Caractérisation sociodémographique, clinique et criminologique d’une population de 210 meurtriers

Introduction

After a saturated media coverage of some murders, questions were raised about the mentally ill and their dangerous and violent nature which may sometimes culminate in homicide. The popular idea that someone who kills an unknown person in the street is mentally ill is firmly rooted in the collective consciousness. Yet, epidemiological data are reassuring: only 15% of such murders are committed by the seriously mentally ill (schizophrenia, paranoia, melancholia).

Aim

To describe the sociodemographic, clinical and forensic characteristics of a convicted population of 210 murderers.

Method

Consecutive series of cases of people convicted of murder in Angers between 1975 and 2005. Information on sociodemographic and clinical characteristics of perpetrators of homicide was collected from psychiatric reports prepared for the courts. This retrospective study identifies several types of pathological murders (schizophrenia, paranoiac delirious disorder, affective disorder: melancholia and hypomania, drugs abuses, personality disorders).

Results

The murderers were men whose mean age was 33. Most were single, living alone and jobless. Two thirds of them had psychiatric records and one third a record of violence against persons. There were 14 cases of schizophrenia (6.7%), eight cases of persistent delusional disorder, 15 cases of affective disorder, 11 cases of mental disorder, five cases of neurological symptomatology, 44 cases of personality disorder and 35 cases of alcohol abuse or alcohol dependency disorder. A third of the murderers did not have any kind of mental disorder (n = 73). Fifty-two (24%) were mentally ill. Two thirds had a history of mental illness and one third had a record of previous convictions of violence. Crimes were mostly committed at nighttime and in the house of the victim. The most common method of killing was stabbing. Fourteen percent had symptoms of mental illness at the time of the offence. The 217 victims were, in decreasing order, a family member, a current or former spouse/partner (53%), an acquaintance (30%) or a stranger (17%). The forensic and juridical consequences (via the application of former article 64 or the present article 122-1 of the French Criminal Code) were envisaged in less than 10% of the cases.

Conclusions

These data allowed the authors to determine the general risk factors of homicidal violence (male gender, youth and alcohol abuse) as well as some more specific factors (mental illness, comorbidities…). The dynamic characteristics of the meeting of the crime protagonists should be added to these factors.     

Homicide et schizophrénie : à propos de 14 cas de schizophrénie issus d’une série de 210 dossiers d’expertises psychiatriques pénales pour homicide

A few murders, which received saturated media coverage, obviously raises questions about the dangerous and violent nature of the mentally-ill, which can sometimes culminate in homicide. Firmly rooted in the collective consciousness is the popular idea that someone who kills an unknown person in the street is mentally-ill. On the contrary, the epidemiological data are reassuring; only 5% of such murders are committed by the persons suffered of schizophrenia.

Aim

To establish the social, clinical and forensic differences between murderers suffering of schizophrenia disorder and murderers who are immune of psychiatric disorder, and especially to compare their respective records of psychiatrics disorder and their respective relationship with their victims.

Method

We studied the cases of 210 murderers, the offences related to the murders, and the social and clinical information collected from psychiatric court reports on persons convicted of homicide. Firstly, we identified the sociodemographic, clinical and criminological profiles of a group of 210 murderers from which were distinguished the schizophrenia murderers. Then, we compared the profiles of murderers suffering from schizophrenia (n = 14), with 73 persons without any mental disorder.

Results

The profile of schizophrenic murderers of our series is characterized by a specific socioprofessional status (single, without child and jobless) and by more frequent records of psychiatrist troubles (this characteristic is always found with criminals that are schizophrenics) and violence against human beings than murderers’ immune of mental disorder. With the exception of these variables and of the clinic of schizophrenia, there is no noticeable difference of sociodemographic profile between schizophrenic murderers and murderers without psychiatric troubles. In addition to the similarities, between the two groups of murderers, in the temporal, location and operating characteristics of the commitment of the homicide (in the evening, at the house of the victim, with three classical means (firearms, knife and knocks), having drunk alcohol), schizophrenic murderers generally commit, alone, a non-premeditated murder. They often strangle their victim in a sudden attack, whereas murderers without a known pathology often premeditate their crime. Therefore, it is possible to talk about a state of emotional violence. In 86% of cases, a delirious psychopathology was at the root of the homicide act of the schizophrenic person. Four criminological themes predominate: persecution, syndrome of influence, mysticism and megalomania. Among the victims of schizophrenic murderers, closest persons to and acquaintance of the murderers are over-represented; in 25% of cases the murder takes place within the family. Finally, penal irresponsibility or mitigation of penal responsibility of the schizophrenic murderer was generally recognized.

