Case Study due 6pm tomorrow

Disorders with Violence

Violence in America has become rampant and seems to be increasing (Bartol & Bartol, 2008). Many experts believe violence will continue increasing because of gangs, drugs, terrorism, availability of powerful weapons, and a growing tolerance of violence in society. Understanding the cause of violence is an ongoing challenge among mental health professionals. The classic debate is whether personality traits or social stressors predict violence (Hillebrand & Pallone, 1995). There is evidence supporting both theories. Several other cases in this book also discuss patterns of violence, such as the cases of O. J. Simpson (Chapter 1), Joseph Westbecker (Chapter 7), Jeffrey Dahmer (Chapter 8), Ted Bundy (Chapter 11), John Hinckley (Chapter 16), and, to a lesser degree, some of the other cases. Here, the focus is on the causes of violence. The first case of Jack Ruby looks at violence in general; the second case looks at the first well-documented case of a serial killer in the United States; and the third and fourth cases consider patterns of violence and abuse in the family.

Liberals have invented whole college majors—psychology, sociology . . . [etc.]—to prove that nothing is anybody’s fault.

P. J. O’Rourke, Give War a Chance

Causes of Violence

As demonstrated by the quote above, there are many differing theories into the causes of violence. Because of the incredible public attention it received, the case of Jack Ruby has provided theorists with fodder for much thought and discussion (scientific and otherwise) on the matter.

The Case of Jack Ruby

On Friday, November 22, 1963, while in a motorcade with his wife, Jacqueline, and others going through the streets of Dallas, Texas, President John F. Kennedy was assassinated. The individual captured for this murder was Lee Harvey Oswald, who was imprisoned in a Dallas jail.

Two days later, on November 24, Jack Ruby entered the basement of the jail where Oswald was in the process of being transferred to a different facility. Somehow Ruby was able to penetrate a legion of police to fatally shoot Oswald. Great controversy still surrounds Jack Ruby because his connections with crime created grave questions about possible motives for Kennedy’s assassination. There are several approaches that can be taken in diagnosing Ruby’s mental status. The early years of Ruby’s life will first be presented, followed by alternative theories that focus on different facts from Ruby’s adult life (Kantor, 1978; Scott, 1994; Summers, 1980).

Jacob Rubenstein was born in Chicago in 1911, the fifth of eight children. Jacob’s parents’ marriage had been arranged through a traditional Jewish Polish marriage broker. His mother, Fanny Rubenstein, who came with a dowry, was uneducated, emotionally unstable, and, like Jacob, an incessant talker. His father, Joseph Rubenstein, was short, stocky, and mean. He had no trade and was known for cursing, drinking, and beating women. Joseph beat Fanny regularly. The couple had come from Poland to America and settled in Chicago in 1905.

Jacob’s home was poor and unhappy. His parents had violent fights that frequently resulted in Fanny filing assault and battery charges against Joseph. Joseph also regularly slapped his children, and he insisted they end their education after grade school.

When Jacob was 10, his parents separated. He and his siblings were placed in foster homes. Occasionally, he stayed with his mother, who abused him physically and emotionally. She was demanding, ate compulsively, was lazy, threw temper tantrums when things didn’t go her way, and often announced that she did not like any of her children. Finally, in 1937, at age 61, she was committed to a mental hospital and diagnosed as having deteriorating paranoia, a term that probably reflected some degree of organic deterioration.

At age 11, Jacob became noticeably defiant and depressed. He constantly skipped school and was disobedient to anyone in authority. The welfare department described him then as having an adequate IQ, being impulsive, unable to pay attention, and self-centered. Jacob quit school in the eighth grade at age 16 and began spending all of his time in the streets. He was unsuccessful at his attempts to hold a regular job because of tardiness and his violent disposition. Some of his ventures included selling race track tip sheets, novelties from a pushcart, peanuts at athletic games, and chocolates in strip shows. He also scalped tickets and ran errands for Al Capone. Later, he was a nightclub bouncer and waiter. He worked out regularly, wore expensive clothes, and saw himself as a ladies’ man.

Jacob soon gained a reputation for engaging in senseless violence. It appeared he was determined to prove to the world he was a man and a Jew. He frequently got into fights with those who expressed anti-Semitic feelings. Before he was a teenager, Jacob had already fought in a gang against others who taunted Jews.

As is often the case, the facts in a case may support more than one theory. The following sections present several theories that might explain Jacob Rubenstein’s (who later changed his name to Jack Ruby) murder of Oswald, along with the facts of the case relevant to each theory.

Social Psychology Theories

Social psychology views behavior as resulting from interactions between the person and his or her environment. One explanation for Ruby’s tendency toward crime and violence is that he learned this behavior from his parents when he was a child. He also probably learned that his parents did not love him. Cognitive dissonance theory maintains that a person with two conflicting beliefs feels tension or stress and is motivated to find ways to remove the conflict. As a child, Ruby may have had conflicting ideas along the line of “I love my parents and they love me” and “Both of my parents are cruel to me and say they do not like me.” One way to resolve this conflict is to conclude “I don’t really need my parents, so it doesn’t matter what I think of them or they think of me.” Perhaps Ruby learned not to care about society’s values, leaving him more apt to resort to criminal activities.

At age 26, Ruby became a union organizer for scrap iron workers. This position evolved into working with Jimmy Hoffa, an underworld leader and head of the Teamsters Union, who was known to have threatened the life of John F. Kennedy. By age 28, Ruby was entrenched with the most notorious criminal leaders of Chicago.

The influence of stress on behavior is a related theory. The diathesis/stress theory of behavior is that everybody has weaknesses and strengths, and when stress increases, a person’s weak area is more likely to surface. For example, in his twenties, Ruby was in another gang that attacked anti-Semites, and in his thirties, he beat up a sergeant who called him a Jew bastard. Here, the diathesis is being a Jew while knowing there are people who hate Jews. Another diathesis is a predisposition to violence, triggered when the stress of being taunted or hated as a Jew becomes too great.

