Patterns of knowing as a method of assessment and intervention for children exposed to family-member homicide

The patterns of knowing identified by Carper in 1978, specifically empirics, aesthetics, ethics, and personal knowing, continue to be applied to the expanding role of nursing. Sociopolitical knowing and unknowing add important dimensions, as well. Knowing is an individual process and a metamorphosis of interplay among theory, research, and practice. These patterns of knowing are inherently applicable to any specialty within the profession of nursing. As nursing specialties such as forensic nursing emerge, the patterns of knowing can provide a foundational approach to comprehensive assessment and intervention for victims of interpersonal violence. As an example, forensic nurses confronted with children who have witnessed family-member homicide can use all of the patterns of knowing for comprehensive nursing assessment and intervention.

Homicide and major mental disorders: a 25-year study

OBJECTIVE

This study was designed to investigate the association between major mental disorders (MMDs) and homicide.

METHOD

The rates of exculpations because of MMDs among 1087 Austrian homicide offenders during 1975 and 1999 were compared with the rates of the respective disorders in the general population.

RESULTS

MMDs were associated with an increased likelihood of homicide (two-fold in men and six-fold in women). This was exclusively because of schizophrenia (age-adjusted ORs in men 5.85, CI 4.29-8.01; in women 18.38, CI 11.24-31.55) and delusional disorder in men (OR 5.98, CI 1.91-16.51). Comorbid alcohol abuse/dependence (additionally) increased the odds in schizophrenia, major depression and bipolar disorder.

CONCLUSION

The increased likelihood of homicide in subjects with MMDs cannot be fully explained by comorbid alcoholism. The results point to the special importance of sufficient treatment for a subgroup of mentally ill individuals being at higher risk of violence.

ADHD and sleep in homicidal men with antisocial personality disorder

A history of attention deficit hyperactivity disorder (ADHD) is commonly found in subjects with antisocial personality disorder (ASP). Besides ASP, childhood ADHD also predicts drug abuse disorders and criminal activity in adulthood. Childhood ADHD and ASP appear to be the only psychiatric disorders reported to be associated with an increase in deep sleep. The aims of the present study were to retrospectively measure the childhood ADHD of habitually violent men with ASP and Cloninger type 2 alcoholism, and to characterize the possible relationship between childhood ADHD and sleep architecture in these men. The subjects of the study consisted of 14 homicidal offenders recruited from a forensic psychiatric examination. Ten age- and gender-matched healthy volunteers served as controls. Childhood ADHD symptoms were measured using the Wender-Utah Rating Scale (WURS). The main findings were that violent offenders with ASP had significantly higher mean WURS scores compared with controls, and both the absolute and percentage amount of stage 4 sleep as well as delta and theta powers in this sleep stage were positively correlated with the WURS scores. The present study supports the idea that childhood ADHD is associated with the abnormal sleep architecture in habitually violent men with ASP. These two disorders seem to share, at least partly, the same central nervous system deficit.

Community-based, acute posttraumatic stress management: a description and evaluation of a psychosocial-intervention continuum

Much of today's psychological trauma can be identified as resulting from sudden and seemingly random events, and particularly from events that involve the loss of human life. This article presents a perspective on how behavioral health providers may approach the design, development, and implementation of community-based psychological trauma interventions. These interventions allow those community members most affected by the trauma to play a central role in the resolution of, and community adaptation to, traumatic losses. After a brief discussion of "critical incident stress debriefing"--a common form of psychological "first aid" that is sometimes used following traumatic events that affect a community--the article turns to the description of a community-based trauma-response program that provides a continuum-of-care model for the care and management of individual and group reactions to shared, traumatic events. A recent evaluation of that program, which was developed by the Community Services Program of the Trauma Center in Boston, is presented as an important first step toward determining the types of community-based responses that show promise in our efforts to ameliorate the impact of traumatic events in communities nationwide and internationally.