Conclusion

Differences between murderers affected with and unaffected with schizophrenia lie on the psychopathology of the morbid process which underlies the homicide of the mentally-ill person.     

Profil psychosocial des familicides commis au Québec - 1986 à 2000

Familicide is defined as the homicide of the intimate partner and at least one child. Studies on this type of homicide are mainly clinical cases. Only one comparative study on familicide have been written. The objective of this study is to analyse the motivation as well as the demographical, criminological, situational and psychological characteristics from 16 familicides. These data are from “Bureau du Coroner en chef du Québec” (Canada) files which are covering the years 1986 to 2000. Results indicate that all familicide has been committed by men. Half of these used excessive violence during the crime and many of them killed themselves after the perpetration of the act. Furthermore, many men showed borderline personality traits or a borderline personality disorder. Finally, four motivations are preponderant: intimate partner loss, social loss, mental state perturbations and the economical motivation. Clinical cases illustrate the different familicide sub-groups according to the motivation. The results allow an increase in the understanding of familicide and have an impact on intervention and prevention.     

Le passage à l'acte homicide en milieu médical et carcéral

Little is known about the frequency and characteristics of the homicide of which medical staff, institutionalized patients and prisoners may be victims. To date, several categories of victims have been described: medical staff murdered during their working hours, mentally ill patients assassinated by other patients, patients killed by medical staff and prisoners murdered by other prisoners. The criminological observation of a female general practitioner assassinated by one of her occasional clients, a perverse multirecidivist psychopath, illustrates the complexity and diversity of the utilitarism and/or pathological motives encountered in such affairs. Homicidal attacks on medical staff can be classified into four categories: the first three (fortuitous crime, occasional crime and personal cause crime) have no relation with therapeutic activity; the fourth (crime for a professional cause) involves a one-off or lasting medical relationship between the aggressor and his victim. Murderers in the latter category have been reported to suffer frequently from paranoid schizophrenia or persistent delusional disorder (paranoiac delusion). Such homicides on medical staff may be impulsive unforeseeable acts, reactions to conflict, or premeditated acts of vengeance. Homicides perpetrated by medical staff on patients are of a euthanasic or “heroic” nature. In those between hospitalized mental patients or between prisoners, the aggressors are frequently violent psychopaths or delusional psychotic patients. The prevention of such dramas is difficult and raises the problem of how we should evaluate the dangerousness, the conditions of institutional life, and the financial and medical means that are made available to hospitals and prisons.     

Réflexions sur la fréquence, l’organisation et les facteurs prédictifs des homicides psychotiques : à propos de trois observations avec mutilation corporelle

The statistically positive correlation between severe mental disorders and physical violence has now been firmly established by international studies. In Europe, about 10% of homicides are committed by psychotic patients who may re-offend. Three medicolegal observations of homicides with bodily mutilation are presented. The first concerns a 31-year-old schizophrenic man who killed a passer-by in the street when in a state of paranoid delusion with themes of homosexual rape and persecution. The crime was committed in two separate phases: first, emotional violence and then, a few hours later, operational utilitarian violence with amputation of the victim's hands. The second case concerns a 21-year-old man suffering from paranoid schizophrenia associated with an antisocial personality disorder. During the night, he assassinated two women who worked in a psychiatric unit, one of whom was decapitated while still alive. Although living freely in the community, the patient acted with premeditation and method under the influence of ideas of persecution and cosmic supernatural terror. The third case concerns a 30-year-old man who had been forcibly hospitalized in a psychiatric unit for delusional disorder of persecution with paranoiac personality disorder. During a period of weekend leave, he killed his own mother in the family home in a totally disorganized emotional moment of acting out, then cut off her leg and threw it out of the window. Six years beforehand, he had already killed a prison inmate who was sharing his cell. In the first two cases, the patients’ behavior was partially or totally organized despite delusional motives of paranoid type. In the light of these three dramas and a litterature review, the main psychopathological predictors of physical violence committed by psychotic patients are discussed: severe psychotic episode, persecutory delusional beliefs, comorbidity with substance abuse (alcohol, cannabis) and personality disorders, little or no antipsychotic treatment, and poor therapeutic compliance. In France, it appears mandatory to apply a rigorous procedure for evaluating the dangerousness of severe mental patients and violent criminals.     

