was expansive, irritable, and themes were noted. For instance, Mr. B rapidly shifting. Attention and concentra- indicated that he had "paranormal facul- tion were markedly impaired, but there ties" that enabled him to project his was no evidence of delirium. thoughts to others and prevent people Available history revealed that Mr. A from hurting others by way of "mental co- was a retired railroad worker, who took ercion." He also expressed the belief that up drinking in later life and, at some he had inadvertently caused a recent hur- point, was diagnosed as a chronic un- ricane to hit Florida and that he was "sin- differentiated schizophrenic. He had pre- gle-handedly" capable of repairing the viously been treated with a variety of ozone layer. Affect was expansive and antipsychotic medications including lith- labile.

226 Bull Am Acad Psychiatry Law, Vol. 23, No. 2, 1995 Stalking and Domestic Violence

Available history revealed that Mr. B interpret. He was clearly obsessed with graduated from a prestigious university her and believed that others could control after attending six years. He denied prior her thoughts by "talking to her, telepathy, psychiatric treatment, indicating that he and subliminal persuasion" and that this had participated in an outpatient "study of would be done in an effort to take her schizophrenia" briefly while in college. away from him. Feelings of jealousy were He endorsed the use of marijuana and co- also prominent as was Mr. C's conviction caine intermittently during his college that none of the charges was serious be- years and acknowledged recent daily al- cause he was going to persuade the victim cohol consumption. He underwent signif- to drop them. Given the factual circum- icant psychosocial decline following stances, this attitude reflected inadequate graduation, living with his parents and reality testing. Affect was expansive, la- working at menial jobs intermittently. bile, and anxious. On cognitive examina- Case 3 Mr. C is a 27-year-old, unem- tion, Mr. C responded to testing rapidly ployed, black male with a history of do- and, generally, accurately. Of note, he was mestic violence charged with stalking, somewhat distractible and concrete. unlawful restraint, breach of peace, viola- Past history was very difficult to ascer- tion of a protective order, harassment, tain, as Mr. C demonstrated pseudologia tampering with a witness, risk of injury to fantastica. His parents denied any history a minor and multiple counts of burglary. of psychiatric treatment. They character- All criminal charges are related to persis- ized him as a "disruptive and disobedient tent harassment of a former girlfriend and child," who was raised in a stable, work- accrued over a period of several weeks. In ing-class family. A history of alcohol several incidents, Mr. C broke into the abuse of several years duration was also victim's home and, on one of these occa- noted. sions, she found him hiding under a bed. Case 4 Mr. D is a 39-year-old, re- Following an arrest, Mr. C telephoned his cently divorced, white male, father of one, ex-girlfriend at work and told her, among with a history of alcohol abuse and do- other things, that she was not to see other mestic violence, who was charged with men. criminal mischief, breach of peace, ha- On mental status examination, Mr. C rassment, threatening, illegal possession presented as a healthy-appearing young of a weapon, multiple related counts of man who was well groomed and polite. burglary, and three counts of violation of Speech was rapid, pressured, and overly a protective order. His ex-wife described productive. Thinking was organized over- him as "very controlling and short fused" all, but circumstantial and evasive at during their five-year marriage and indi- times. Even though there was no overt cated that he could not hold a job because psychotic symptomatology, grandiose of aggressive behavior. She reported that and paranoid trends were noted. Mr. C he had been physically assaultive on only also demonstrated ideas of influence with two occasions while married, but was ver- regard to the victim that were difficult to bally abusive and had frequent explosive

