Articles

THE SEXUAL PSYCHOPATH: THE CLINICAL IMAGE OF THE SEXUAL PSYCHOPATH

In addition to the voluminous statements of various clinicians available to us in the official records, we also interviewed in institutions housing sexual psychopaths, three psychiatrists, seven psychologists, two social workers, and two chaplains. There was near unanimity of opinion that sexual psychopathy was a legal rather than a clinical entity. Nevertheless, it was felt that the sexual-psychopath observation procedure was functioning fairly well in selecting out of the mass of sex offenders those with relatively acute mental and emotional problems amenable to treatment. For example, the clinicians whom we queried estimated the incidence of psychosis among sexual psychopaths as quite low (less than 1 to no more than 5 per cent) despite some descriptive adjectives in the official records suggesting a higher figure. At this juncture we would like to deplore the increasing tendency of many clinicians to use very loosely such words as "psychotic" and "schizophrenic."

It is almost inevitable that in a clinical diagnostic report to a court personality characteristics are described in their negative rather than positive aspects. There is always the dangerous probability of misinterpretation: the happy extrovert may be labeled manic and irresponsible while the quiet reserved individual may be termed despondent and withdrawn. This brings up a contention sometimes made and never adequately rebutted that certain traits such as passivity and anxiety may be by-products of confinement rather than characteristics of the individual.

In reviewing the written records of the clinicians we compiled a list of the more commonly mentioned traits, generally in adjective form. Many of these come from the vocabulary of psychoanalysis (e.g., oral type, narcissistic), others stem from psychiatry (e.g., schizoid, compulsive), and still others are borrowings from the lay vocabulary (e.g., anxious, unstable). Inasmuch as the terms were applied with varying frequency to the six groups of sexual psychopaths under consideration, there is no merit in giving the adjectives applied to sexual psychopaths as a whole except to say that no one descriptive term was applied to as many as half of the men. The most popular word, "neurotic," was used in 45 per cent of the cases; the second most popular (38 per cent) was "immature."

Curiously enough, while almost all the clinicians whom we interviewed rejected the concept of sexual psychopathy as a clinical entity, about half of them were equally resistant to the idea of categorizing the men according to their offenses. Their attitudes might be simply summed up as follows: the men labeled sexual psychopaths are sick, their offenses are just one of many symptoms of their sickness, and the nature of the offense is largely an artifact of external circumstances and is often almost fortuitous. Those who subscribed to this philosophy tended to have heterogeneous therapy groups of various offender types. Other clinicians differentiated pedophiles, exhibitionists, homosexual offenders, etc., and often tried to keep their therapy groups homogeneous. These clinicians were willing to make generalizations concerning offender types, and it is interesting to note that their generalizations did not always match the frequency with which certain descriptive words appeared in the written reports. Such discrepancy is to be expected since the clinicians we interviewed constituted only a minority of the authors of the reports. Moreover, as we know only too well, clinical impressions can frequently be seriously in error.

An examination of the written reports and the words used to describe the six varieties of sexual psychopaths under consideration, shows that some groups not only received certain labels more consistently than other groups, but got more than their fair share of verbiage.

The sexual psychopaths who were offenders vs. children were described with great brevity, and the description does not leave a coherent image in the reader's mind. They had the largest proportion labeled latently homosexual or as having homosexual tendencies (22 per cent). They also ranked highest in being termed inadequate (22 per cent) and depressed (33 per cent). There was much clinical interest in whether the patients viewed women as domineering, oppressive figures (the stock phrase was "the patient views women as castrating"). This view was allegedly held by a large proportion (35 per cent, the second largest proportion recorded) of the offenders vs. children. It is evident that the clinicians did not regard these men as a clearly defined group.

In contrast, the sexual psychopaths who were aggressors vs. adults received much description and held distinctive rank with regard to many labels. They ranked first in the following: psychopathic (44 per cent), schizoid (31 per cent), paranoid (12 per cent), passive-aggressive (12 per cent), inferiority feelings (12 per cent), aggressive (44 per cent), oral type (19 per cent), and hostile (12 per cent). Here we have a clear picture of disturbed and aggressive persons. They ranked lowest in the labels of passive-dependent (6 per cent), anxiety (12 per cent), viewing females as castrating (12 per cent), and narcissism (0 per cent).

The sexual psychopaths who were incest offenders vs. children ranked first as being passive-dependent (15 per cent), psychopathic (44 per cent), immature (52 per cent), having castration fears (15 per cent), narcissistic (11 per cent), and sadistic (11 per cent). They ranked lowest only for the term schizoid. This is not a too sharply focused picture, psychopathy and immaturity being the major criteria, and neither of them are well-defined words.

The sexual psychopaths who were homosexual offenders vs. children ranked first or last in relatively few respects. They had the largest proportions of persons called unstable (20 per cent), regressed (16 per cent), and hostile (12 per cent). They had no individuals termed paranoid, obsessive, passive-aggressive, and oral type, nor did any of them have inferiority feelings or castration fears.

The sexual psychopaths who were homosexual offenders vs. minors were characterized as anxious (41 per cent), sociopathic (28 per cent), and feminine (45 per cent), ranking first in these three traits. They ranked last in paranoid tendencies, compulsivity, instability, depression, regression, hostility, and aggressiveness. One is left with the picture of a nonaggressivc, rather emotionally well-balanced group of men whose main difficulty lay in their choice of sexual object (sociopathic ) and who were disturbed over their conviction and confinement (anxious).

Lastly, the exhibitionists ranked first in the terms neurotic (74 per cent), compulsive (59 per cent), obsessive (37 per cent), inadequate (22 per cent), viewing females as castrating (44 per cent), immature (52 per cent), and passive-dependent (15 per cent). On the other hand, they were least often labeled psychopathic or sociopathic.

From an examination of these collections of descriptive words it is clear that despite the assertions of some clinicians there is a consensus that certain personality traits are connected with certain offenses. Thus the aggressors vs. adults rank high in terms concerning aggression. Similarly, the words used to describe the exhibitionists predictably group around neurosis, obsession, and compulsivity.

A cynic might say that these are post-factum diagnoses dependent upon the clinicians' knowledge of the offense, but this does not seem to be true. Note, for example, the differences between the descriptions of the homosexual offenders vs. children and the homsexual offenders vs. adults, and also that both homosexual groups were not heavily weighted with the labels usually applied to homosexuals, such as references to fixation at infantile levels, Oedipus conflicts, and castration fears.

It is unfortunate that we do not have a tabulation of the descriptive terms used for the offenders who were not judged sexual psychopaths. This omission is no oversight on our part; it is due primarily to a paucity of data resulting from the fact that the majority of men were not subjected to sexual psychopathy examination. While the psychologists and other clinicians working in the prisons did make some descriptive comments about men convicted of the same offenses, we hesitated to compare these comments with the sexual psychopath data, for in doing so we would not only be comparing sexual psychopaths with other offenders, but also comparing the clinicians of the Department of Mental Health with those of the Department of Correction and thereby introducing yet another uncontrolled variable.

*401\161\2*

Menís Health Erective Dysfunction