Understanding and Preventing Violence, Volume 2: Biobehavioral Influences (1994)
Chapter: VIOLENCE IN PERSONS WITH NEUROPSYCHIATRIC DISORDERS
aggressiveness/violence is beset with confusing, highly controversial, and often contradictory legal, psychologic, medical, and sociologic issues. The acts that involve the criminal justice system range from robbery and aggravated assault through rape and homicide, whether these acts are actually committed, merely threatened, or attempted. The data on which research has been based are manifold. They consist of records obtained from official sources (prison, hospital, and outpatient clinical records), which may be biased in significant ways because of the nature of the clients who are involved with that institution. Some data have been gathered by questioning the subject about his or her behavior, or by questioning those who are familiar with the subject, such as teachers, nurses, peers, parents, and other relatives. These two sources cover the bulk of investigations in this review. In only a relatively small proportion of studies are there actual observations of the commission of aggressive or "violent" acts (which would be formally similar to the animal model studies) during the course of the investigation; these consist of a small number of treatment studies of hospitalized psychiatric patients and one study of epileptic patients monitored on closed-circuit television.
Since violent behavior is a relatively low-frequency act, and since it is likely to occur in circumstances where direct observation is unlikely, any conclusions we may draw from our review of research in human violence are based on second- or third-hand reports of behavior of varying (or unknown) degrees of reliability and validity.
Most likely, these criticisms lose their force in the case of documented repeat offenders in the criminal justice system. However, in other instances, including poorly documented studies of the effects of therapeutic brain lesions on "aggression, hyperkinesis, destructive tendencies and wandering tendency" (Ramamurthi, 1988), it is difficult to evaluate the merit of the contribution. This must temper our conclusions and will also influence the recommendations we make for future work in this area.
VIOLENCE IN PERSONS WITH NEUROPSYCHIATRIC DISORDERS
In the introduction to this paper we made reference to the concept that a person who commits crimes, of either a violent or a nonviolent nature, may need to be treated as one suffering from a disorder, rather than as a criminal. The work of Papez (1937) and MacLean (1952) identifying and promulgating the limbic system as the cerebral region necessary for the support and expression