In modern times, there has been an increasing awareness of the role of the media in facilitating a violent society. Researchers such as Edward Donnerstein have found that rates of physical aggression in TV programming has held steady at about 60 percent for several years and often escalate to higher rates in prime time. A consensus from such studies also finds that (1) “good” characters, or heroes, the attractive/role models that children often emulate, commit more than nearly 40 percent of violent acts; (2) more than one-third of programs feature bad characters who are not punished and physical aggression that is condoned, and younger children oftentimes don’t make the connection when the bad guy is punished in the end; (3) more than 70 percent of aggressors show no remorse for their violence and experience no criticism or penalty when it occurs; and (4) approximately half of TV violence produces no evident physical injury and no pain and suffering in the victim or any negative impact on the family or the community.

Organic/Biological/Genetic Theories

The condition of deteriorating paranoia in Ruby’s mother indicates that Ruby may have inherited some genetic predisposition to a form of organic dysfunction that resulted in delusions. For example, in his mid-fifties, while in jail, Ruby believed Jews would be tortured as a result of his shooting Oswald. This became most apparent after Ruby was found guilty of first-degree murder and during his subsequent time in jail. Similarly, Ruby’s mother’s delusions increased as she became older.

An organic explanation for Ruby’s actions offered at trial (possibly because the attorneys had no other option) that he used in trying to prove he was innocent by reason of temporary insanity was psychomotor epilepsy. Epileptic seizures are subdivided into two major groups: partial or generalized. Partial epilepsy, also called focal epilepsy, is a type of seizure that begins in a limited area of the brain and either stays in that area or spreads adjacently. It may or may not be associated with loss of consciousness.Generalized epileptic seizures involve large areas of the brain from the beginning and invariably involve loss of consciousness.

Psychomotor epileptic seizures are complex partial seizures. These involve experiences of illusions and behavioral responses to the illusions. Applying this diagnosis to Ruby would construe his behavior immediately before and during the shooting of Oswald as outside of his normal consciousness. He may have experienced visions that he thought were real and to which his shooting responded. Testimony at his trial described the shooting as occurring during an epileptic blackout.

However, there were problems with this diagnosis—for example, evidence suggesting that he planned this act. In addition, psychomotor epilepsy has a particular physical course that was not exhibited by Ruby. Even if it could be persuasively argued that this was the very first seizure he had ever had, which would be unusual, there was no evidence that he experienced any subsequent seizures. Psychomotor epilepsy takes a kindling course, which means that after one seizure occurs, it takes less stimulation to produce future seizures. Finally, there is no evidence that Ruby was ever prescribed anticonvulsant drug therapy for this condition. However, there was some evidence at autopsy of a brain tumor, which could support the diagnosis.

If testimony in support of psychomotor epilepsy was along the lines of there being a disruption in Ruby’s consciousness, a more appropriate diagnosis may have been a dissociative disorder (see Chapter 4), a condition in which the predominant feature would be an interruption in the usually integrated mechanisms of consciousness. However, this diagnosis would also be difficult to prove in light of there being no prior or subsequent events similar to the alleged dissociative experience. Thus, with psychomotor epilepsy as Ruby’s main defense, it is not a great surprise that Jack Ruby was found guilty of first-degree murder and sentenced to death.

There is another interesting and alternative biological perspective on violence. For centuries, many theorists have held to the hypothesis that only humans deliberately kill others of their own species without survival reasons. However, in the early afternoon of January 7, 1974, as Richard Wrangham and Dale Peterson reported in Demonic Males: Apes and the Origins of Human Violence (New York: Houghton Mifflin, 1996), in Gombe National Park in Tanzania, eight chimpanzees purposefully traveled to the border of their range, entered a neighboring chimpanzee territory, attacked and mortally wounded a young male from another community, then returned home—the first recorded instance of lethal raiding among chimpanzees. The event was significant not only as an example of another species that killed its own deliberately and without apparent purpose but also because the species happened to be the one most closely related to humans. Subsequent research has found gratuitous violence in other species.

Affective Disorder Theory

An intriguing possibility is that Ruby suffered from an affective disorder such as atypical depression, bipolar disorder (major mood swings), or cyclothymia (less intense mood swings) (see Chapter 7). Information is insufficient to determine if Ruby was prone to have periods of time when he was uncharacteristically active (manic). There were times, however, when he was depressed; for example, the welfare department described him as being depressed as a child. Ruby admitted that as an adult he overate in order to ward off depression, a not uncommon pattern (Williams et al., 2008). He then took medication to suppress his appetite and give him energy. Later, Ruby stopped taking his weight-loss medication when he worried that it was making his hair thinner.

Unlike some diagnoses, such as antisocial personality disorder (ASP), that are manifest throughout a person’s life, the diagnosis of depression or a related affect disorder leaves open the opportunity for remission. Something like this occurred in 1944, the same year that Ruby’s mother died, when he joined the U.S. Army Air Force. Ruby’s experience in the Army Air Force was in contradiction to his previous behavior patterns: He was an aircraft mechanic who seldom got into fights and earned a good conduct metal. When he was discharged in 1946, he was a private first class.

Ruby did not necessarily seek out the life of a criminal. When he returned to civilian life, he struggled for eight years in a business distributing punch boards, key chains, and other miscellaneous items with his brothers, with whom he fought constantly. For a few years following this venture, Ruby did not speak to two of his brothers. This experience may have caused Ruby’s mood swings to return. It was after this that Ruby allegedly responded to instructions from organized crime to go to Dallas.

Depression can be accompanied by psychosis (DeBattista, 1998). When Ruby heard the verdict of electrocution, he likely lost all hope. His delusions about all Jews being killed took control, and he realized he would never see his dogs again, whom he considered to be his wife and children. Expecting electrocution at any time, he tried several times to kill himself in different ways, such as by crashing his head against the wall, hoping to split his skull. At this point in his life, all would agree that Ruby was very depressed.