Risque d’homicide et troubles mentaux graves : revue critique de la littérature

Introduction

Tragic and high profile killings by people with mental illness have been used to suggest that the community care model for mental health services has failed. It is also generally thought that schizophrenia predisposes subjects to homicidal behaviour.

Objective

The aim of the present paper was to estimate the rate of mental disorder in people convicted of homicide and to examine the relationship between definitions. We investigated the links between homicide and major mental disorders.

Methods

This paper reviews studies on the epidemiology of homicide committed by mentally disordered people, taken from recent international academic literature. The studies included were identified as part of a wider systematic review of the epidemiology of offending combined with mental disorder. The main databases searched were Medline. A comprehensive search was made for studies published since 1990.

Results

There is an association of homicide with mental disorder, most particularly with certain manifestations of schizophrenia, antisocial personality disorder and drug or alcohol abuse. However, it is not clear why some patients behave violently and others do not. Studies of people convicted of homicide have used different definitions of mental disorder. According to the definition of Hodgins, only 15% of murderers have a major mental disorder (schizophrenia, paranoia, melancholia). Mental disorder increases the risk of homicidal violence by two-fold in men and six-fold in women. Schizophrenia increases the risk of violence by six to 10-fold in men and eight to 10-fold in women. Schizophrenia without alcoholism increased the odds ratio more than seven-fold; schizophrenia with coexisting alcoholism more than 17-fold in men. We wish to emphasize that all patients with schizophrenia should not be considered to be violent, although there are minor subgroups of schizophrenic patients in whom the risk of violence may be remarkably high. According to studies, we estimated that this increase in risk could be associated with a paranoid form of schizophrenia and coexisting substance abuse. The prevalence of schizophrenia in the homicide offenders is around 6%. Despite this, the prevalence of personality disorder or of alcohol abuse/dependence is higher: 10% to 38% respectively. The disorders with the most substantially higher odds ratios were alcohol abuse/dependence and antisocial personality disorder. Antisocial personality disorder increases the risk over 10-fold in men and over 50-fold in women. Affective disorders, anxiety disorders, dysthymia and mental retardation do not elevate the risk. Hence, according to the DMS-IV, 30 to 70% of murderers have a mental disorder of grade I or a personality disorder of grade II. However, many studies have suffered from methodological weaknesses notably since obtaining comprehensive study groups of homicide offenders has been difficult.

Conclusions

There is an association of homicide with mental disorder, particularly with certain manifestations of schizophrenia, antisocial personality disorder and drug or alcohol abuse. Most perpetrators with a history of mental disorder were not acutely ill or under mental healthcare at the time of the offence. Homicidal behaviour in a country with a relatively low crime rate appears to be statistically associated with some specific mental disorders, classified according to the DSM-IV-TR classifications.     

Psychiatric aspects of homicide

Homicide is frequently associated with mental illness and suicide. The present study is an investigation of all known homicide incidents in Iceland during the past 80 years (1900–1979). There were 45 homicide incidents, involving 52 victims and 47 offenders. One-third of the perpetrators were either psychotic, mentally subnormal, or committed suicide. A further one-third were diagnosed as personality disordered, alcoholic, drug dependent or neurotic. A substantial proportion of the offenders suffered from fairly marked physical disabilities, and the mentally ill were significantly more frequently afflicted by such defects. Over 60 % of the offenders and 50 % of the victims were under the influence of alcohol at the material time. The findings are generally consistent with those of previous psychiatric studies of homicide.     

Risque de violence et troubles mentaux graves

In opposition to a widespread belief in psychiatry, mental disorders per se, without alcohol or drug abuse, represent a risk for violence against others, including homicide, that is significantly higher than that of the general population. The present paper extensively reviews the scientific literature during the past 15 years and present their findings in a summary table. The contradictory results of the notorious McArthur study are also presented and critically discussed. Elevated risks of assaults are more closely associated with a subgroup of patients showing one or more of the following characteristics: a history of previous violence; non compliance with antipsychotic medication and follow-up; alcohol and/or illegal drug abuse; violent fantasies; acute psychotic symptoms; and cerebral damage. Although violence associated with mental disorders is significantly higher than that observed among the general population, the absolute number of assaults committed by patients is still low. Between 85 and 97% of violent offenders are not mentally ill. Certain aspects of the deinstitutionalization, such as lack of outpatient resources and a modification of the law reflecting more concerns for the rights of the patients might provoke health care interruptions. However, a clinical commitment relayed by legal interventions in case of danger generate significant reduction of the risks for violence.     

