Violence, law and psychiatry: from institutionalization to deinstitutionalization, from the cessation of dangerousness to sexual homicides

Abstract

This research aimed to study the various relationships between violence, law and psychiatry, by compiling a collection of six scientific articles divided into three chapters. A literature review revealed that the presence of mental illness, in isolation, is not a factor directly associated with a higher risk of violence and that factors related to institutionalization and deprivation of liberty are related to the prediction of violence. The suffering of institutionalized mentally ill individuals, due to neglect of both their physical and mental health, are factors that cause great concern. A second study conducted in a long-term care institution in Brasília revealed a profile of institutionalized individuals who were men, with an average age of 47.6 years, single, with low education, few professional qualifications and on polymedication with a history of aggressive behavior and a diagnosis of schizophrenia. Two items were highly related to a longer time of institutionalization, with statistical significance: polymedication and a history of hospitalization for violent behavior. A third study, of a series of cases on parricide, matricide and filicide, showed that these crimes were committed by individuals with mental disorders and without adequate therapeutic monitoring, and that judicial decisions opted for non-imputability and semi-imputability, hence the security measure for all, with protective and therapeutic purposes. A fourth study carried out at the Forensic Medical Institute of the Federal District, with the purpose of verifying factors considered relevant by official experts for the cessation of dangerousness in individuals who were serving security measures, showed that the main items considered by the experts in the evaluations were those related to the PCL-R, START instruments and the non-static part of the HCR-20 and TTV, which are subject to change over time. The standardization and systematization of these expert assessments is essential for decisions to become cohesive and supported by the most up-to-date scientific studies. A fifth study on the updated scientific literature showed an increase in several types of violence against women during the period of social isolation: sexual violence, deaths due to domestic violence, reduction of reproductive rights, sexual exploitation and greater economic and financial impact, including greater job losses and increased sexual exploitation of women, even more serious in poor countries. Social isolation measures, which are undoubtedly necessary to control the spread of the virus in a pandemic context, must be adopted, but the way in which they are implemented must be improved in order to minimize damage to individuals' mental health, given the risk of serious illness, especially for the most vulnerable populations, such as women and people with mental disorders. In a sixth study, we compared sexual and non-sexual homicides in Australia and New Zealand, using two controlled samples, finding quite relevant results, with the presence of 101 significantly different items, according to a detailed statistical study. The differences between the lifestyle of the aggressor and the victim in each type of homicide, differences in relation to the aggressor's approach to the victim and the victim's activity prior to the crime stand out. Death caused by strangulation or asphyxiation, brutal murder with excessive violence (“overkilling”), the presence of sadistic behavior, the use of multiple weapons, and a history of some previous sexual offense were significantly more frequent in sexual homicides. This reinforces the hypothesis that sexual homicide is a specific crime and very distinct from other homicides, and even from other sexual crimes. After the results of the comparative study, five logistic regressions were performed, aiming to create models with the intention of predicting the possibility of a homicide being sexual, with the items studied being separated into four dimensions: profile of the aggressor; characteristics of the victim and their activities at the time of the crime; crime scene; place where the victim's body was recovered. The 5th logistic regression unified the four related to the dimensions analyzed, creating a general predictive model. All regressions were significant and the last one showed that, in the case of a homicide in which the following characteristics are present simultaneously: victim and aggressor did not know each other previously; the duration of the crime was more than one hour; the victim was working moments before the crime; the crime scene was a bedroom or accommodation (environment/room used for sleeping); and the victim was found naked, in a place where it would not be possible to hear the victim, suggest that this is a sexual homicide, according to the predictive model obtained. This thesis concluded that the relationship between psychiatry, law and violence can be explored and interpreted from different perspectives, from the processes of institutionalization and the study of factors associated with the risk of violence in individuals with mental illness, to the repercussions on mental health and violence against women, whether in the context of social isolation or in the study of sexual homicides. Our objective was not to conclude this broad theme or reach any definitive conclusion on it, but rather to foster technical-scientific knowledge and promote reflections in closely related areas, but often analyzed and studied independently.