Psychopathy: Antisocial Personality Disorder Theory

Ruby’s life of crime that began as a child supports the diagnosis of psychopathy and/or ASP (see Chapter 11). His connections with Cuba linked him with the U.S. government and the underworld. Six years before the assassination, he began smuggling guns and ammunition to Cuba in support of Fidel Castro. Organized crime supported Castro to ensure good relations when the revolution ended. However, the same group later turned against Castro because he would not endorse their activities. It may not have been a coincidence that the head of the underworld wished Kennedy dead.

Examples of additional activities characteristic of the antisocial personality disorder abound. For example, Ruby’s name became associated with the expansion of organized crime into Dallas. He became involved with smuggling narcotics and operating bootleg whiskey. In addition, he opened nightclubs where underworld figures attended regularly. He beat up those who crossed him, but he never was punished. Throughout the nightclub years, Ruby was arrested nine times for various acts of violence, but the only thing he ever received a punishment for was a traffic violation. This probably reflects his manipulativeness as well as the extent of his contacts among local law enforcement officials and judges.

The antisocial personality might be willing to kill for money, and that is what many believe caused Ruby to kill Oswald. In 1963, before Kennedy’s assassination, Ruby was in financial trouble. Debts and unpaid taxes forced him to sell one of his nightclubs. He agonized over finances, and then suddenly, immediately before the assassination, he behaved entirely differently, confident that his financial troubles would soon end. On November 19, 1963, three days before Kennedy’s assassination, Ruby told his tax lawyer he was going to be able to pay his debts as a result of a connection. There is some evidence that he received large sums of cash payments immediately after Kennedy’s assassination.

Another characteristic of ASP is deceitfulness (Boyd et al., 2007). Immediately following the assassination, Ruby showed up at a variety of public places and displayed an exaggerated amount of grief about Kennedy’s death (although this could reflect a dissociative process, as well). The possible deceit continued, as, after killing Oswald, Ruby denied any connections with the underworld or Cuba. His verbalized motive for killing Oswald was allegedly to save Mrs. Kennedy from the pain of attending Oswald’s trial.

However, there were facts that contradict the psychopathy-antisocial personality disorder theory. The most striking is the way Ruby killed Oswald. He was certain to get caught and be punished—something a psychopath would try to avoid.

Conclusion

Despite the appropriateness of any of these theories to his case, Jack Ruby was found guilty of the first-degree murder of Lee Harvey Oswald on March 14, 1964, and was sentenced to death. Ruby died in 1967 of cancer while awaiting a new trial after his death sentence conviction was overturned.

Interventions

As noted, there are numerous potential causes of violent behavior. The following gives an overview of the common causes, along with consensus intervention strategies:

1. Violence as an Inherent Part of Human Nature: (a) individual psychotherapy to modify basic personality patterns; (b) medications to diminish anxiety and minimize inappropriate reactions; (c) psychosurgery to change or interrupt patterns of brain functioning

2. Violence as a Consequence of Social Learning: (a) family therapy to change home environment or facilitate coping in the family setting; (b) group therapy to enhance appropriate coping in social situation; (c) assertiveness training and social-skills training to give concrete training in self-assertion without violence; (d) systematic desensitization (SDT) to desensitize client to the precipitating stimuli, so as to diminish inappropriate or excessive reactions; (e) token economy, time out, social isolation to extinguish violent behavior through removal of environmental reinforcers, as well as to strengthen appropriate responses; (f) classical conditioning to extinguish violent behavior, as in aversive conditioning; (g) parent effectiveness training, Parents Anonymous to enhance adequate coping skills and provide a supportive peer group

3. Violence as a Consequence of Frustration and Other Situational Factors: (a) traditional psychotherapy to release frustrations and to change coping patterns; (b) family therapy (see 2a); (c) group therapy (see 2b); (d) assertiveness training, social-skills training (see 2c); (e) token economy, providing opportunities for positively reinforcing experiences while extinguishing the violent behavior; (f) parent effectiveness training (see 2g)

4. Violence as a Means of Communication: (a) expressive therapies to substitute alternate means of expression of feelings underlying violent acting out; (b) assertiveness training (see 2c); (c) SDT (see 2d); (d) parent effectiveness training (see 2g)

5. Violence and Aggression as Protection of Territorial Integrity and Body Space: (a) SDT (see 2d); (b) assertiveness training (see 2c); (c) individual psychotherapy to improve the sense of self and self-esteem

Prediction of Violent Behavior

The prediction of violent behavior is perhaps one of the most formidable tasks asked of any mental health professional, and because it cannot be consistently accurate, it is better termed risk assessment. At a personal level, it may be viewed as an unpleasant and anxiety-producing situation that brings the psychologist too close to the darkest side of the human condition. On a professional level, Monahan (1981) was one of the first to thoroughly describe many of the problems inherent in making such judgments. The difficulties for the professional were heightened even more when, in 1976, a major precedent was set by the California Supreme Court in Tarasoff v.Regents of the University of California (551 P.2d 334 [Cal. 1976]). Tatiana Tarasoff had become the romantic obsession of Prosejit Poddar after she gave him a ritual New Year’s Eve kiss. In therapy at the counseling center, Poddar told the therapist that he felt like killing Tarasoff. The campus police were sent to pick Poddar up, but he convinced them he would not be a problem, so they left. He later killed Tarasoff. Her estate sued, and the California Supreme Court held that the therapist had a “duty to warn” Tarasoff (later amended to a “duty to protect”). Unfortunately, given the low base rates of severe aggressive behaviors (and suicide, as well), making an accurate prediction of specific actual behavior is virtually impossible, and overprediction is common (Meyer & Weaver, 2006).

The Problems of Prediction and Overprediction

Five factors primarily contribute to problems of prediction and to overprediction. First, predicting rare events is an inherently difficult task, and violence (and suicide) is something of a rare phenomenon. Any attempt at predicting a low base rate event will guarantee a significant number of false positives. A second bias toward overprediction stems from the relative costs of mistaken predictions. Mistakenly labeling an individual dangerous (i.e., a false positive) may result in continued confinement to a hospital or treatment program, with little potential for adverse consequences for the therapist. By comparison, incorrectly labeling someone safe who later commits a violent act (i.e., a false negative) exposes the predictor to public outcry and civil liability. The high costs of false negatives create a bias to overpredict out of self-defense.

