Homicide: A Psychiatric Perspective.

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MALMQUIST, CARL P. Homicide: A Psychiatric Perspective. Washington, DC: American Psychiatric Press, 1996. xi + 395 pp. $45.00.Unlike other recent books on violent behavior, Malmquist focuses on intrapsychic and other individual properties of the perpetrator rather than on statistical comparisons between groups. The author's standpoint is primarily clinical and forensic, although he also reviews epidemiological and neurobiological aspects of violence. As he points out, the difference between a homicide and an aggravated assault is often a matter of chance (e.g., a slight variation of a bullet's trajectory); this fact made it necessary to occasionally expand the focus of the book from homicide to nonlethal violent behaviors.The book is introduced by a review of epidemiology and criminology of homicide; most of his material will be new to psychiatrists. Next, biological factors in homicide are presented. The neurological aspects are covered in relatively greater depth than the neurochemical and genetic ones. This is perhaps due to the fact that issues such as EEG and history of seizures have been important in forensic psychiatry for many years, whereas the more recent neurochemical and genetic findings, while on the cutting edge of progress, have not yet been incorporated into forensic practice.The substance of the book is in the subsequent chapters that have a clinical and forensic character. Each chapter is devoted to a specific disorder. The chapters are somewhat similar to each other in their structure. First, the characteristics of the disorder that may predispose to violent behavior are discussed. Malmquist explains various psychodynamic processes and interactions with the patient's environment that may lead to homicide. Theoretical explanations are illustrated by interesting and well-written clinical vignettes. Legal aspects of the disorders are discussed; these reflect the considerable practical forensic experience of the author. The disorders discussed in individual chapters are schizophrenia, borderline personality disorder, dependent personality disorder, narcissism, masochism, and depression. Subsequent chapters are devoted to juveniles and homicide and to sexual killing.The chapter that interested me most compares the legal and the clinical views on homicide. The core problem of interaction between brain disease and voluntariness is approached, in turn, from the standpoint of the practicing psychiatrist and the practicing attorney. The issues that are discussed here include societal protection, the fate of the perpetrators, the distinction between focusing on the act (legal approach) and the actor (clinical approach), and, in general, differences in the legal and clinical thinking about violence. Attorneys and psychiatrists will be able to understand each other better after they read this chapter.This book is important not only for forensic clinicians but for every practicing psychiatrist and psychologist: violent behavior, unfortunately, is ubiquitous. The clinical chapters as well as the chapter comparing legal and clinical viewpoints will be useful for lawyers. At the time of increasing interpenetration of the criminal justice and mental health systems, it is critically important that the professionals running these systems improve their mutual understanding. This book contributes toward that goal.Jan Volavka, M.D., Ph.D.

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