Letting the story unfold: a case study of client-centered therapy for childhood traumatic grief

There has been increasing interest in the newly identified condition of childhood traumatic grief (CTG) since the 2001 attack on the World Trade Center. The case presented here is one of an adolescent girl who was diagnosed with CTG following the death of her father, a firefighter killed in the line of duty on September 11, 2001. Literature on CTG, its treatment, and adolescent development will be discussed. The application of client-centered treatment to CTG will be highlighted by the case description and diagnostic findings prior to, during, and following treatment.

Facing fears and sadness: cognitive-behavioral therapy for childhood traumatic grief

The term childhood traumatic grief (CTG) is being increasingly used to refer to the particular reaction in children that may follow the death of a loved one during a traumatic event. The goal of this case study is to describe the theoretical argument and framework for, as well as a clinical example of, cognitive-behavioral therapy (CBT) for CTG. We present a case of a five-year-old boy whose father, a firefighter, died in the line of duty at the World Trade Center on September 11, 2001. This specific case will highlight the steps of CBT for CTG, the value of assessment during the therapeutic process, and the need to consider developmental and family factors in treatment.

Sleepwalking violence: a sleep disorder, a legal dilemma, and a psychological challenge

OBJECTIVE

The purpose of this article is to further an understanding of the psychological state when aggression follows an episode of partial arousal from early non-REM sleep during which some areas of the brain appear to be functioning as in waking while others appear to remain in a state of sleep. To illustrate this, the author examines a case of homicide for which the defense argued lack of responsibility due to sleepwalking.

METHOD

A review of the forensic literature on sleepwalking aggression and sleep studies suggests that these fall into one or both of two DSM-IV-TR diagnoses: sleepwalking disorder and sleep terror disorder. The new case, which would meet criteria for an overlap disorder in which sleepwalking is followed by sleep terror, is compared to one previously published.

RESULTS

These findings support sleepwalking violence as a distinct overlap disorder with common disturbed psychological functioning during and for a period up to 1 hour following an aggressive episode.

CONCLUSIONS

Research clarifies the pathology of this disorder and highlights the need to both refine the differential diagnosis and test the efficacy of treatment protocols.

Family consequences of refugee trauma

OBJECTIVE

To construct a model on the consequences of political violence for refugee families based upon a qualitative investigation.

METHODS

This study used a grounded-theory approach to analyze qualitative evidence from the CAFES multi-family support and education groups with Bosnian refugee families in Chicago. Textual coding and analysis was conducted using ATLAS/ti for Windows.

RESULTS

A grounded-theory model of Family Consequences of Refugee Trauma (FAMCORT) was constructed that describes Displaced Families of War across four realms of family life: (1) changes in family roles and obligations, (2) changes in family memories and communications, (3) changes in family relationships with other family members; and (4) changes in family connections with the ethnic community and nation state. In each realm, the model also specifies family strategies, called Families Rebuilding Lives, for managing those consequences.

CONCLUSIONS

Political violence leads to changes in multiple dimensions of family life and also to strategies for managing those changes. Qualitative family research is useful in better understanding refugee families and in helping them through family-oriented mental health services.

Practicing school psychologists' perceived role in prevention of school violence

School psychologists have been called upon to take a leadership role in school-violence prevention, but little is known about their involvement in this issue, especially in states where school shootings have occurred. The current study surveyed 258 Michigan school psychologists about their role in prevention of school violence. Analysis suggested respondents felt prepared to address violence prevention but do not have a leadership role and are not sought for advice about prevention. The number of annual special education evaluations was significantly associated with frequency of being sought for advice on violence prevention but was not related to perceptions of leadership or preparedness. Modest relationships were noted between feeling prepared, knowledge of risk factors, and self-perceptions of a leadership role. Suggestions for research are included.

Predicting presence of offender's criminal record from antisocial lifestyle indicators of homicide victims

The aim of the present study is to explore the possibility of predicting the presence of a criminal record in the background of a homicide offender on the basis of victim characteristics. Eight victim characteristics, as well as the presence or absence of offender criminal record and offender violent criminal record, were coded for 502 Finnish homicides. A configural frequency analysis (CFA) showed that it was possible to predict the presence of a criminal record on the basis of the victim variables. The practical significance of the results for police investigations is discussed.