Third, although one can develop lists of factors that contribute to some type of dangerousness (e.g., to others in general, to a spouse, to self, etc.), one cannot and likely will never be able to develop an accurate predictive equation in which to plug these lists of factors. That is, definite weights cannot be assigned to each factor, and each case is likely to show variations of a pattern of contributing factors. Fourth, most studies on the prediction of dangerousness to self or others are based on long-term follow-up, usually for many years and seldom for less than one year. Yet, in the real world, the requested predictions are usually for “imminent” predictions (i.e., for that day or a few days). Fifth, “dangerousness” is not a simple trait or predisposition. People vary along many dimensions; they may be dangerous or violent at some point, but no one is invariably and constantly dangerous. Under the right conditions, nearly any individual may become assaultive, while even very impulsive, hostile individuals are not violent most of the time. Unlike other characteristics that are viewed as highly stable, dangerousness fluctuates over time in accordance with a variety of environmental factors, maturation, changes in level of adjustment, and so forth. Violence and dangerousness may be viewed most parsimoniously as an interaction of personality and environmental factors. It is the second group, environmental factors, that greatly confounds the prediction problem due to its constant variation.

Specific Indicators of Aggression

Early on, Monahan (1981) pinpointed eight of the most critical demographic predictor variables for aggression. Violence is more common if the potential perpetrator (1) is young (this variable correlates strongly up until the 30–35 age range, after which the correlation is close to random), (2) is male, (3) is of a lower socioeconomic class, (4) is from a disadvantaged minority, (5) is less educated, (6) has a lower intellectual level, (7) has an unstable school and/or vocational history, and (8) has a history of juvenile violence and/or alcohol and/or drug abuse.

Other demographic indicators of a potential for violence that have been noted throughout the literature are (1) a prior history of violent behaviors; (2) a prior history of suicide attempts; (3) a history of family violence; (4) soft neurological signs; (5) bipolar disorder or schizophrenia, especially if the schizophrenia includes command hallucinations; (6) fascination with weapons; (7) histrionic personality traits; (8) a pattern of cruelty to animals as a child or adolescent; (9) a rejecting or depressed father; and (10) recent stress, especially if associated with low levels of serotonin.

Serial Killers

Although public interest seems to be insatiable, Schechter (2003) has pointed out that “serial killers always existed ... many ... for whatever reason ... never achieve lasting notoriety ... there’s nothing new about the interest in serial murder ... only the technology has changed” (p. 3). A reasonable consensus definition includes (1) premeditation, (2) three or more victims, and (3) a cooling-off period between killings. In the United States during the frontier days up to the Civil War, and in the chaos that followed, there were likely people who fit that definition. However, the following is the first well-documented case of a serial killer in America—an individual so horrific that the fictional character of Hannibal Lector in The Silence of the Lambs pales by comparison. Erik Larson integrated some truthful components of Hermann Mudgett in his somewhat fictionalized novel, The Devil in the White City, published in 2003 by Vintage Press. Both Leonardo DiCaprio and Tom Cruise are allegedly working on movies depicting aspects of his life. An excellent 64-minute documentary film by John Borowski is available at www.hhholmesthefilm.com.

The Case of Hermann Mudgett (Dr. Henry Holmes)

Hermann Webster Mudgett was born into a strict Methodist family on May 16, 1860, in Gilmanton, an isolated village in New Hampshire’s Lake District. His father, Levi, was a strict disciplinarian. Hermann was a “delicately built boy, blue-eyed and brown haired, with a reputation as ‘the brightest lad in town’ ... his father ... beat the boy with savage regularity” (Schechter, 2003, p. 180). The beating was often followed by a day of confinement in the attic with neither food nor speech. Hermann was also often bullied by his peers. On one occasion they grabbed him, dragged him into the office of the village doctor, who was out on a call, and forced his face into the hands of the skeleton the doctor used for demonstrations. Though hysterically traumatized, Hermann later said this incident led to his interest in anatomy. By age 11, he was “experimenting” by dissecting live animals and keeping a collection of their bones. His closest and possibly only childhood friend was killed in a suspicious “fall” while the two of them were playing in an abandoned house. Hermann was standing just behind him before he fell.

Hermann graduated from high school at age 16 and at age 17 married Clara Lovering, who had some wealth. He used much of her money and rather quickly abandoned her. Hermann decided to become a physician. He enrolled in a small college in Burlington, Vermont, but quickly transferred to the University of Michigan when he learned they had begun using the then-controversial practice of dissecting cadavers. While there, he developed a scam wherein he would purchase insurance policies on a faked individual, steal a corpse, and then claim the settlement when these “family members” suffered disfiguring “deaths,” preventing accurate identification of the bodies. After graduating in 1884 with a medical degree from Michigan, he moved around, first running a business, working as a “keeper of an insane asylum,” and then working as a pharmacist. As he traveled around, an uncommon number of unexplained deaths occurred in his vicinity, but he was never suspected.

He eventually settled in Chicago. At age 26, he formally registered himself as Henry Howard Holmes when he passed the licensing exam as a pharmacist and used that name from then on. He started to work at the Holton Pharmacy in Englewood, a section of Chicago. Eventually, he bought the business from Mr. Holton’s widow but reneged on the payments. She took him to court, but then, although she was old and frail, he reported that she suddenly “moved out West,” never to be heard from again.

Holmes then bought the land across the street in order to build his “Castle.” He employed over 500 workers in order that, with the exception of his “assistant” Benjamin Pitezal, no one worker had any real idea of the purpose of the Castle. The Castle had many hidden peepholes, various soundproof chambers, hidden gas jets in the guest rooms, several rooms ideal for surgery, a 3′ × 3′ × 8′ oven that would fire at 3,000 degrees Fahrenheit “for bending glass,” various body-sized chutes leading to the cellar, which had several steel-lined acid vats and a lime pit. He obtained most of his victims (most commonly young females) through want ads, or he killed those visiting the Castle, including at least 50 visitors to the Colombian Exposition (or World’s Fair) in 1893. He eventually killed most of the people who were close to him at one point or another. Although no one knows for sure, it is estimated that he killed at least 200 people. Many were used in his insurance scams or were rendered down to bones that were then reassembled as skeletons and sold to physicians or medical schools or were simply killed and discarded, which he later admitted was for the pleasure of killing.

