Considerations about the article "Nonimputability: a study on inmates at Instituto Psiquiátrico Forense Maurício Cardoso"

LETTER TO THE EDITORS

Considerations about the article "Nonimputability: a study on inmates at Instituto Psiquiátrico Forense Maurício Cardoso"

Guido Arturo Palomba

Forensic psychiatrist in São Paulo, SP, Brazil. Correspondence: [e-mail]

Dear Editors,

We carefully read the article "Nonimputability: a study on inmates at IPFMC," published on Rev Psiquiatr RS, v. 29, n. 3, Sep/Dec 2007, pages 286-293, and felt some disappointment: the absence of epilepsy as a diagnosis!

It is impossible not to have any epileptic patients if the institute received criminals that committed crimes against the person and were considered as nonimputable. There are 381 mental patients according to the research. The authors claimed that they "used the criteria of the International Classification of Diseases (ICD-10)." Indeed they used this semi-medical criterion that perverts diagnoses, a text-book of modern psychiatrists, useless to quality forensic psychiatry.

We categorically state, without even having examined a single patient of that research that selected 381 "nonimputable inmates who committed crimes against the person," that there must be some patients who committed crimes and had six out of nine characteristics catalogued for violent crimes committed by epileptics, namely:

1 - absence of plausible reasons;

2 - absence of premeditation;

3 - instantaneousness of the action;

4 - ferocity in execution;

5 - multiplicity of blows;

6 - absence of dissimulation;

7 - absence of remorse;

8 - absence of an accomplice;

9 - amnesia or confusing mnemonic recollections about the crime.

And if there is, it is essential to pay due respect to the masters of forensic psychiatry, who dedicated their lives to the study of violent crimes by epileptic inmates, starting with Henry Legrand du Saulle, the first to describe the aforementioned list, and his followers, Richard von Krafft-Ebing, Henry Maudsley, Cesare Lombroso, Eugenio Tanzi, and Carlo Ferrio. Among Brazilian psychiatrists are the immortal Afrânio Peixoto, Antonio Carlos Pacheco e Silva, José Alves Garcia, and Hélio Gomes. Of current psychiatrists, only time will tell.

One may wonder if the names mentioned above are not old references. Regardless of this, they are still important names until others come and write better books than the treatises those authors left us, which hold perennial teachings for quality forensic psychiatry.

Ordinary clinical psychiatry (in the sense of the most practiced type), dominant in modern times, has its rules based on the ICD, which does not even have a psychopathology focus, and thus allows us to say that current psychiatry, totally needy of studies in that area, is ordinary (in the sense of inferior).

Epi, "above", lepsis, "to seize", epilepsis, "the devil comes from above and seizes" the energoumenos ("possessed by the devil"), poorly sacred, poorly devilish, the only one who has never changed his name since it was coined, which is part of the Code of Hammurabi (where there is the first forensic-psychiatric reference of history). And it is not up to the decadent ICD, which changes the names of diseases at each review (there are 10 so far) that will destroy epilepsy in psychiatry, even if such a huge catalogue of diseases has seduced most modern psychiatrists. These are only the current psychiatric times, ruled by drug manufacturers, by diagnoses that interest such industrial conglomerates. The true science, the true phenomenological psychopathology will be resumed one day, and then the psychiatrists today called the "sons of ICD" will be excluded from the scenario.

Despite the militant content of this letter, but showing respect and admiration to the authors (in fact, nobody is to blame, since it is almost impossible to clinical psychiatrists not to be swallowed by the system of marketing, advertisement and drug sales), we convey to the authors our compliments. Your work has something very good in it: it belongs to forensic psychiatry and is written with kindness, although one may disagree with its content in some points.

Authors' reply

Dear editors,

We would like to clarify the comments made by Dr. Guido Arturo Palomba about our article "Nonimputability: a study on inmates at IPFMC," published on Rev Psiquiatr RS, v. 29, n. 3, Sep/Dec 2007, pages 286-293. Firstly, we would like to express our agreement with the criticisms and acknowledge the contributions, which will be of great value in the planning of further research. However, we want to stress some features of our research. It was a retrospective study, in which we reviewed medical charts. During the process of data collection, priority was given to the main psychiatric diagnosis, present in filed judicial medical charts. In the sampling process, not all nonimputable inmates at Instituto Psiquiátrico Forense Maurício Cardoso were included. When a study with this type of design is performed, the findings are limited to what has been recorded. And when the entire universe of individuals belonging to a given population is not evaluated, there is always the risk of having findings that do not represent exactly what a given population presents. We therefore acknowledge that our study has limitations. Ideally, a study should be conducted using only data obtained directly from patients' evaluation, preferentially including all of them. However, although aware of our study limitations, we chose to socialize the findings, since, in our understanding, they suggest some relevant data for further investigations and for the scientific community in general. As an example, the data we obtained suggested a relationship between the offense and the existence of a severe, chronic mental disorder in an individual with previous episodes and low socioeconomic level. This fact suggests that the lack of public and support policies by the community in general is one of the main factors contributing to occurrence of violent behavior in patients with mental disorders. I will no longer discuss the findings, because the article has already been published. We would like to stress that we received positive manifestations about the article in our personal e-mail, as well as some constructive criticisms. I appreciate the attention and opportunity granted by the editors.

