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11 - Dangerous cases: when treatment is not an option
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- By J. Reid Meloy, Associate Clinical Professor of Psychiatry University of California, San Diego, CA, USA; Adjunct Professor University of San Diego School of Law, San Diego, CA, USA; President, Forensis San Diego, CA, USA, James A. Reavis, Director of Forensic Services Relationship Training Institute, San Diego, CA, USA
- Edited by Bert van Luyn, Salman Akhtar, Thomas Jefferson University, Philadelphia, W. John Livesley, University of British Columbia, Vancouver
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- Book:
- Severe Personality Disorders
- Published online:
- 14 August 2009
- Print publication:
- 06 September 2007, pp 181-195
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Summary
There are those who walk among us that have no conscience. They mouth certain feelings, but have no emotion. They do not bond to any living creatures. Because of their chronic emotional detachment and often sadistic impulse, they aggress without inhibition when their desires are thwarted. Their sole relational goal is to dominate their objects. They are the consummate “intraspecies predators” (Meloy and Meloy, 2002).
Although this sounds like fiction, it is not. Each of these assertions is supported by abundant empirical evidence. We are describing, of course, the psychopathic subject in his most severe, ontogenetic form. Psychopathy research is burgeoning, and over the past decade the world scientific literature has yielded over a thousand studies. When psychopathy enters the consulting room, for the psychotherapist or psychoanalyst it is a sign of danger.
The nature of the beast
We theoretically conceive of psychopathy as a genotype, much like schizotypy (Raine et al., 1995) – a stable constellation of biologically predisposed traits and behaviors which exists in various members of our species. In the context of certain social and cultural norms, psychopathy has different levels of phenotypic expression. For example, best estimates suggest that psychopathy in its most severe form is present in 1% of the world's population (Hare, 2003). However, the prevalence of antisocial personality disorder (ASPD), as most recently defined in DSM-IV-TR (American Psychiatric Association, 2000), varies considerably across cultures.
13 - Threats, Stalking, and Criminal Harassment
- Edited by Georges-Franck Pinard, Université de Montréal, Linda Pagani, Université de Montréal
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- Book:
- Clinical Assessment of Dangerousness
- Published online:
- 03 July 2009
- Print publication:
- 13 November 2000, pp 238-257
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Summary
I have had my life verbally threatened on several occasions. The most serious threat, and the most frightening, involved a paranoid schizophrenic and psychopathic patient whom I testified against and played a role in his recommitment. I received word that he was attempting to have me killed by paying a third party a sum of money – a conspiracy to murder – but fortunately, his funds were quite limited, although his potential employees were not.
I was neither approached nor attacked in any of these threat situations. They were, as expected, all false positives; but for me the affective memories remain. As Shakespeare wrote, “between the acting of a dreadful thing and the first motion, all the interim is like a phantasma, or a hideous dream” (Julius Caesar, II, i).
Threats against clinicians do occur (Flannery, Hanson, & Penk, 1995; Lion, 1995), and are varied in their frequency, intensity, and meaning. Unfortunately the threat literature appears minuscule when compared to the ubiquity of expressed threats in society. In this chapter I will first focus on articulated threats in the context of the chronically intrusive and sometimes violent behavior of stalking or criminal harassment. Current knowledge of the latter acts will then be summarized to suggest a clinical framework for violence risk assessment and define future research needs.
Definitions
A threat is a written or oral communication that implicitly or explicitly states a wish or intent to damage, injure, or kill the target.