Dr. Holmes’s many scams and his consistent avoidance of paying his bills finally caught up with him in the fall of 1893. A collection agent arranged a meeting with Holmes and over 20 of his creditors. He was charming and responsive during the meeting and then left Chicago the next day. He moved from city to city until he was arrested in Boston in November 1894. During the period he moved about, he killed numerous people, including the person who had been closest to him, Benjamin Pitezal. He had taken out an insurance policy on Pitezal, telling him he would fake his death. Instead, he poured gasoline on Pitezal, burned him alive, then poured a caustic solvent on his face and left him in the sun to make it look like an accident. He went on to kill Pitezal’s three children separately, over a period of time. Shortly thereafter, Holmes was arrested but was relieved to realize it was for insurance fraud and not murder. He pled guilty on May 28, 1895, and faced only a few months in jail.

Meanwhile, however, a Philadelphia police detective, Frank Geyer, continued the investigation of Pitezal’s missing children. He visited various cities Holmes had moved through, including Fort Worth, Cincinnati, Philadelphia, Indianapolis, Toronto, and several smaller cities. Geyer was able to find evidence that the children had been killed in separate cities, and based on this evidence the Chicago police searched the Castle. In addition to the horrors included in the original building, they found that Dr. Holmes continued to devise and use new torture devices, including an “Elasticity Determinator” designed to stretch the human body to twice its normal size. Holmes did confess to killing 27 people (Schechter, 2003) but as noted here, it was likely many, many more. Philadelphia indicted and convicted Holmes for killing Benjamin Pitezal and hanged him on May 7, 1896. As the hangman prepared the noose, Holmes joked to him, “Take your time, old man. I’m in no hurry.”

Comment

Only in recent years have there been attempts to collect scientific data on such individuals (Schechter, 2003). For example, the FBI has traditionally categorized serial killers as either organized or disorganized. But so far, such categorizations have proven to be too simplistic. Indeed, there are several problems in obtaining adequate data. First, it is a low base rate phenomenon. Also, most of these individuals are very deceptive and much of the data that have been collected are either from hindsight or self-reports; hence what little data that are available are significantly tainted (Boyd et al., 2007).

The Death Penalty

A discussion of the death penalty may be appropriate at various junctures in this book. But it is probably most applicable here because serial killers are almost always considered for it if the relevant state’s law allows the death penalty. The first critical case in modern times was Furman v.Georgia (408 U.S. 238, 1972), wherein the Supreme Court held that the death penalty was unconstitutional as it was being applied at that time but might be constitutional if juries or judges were not given complete discretion in imposing death; that both mitigating (e.g., horrific childhood, etc.) and aggravating (more than one person was killed, another felony such as rape was included in the crime, etc.) circumstances should be allowed to be presented; that the death penalty could never be mandatory; and that imposing a death penalty for rape or kidnapping was disproportionately severe, that is, no life was taken, under the Eighth Amendment’s “cruel and unusual” clause. Then, a few years later, the Supreme Court in Gregg v. Georgia (428 U.S. 153, 1976) found the death penalty to be explicitly constitutional. Related to the issue of aggravating circumstances, the Supreme Court in Payne v. Tennessee (501 U.S. 808, 1991) allowed “victim impact” statements to be used in the penalty phase (rather than the guilt or innocence phase) of a death penalty trial.

The issue as to whether children may be executed has long been controversial. In colonial times children as young as 12 were executed, although rarely so. In modern times, Thompson v.Oklahoma (487 U.S. 815, 1989) established that children under age 16 at the time of the crime could not be executed. It was assumed that persons over the age of 18 at the time of the crime could be executed, and then the Supreme Court in Stanford v. Kentucky (492 U.S. 937, 1989) held that children ages 16 to 18 could be executed. The Court then revisited the issue in Roper v.Tennessee (125 S. Ct. 1183, 2005) and held that children ages 16 to 18 could not be executed, citing the concept from the admonition in Trope v. Dulles (1957) that judges should be guided by “evolving standards of decency that mark the progress of a maturing society” (p. 4). It is of course debatable whether our society is maturing. In a related vein, in Ford v. Wainwright (477 U.S. 399, 1986), the Supreme Court held that a person must be “competent to be executed,” that is, he must be able to comprehend why he is being executed. The issue of competency and mental retardation is discussed at length in the case of Daryl Atkins in Chapter 15.

The controversy over the death penalty centers on the taking of a life. What other alternative is available for those horrific individuals like Dr. Henry Holmes? In various papers and presentations, the senior author (Dr. Meyer), has reported on data that suggest there are two options in which no one is executed, but people generally perceive these options as having greater deterrent value than the death penalty or life without parole. The first is banishment, wherein the person is forever in solitary confinement but is allowed no human contact except for medical or legal purposes, that is, no television, Internet, letters, visits, and so forth. The second option is permanent coma, with the choice of making it revocable or irrevocable (the latter only if all appeals have been exhausted). In addition to avoiding actually taking a life, a second advantage of permanent coma is that it would be extremely economical. All such inmates would be in morgue-like drawers, monitored physiologically, with a technician on site and a physician on call. No treatment or correctional staff or even lights or standard meals would be necessary. All could be housed in a rather small building, placed in an inexpensive real estate site. The majority of those sampled said banishment has the most deterrent value, with permanent coma not far behind and well ahead of the death penalty. The legal issues would be sticky but not insurmountable.

