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4 APTO 1 (1960)

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       9 E. 97,  N.Y.C.   29


The   Journal of the Association for Psychiatric Treatment of Offenders

                               April,   1960, Vol. 4, No. 1



  The Concept of Psychopathy                         APTO Chapter News

            JAMES   M.  TOOLAN,   M.D.                  The Board of Directors announces with pride
                                                     the formation of a Massachusetts Chapter, under
      The term psychopathic personality has created  the Chairmanship of Donald Hayes Russell, M.D.
   difficulty since Koch introduced it into psychiatric  Brooks S. White, M.D., is the Secretary of the
   nosology in 1888. It has been employed to describe new Chapter, whose  address is: Massachusetts
   all perverse, antisocial and unacceptable delin-  APTO,  Quincy Court Clinic, 8 Coddington Street,
   quent or criminal behavior. More recently, accord- Quincy 69, Massachusetts.
   ing to the official American Psychiatric Associa- The Charter Members of Massachusetts APTO
   tion diagnostic manual, the term has been used    are:
   to describe a chronically antisocial individual   are-


who  is always in difficulty, feels no loyalty, and
fails to profit from experience. However, any
diagnostic entity based primarily upon  an in-
dividual's attitude to society is on tenuous ground.
Similarity in behavior  may   be exhibited by
individuals with markedly  different personality
structures.
   It is suggested, therefore, that this entity be
considered as but one variety of the character
disorders, and that the diagnosis be limited to
those showing: 1) no conscious guilt or anxiety.
(Depression may be seen as a reaction to stressful
situations, e.g. prison.) 2) defective superego or
conscience. 3) difficulty in identifying with and
relating to other persons. 4) antisocial behavior.
The latter is not a necessary feature of the defini-
tion, but usually follows from the previous ele-
ments. Some psychopaths are able to avoid overt
difficulty with society and may even manage to
be highly successful in business or politics. If the
above criteria are strictly applied, we encounter
few true psychopaths even in prisons.
   Behavioral  patterns vary  during  different
periods of the life of an individual. One's personal-
ity structure is not static, and noticeable changes
are frequently encountered during the transitional
years of adolescence. The cases which follow all
illustrate the variation which is so often encoun-
tered in the individual patients life history.
   Patient A. was 16 years of age when brought
for help by  his parents. He had  been a well-
behaved  youngster from  a middle-class family.
He was  sensitive about his small physical stature.
Although  only an average student, he had enjoyed
school and studied diligently. At 15, he began to
associate with a delinquent gang and engaged in
several gang fights, which he enjoyed. He  was
eager to be a big shot in the gang and eventually
was  expelled from  school. Short-term psycho-
therapy enabled  him to  recognie that he  was
attempting  to bolster his somewhat weak  self-
image by identifying with a strong gang. He was
able to give up his gang friends, secure employ-
ment,  and  avoid further delinquent behavior.
This  patient was essentially a normal youngster
who   during adolescence had attempted to solve
his problems  by identifying with a  delinquent
group  and  as a result exhibited delinquent be-
havior. The process was quickly reversed with the
aid of psychotherapy.


DONALD HAYES RUSSELL, M.D.-Director,
  Massachusetts Court Clinics Program
BROOKS S.- WHITE, M.D.-Director, Quincy
  Court Clinic
EUGENEJ. BALCANOFF, M.D.-Director, Suf-
  folk Superior Court Clinic
SHEPARD     C.  GINANDES, M.D.-Director,
  Cambridge  Court Clinic
THOMAS      P.  HACKETT, M.D.-Cambridge
  Court Clinic
JOHN   W. DONOGHUE, M.D.-Dircctor, Spring-
  field Court Clinic
JOSEPH    I.  BERNSTEIN, M.D.-Springfleld
  Court Clinic
J. BURNS  AMBERSON, M.D.-Springfield Court
  Clinic
EDWARD MASON, M.D.-Director, Worcester
  Court clinic
RICHARD ROSENWALD, M.D.-Director,
  Framingham  Court Clinic
EUGENE MITTELMAN, M.D.-Director, Mal-
  den Court Clinic
LAWRENCE CLAMAN, M.D.-Director, Brook-
  line Court Clinic
WILLIAM SHELTON, M.D.-Director, Wal-
  tham  Court Clinic
WALTER KAUPE, M.D.-Director, Stoughton
  Court Clinic

  The   next issue of the APTO Ja-al  will be a
Massachusetts issue, in honor of our new Chapter.


    Patient B. had been an anxious child, fearful
of the dark and especially dose to an older sister
who  assisted him in his school work and calmed
his fears. He was an excellent student but when
his sister married, he lost all interest in school and
became  delinquent. The Children's Court allowed
him  to enlist in the Navy but he was often AWOL,
insubordinate, and  had  a poor  service record.
After leaving the Navy, he was sexually promiscu-
ous  and perverse, had no feelings for others and
wss  especially insulting to women. At his work,
despite obvious talent, he was always in difficul-
ties with his superiors.

               Cautinerd -n paer 4


A   Lawyeis Guide to the

Perplexed Psychiatrist

       NATHAN DECHTER, L.B., Pa.D.

   With   growing   frequency police  agencies,
judges, district attorneys, lawyers, social workers,
and  institutions are asking  psychiatrists for
reports on offender-patients. These requests are a
challenge and a responsibility, and even the ex-
perienced psychiatrist may sometimes find himself
at a loss where to begin. However, the task will
be much  simplified if a systematic approach is
adopted.
   Assuming  that  the psychintrist has already
examined, evaluated, and diagnosed the offender-
patient, there are still four important questions
to be asked:
   1. Who,  exactly, has requested the report?
   2. Have the necessary releases been sumbitted?
   3. What,  specifically, does the inquirer want
en know?
   4. To  what use will the information in the
report be put?

   1. The  frst question  requires very careful
consideration. Police agencies and the district
attorney's office are concerned primarily with
prosecution and conviction; information will be
used in support of these objectives. Defense at-
torneys seek exoneration or mitigation of punish-
ment. Judges, probation officers and social workers
are concerned with final disposition and treat-
ment.  (Psychiatrists, however, are aware that
treatment  is sometimes only disguised punish-
ment.) Although  a psychiatrist may occasionally
tend to tailor a report, it is actually a mistake
to thus be influenced by the source of the request.
Absolute  medical objectivity is vital to the fair
and  proper administration of justice.

    2. The problem  of  medical releases is not
 within the scope of this brief discussion, but the
 psychiatrist should be warned that it is essential
 to possess an appropriately executed release from
 the offender-patient before forwarding the report


               Caursrd e pap 4

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