The British Journal of Psychiatry (2001) 179: 276
© 2001 The Royal College of Psychiatrists
Madness and Murder
Derek Chiswick, Consultant Forensic Psychiatrist
Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF,
UK
EDITED BY SIDNEY CROWN and ALAN LEE
By Peter Morrall. London: Whurr. 2000. 228 pp. £20.00 (pb). ISBN 1
86156 164 4
Peter Morrall, a senior lecturer in health and sociology, claims to have
written "a polemic against the unified voice of conservatism and
progressive viewpoints within the mental health industry" concerning
homicides by people with mental illness. To support this claim Morrall offers
us the following propositions: mental illness is a real entity; patients are
at greater risk of committing suicide than homicide; the repercussions of
psychiatric homicides are profound; killings are not caused by labelling
theory or by moral panic; and both patients and public need protection. Few
readers will find anything polemical in any of
that.
Madness and Murder is a book of disconnected parts that fails to
deliver the polemic the author promises. Chapters on mental illness, deviance,
crime and homicide have the feel of an undergraduate text. The long-running
debate between individualist and societal theories of crime is given an
airing, while Dadd, M'Naghten, Foucault and Szasz duly make appearances. But
how all this affects today's psychiatric homicides is not easy to see.
Morrall reserves the final chapter (entitled The terror) for
his main point. He claims that psychiatrists caused the media panic about
psychiatric homicides in the 1990s by their defensive attitude. He studied
newspaper reports he calls them a "catalogue of killings"
between 1994 and 1999. In 13 pages he lists 94 killings, not all of
them in the UK, and a further 27 near-killings. Morrall acknowledges that
newspaper reporting of these cases is "sloppy, careless and
injudicious", but he emphasises their frequent allusion to current or
previous contact by the perpetrator with mental health services. He concludes
that it is because psychiatrists interpret this "reporting of their
professional gaffs as media orchestrated panics" that the panic took
hold. And that claim is the nearest we get to a polemic.
It seems to me that Morrall has missed an opportunity. Psychiatry must
articulate the role it and other agencies have in the prevention of
psychiatric homicides. I had hoped Morrall would offer some suggestions on
what the profession (or, if he prefers, the industry) should do.
Is further restriction of those with mental illness feasible? Is it justified?
Will it be effective in reducing risk? On these questions Morrall's polemic is
deafeningly silent.