Family Violence: Physical and Sexual Abuse of Children and Spouse Abuse

Throughout history, as well as across cultures, the abuse of children has been clearly documented (Laws & O’Donohue, 2008; Finkelhor & Dzuiba-Leatherman, 1994; Melton et al., 1997). It is ironic that the first formal legal intervention in a child abuse case, that of Mary Ellen in New York in 1875, had to be prosecuted through animal protection laws and primarily as a result of the efforts of the Society for the Prevention of Cruelty to Animals. However, all 50 U.S. states have now established legislative routes to identification of abusive families and to intervention. As a result, the number of identified cases has grown enormously. Because of the private nature of abuse and the reluctance of both perpetrators and victims to reveal it, clearly identified cases of child abuse are still generally believed to represent only a portion of actual cases. Estimates vary widely, and debate over incidence of child abuse will doubtless continue. However, whatever the true incidence rates, the problem is obviously substantial.

The consequences of abuse to children are usually extensive and debilitating (Chu et al., 1999;Finkelhor & Dzuiba-Leatherman, 1994). And the effect goes beyond consequences to the child to encompass consequences to others with whom the child later interacts—for example, abused children are prone to grow up to be abusers, as will be seen in the following case of Abby. Most experts believe that the problem is of massive proportion.

Spouse Abuse

As the data indicate, there’s no place like home, for either happiness or violence. As a marriage breaks down, the potential for violence soars (Kubany, McCaig, & Laconsay, 2004). It may be directed toward a child or toward the spouse. Estimates of the percentage of couples who experience physical violence at some time in the course of a marriage range from 30 to 60 percent, and it is clear that the amount of reported violence is far less than the amount of actual violence. In most cases, the wife is the victim, although there are a few reports of the husband being abused. Family therapy can sometimes be helpful, although often by the time the abuse pattern has been made public, the bonding between the two parties has been so violated that reconciliation is highly improbable. As is noted in the subsequent case of Abby, many spouse abusers were themselves abused as a child by one or both of their parents.

Recognizing a Potentially Abusive Adult Relationship

Cases such as O. J. Simpson’s (see Chapter 1) and recognition of such patterns as “date rape” bring home the need to be aware of the cues that help one recognize a potential abusive adult relationship and/or a potential batterer, especially when entering a relationship. The following pattern may suggest potential abuse behavior:

· Having been a participant in, a victim of, or witness to (in that order of predictive power) abusive patterns or, to a lesser degree, an abusive or violent episode

· Violence toward pets, other animals, or even inanimate objects

· General problems with anger control or evidence of a “temper”

· Problems in impulse control

· “Playful” use of force during sex

· Threats of violence and/or use of force or threats to manipulate arguments

· Evidence of control issues, especially when there are problems of relinquishing control in relationships, and especially when this is combined with tendencies to avoid responsibility for behaviors or project blame on others

· Evidence of possessiveness toward persons, or jealousy

· An increasing dependency on the relationship

· Substance abuse in either party

· Verbalizations of strong adherence to traditional male/female roles in relationships

· Evidence of psychopathy or sadistic personality patterns

· Feelings of being possessively controlled, jealousy, or anger easily elicited by the person potentially abused

· Indicators of emotional or physical isolation or vulnerability, or being prone to masochism or excessive dependency in the person potentially abused

Child Abuse

I was coming home from kindergarten—well, they told me it was kindergarten. I found out later that I had been working in a factory for ten years. It’s good for a kid to know how to make gloves.

Ellen DeGeneres

First is a classic pattern of child sexual abuse, the case of Charles, followed by one of physical abuse, the case of Abby.

The Case of Charles

Charles is a 39-year-old civil engineer who lives in a medium-sized city in Kentucky. He works for a large construction business, makes a good salary, and would certainly be characterized as a model citizen by most who know him. He is a long-time member of a church (although he doesn’t profess or practice any strong religious beliefs) and belongs to a number of civic organizations. All indications are that he had a normal childhood. He has never sought help for any psychological disorder.

Charles married at age 25. The marriage was certainly a good one at the outset, and both he and his wife were delighted when she had a baby girl, Vicki, when Charles was 30. Unfortunately, the marriage started to deteriorate shortly thereafter. Charles’s wife enjoyed the status of being a mother but not the functions. She returned to her job as a secretary as soon as she could after Vicki’s birth and often hired babysitters in order to escape the routine demands of child care. She had always been a regular social drinker but now began to drink more secretively and more often, probably to dissolve both guilt and anxiety. Within several years, she had developed a true alcoholic pattern. She was just barely able to hold on to her job and was almost nonfunctional as a wife and mother.

Charles, on the other hand, enjoyed fathering and developed a strong bond with Vicki. He had few friends or interests away from home. He and his wife now simply tolerated each other, with only rare sexual or emotional encounters. He satisfied his sexual needs in several ways: an occasional affair, a visit to a prostitute, or by masturbation to stimulation from pornographic magazines and videotapes.

Charles had always allowed Vicki to lie down next to him or put her head in his lap for 15 minutes or so before she went off to bed. One night, when Vicki was 8 years old, he let her lie next to him on the couch for almost an hour, enjoying the closeness to her—a closeness that seemingly was not available to him elsewhere. He became aroused sexually and responded by sending Vicki off to bed. Several nights later, he was again lying with Vicki and again became aroused. This time, he just lay there. After a while, as Vicki moved around a bit, he suddenly had a strong orgasm. He felt some upset at this time but allowed a repetition on a couple of subsequent occasions.

A week later, the situation escalated further. When Charles had become very aroused, he raised the back of Vicki’s nightgown and gently rubbed his penis against her buttocks, again having a strong orgasm. He told Vicki everything was all right and not to be upset, and she wasn’t. This, however, was the first time that he had acted to directly cause a sexual act, and this seemed to break down any remaining inhibitions. He would sometimes have Vicki reach behind her and rub his penis. Also, he would now touch her occasionally on her genitals and would bring on his orgasm by rubbing his penis between her legs. He eventually asked her to “lick it” at a point of high arousal and would ejaculate on her face, all the time presenting all of this to Vicki as a sort of game, though always emphasizing her need to keep secret about it. He tried to penetrate her vagina a couple of times but quickly backed off when Vicki complained that it hurt.

