Maximum Security Psychiatric Institution Research Articles

Sexual Aggressors' Perceptions of Effectiveness of Strategies to Cope With Negative Emotions and Deviant Sexual Fantasies

The aim of this study was to investigate sexual aggressors' perceptions of effectiveness of strategies to cope with high-risk situations and their reasons for not using the adaptive coping strategies they learned in treatment. A total of 32 sexual aggressors, incarcerated in a maximum security psychiatric institution, filled out the Coping Strategy Report daily for 2 months. A lack of will, ignorance, and an emotional disturbance were the most frequently reported reasons for not using adaptive coping strategies to deal with a negative mood, whereas anticipation of failure and emotional disturbance were most frequently reported with interpersonal conflicts. For deviant sexual fantasies, child molesters most frequently reported a lack of will and an anticipation of failure as justification for not using adaptive coping strategies, whereas sexual aggressors of women most frequently reported a lack of will and emotional disturbance. For negative moods and interpersonal conflicts, behavioral strategies, such as social skills, were reported to be the most effective. Cognitive strategies, such as covert sensitization, were reported to be most effective for coping with deviant sexual fantasies. Theoretical and clinical implications of these results are discussed.

Violent Recidivism of Mentally Disordered Offenders

Multivariate techniques were used to derive and validate an actuarial instrument for the prediction of violent postrelease offenses by mentally disordered offenders. The 618 subjects were a heterogeneous group of men who had been charged with serious offenses. Approximately half had been treated in a maximum security psychiatric institution and the rest had been briefly assessed prior to imprisonment. The actuarial instrument consisted of 12 variables and significantly predicted violent outcome in each of five subgroups. The instrument's practical application and its use in clinical appraisals of dangerousness are discussed.

Maximizing the discriminant validity of phallometric assessment data.

Independent data sets from phallometric assessment studies were analyzed to examine methods of maximizing the discriminant validity of phallometric testing. Community volunteers and non-sex-offender patients were compared with rapists and child molesters recruited primarily from a maximum security psychiatric institution

Firesetters Admitted to a Maximum Security Psychiatric Institution

The characteristics of 243 male arsonists in a maximum security psychiatric facility were examined. Demographic and psychosocial history variables of the arsonists were compared to those of 100 comparison patients admitted to the same institution for behavior other than firesetting. Discriminant analyses were used to determine how these two groups differed, as well as how arsonists who set just one fire differed from those known to have set more. DSM-III-R criteria for pyromania were examined, as was the role of sexual motivation. The results strongly supported the idea that pyromania and sexual motivation are uncommon in the clinical presentation of mentally disordered firesetters. Social competence and social isolation were much more important and potentially modifiable antecedents.

Sexual recidivism among child molesters released from a maximum security psychiatric institution.

Sexual recidivism among child molesters released from a maximum security psychiatric institution.

Evaluation of an Institution-based Treatment Program for Child Molesters

Abstract: Although treatment programs for child molesters have become common, few have been subjected to rigorous evaluation. In this article we discuss issues in the evaluation of treatment programs for child molesters and then describe an evaluation of a behavioral program for child molesters treated in a maximum security psychiatric institution. The results provided no evidence of program efficacy, although support was found for the predictive validity of the phallometric test procedure used to measure deviant sexual arousal. Implications of the findings for the assessment and treatment of child molesters are discussed.

Sexual recidivism among child molesters released from a maximum security psychiatric institution.

The recidivism of 136 extrafamilial child molesters who had received phallometric assessment in a maximum security psychiatric institution from 1972 to 1983 was determined over an average 6.3-year follow-up. Fifty had participated in behavioral treatment to alter inappropriate sexual age preferences. Thirty-one percent of the subjects were convicted of a new sex offense, 43% committed a violent or sexual offense, and 58% were arrested for some offense or returned to the institution. Subjects convicted of a new sex offense had previously committed more sex offenses, had been admitted to correctional institutions more frequently, were more likely to have been diagnosed as personality disordered, were more likely to have never married, and had shown more inappropriate sexual preferences in initial phallometric assessment than those who had not. Behavioral treatment did not affect recidivism.

