Management

It should be obvious from the foregoing that no single form of management is likely to be effective. Because fire-raising behaviour is so diverse and, as Barker (1Z) suggests, best treated as a 'symptom', every case deserves painstaking analysis, however 'obvious' the motivation may seem. It is hoped that the classifications already outlined, even with their acknowledged deficiencies, will facilitate the process of management. This process can be summarized as follows.

• Distinguish the fraudulent fire-raiser.

• Distinguish the politically motivated. However, it is wise to remember that some politically motivated fire-raisers have mental health problems.

• Distinguish those with motives of vandalism.

• Distinguish those who are driven to fire-raising by clear evidence of mental disorder, notably functional psychosis, organic disorder, and mental retardation.

• Distinguish those who appear to exhibit pyromania as defined in DSM-IV.

• Distinguish those cases in which sexual disorder of some type seems to play a significant role.

• Distinguish those driven by motives of revenge. These may include a number of fire-raisers classifiable under the mental health legislation in England and Wales as suffering from psychopathic disorder.

Successful management must rest on a multifaceted approach and the ability of all members of the psychiatric team to co-operate in the interests of the patient and the community. The management of fire-raisers has no place for 'prima donna' activity. An excellent example of a multidisciplinary approach is given by Clare et a/.,(24) who describe their management of a case that required an understanding of both physical disability and mental retardation and a capacity to work intensively using eclectic behavioural techniques over a prolonged period of time. Despite minor setbacks, the patient, who had been subject at one time to containment in a high-security hospital, remained free of his long-standing fire-raising behaviour at 4-year follow-up.

It would be a mistake to believe that formal psychoanalytically based psychotherapy has no place in the management of psychotic and seriously personality disordered fire-raisers. Cox(25) has described some very useful group work with such patients. He made the very important point that 'the almost limitless range of clinical presentations means there is no neat unitary hypothesis which can underlie the behaviour of all patients convicted of arson'. (25)

Vengeful fire-raisers and those who engage in pyromania may do so because they feel wronged or misunderstood. Any attempts that can be made to help them find ways in which they may achieve more satisfaction from their life experiences are to be welcomed. Many of them are socially inept; they set fires to draw attention to themselves, so that techniques aimed at improving their self-regard, self-image, and social competence should help to minimize the risk of future offending. Social skills training has an important part to play with this group of fire-raisers. (2,2Z)

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