This pattern went on for about six months. There was some reason to believe that Charles’s wife may have been at least vaguely aware what was happening. But she did nothing and in fact had been using alcohol even more heavily over the last year or so. Then, one day while Vicki was playing with a neighbor girl, the word penis came up, and Vicki blurted out, “Well, Daddy lets me lick his.” The friend’s mother overheard this, asked Vicki what she meant, and Vicki described it all in vivid detail. The neighbor called her husband, who, as a physician, knew it had to be reported, and where, and did so.

When confronted by a worker with the child protective services division, Charles broke down and confessed. He was later convicted. But based on his history and the recommendations of a psychologist and social worker, his sentence was probated, with a stipulated requirement for community service and treatment.

Treatment was successful in the sense that Charles never sexually abused Vicki again. But he and his wife could never reconcile their feelings about this and were divorced within the year. It’s not yet clear how much psychological damage Vicki has incurred. However, it was probably quite a bit; indeed, it is very likely that over time she will pay the highest price of all.

Then spare the rod and spoil the child.

Samuel Butler, Hudibras (1663)

The Case of Abby

Abby was born to a poor family in the mountains of West Virginia. When she was age 4, the family moved to Akron, Ohio, in hopes of her father getting work in a tire factory, where her uncle already had a job. Unfortunately, this was at the time when such jobs were drying up. After struggling for several years, often surviving only on welfare, the family moved to Tennessee to try to find work at a new General Motors plant being built there.

There were no dramatic problems or incidents in Abby’s childhood. However, child care was minimal, and there was little value placed on education or achievement. She seldom had any interaction with her father, who spent his time away from home when he could. When he was home, he spent his time eating, sleeping, drinking, or beating Abby’s mother or one of the five children if they gained too much of his attention. Abby’s mother loved the children, but her emotional, intellectual, and physical resources were overwhelmed to the point that she could do little more than meet their basic needs.

Eventually, Abby made it through high school, though with close to failing grades. She had become pregnant in her junior year but aborted without letting her parents know. One month after getting out of high school, she discovered she was again pregnant, but this time she maneuvered the father into marrying her. They moved to a nearby city, and she delivered a healthy girl and almost immediately became pregnant again. This pregnancy and labor were difficult, and the child, a boy, soon showed some signs that he had incurred brain damage.

Abby’s husband soon had enough of fatherhood and left town, to be seldom heard from again. Abby was not especially attractive and was neither very bright nor had any marketable skills. With two young children and no money, she did not attract the most eligible of men. She had a string of live-in boyfriends, and several of them would beat whichever child bothered them in some way, and it was usually the youngest child.

Abby herself was confused and overwhelmed by the tasks of child care. Her daughter was quiet and docile, almost to the point of being withdrawn, so she caused Abby few problems. However, as her youngest became more mobile, he became more difficult to control. Abby had few skills or resources to bring to the task, and more and more she quickly resorted to beating this child. A week after yet another boyfriend had abruptly walked out on her, her son broke a small vase that Abby had received years ago from a much loved grandmother. Abby started shrieking at her son, grabbed him roughly, dragged him by the arm into the kitchen, and started hitting him and beating him. When she finally stopped, he was bleeding and bruised, and it became evident he could hardly move his arm. He was still not moving the arm the next day, and Abby took him to a hospital emergency room, where attendants quickly recognized the probability of child abuse. At first, Abby tried to deny it, but she eventually admitted what had happened. She was diverted into treatment and a parents’ training group and began to make some progress in handling her children. But there were repeat incidents, and then Abby left town with a new boyfriend. No follow-up information is available, but it is probable that the abuse occurred again, becoming a legacy her children would carry into their own world as parents.

Etiology

Many overall factors contribute to the ultimate emergence of an episode of physical and/or sexual child abuse (Laws & O’Donohue, 2008; Kubany, McCaig, & Laconsay, 2004; Finkelhor & Dzuiba-Leatherman, 1994). These factors are found within three contributing systems: sociocultural, familial, and individual. To the degree these factors are present, the probability of an occurrence of child abuse is increased. At the most basic level are the following sociocultural factors that facilitate an increase in episodes of child abuse:

1. Lack of affirmation and support of the family unit

2. Lack of emphasis on parent training skills as a prerequisite to parenting

3. Acceptance of and high media visibility of violence

4. Acceptance of corporal punishment as a central child-rearing technique

5. Emphasis on competitiveness rather than cooperation

6. Unequal status for women

7. Low economic support for schools and child-care facilities

Sociocultural factors heighten the probability of abuse in conjunction with the following familialfactors:

1. Low socioeconomic and educational level

2. Little availability of friends and extended family for support

3. A single parent or merged parent family structure

4. Marital instability

5. Family violence as common and traditionally accepted

6. Low rate of family contact and information exchange

7. Significant periods of mother absence

8. High acceptance of family nudity

9. Low affirmation of family member privacy

10. “Vulnerable” children—that is, to the degree they are young, sick, disturbed, retarded, or emotionally isolated

The probability of abuse in a specific instance is then in turn increased by the following individualfactors:

1. History of abuse as a child

2. Low emotional stability and/or self-esteem

3. Low ability to tolerate frustration and inhibit anger

4. High impulsiveness

5. Lack of parenting skills

6. High emotional and interpersonal isolation

7. Problems in handling dependency needs of self or others

8. Low ability to express physical affection

9. Unrealistic expectancies for child’s performance

10. Acceptance of corporal punishment as a primary child-rearing technique

11. Presence of drug or alcohol abuse

As with most cases, many but not all of these factors are found in the cases of Charles and of Abby. Some predict more to physical abuse and some to sexual abuse, but most factors predict to either type of abuse. However, from an overall perspective, the following general factors were evident in the cases of Charles and of Abby:

1. Impulsivity: The actual incident often occurs in persons in whom either training or temperament (or both) has predisposed to immediately act on impulse, not bring inhibitory belief systems to bear on impulse, or delay gratification. In a similar vein, the demands of child rearing are too much for an immature personality, who lashes out in retaliation at the cause for these demands. Remorse may follow, but the damage is done.

