No abstract

The landmark Miranda decision established an explicit set of warnings that a criminal suspect must understand to insure that his statement to the police was knowing, intelligent, and voluntary. Mental health experts are routinely used to assist both prosecution and defense in determining whether the suspect's understanding of the Miranda warnings was sufficient to allow his statement into evidence. This article delineates issues and procedures to assist the evaluator in conducting such evaluations.

This article presents an overview of psychotherapeutic treatment modalities of adult sex offenders. It considers recent developments in treatment methods; discusses methods of measuring therapeutic change; presents a discussion of evaluation and outcome studies of these modalities.

Emphasizing the power and fundamental nature—comparable to the basic mammalian drive for food—of sex drives and urges in almost everybody, including paraphilics and sex offenders, this article gives an overview of biologically-based, or “organic” approaches to the treatment of paraphilics and sex offenders. Organic treatment approaches for this population may be divided into surgical and pharmacotherapeutic categories. Surgical approaches include castration (orchiectomy), sterotactic (brain) surgery and estrogen implants, the latter two approaches are not used in the United States (U.S.). All surgical approaches act hormonally, in reducing or blocking the amount of circulating androgens in the subject. Pharmacotherapeutic approaches include: (1) Indirect-acting and direct-acting antiandrogen hormones, also intended to reduce or block the amount of circulating androgens in the subject. (2) Psychotropic medications for primary treatment of male aggressive hypersexuality, for treatment of co-occurring psychiatric symptomatology, or for both. (3) An experimental pharmacologic approach to the treatment of this population consists of the use of antiepileptic drugs, or “AED's” to stabilize the impulsivity/compulsivity of these subjects, in reducing the hypothesized “kindling” that may occur during impulsive/compulsive periods in these individuals. Whatever organic approach may be used for paraphilics and sex offenders, such an approach alone is not sufficient treatment for this population. Psychotherapeutic and cognitive/behavioral approaches must also be included in these individuals' treatment regimens. A companion piece to this article, giving an overview of psychotherapeutic and cognitive/behavioral treatment approaches to this population will be published in a future issue of this Journal.

What if the rule-breaking behaviors in which an individual (allegedly) engaged which brought him/her to the attention of law enforcement authorities were something which the individual simply had to do, or not do, and could not resist? In other words, what if the alleged offender could not have chosen to do otherwise? This situation takes us into the realm of what the law calls criminal responsibility, which is the broad subject of this aticle. In the law, the concept of criminal responsibility is an old one. It goes back in formal codified form, as far as we know, to the Code of Hammurabi from ancient Susa in Babylonia, ca. 1792–1750 BCE. This article looks at the types of criminal responsibility used in various jurisdictions, conceptions of diminished capacity, and attempts to discern truth using functional Magnetic Resonance Imaging (fMRI) technology.