Penile Responses of Child Molesters and Normals to Descriptions of Encounters with Children Involving Sex and Violence

In total, 14 heterosexual, 7 homosexual, and 4 bisexual child molesters from a maximum security psychiatric institution were compared with 8 low SES men from the local community and 6 nonsex offenders from the same institution. Penile tumescence changes were measured in response to 22 audiotaped descriptions involving consenting sex with an adult partner, sex with a child (at 3 levels of force and violence), nonsexual violence with a child victim, and neutral interactions with a child. Half of the target persons in the stories were male and half female. Child molesters preferred stories depicting sex with children to sex with adults, showed sexual interest in children of both genders, and did not respond to depictions of nonsexual violence. Compared to other child molesters, those who had physically injured their victims responded relatively more to children than adults and to coercive sex with children. Comparison subjects showed no sexual interest in any of the stories involving children.

Maximum Security Psychiatric Patients

Ratings of the dangerousness of 360 men in a maximum security psychiatric institution were obtained from experienced forensic clinicians. These ratings were well predicted (R = .61) from historical, offense, and in-hospital data. Seriousness of outcome scores based upon an 11-year minimum follow-up time were obtained on 85 additional men released from the same institution; this outcome sample was constructed so that the entire range of outcomes, from good to the commission of very serious crimes against persons, was represented. The seriousness of outcome scores were well predicted from the same variable sets used to predict the clinicians' ratings (R = .55); however, the regression model based upon the clinicians' ratings of dangerousness did not predict the outcome scores. The lack of relation between the clinical judgment model and outcome was maintained when the data were analyzed separately according to whether the patients were personality disordered or psychotic. The most important variables associated with dangerous outcome were seriousness of the index offense, an economic index offense, criminal as opposed to civil commitment, young age, and number of previous correctional institutionalizations.

Rape completion and victim injury as a function of female resistance strategy.

Descriptions of 95 completed rapes and 41 attempted rapes which were committed by 72 men referred to a maximum security psychiatric institution were obtained from victim and police reports. Fifty of the victims received slight injury, fifteen were more seriously injured, and two were murdered. Rapists were more likely to complete the rape when the attack was conducted in an inside location, with a weapon, and not against a stranger. Victims were more likely to avoid being raped when they resisted, particularly when they screamed or yelled for help. There was no positive association between victim resistance and the probability of subsequent injury. Previous reports of resistance being related to victim injury may be because victims resist more strongly when they are being injured. Increasing attention has been focussed on the crime of rape over the past decade. Much of this attention has been in the form of advice to women on how rape might best be avoided. Unfortunately, however, this advice has often been contradictory (Quinsey, Marion, Upfold & Popple, in press; Storaska, 1975). Among the reasons for this discordant advice is the difficulty in comparing the effectiveness of various victim resistance strategies, partly because successful strategies are often undetectable. For example, a strategy implemented early in an attempted rape may remove the incident from any possible data set. If a woman is grabbed and immediately kicks her assailant and walks away, it may be unclear what the assailant's intent was. The more easily the intended victim deals with her assailant (i.e., the more effective the strategy) the less likely the act is to be reported. Despite their limitations, however, empirical studies of the outcome of identified rape attempts are the only means of providing an empirical base for advice to women on rape resistance methods. There have been a number of surveys based on police data which have examined women's rape resistance strategies. Bowker (1979) has summarized these studies and concluded that most women resist their attackers. Amir (1971) observed that 27% of the victims he studied resisted the attack and 18% physically fought back. Wright (1980) found that 70% of the victims in his study struggled and 16% fought. Both severe beatings and unsuccessful rapes were associated with victim fighting. Hursch (1977) concluded that in most successful instances of resistance, the This research was supported by Grant 847 from the Ontario Mental Health Foundation. We wish to thank G. Harris, M. Pruesse, and M. Rice for their comments on an earlier version of this paper. The first author is now at Institut Philippe Pinel de Montreal.

Sexual arousal to nonsexual violence and sadomasochistic themes among rapists and non sex-offenders.