Psychiatric and neurological characteristics of murder defendants referred for pretrial evaluation

After literature review, this paper presents the largest study to date (n = 270) of psychiatric and neurological characteristics of accused murderers in the United States. This retrospective record review of pretrial detainees undergoing competency to stand trial and criminal responsibility evaluations examined demographic characteristics, psychiatric diagnosis, substance use patterns, Intelligence Quotient (IQ), and results of electroencephalogram (EEG), neuroimaging (MRI or CT) and neurological examination. Substance use and mood/adjustment disorders were common. Neuroimaging was abnormal in 18% of subjects and was associated with lower Performance IQ. EEG and neurological exam findings were not associated with measured cognitive impairment. While 16% of subjects had a FS IQ < 70, only 6% were diagnosed with mental retardation. Subjects with a psychotic disorder (p = 0.001) or an anxiety disorder (p = 0.005) were more likely to use a knife than other subjects in the study. Violence risk assessment in these patients must not only involve inquiry about firearm availability.

Mental illness in people who kill strangers: longitudinal study and national clinical survey

OBJECTIVES

To establish changes over time in the frequency of homicides committed by strangers, and to describe the personal and clinical characteristics of perpetrators of stranger homicides.

DESIGN

Longitudinal study and national clinical survey.

PARTICIPANTS

People convicted of homicide in England and Wales between 1996 and 1999 and whether the victim was known to the perpetrator.

SETTING

England and Wales.

MAIN OUTCOME MEASURE

Characteristics of perpetrators of homicides according to whether victims were strangers or not.

RESULTS

Stranger homicides increased between 1967 and 1997, both in number and as a proportion of all homicides. No increase was found, however, in the number of perpetrators placed under a hospital order after homicide, whether all homicides or stranger homicides only. 358 of 1594 (22%) homicides were stranger homicides. In these cases the perpetrator was more likely to be male and young. The method of killing was more likely to be by hitting, kicking, or pushing (36% (130 of 358) for victims who were strangers to the perpetrator compared with 14% (145 of 1074) for victims who were known). Perpetrators were less likely to have a history of mental disorder (34%, n = 80 nu 50%, n = 142), a history of contact with mental health services (16%, 37 of 234 nu 24%, 200 of 824), and psychiatric symptoms at the time of the offence (6%, n = 14 nu 18%, n = 143). They were more likely to have a history of drug misuse (47%, n = 93 nu 37%, n = 272); alcohol (56%, n = 94 nu 41%, n = 285) or drugs (24% n = 44 nu 12%, n = 86) were more likely to have contributed to the offence.

CONCLUSIONS

Stranger homicides have increased, but the increase is not the result of homicides by mentally ill people and therefore the "care in the community" policy. Stranger homicides are more likely to be related to alcohol or drug misuse by young men.

[From the person to an isolated case: Frank Schmökel in the discourses of power and stigmatization]

OBJECTIVE

Representations of psychiatry in the media reflect the societal perception of psychiatries. These representations are influential in terms of society and health politics in that the societal perception of psychiatry is determined by the media, and the media convey what is thinkable and sayable.

METHOD

A formal textual analysis, employing a discoursive analytical method (M. Foucault), will be carried out based on the concrete example of the daily coverage of the case of Frank Schmökel.

RESULTS

It will be demonstrated that the means by which the media sketched an image of Frank Schmökel left little understanding for the person and his action. Schmökel was exposed to a sphere of control which arose from various competing discourses. The crystallization of the participating discourses (psychiatry, law, publicity) in power shows, in addition to repeated stigmatization and the generation of clichés, the isolation of the individual: the person Frank Schmökel is made into an isolated case.

CONCLUSIONS

Images of this type are quickly generalized and lead to a public image of psychiatry (psychiatries) that distort reality. Such conveyance of opinion is amazingly influential in terms of societal politics and health politics, and has repercussions in law and politics.

