Assessment and training of social competence in dangerous psychiatric patients.
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OBJECTIVE: This article aims to review the literature on firesetters particularly looking at recidivism rates. The early literature described firesetters as dangerous individuals. This article reviews the more recent empirical data to examine if it supports the early literature. METHOD: A literature review was performed examining papers which described firesetters with any reference to recidivism. These were divided into three broad categories based on where studies have been performed, namely in forensic psychiatric settings, the criminal justice system and general and psychiatric hospitals. RESULTS: The literature has been poorly focused and provides little help when assessing an individual firesetter. Risk factors associated with general criminology have been cited. CONCLUSIONS: The empirical literature cannot support the hypothesis that firesetters are inherently dangerous. More research should target different groups of firesetters and examining individual risk within that group with an aim of researching treatment for the different groups.
A recent Vermont Supreme Court decision adopts and extends the Tarasoff precedent. This paper emphasizes three aspects of the new precedent that are of possible consequence to providers of mental health care. First, the decision imposes the Tarasoff duty on all "mental health professionals". Second, it demonstrates a legal scenario that in effect permits a single standard of care to be applied to all mental health professionals. Third, it creates liability for property damage as well as for personal injury.
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In the writings of the Japanese novelist, Yukio Mishima, primal scene experiences and derivative expressions of them recur persistently. The element of fire figures prominently in connection with the wish to wreak vengeance on the persons originally observed in the act of intercourse. As a destructive, attention-compelling spectacle, fire is a particularly suitable vehicle for this purpose. In Mishima's works, revenge takes the form of retaliation in kind: parental figures, or their surrogates, are put into the position of having to observe the child, or substitutes for him, in the act of sexual infidelity. These observations as well as clinical reports in the literature suggest some insights into fantasies of pyromania. They also make possible certain speculations concerning Misima's turbulent life and dramatic suicide.
Police called to investigate a fire in a snackbar in Mount Gambier, South Australia, discovered four cakes with characteristics marks apparently produced by human teeth. These marks were examined and compared with the teeth of a suspect arsonist. The comparison was made by computer imaging analysis and a remarkable similarity in arch shape was observed.
In order to investigate the nature of animal cruelty in childhood two groups of male psychiatric patients were compared: an Animal Cruelty Group and an Assaultive Group. Most in both groups showed other signs of aggression dyscontrol in childhood. Most in both groups were subjected to parental brutality. Emotional or physical unavailability of a father figure may be a common etiologic factor in childhood cruelty to animals. This may compare with the absence of a father figure noted by several investigators in boys who set fires.
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OBJECTIVE: We wanted to study the prevalence and characteristics of dangerousness among female psychiatric patients. METHOD: A national survey was performed in Norway, covering all psychiatric in- and out-patient units. RESULTS: There were 329 persons reported to have a psychiatric disorder and to satisfy our criteria for dangerousness, giving a total prevalence of 9.9/100000 adults. There were 54 women, giving a female prevalence of 3.1/100 000. When compared to a matched sample of the men, fewer women were out-patients or had had jail sentences. We found no sex differences with regard to frequencies of psychosis, mental retardation, personality disorders, or drug or alcohol abuse. The women had an increased frequency of suicide-related and self-injurious behaviours and previous commitment for arson. CONCLUSION: The prevalence of women with psychiatric disorders who are considered to be dangerous was 3.1/100 000. The dangerous men did not show higher frequencies than the women for psychopathology, drug abuse, behaviour or criminality.
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A case of a 12 1/2-year-old female fire-setter is presented. The symptom was the result of long term developmental problems precipitated by the onset of puberty. Psychoanalytically oriented individual psychotherapy combined with marital and family therapy were the modes of treatment. The continuous struggle to establish a therapeutic alliance with an early adolescent is discussed. A patient whose main mechanisms of defense are repression, suppression, denial, and projection presents a challenge for the therapist.
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