2. Incompetence: As with Abby, far too many parents come to this crucial task with little preparation or support (e.g., poverty markedly increases the potential for child abuse). When the task overwhelms them, they react with harsh punishments in an attempt to regain control.

3. Disturbance: Psychological and physical disturbances (not in the child), such as schizophrenia, drug and alcohol abuse, mental retardation, or, as in the case of Charles, a disrupted marriage generate problems that facilitate child abuse.

4. Modeling: The child who has been abused or who has witnessed a pattern of spouse abuse is much more likely to become an abuser than the average child.

5. Characteristics of the Child: As was the case with Abby’s younger child, children who have characteristics that make frustration or disappointment more likely (e.g., ADHD, physical or psychological disabilities) are more likely to be abused. The amount of parental bonding and the vulnerability of the child are also relevant; thus, stepchildren and younger children are more often the victims. Indeed, live-in boyfriends are a common source of child abuse.

Physical Abuse

Mothers physically abuse more in absolute terms; fathers physically abuse more in number of abuse events per contact hours. Predictors of physical abuse of children (with the greatest applicability to mothers who become physical abusers) are (1) single parent, (2) younger, (3) less educated, (4) lower SES, and (5) a history of abuse. These are the best predictors, but demographic predictors are not usually responsive to intervention. Mediating-causative variables, which offer more potential for intervention, are (1) higher physiological reactivity to a crying child, to children in general, and probably just in general; (2) a higher proclivity to label negative child behaviors with internal and stable attributions and positive events with external and transient attributions; (3) acceptance of fewer mitigating factors for problematic behavior (thus facilitating judgments of “badness” and subsequent punishment); (4) unrealistic expectations before and after birth for a child’s performance, especially regarding more complex behavior sequences; (5) more rigid attitudes; (6) higher than normal rates of physical illness, stress, and depression; (7) lower self-esteem; and (8) lack of empathy. Surprisingly, physical abusers show only slightly higher levels of precipitating substance abuse. They generally like their children less (some research indicates this is not usually based on objective fact), and they attend to and track their children’s behavior less often (Milner, 1998).

Sexual Abuse

The factors that generate physical child abuse are also often relevant to cases of sexual child abuse. However, a number of specifically relevant factors are also critical (Laws & O’Donohue, 2008; Marvasti, 2004). For example, psychodynamic features here include the interaction of such parental factors as marital discord, personality disorder, loss of an important relationship or fear of disintegration of the family, and emotional deprivation. Other factors include the equating of sexuality and affection, the importance of heterosexual success to self-identity, a focus on sexual acts rather than on relationships, and any acceptance of younger and smaller sexual partners. See also the discussion of pedophilia in Chapter 8.

The seriousness of consequent disorder in the child resulting from sexual abuse appears to depend on several factors. More serious problems are likely if (1) the offender is in a close relationship to the child, such as the father; (2) the sexual activity included genital contact, and especially if this includes penetration; (3) the child is older (e.g., adolescent) at the time of abuse; (4) the abuse is frequent and/or of long duration; (5) the child has strong negative feelings about the abuse and/or is somehow aware of its wrongness; and (6) much upset and/or distress occurs around the event (e.g., court testimony).

Diagnostic Problems in Sexual Abuse

The following list is adapted in part from the review of research and clinical data by Michael P. Maloney, Ph.D., the lead defense psychologist in the McMartin trial, the first “false memories of abuse” trial that attained national notoriety. The research presents the levels of confidence or quality of inference allowed by various types of evidence often employed in assessing allegations of child sexual abuse:

1.	Personal involvement/personal observation	Typically Conclusive
2.	Pregnancy; DNA testing	Typically Conclusive
3.	Photographic documentation	Minimal Inference
4.	Sexually transmitted disease	Minimal Inference
5.	Confession by offender in context of child accusation	Minimal Inference
6.	Physical/medical findings with disclosure	Minimal/Moderate Inference
7.	Physical/medical findings without disclosure	Moderate Inference
8.	Inappropriate sexual behavior or knowledge with disclosure	Moderate Inference
9.	Sexualized responses to anatomical dolls with no contextual behavior	High Inference
10.	Nonsexual inappropriate behavior with disclosure	High Inference
11.	Sexualized drawings with no contextual behavior	High to Extreme Inference
12.	Inappropriate behavior with no disclosure	High to Extreme Inference
13.	Examiner/therapist “hunches”	Extreme Inference

Note that a determination of moderate to extreme inference does not suggest that abuse did not occur, but rather that such a conclusion is based on limited critical data. These cases necessitate a careful analysis of a variety of contextual factors. Any conclusions must be carefully weighed and documented.

Treatment Options

The interventions noted in these two classic patterns of Charles and Abby are those typically employed (Marvasti, 2004; Kubany, McCaig, & Laconsay, 2004). The emphasis is obviously going to differ depending on issues in an individual case. However, in addition to individual psychotherapy, there are three core approaches that are potentially useful in almost all such cases:

1. Family Therapy: Since the family is virtually always disrupted, family therapy is necessary. Even when the family system eventually changes, as in the case of Charles, family therapy can help to mute the damage to all concerned.

2. Parent Training: When the abuse comes from a parent, parent training is necessary to deal with not only the problems that led to the abuse but also those generated by the abuse.

3. Support Systems: As in the cases of both Charles and Abby, abuse often comes where there has been a sense of having been emotionally isolated. In this vein, a community-based counseling and support group is helpful both to victims and abusing parents.

These three approaches can be supplemented by other interventions, such as attempts to change the person’s employment possibilities or social skills (both would be important for Abby). When there is a couple involved, marital therapy is likely to be necessary if the marriage is to continue. Last, and from a moral perspective, it is emphasized that the most deserving of specific treatment attention is the child victim or other siblings who may be vicarious victims.

Comment

Treatment may help in a specific case. But the greatest changes will come with efforts at prevention (e.g., parent training before becoming parents, the reduction of the percentage of very young and/or single parents without enough skills or resources, educational programs in the schools) or cultural change (e.g., efforts to reduce the acceptance of the common use of physical discipline).