精神病患者控制障碍作案特点的分析

目的 探讨精神病患者控制障碍作案的特点。方法 采用回顾性研究的方法,对１２１例精神病患者（研究组）控制障碍作案及１１５例精神正常人（对照组）作案的特点进行分析和比较。结果 研究组以故意伤害和故意杀人为主（７４．４％）,抢劫案比例（５．０％）低于对照组（１３．０％;Ｐ〈０。０５）;冲动作案较多（５３。７％）,心理危机作案为其所特有（７．４％,对照组为０）,生物性动机的比例（３５。５％）高,常缺乏反动     

Homicide and psychosis: criminological particularities of schizophrenics, paranoiacs and melancholic. A review of 27 expertises

INTRODUCTION: During the night of the 11 to 12 of December 2002, Mathieu X. 21 years old, convinced he was defending himself from evil human beings decapitated a nurse and an auxiliary nurse of the psychiatrist hospital. This crime, which received saturated media coverage, obviously raises questions about the dangerous and violent nature of the mentally ill, which can sometimes culminate in homicide. Firmly rooted in the collective consciousness is the popular idea that someone who kills an unknown person in the street is mentally ill. Conversely, the epidemiological data are reassuring; only 15% of such crimes are committed by the seriously mentally ill (schizophrenia, paranoia, melancholia). AIM: Typing and comparison of homicides committed by schizophrenic, paranoiac and melancholic persons. METHOD: Several murders committed by psychotic persons are presented in this article. This retrospective study shows several types of pathological murder (schizophrenia, paranoiac delirious disorder, affective disorder: melancholia and hypomania). Twenty-seven cases have been selected and analysed from 268 cases prepared over 30 years by two psychiatrists, whose diagnoses were schizophrenia, paranoia, melancholia or hypomania. RESULTS: From these 268 cases of homicide examined, 27 murderers were psychotic. Ten of these were young, single, jobless, male schizophrenics: they drank little alcohol. Most of them had a criminal history. They were paranoid schizophrenics whose hallucinatory mechanisms fed mostly persecuted, sexual and metaphysical themes. Forty percent of them were disorganised, and half of them showed negative features. They knew their victim (family, friends). Nine others were paranoiac, for the most part male, older, married, family men, without psychiatric or criminal record. Intuitions with delirious fed persecuted (77%), jealous (40%) or prejudicial themes. They murdered their wife or husband or neighbour. Alcohol consumption was often involved. Schizophrenic and paranoiac murderers often have an emotional temper. Conversely, melancholic murderers are mostly female aged around 30, married, family women, drinking little alcohol. Two-thirds of them have psychiatric records of depression, bipolar disorders and attempted suicide. Altruism is the most frequent delirious theme. Their murders are more often premeditated. They know the victim: child or partner. Suicide often follows the murder.     

Les auteurs de violences sexuelles en unité pour malades difficiles

Introduction

Literature concerned with the care of the mental patients perpetrators of sexual violence in psychiatric high security care unit is sparse and fragmented. According to studies, it is reported that a small proportion of such patients that suffer are between 3 and 5%. These patients are described as perverse and incurable and no subject to any treatment with the exception of surveillance in institutional settings. Based on the observation of an ancient literature and limited, our aim was to realize a study covering the year 2010. This proportion, has it changed? What are the profiles of sexual offenders in this care unit?

Material and method

We realized a retrospective study with all patients who were hospitalized in care unit for dangerous patients covering the year 2010 in Sarreguemines. We studied a sample of 124 patients who were all in forced hospitalization. We identified forensic history, judicial history, and sexual violence history for every patients who were studied.

Results

Sexual violence concerns only 10% of transfers in care unit for dangerous patients over the period studied. In this case, it's mainly sexual assaults occurring in community settings and not psychiatric. Sexual violence constitutes an indication of the forced hospitalization then transfer in this care unit. However, we find history of sexual violence in nearly 30% of patients being hospitalized in the care unit. It's primarily mental retardation closely followed by schizophrenia. These patients with history of sexual violence have important comorbidities: consumption of toxic and personality disorder. Finally, the prevalence of paraphilias remains low and only concerns 16% of sexual offenders in psychiatric high security care unit.

