A Comparison of Psychosocial and Psychiatric Features of Mentally
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A comparison of psychosocial and psychiatric features of mentally capable versus mentally incapable individuals referred by the courts for forensic psychiatric observation in relation to an alleged sexual offence A thesis submitted in fulfilment of requirements for the degree of Doctor of Philosophy in Psychiatry CANDIDATE: Funeka B N Sokudela PROMOTER: Prof J L Roos CO-PROMOTER: Prof H W Pretorius Faculty of Health Sciences, University of Pretoria 2017 THESIS SUMMARY This is a mixed research methods study based at the forensic mental health unit of Weskoppies Psychiatric Hospital in Pretoria, Gauteng Province, South Africa. The overarching aim of the study was to help add insights that could indirectly inform the wider discourse on sexual offending in society and to the body of knowledge on the prevention of sexual violence – including in forensic mental health. Qualitative and quantitative methods were applied through concurrent and transformative mixed research methods, premised on the philosophical stance of pragmatism. Records of individuals accused of sexual offences were explored and in-depth interviews with individuals accused of sexual offending and / or other types of charges referred for observation in terms of the Criminal Procedure Act, 51, 1977 (CPA 1977) were conducted. Psychiatric and psychosocial features and general perspectives on sexual offending were explored. Data collection was done from the end of 2014 to the end of 2015. In terms of findings, the record-based component of the study revealed that the majority of those referred were mentally capable, were known to the victims and lived in close proximity to them. Boys and girls, elderly women and socially isolated individuals seemed the most vulnerable irrespective of the mental capacity of the accused at the time of an alleged incident. In-depth interviews revealed scepticism, myths and new locally relevant ways of defining sexual violence. Socio-economic determinants of health seemed to render potential perpetrators of sexual offending vulnerable to violence and included adverse childhood events, poverty, unemployment and inequality. Experiences during and after arrest revealed possible human rights violations of alleged offenders by communities and law enforcement systems. Mental illness worsened stigma even in the hands of law enforcement systems. Central phenomena viz. ‘the perceived oppression of men’ and ‘vulnerability’ of potential victims and potential perpetrators emerged. A tentative theory of ‘vulnerability’, as an explanation and an approach to preventing sexual and other forms of violence in society, is proposed for both victims and potential perpetrators. Public health, socio-ecological frameworks of sexual violence prevention and other explanatory and prevention frameworks on sexual offending seem aligned to the study’s findings. Patriarchy, collective violence inherited from South Africa’s past, social cognitive theory on learning, trauma re-enactment, and other factors seem to play a role. In terms of mixed research contributions, a need for robust ways of studying diverse populations such as South Africa is emerging. Further, an initial stance of studying prevention of sexual violence from a victim-centred advocacy lens, has been transformed to yield accused individuals’ advocacy issues as well. Multisystem prevention approaches involving at-risk potential perpetrators, and not just victims, seem to be the next frontier for research and interventions. The study reveals insights that may contribute to the field of violence prevention. Keywords: mental illness, forensic psychiatry, forensic mental health observation, sexual violence, child sexual abuse, transactional sex, vulnerability theory, oppression, stigma, human rights ii ACKNOWLEDGEMENTS: I wish to thank the following people without whom this work would not have come to life. Some helped with the conceptualisation of the project. Some helped with the work. Some journeyed with me. Some just held my hand in spirit – ngomoya wenzulu yemfihlakalo, inzulu yesimanga; engenangqaleko engenangqibeko… Prof J Louw Roos my promoter, for absolutely everything. Prof Herman W Pretorius my co-promoter, for understanding when I would not to take no for an answer. Mrs Maureen Mabena the then CEO of Weskoppies Hospital, for mentoring me. The co-observers that sat with me, for all the long hours of sheer support and dedication to our cause. Our secretaries, the forensic Mr’s and our administration staff, for all the running around, support and going the extra mile in leaps and bounds and multiple-languages. My colleagues at the Forensic Mental Health Unit (the Bird-cage), the Department of Psychiatry and Weskoppies Hospital, for all your support. My parents umama notata Nomvuyiso no Sipho Sokudela, Dorset,and Di Eccles and my entire family ooJama, Sijadu, Fakade, namaBhele and friends, for being present. My husband Neil and our beautiful babies V-v and Sa-sa for waiting with me. And lastly, to the participants and to those children, women and men whose lives continue to be touched by this and similar work – we shall overcome. This work is dedicated to a better future for all of us – Makubenjalo! iii DECLARATION OF ORIGINALITY I declare that the thesis, which I hereby submit for the Doctor of Philosophy (Psychiatry) programme at the University of Pretoria, is my own work and has not previously been submitted by me for a degree at another university. Where secondary material is used, it has been carefully acknowledged and referenced in accordance with University requirements. I am aware of the University’s policy and implications regarding plagiarism. Name and signature: _____________________________ _________________________ Date: _____________________________ iv TABLE OF CONTENTS THESIS SUMMARY ...................................................................................................................... ii ACKNOWLEDGEMENTS: ............................................................................................................ iii DECLARATION OF ORIGINALITY ................................................................................................ iv LIST OF TABLES: ....................................................................................................................... xiii LIST OF FIGURES: ..................................................................................................................... xiv GLOSSARY OF TERMS AND ACRONYMS: .................................................................................. xv 1 INTRODUCTION .................................................................................................................. 1 1.1 RESEARCH PROBLEM AND RESEARCH AIMS ............................................................... 2 1.1.1 RESEARCH PROBLEM ........................................................................................... 2 1.1.2 RESEARCH AIMS ................................................................................................... 3 1.2 MOTIVATION TO DO THE STUDY AND ANTICIPATED CONTRIBUTIONS ..................... 4 1.2.1 SEXUAL OFFENCE PREVENTION ........................................................................... 4 1.2.2 THE PLIGHT OF THE SURVIVOR ............................................................................ 6 1.2.3 JUSTICE AND REHABILITATION FOR THE ALLEGED OFFENDER ............................ 7 1.3 BACKGROUND LITERATURE ......................................................................................... 8 1.3.1 THE SOCIAL PHENOMENON OF SEXUAL OFFENDING .......................................... 9 1.3.2 THE LEGAL PHENOMENON OF SEXUAL OFFENDING ......................................... 12 1.3.3 THE PHENOMENON OF MENTAL ILLNESS AND SEXUAL OFFENDING ................ 13 2 METHODOLOGY ............................................................................................................... 17 2.1 THE STUDY SETTING .................................................................................................. 17 2.2 THE STUDY PHILOSOPHY ........................................................................................... 18 2.3 DESIGN AND RATIONALE FOR USING MIXED RESEARCH METHODS ........................ 19 2.4 THE STUDY CONTEXT ................................................................................................. 21 2.5 SAMPLE ...................................................................................................................... 21 2.5.1 SAMPLING METHODS ........................................................................................ 22 2.5.2 SELECTION CRITERIA .......................................................................................... 24 2.5.3 SAMPLE DESCRIPTOR – ALLEGED SEXUAL OFFENDER GROUP .......................... 25 2.5.4 SAMPLE DESCRIPTOR – NON-SEXUAL OFFENCE GROUP ................................... 27 2.5.5 CO-OBSERVER / INTERPRETER GROUP .............................................................. 29 2.6 PROCEDURES AND DATA COLLECTION ..................................................................... 30 2.7 DATA RECORDING ..................................................................................................... 33 2.7.1 INSTRUMENTS AND TOOLS ................................................................................ 33 v 2.8 DATA ANALYSIS PROCEDURE .................................................................................... 34 2.8.1 SUMMARY OF FIRST CYCLE CODING STYLES AND