Twenty heterosexual rapists, 10 non-sex-offender patients from the same maximum security psychiatric institution, and 10 men with low socioeconomic status recruited from the local community were presented with audiotaped narrations while their penile tumescence was measured. The story categories were as follows: female victim/partner (neutral situation, consenting sex, rape, nonsexual violence, consenting bondage and spanking, masochistic bondage and spanking, and nonconsenting bondage and spanking) and male victim/partner (neutral situation, consenting sex, rape, and nonsexual violence). There were no differences between the two non-sex-offender groups, and they were combined. Rapists showed more sexual arousal to rape descriptions and less to consenting sex stories than the control subjects. As predicted, rapists were sexually aroused by stories involving nonsexual violence with female but not male victims. Surprisingly, there were no differences between rapists and control subjects in their responsiveness to the spanking and bondage stories. It was concluded that the amount of violence in the rape descriptions is critical in differentiati ng rapists from non-sex-offenders. A number of investigators have shown that rapists' sexual arousal patterns are different from those of non-sex-offenders (Abel, Barlow, Blanchard, & Guild, 1977; Barbaree, Marshall, & Lanthier, 1979). These differences are shown most clearly by a measure of the relative amount of penile tumescence increase elicited by audiotaped descriptions of rape and descriptions of consenting sexual intercourse. Relative responsiveness to these two stimulus categories is expressed by the rape index, the average response to the rape category divided by the average response to the consenting sex category. Rapists typically show higher rape indexes than non-sex-offenders. In our laboratory, we have replicated this basic finding using different subjects and stories by demonstrating that rapists are differentiable with the rape index from (a) non-sexoffender patients from the same maximum security psychiatric institution and (b) normal control subjects with low socioeconomic status

Assertion and overcontrolled hostility among mentally disordered murderers.

The Overcontrolled Hostility (Q-H) subscale of the Minnesota Multiphasic Personality Inventory differentiates murderers without previous criminal records from men who have committed less serious assaults and murderers with extensive histories of assault. Murderers scoring high on the O-H scale are described as passive and unassertive on the basis of their histories, and psychometric correlates of the O-H scale support this description. The purpose of the present study was to determine whether men who had committed very severe assaults and who scored high on the O-H scale had assertion deficits that could be measured behaviorally. High O-H murderers or attempted murderers in a maximum security psychiatric institution were compared with low O-H murderers or attempted murderers, non-person offenders, and a control group of primarily unemployed men from the local community on a variety of assertion measures. The high O-H group was significantly less assertive than each of the other groups in role playing tasks and on a questionnaire that asked subjects how aggressive they would be in extremely provocative situations. These findings support the O-H construct and suggest that assertion training may be a useful therapeutic technique to employ with high O-H murderers.

Release From a Maximum Security Psychiatric Institution

A stepwise regression analysis was used to predict length of stay in a maximum security psychiatric institution from 14 clinical and demographic variables. Two groups were studied separately: a cross sectional group of 181 men who were potentially eligible for release to a less secure setting and a group discharged to a less secure setting (N = 94). It was predicted that an admission offense of homicide, a diagnosis of personality disorder, and a younger age on admission would be positively correlated with length of stay because these variables are related to perceived dangerousness. In the cross sectional group, education was the best predictor (r = -.26), followed by age on admission, and an offense of homicide. In the discharge group, an offense of murder was the best predictor (r = .40), followed by a diagnosis of retardation. The reasons for the relationship between length of stay and both years of education and a diagnosis of retardation are at present obscure but are probably not related to the patients' perceived dangerousness.

The Dangerousness of Patients Released from Maximum Security: A Replication

Two hundred six male discharges from a maximum security psychiatric institution were followed up for a 37–49 month period. Failures were defined as men with new convictions or a readmission to the security hospital. Forty-six percent of the sample failed, usually by the commission of minor property offenses, and 17% of the total committed at least one violent offense against persons. As in earlier studies of patients discharged from this hospital, younger, personality disordered patients were more likely to fail. Younger, personality disordered patients were also more likely to commit a violent offense than older, nonpersonality disordered patients.

A follow-up of patients found "unfit to stand trial" or "not guilty" because of insanity.

Fifty-six patients who were found unfit to stand trial or not guilty by reason of insanity were followed up after their release from a maximum security psychiatric institution. At the time of follow-up 50 percent lived in the community, 43 percent were in psychiatric facilities and 5 percent were in correctional facilities -- 9 percent of the patients were either returned to the maximum security hospital or had committed new offences. The twenty-seven ex-patients who were interviewed generally exhibited little psychiatric symptomatology and there was evidence that they had adjusted well to the psychiatric facility or community in which they lived. As a group they appeared to have made a better vocational than social adjustment.

Behavioural Changes Associated with the Introduction of a Token Economy in a Maximum Security Psychiatric Institution

Behavioural Changes Associated with the Introduction of a Token Economy in a Maximum Security Psychiatric Institution