Discussion

It was admitted in literature that patients perpetrators of sexual violence were infrequent in dangerous patient care unit especially sexual perverts. Against all odds, one third of patients hospitalized in this care unit have committed sexual assault (a large proportion). More than half of these patients with mental retardation, schizoaffective disorder, bipolar disorder or personality disorder. Only 13% of schizophrenic patients have committed sexual violence: it's a small proportion compared to other mental illnesses.

Conclusion

The profile of sexual pervert exists in psychiatric high security care unit (sexual homicide with torture and barbaric act) but it's an uncommon cases. Sexual violence is frequent among hospitalized patient in psychiatric high security care unit (sexual violence found are varied: sexual touching, attempted rape of a nurse).     

Un cas « mixte » de meurtre sexuel sadique avec incendie criminel nocturne : psychopathie ou psychose ?

Bénézech organised sexual homicide into two distinct categories — psychopathic and psychotic — but warned that this taxonomy has only an indicative value, since certain sexual homicides fall in-between these categories. Therefore forensic experts must determine which of the two components (psychopathic or psychotic) dominate as the risk of recidivism as well as the measures that should be taken are determined by the subjective structure of the perpetrator. Given this need, criminal analysis could benefit greatly from a thorough clinical analysis. The author presents a mixed case of sexual psychotic homicide with criminal nocturnal arson. The difficulties in diagnosing of such a case are discussed.     

Application de l’EMDR au deuil traumatique après une collision de train

The aim of this exploratory study is to test the application of therapy EMDR in case of traumatic bereavement. The traumatic bereavement, which corresponds to the brutal loss of “other significant”, answers a precise clinical picture whose principal characteristics are the intrusive thoughts concerning the late one and of the difficulties of adjustment to the loss (feeling of vacuum, difficulties of recognizing the death, irritability, lack of reactivity, etc). The eight participants all of this study are of the members of the family of the victims of the train collision, which took place on October 12, 2006 in Zoufftgen. The subjects, old on average 35.2 years (S.D. = 11.1) and including 75 % women, followed between eight to 15 meetings (m = 10.75, S.D. = 2.21) answering protocol EMDR. The effectiveness of the therapy was evaluated starting from several criteria including traumatic bereavement, anxiety, depression and psychological distress. Five evaluations were carried out: before the therapy (T0), after six meetings (T1), at the end of the therapy (T2), then in three months (T3) and 12 months (T4) after the end of the therapy. The principal results seem to indicate an effectiveness of the therapy EMDR. Indeed, we observe a reduction in all the indicators between the beginning (T0) and the end of the therapy (T2). Moreover, when this reduction does not continue to three and 12 months, it remains, at least, stable at one year. These observations are very encouraging especially when it is known that 10 to 15 % of the patient develops a chronic depression.     

Hétérogénéité de la maladie maniaco-dépressive : intérêt des sous-groupes d'âge de début

Clinical, familial, and biological differences according to age at onset (AAO) and the correlation observed for AAO in relatives with bipolar affective disorder (BPAD) suggest that AAO is a valid candidate characteristic for genetic studies of BPAD. Although much data is available, none of the various thresholds of AAO used has been validated. A preliminary study of AAO in BPAD showed there to be three subgroups of the disease according to AAO. Replication in independent samples, with different methods is needed. Admixture analysis was used to determine the model that best fitted the observed distribution of AAO. In addition, affected sibs were more likely to belong to the same theoretical subgroup identified by admixture analysis. Both analyses were consistent with the existence of three AAO subgroups in BPAD (mean ± S.D.): 17.4 ± 2.3, 25.1 ± 6.2 and 40.4 ± 11.3 years). The proportion of the population in each subgroup differed between the samples, reflecting heterogeneity in sampling procedure. These data further demonstrate the existence of three AAO subgroups in BPAD. Together with the results of clinical, epidemiological, segregation and genetic studies, these results suggest the existence of specific familial vulnerability factors underlying each of the AAO subgroups and/or vulnerability factors involved in the onset of the disorder. Future biological and genetic studies of BPAD should focus on AAO subgroups.