[Multiple homicides--forensic and criminologic aspects]

The interpretation of medicolegal findings in homicide is an important tool of case profiling (so-called "operative case analysis"). In 17 cases of "multiple homicides" involving 22 offenders (21 males, 1 female; mean age 33 years) and 45 victims (21 males, 24 females; mean age 35 years; 41 fatalities, 4 survivors), the autopsy reports and the prosecution authorities' files were retrospectively analysed with regard to individual characteristics of perpetrators and victims, circumstances, and mode of commitment in order to comprehensively characterise relevant forensic and criminologic aspects. 31 victims were found to belong to the close social environment of the perpetrator, and 32 killings were committed in the victim's, perpetrator's or the joint flat. The main motives included greed (n = 7), personal conflicts (n = 5) and concealing of a crime (n = 9). The relevant injuries were attributable to gunshot wounds (n = 13), sharp force (n = 11), blunt force (n = 3), ligature strangulation (n = 3), smothering (n = 6), fire/carbon monoxide (n = 2) and combined impacts (n = 7). In 12 victims, defense injuries were found. The blood alcohol concentration exceeded 1.5 g/l in 5 victims. In 5 offenders, a psychiatric impairment of juridical responsibility was assessed (and 20 German criminal code, n = 1, psychosis; and 21 German criminal code, n = 4; acute alcohol intoxication). As far as data were available, 16 crimes were judged as murder, 12 as manslaughter and one as physical injury with fatal outcome.

Adolescent coping and neighborhood violence: perceptions, exposure, and urban youths' efforts to deal with danger

Neighborhood violence is a persistent source of danger, stress, and other adverse outcomes for urban youth. We examined how 140 African American and Latino adolescents coped with neighborhood danger in low, medium, and high crime neighborhoods throughout Chicago. Participants reported using a range of coping strategies (measured via a modified version of the Ways of Coping Scale; R. S. Lazarus & S. Folkman, 1984). In low and medium crime rate areas, using confrontive strategies was significantly correlated with increased exposure to violence, and no strategies were associated with perceptions of safety. Coping strategies were associated with perceived safety to a substantial degree only in high crime neighborhoods, and none were associated with exposure to violence. A k means cluster analysis identified groups that differed in coping profiles and varied in rates of exposure to violence. Moderating effects of gender, ethnicity, and neighborhood were found for both person level and variable level analyses.

Are stepchildren over-represented as victims of lethal parental violence in Sweden?

Evolutionary psychologists have suggested that stepchildren should be over-represented as victims of lethal parental violence compared with children living with their two genetic parents, because of relatively more lapses in parental solicitude among stepparents. In our study, using data over a period of 35 years in Sweden (1965-1999), there was no overall over-representation of stepchildren as victims. For very young stepchildren there was a tendency for over-representation. In families with both stepchildren and children genetically related to the offender, genetic children tended to be more likely to be victims.

Effects of Defendant Age on Severity of Punishment for Different Crimes

After reading a murder or theft vignette in which the perpetrator was a 20-, 40-, or 60-year-old man, 95 undergraduates gave sentence and parole recommendations. Punishment was harsher for the murder than for the theft. For murder, participants treated the 20- and 60-year-old men less harshly than the 40-year-old man, which confirms previous archival findings. However, this inverted U-shaped function occurred for murder only. The authors discussed the results in the context of the just-desert and utilitarian rationales that guide sentencing and gave suggestions for future research.

Cries from the morgue

TOPIC

Family member homicide.

PURPOSE

To explore the unique facets of bereavement for a family member of a homicide victim in order to assist clinicians during assessment, evaluation, and intervention with children.

SOURCES

The authors' experience in working with children at a child grief center and published literature.

CONCLUSIONS

Children experience grief uniquely and use differing methods of coping and adaptation. Knowledge of these differences can assist clinicians with promotion of adaptive coping and grieving in children who have been exposed to murder.

Community-based trauma response for youth

The "golden rule" of youth trauma response is that those most affected by the trauma or threat event must be afforded an ongoing opportunity to play a central role in the resolution of and recovery from the trauma and its aftermath.