Question

Biopsychosocial characteristics of children who later murder: A prospective study. By Dorothy otnow Lewis, M.D. , Ernest Moy, B.S. Departement of Psychiatry

Answer 1

Abstract

The authors document the childhood neuropsychiatric and family characteristics of nine male subjects who were clinically evaluated as adolescents and were later arrested for murder. Those subjects are compared with 24 incarcerated delinquents who did not go on to commit violent offenses. The future murderers displayed a constellation of biopsychosocial characteristics that included psychotic symptoms, major neurological impairment, a psychotic first-degree relative, violent acts during childhood, and severe physical abuse. The authors relate this combination of factors to prediction of violence and discuss ethical issues that are involved in intervention to prevent violence.

There is a controversy in the literature regarding the prevalence and severity of mental illness in murderers.

McKnight et al. found that 77% of 100 murderers received psychiatric diagnoses (schizophrenia, especially paranoid, manic-depression, psychopathic personality, and epilepsy).

Several other authors (3–7) have found murderers to have a higher prevalence of psychoses, especially the schizophrenias, than the general population.

Wolfgang, on the other hand, found that only 3% of the murderers in Philadelphia prisons were insane.

Wong and Singer found that only 7% of the 621 murderers they studied in Hong Kong were mentally ill or not guilty by reason of insanity.

The literature on homicidal aggression from the 1940s, 1950s, and early 1960s focused primarily on social and psychodynamic factors to the almost complete exclusion of neurobiologic factors.

Easson and Steinhilber concluded: “All cases demonstrate that one or both parents had fostered and had condoned murderous assault.”

Michaels.using Easson and Steinhilber's clinical data, highlighted factors that Easson and Steinhilber had minimized, namely, history of enuresis, epilepsy, and abuse.

Martin evaluated the psychodynamics of two adolescent murderers but failed to elaborate on several symptoms of organic brain impairment, which he mentioned only in passing.

Smith, after evaluating eight young murderers, concluded that they suffered from early experiences of deprivation which resulted in underdeveloped egos and vulnerability to outbursts of violent aggression.

Miller and Looney theorized that adolescents who tended to dehumanize others were at greatest risk of committing murder when their wishes were thwarted.

In 1978 McCarthy found that “narcissistic disturbances, particularly an impaired capacity for self-esteem regulation and underlying narcissistic rage, were related to homicidal behavior.”

Malmquist suggested that homicide “can serve the illusory function of saving one's self and ego from destruction by displacing onto someone else the focus of aggressive discharge.

Much has been written about the association of parental brutality and homicidally aggressive behavior.The presence of repeated violence and abuse in the environment of many adolescent murderers led Pfeffer to view much of the adolescent's assaultive and homicidal behavior as an attempt to master the trauma he has experienced by controlling and victimizing others.

Duncan and Duncan and Lander and Schulman, in studies based on small numbers of cases, described destructive and nonnurturing parent-child relationships and hypothesized that these may have led to acting out of intense hostility and homicidal behaviour

Extensive information pointing to the presence of a continuum of learning deficits and neurological problems associated with youthful homicidehave also been reported through various studies.

Lower intelligence and mental retardation have also been reported to play a role in homicide.

The studies we have cited can be characterized in two ways. First, each study tends to focus on a single dimension of behavior (e.g., psychodynamic, neurological, experiential). Second, all of the studies of more than one subject are retrospective. That is, they reconstruct childhood factors after murder has occurred. For these reasons, we considered it important to report the neuropsychiatric and psychosocial characteristics of nine murderers examined before their commission of homicidal acts.

Discussion

It seems that severe CNS dysfunction, coupled with a vulnerability to paranoid psychotic thinking, created a tendency for the nine homicidal subjects to act quickly and brutally when they felt threatened.

Living within psychotic households, they were frequently the victims of and witnesses to psychotic parental rages, experiences that undoubtedly further exacerbated their tendencies toward the physical expression of violence.

Whether or not these youngsters dehumanized their victims, could not be determined. If, indeed, they did, these objectively identified neuropsychiatric vulnerabilities undoubtedly contributed to their distortions of reality

The finding that the parents of these youngsters were often both psychotic and violent may shed light on earlier studies purporting to document a genetic predisposition to violence

Previous studies of large samples of antisocial individuals have revealed that their offspring are significantly more likely to become antisocial, even when raised apart from the biological parents.

The parents of these nine murderers were violent and, although police records were not available, we suspect that many had come in conflict with the law.

Each of the clinical factors identified in this study has implications for potentially therapeutic interventions. A recognizable constellation of biopsychosocial factors such as that described signals a need for specific medical, psychiatric, and social assistance