Saaz wrote, "The principle problem in psychiatry has always been, and still is, the threatened and feared violence of the "madman," and the actual counter violence of society and the psychiatrists against him." (Manufacture of Madness p. xvii)

Is there any method that reliable predicts violence? Is there any research that shows the psychologist/psychiatrist is significantly better at predicting violence than the layman?

-- John Hedlin (jhedlin@canada.com), January 25, 2002

Answers

Not at the time I was researching my book (Pure Types are Rare: Myths and Meanings of Madness) in the early 80s, and I have not seen news of any breakthroughs since.

During that period, I worked for an agency in north Florida involved in 24 hr crisis call for police, hospital ER's, etc., which enabled me to make involuntary commitments for danger to self or others. I was in the Sheriff's Dept. finishing a call one night when a very large, drunk and angry dude was brought into a holding cell nearby, requiring no fewer than half a dozen deputies. While I was watching this scene, the Sgt at the desk said, "Don't worry Doc - we're not going to call you for this guy - he's really dangerous."

A defining moment -

-- Irwin Silverman (isilv@yorku.ca), January 26, 2002.

John - fear of the potential violence from "crazies" is often a projection hiding mistrust of people that are different from the "norm" and therefore, unpredictable.

Those who enter the field of psychology, often do so in order to gain control over what they perceive to be a chaotic world inhabited by chaotic people.

That's a pretty accurate assessment but an oxymoron, since the most violent members of society are usually those who appear to be predictable and sane but whose destructive violence drives more sensitve indivuals "crazy".

These "predictable and sane" people are almost never the ones who voluntarily go for help.....therapists almost exclusively get to council their victims.

So you see....Szasz was right :-)

-- visualize me (visualizeme@webtv.net), January 26, 2002.

[Posted for VLQ by cdg.]

It depends on what kind of prediction is meant. Actuarial methods can very effectively estimate the likelihood with which a criminal offender or forensic psychiatric patient will commit a new violent (including sexual) offense over a period of several years of opportunity to do so. Clinicians, although they sometimes perform better than chance at this task, make the same judgments as lay people. It is possible that clinicians can do better if they employ standard specific criteria in making their judgments (which makes them function like inefficient actuarial instruments).

There are other prediction situations in which predictive accuracy is known or likely to be poor. Very low base rate situations (where there are extremely few dangerous individuals in a sea of non-dangerous ones), such as trying to determine who in the general population will commit a violent act. One could use an actuarial instrument developed on offenders for this task and its accuracy would likely be high. The problem is that despite this accuracy most people who would look dangerous on the instrument would in fact not be (they would be false positives) just because they are so rare. If we could encourage many more people to commit violent offenses, the prediction situation would improve!

Another problematic prediction situation is in trying to predict when an individual might commit a violent offense. There is no quantitative way of doing this at present, although techniques exist that indicate when the probability is increasing or decreasing. It is much easier to deal with variations in the likelihood that an offender will commit at least one violent or sexual offense over a lengthy period of time.

Reference

Quinsey, V.L., Harris, G.T., Rice, M.E., & Cormier, C. (1998). Violent offenders: Appraising and managing risk. Washington, D.C.: American Psychological Association.

-- Vernon L. Quinsey (quinsey@psyc.queensu.ca), January 28, 2002.

John - Sorry....my belated response to your actual question: A person's violence-potential can often be predicted by careful observation. Some indicaters:

--->erratic speech pattern

--->impulsive or repetitive hand, leg, or shoulder movements.

--->low frustration-level with mechanical tasks or attempts at intellectual understanding

--->violence towards inanimate objects

--->rigid body-control combined with lack of emotional affect

-- visualize me (visualizeme@webtv.net), January 29, 2002.