Bull Am Acad Psychiatry Law, Vol. 23, No. 2, 1995 227 Kurt episodes over minor issues that resulted in ity. Cognitive examination was essentially him breaking up the home furnishings within normal limits. once or twice a week. Following their di- Past psychiatric history revealed re- vorce, for a period of approximately six mote inpatient treatment for alcohol de- months, she noted that his behavior be- pendence, but no history of psychiatric came increasingly erratic and irrational. hospitalization. Mr. D sought outpatient She stated that he seemed "obsessed" psychiatric treatment several years earlier with her and their child, harassed and for a chief complaint of "difficulty con- followed her on numerous occasions, centrating" and was placed on 5 mg daily and burglarized the family home several of Dexedrine (dextroamphetamine sul- times (once while lying in wait for his fate, Smithkline Beecham) for adult atten- ex-wife). It is alleged that he also im- tion deficit disorder. His treating psychia- personated a private investigator and trist, at the time of the competency a lawyer, contacting the family and evaluation, indicated that he carried a pri- friends of his ex-wife to "inquire about mary diagnosis of antisocial personality me or intimidate others." Arrest warrants disorder and amphetamine dependence. describe several violent incidents, one of She estimated that he was taking 60 mg which was quite serious and might have daily. He was poorly compliant with treat- resulted in the murder of Mr. D's ex-wife ment and verbally threatening when she if other factors had not intervened. Mr. D initiated a plan to taper him off Dexe- was out on bond at the time of the eval- drine. When hospitalized for restoration uation. to competency, he acknowledged that he On mental status examination, Mr. D had been taking approximately 120 mg was unctuous, obsequious, superficially daily. cooperative, and quite guarded. He dealt with the most serious criminal charges by Discussion denying any knowledge of the incidents. In addition to obvious signs of de Cler- Although his thinking was organized ambault's syndrome, Mr. A's presentation overall, Mr. D was quite tangential, cir- suggested organicity, either with psy- cumlocutory, and frankly evasive. He ap- chotic features, or superimposed on a pre- peared excessively preoccupied with his existing psychotic process. Mr. B's case family situation and obsessed with his also highlights the frequent association of daughter. He denied frank psychotic erotomania with major psychotic disor- symptoms, but paranoid trends were ders, although it was unclear if he suf- noted with regard to his ex-wife, whom fered from a schizophrenic or schizoaf- he described as trumping up all the fective disorder. charges "out of spite . . . because she hates In cases 3 and 4, both individuals were me." Affect was constricted, disingenu- obsessed with their victims, but there was ous, overly controlled, and anxious. Mr. D no evidence of de Clerambault's syn- denied significant affective symptomatol- drome. Their histories were striking for ogy, as well as homicidality and suicidal- hostility and repeated acts of aggression,

228 Bull Am Acad Psychiatry Law, Vol. 23, No. 2, 1995 Stalking and Domestic Violence including physical assaults, directed at the Given our current understanding, this victims following the dissolution of the subtype would consist largely of individu- relationships. While there were prominent als with primary personality disorders and signs of a personality disorder and so- no major mental disorders apart from the ciopath~in both cases, in Mr. C's case, newly founded "erotomania." To make manic and quasi-psychotic features also this theoretical leap before the subject has raised the question of an incipient bipolar received scientific scrutiny is imprudent disorder. By history and presentation, Mr. on its face and has serious implications D met DSM-3-R criteria for antisocial with respect to criminal responsibility. personality disorder, in addition to am- Inasmuch as historically the insanity de- phetamine and alcohol dependence. His fense has been applied in circumstances condition was clearly exacerbated by am- in which the defendant suffers from a psy- phetamine abuse, but there was little to chotic disorder, this change represents a suggest a discrete amphetamine-induced substantial departure and would soften paranoid disorder or other psychosis. the current standard that defines a mental Using Meloy's conceptual framework for disorder for this legal purpose. The obvi- borderline erotomania, one could infer ous consequences include misapplication that both Mr. C and D demonstrated by of the insanity defense to circumstances their thinking and behavior "an extreme that simply do not warrant its use, dilution disorder of attachment" consistent with of the potential for deterrence provided borderline personality organization. Be- by the current stalking statutes, and grow- yond this, however, their clinical presen- ing public unpopularity and skepticism tations are quite disparate, as are the dif- around the legitimate use of the insanity ferential diagnoses they evoke. defense. Although one would expect a greater incidence of mental illness in a sample Summary drawn from a group referred for compe- Stalking as a variant of domestic vio- tence to stand trial evaluation, scrutiny of lence is a serious social problem that has this small sample of stalkers also suggests received little scientific scrutiny, despite a broad range of psychopathology. Over- the fact that it is far more common than all, the group can be divided by predomi- "stranger" or celebrity stalking.26 It is nant symptomatology into those who also a complex behavior with social and have psychotic disorders versus those cultural underpinnings as well as psycho- who have personality disorders, and this logical determinants. To reason that this rough division has important implica- behavior is irrational and, thus, must rep- tions. Equating Money's notion of "love resent a mental "disease7' removes it from sickness" with Meloy's concept of non- the spectrum of ordinary human experi- delusional erotomania and applying their ence and provides a pat answer before the theories to our current definition of eroto- essential questions have been asked. Re- mania would expand this diagnostic cate- search in this area will be helpful in iden- gory by creating a nonpsychotic subtype. tifying the most common psychiatric

