Literature in the early twentieth century contained grossly exaggerated prevalence figures for 'feeble-mindedness' among offenders and has been criticized by Day.(H4) He points out that the intellectual tests used on criminal populations had a high verbal bias and were more indicative of poor educational achievement than of innate low intelligence. Reviews by Day(l14) of early population studies showed either nil or modest increased offending by mentally retarded citizens compared with controls. However, Day cautioned of an anticipated rise in such offending as the effects of community care for people with mental retardation give rise to greater opportunities for offending and as 'hidden offences' within institutions become more visible.

Recent birth cohort studies suggest he may be correct. In the Stockholm 1953 birth cohort study Hodgins(61) identified 113 men and 79 women as 'intellectually handicapped'—defined as having been in a special class at high school. Both men and women were three to four times more likely than those with no psychiatric disorder to have committed a crime by the age of 30, and the risk of a violent crime was even greater. Reference has been made (Table.3) to the Danish birth cohort study,(63) in which the relative risk of committing any or a violent crime was roughly the same in those with mental retardation (men and women) as in those with antisocial personality disorder.

In a comprehensive review of 11 studies of offending patterns by the mentally retarded, Day ^l4) concludes that, while property offences are the most common, sex offences and arson are over-represented. Crimes of personal violence are low but are disproportionately high in mentally retarded offenders who receive a hospital disposal from court. Day(H6) has drawn attention to the cluster of features in those youths and young men of borderline intelligence who account for the bulk of sex offending by the mentally retarded. These include evidence of brain damage, distinctive physical disability, psychosocial deprivation, other criminal convictions, history of residential care, relationship problems, and sexual inexperience. There are distinctive features too in the nature of sexual offending by the mentally retarded.

• They are less likely to be convicted of serious sexual offences.

• There is low specificity in the age and sex of victims, suggesting circumstances and opportunity are more significant than sexual preference.

• The majority of female victims are under 16, reflecting sexual immaturity in the offender and ease of victim accessibility.

• Offences against adult women rarely occur in the context of a relationship and such victims are usually strangers to the offender.

• True sexual deviancy is rare and most offences are crude expressions of sexual frustration. Mentally retarded offenders usually lack the sophistication and cognitive capacity for extreme paraphilias.

Reasons for the excess of arson in offending by the mentally retarded are poorly understood but probably do not greatly differ from those of fire-setters who are non-retarded. Conflicts that are difficult to verbalize, displaced passive aggression, and a sense of power or excitement have all been suggested. (!JJ Recidivism is probably more common in mentally retarded arsonists than in others.

Offending (of all types) by people who are mentally retarded does not occur in a vacuum; it is influenced by all those factors known to be associated with offending, i.e. unstable families, poor parenting, socio-economic disadvantage, educational underachievement, and substance misuse. There is some evidence to support increased arrest rates among those with learning disabilities. (!1Z)

Substance abuse

The relationship between substance (alcohol and drug) abuse and crime is complex and not necessarily causal, even though problems of substance abuse are almost endemic among offender populations'43,46» and offending is common in those with alcohol and drug problems. A full discussion of forensic issues in alcohol misuse disorders is contained in Chapter !1.:4.4, and the American perspective has been reviewed by Bradford et a/.(U8) Suffice it to say that intoxication at the time of the offence, which is commonly described, combines with contextual factors in contributing to offending, for example situational and relationship factors are nearly always significant for crimes of violence. This observation simply reinforces the fact that any crime rarely has unitary causation. Alcohol consumption has been implicated in family violence, child abuse, rape, and other sex offences. In a Scottish sample of 400 individuals charged with murder Gillies (119) reported that 58 per cent of the male accused and 30 per cent of female accused were intoxicated at the time of the offence. Over a third of the victims had also been abusing alcohol. A report from Finland found 39 per cent of men and 32 per cent of women convicted of homicide had diagnoses of alcoholism.(!20)

Offending may be associated with the neuropsychiatric sequelae of alcoholism, such as delirium tremens or alcoholic hallucinosis. Chronic drinkers with multiple social handicaps form a proportion of the short-sentence populations in most prisons. Many receive their only medical care when in prison.

The extent of drug abuse associated with offending is apparent from health data on prisoners (46) though, as with alcohol abuse, the ways in which drug abuse contributes to offending are complex and inadequately understood. Stated most simply, it is not known whether the use of psychoactive substances leads to crime or vice versa. Drug abuse is usually endemic in areas of deprivation and crime, a factor which demonstrates the huge problem in tackling drug abuse among an increasingly young population of users. The types of substances used show wide geographical and temporal variations and it seems most likely that there are few simple and generalizable relationships between drug abuse and crime. A recent research review from California is reported by Anglin and Perrochet. (12,!)

Use of anabolic androgenic steroids by athletes to enhance performance and increase muscle mass is now ubiquitous. It may be associated with impulsive violence.'122, !23) A series of 14 cases reported from Stockholm'!24) were all young white males charged with homicides, assaults, and robberies—six perpetrators had used high doses of steroids and three of these were also intoxicated by alcohol. Only one man had a paranoid psychosis, but in three there may have been mental symptoms of anabolic steroid withdrawal.

Organic disorders

Organic brain disease may contribute to offending behaviour either in a specific criminal act or as a factor leading to social disadvantage and exclusion and thence to offending. Disinhibition and impaired judgement, characteristic of organic brain disease, may lead to minor crimes of dishonesty or sexual offences. In practice, elderly sexual offenders, in whom brain disease might be a possibility, rarely have psychiatric or organic disorders. (!25) Those few elderly offenders who are convicted of crimes have high rates of alcohol misuse. In younger men, offending may be associated with any cause of organic brain disease such as head injury or Huntington's chorea.

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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