Bull Am Acad Psychiatry Law, Vol. 23, No. 2, 1995 229 Kurt disorders associated with stalking in a ters to members of the United States Congress. J Forensic Sci 36: 1445-68, 1991 domestic context, and in elucidating the 11. Dietz PE, Matthews DB, Martell DA, et al: underlying dynamics in cases in which Threatening and otherwise inappropriate let- character pathology is the predominant ters to Hollywood celebrities. J Forensic Sci 36: 185-209 disorder. Identification of risk factors as- 12. Dietz PE: A remedial approach to harassment. sociated with serious or tragic outcomes Va L Rev 70:507,1984 13. National Criminal Justice Association: Project would be of considerable value, as re- to Develop a Model Anti-Stalking Code for straining orders and other legal remedies States. Washington, DC: National Institute of thus far have typically afforded little pro- Justice, 1993 14. Enoch MD, Trethowan WH: Uncommon Psy tection to victims. Assessment of the im- chiatric Syndromes (ed 2). Chicago: Year pact of new stalking statutes on recidi- Book Medical Publishers, 1979 15. Esquirol E: Mental Maladies: A Treatise on vism is also worthy of attention. Insanity. New York: Hafner. 1965 16. de Clerambault CG: Les psychoses pas- References sionelles. In Oeuvres psychiatriques. France: Presses Universitaires de France, 1942, pp 1. Franks L: To catch a judge: how the F.B.I. 315-22 tracked Sol Wachtler. The New Yorker. De- 17. Taylor P, Mahedra B, Gunn J: Erotomania in cember 21, 1992:58-66 males. Psycho1 Med 13:645-50. 1983 2. Roberts S: As Wachtler awaits fate, a tortured 18. Goldstein RL: More forensic romances: De tale emerges. The New York Times. March 29, Clerambault's syndrome in men. Bull Am 1993. at B3 Acad Psychiatry Law 15:267-74, 1987 3. Money J: Law and order is no cure for sex 19. Kraepelin E: Manic-Depressive Insanity and 'crimes.' Newsday. November 24, 1992, at 70 Paranoia. Edinburgh: E & S Livingstone. 1921. 4. Kleinfield NR: Admitting guilt, Wachtler of- pp 255,259 fers account of plot. The New York Times. 20. Segal JH: Erotomania revisited: from Krae- April 1, 1993, at A1 pelin to DSM-111-R. Am J Psychiatry 146:10, 5. Saltzman LE, Mercy JA, Rhodes PH: Identifi- 1261-6,1989 cation of nonfatal family and intimate assault 21. Seeman MV: Delusional loving. Arch Gen incidents in police data. Am J Public Health Psychiatry 35:1265-7. 1978 82:1018-20.1992 22. Meloy JR: Unrequited love and the wish to 6. Berrios DC, Grady D: Domestic violence: risk kill: diagnosis and treatment of borderline ero- factors and outcomes. West J Med 155:133-5, tomania. Bull Menninger Clin 53:477-92, 1991 1989 7. Mercy JA, Saltzman LE: Fatal violence among 23. Hamberger L, Hastings J: Characteristics of spouses in the United States, 1976-1985. Am spouse abusers. J Interpersonal Violence, 1: J Public Health 79:595-9. 1989 363-73,1986 8. Kellerman AI, Mercy JA: Men, women, and 24. Hastings J, Hamberger L: Personality charac- murder: gender-specific differences in the teristics of spouse abusers: a controlled com- rates of fatal violence and victimization. J parison. Violence Vict 3:3149, 1988 Trauma 33:l-5, 1992 25. Else LT, Wonderlich SA, Beatty WW, et al: 9. Dietz PE. Martell DA: Mentally disordered of- Personality characteristics of men who physi- fenders in pursuit of celebrities and politi- cally abuse women. Hosp Community Psychi- cians. National Institute of Justice Grant No. atry 4454-8 83-NI-AX-0005. October 1989 26. Cooperative Agreement to Develop Model 10. Dietz PE, Matthews DB, Martell DA, et (11: Anti-Stalking Law. U.S. Newswire. December Threatening and otherwise inappropriate let- 23, 1992

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