Gabriel J. Chittó Gauer

Faculdade de Psicologia, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil. Correspondence: Gabriel J. Chittó Gauer, Av. Cel. Lucas de Oliveira, 576/501, Mont'Serrat, CEP 90440-010, Porto Alegre, RS, Brazil. Tel.: [phone], Ramal 7745, Fax: [phone]. E-mail: [e-mail]

LETTER TO THE EDITORS

Considerations about the article "Nonimputability: a study on inmates at Instituto Psiquiátrico Forense Maurício Cardoso"

Considerações sobre o artigo "Inimputabilidade: estudo dos internos do Instituto Psiquiátrico Forense Maurício Cardoso"

Guido Arturo Palomba

Forensic psychiatrist in São Paulo, SP, Brazil. Correspondence: [e-mail]

Dear Editors,

We carefully read the article "Nonimputability: a study on inmates at IPFMC," published on Rev Psiquiatr RS, v. 29, n. 3, Sep/Dec 2007, pages 286-293, and felt some disappointment: the absence of epilepsy as a diagnosis!

It is impossible not to have any epileptic patients if the institute received criminals that committed crimes against the person and were considered as nonimputable. There are 381 mental patients according to the research. The authors claimed that they "used the criteria of the International Classification of Diseases (ICD-10)." Indeed they used this semi-medical criterion that perverts diagnoses, a text-book of modern psychiatrists, useless to quality forensic psychiatry.

We categorically state, without even having examined a single patient of that research that selected 381 "nonimputable inmates who committed crimes against the person," that there must be some patients who committed crimes and had six out of nine characteristics catalogued for violent crimes committed by epileptics, namely:

1 - absence of plausible reasons;

2 - absence of premeditation;

3 - instantaneousness of the action;

4 - ferocity in execution;

5 - multiplicity of blows;

6 - absence of dissimulation;

7 - absence of remorse;

8 - absence of an accomplice;

9 - amnesia or confusing mnemonic recollections about the crime.

And if there is, it is essential to pay due respect to the masters of forensic psychiatry, who dedicated their lives to the study of violent crimes by epileptic inmates, starting with Henry Legrand du Saulle, the first to describe the aforementioned list, and his followers, Richard von Krafft-Ebing, Henry Maudsley, Cesare Lombroso, Eugenio Tanzi, and Carlo Ferrio. Among Brazilian psychiatrists are the immortal Afrânio Peixoto, Antonio Carlos Pacheco e Silva, José Alves Garcia, and Hélio Gomes. Of current psychiatrists, only time will tell.

One may wonder if the names mentioned above are not old references. Regardless of this, they are still important names until others come and write better books than the treatises those authors left us, which hold perennial teachings for quality forensic psychiatry.

Ordinary clinical psychiatry (in the sense of the most practiced type), dominant in modern times, has its rules based on the ICD, which does not even have a psychopathology focus, and thus allows us to say that current psychiatry, totally needy of studies in that area, is ordinary (in the sense of inferior).

Epi, "above", lepsis, "to seize", epilepsis, "the devil comes from above and seizes" the energoumenos ("possessed by the devil"), poorly sacred, poorly devilish, the only one who has never changed his name since it was coined, which is part of the Code of Hammurabi (where there is the first forensic-psychiatric reference of history). And it is not up to the decadent ICD, which changes the names of diseases at each review (there are 10 so far) that will destroy epilepsy in psychiatry, even if such a huge catalogue of diseases has seduced most modern psychiatrists. These are only the current psychiatric times, ruled by drug manufacturers, by diagnoses that interest such industrial conglomerates. The true science, the true phenomenological psychopathology will be resumed one day, and then the psychiatrists today called the "sons of ICD" will be excluded from the scenario.

Despite the militant content of this letter, but showing respect and admiration to the authors (in fact, nobody is to blame, since it is almost impossible to clinical psychiatrists not to be swallowed by the system of marketing, advertisement and drug sales), we convey to the authors our compliments. Your work has something very good in it: it belongs to forensic psychiatry and is written with kindness, although one may disagree with its content in some points.

Authors' reply

Dear editors,

We would like to clarify the comments made by Dr. Guido Arturo Palomba about our article "Nonimputability: a study on inmates at IPFMC," published on Rev Psiquiatr RS, v. 29, n. 3, Sep/Dec 2007, pages 286-293. Firstly, we would like to express our agreement with the criticisms and acknowledge the contributions, which will be of great value in the planning of further research. However, we want to stress some features of our research. It was a retrospective study, in which we reviewed medical charts. During the process of data collection, priority was given to the main psychiatric diagnosis, present in filed judicial medical charts. In the sampling process, not all nonimputable inmates at Instituto Psiquiátrico Forense Maurício Cardoso were included. When a study with this type of design is performed, the findings are limited to what has been recorded. And when the entire universe of individuals belonging to a given population is not evaluated, there is always the risk of having findings that do not represent exactly what a given population presents. We therefore acknowledge that our study has limitations. Ideally, a study should be conducted using only data obtained directly from patients' evaluation, preferentially including all of them. However, although aware of our study limitations, we chose to socialize the findings, since, in our understanding, they suggest some relevant data for further investigations and for the scientific community in general. As an example, the data we obtained suggested a relationship between the offense and the existence of a severe, chronic mental disorder in an individual with previous episodes and low socioeconomic level. This fact suggests that the lack of public and support policies by the community in general is one of the main factors contributing to occurrence of violent behavior in patients with mental disorders. I will no longer discuss the findings, because the article has already been published. We would like to stress that we received positive manifestations about the article in our personal e-mail, as well as some constructive criticisms. I appreciate the attention and opportunity granted by the editors.

Gabriel J. Chittó Gauer

Faculdade de Psicologia, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil. Correspondence: Gabriel J. Chittó Gauer, Av. Cel. Lucas de Oliveira, 576/501, Mont'Serrat, CEP 90440-010, Porto Alegre, RS, Brazil. Tel.: [phone], Ramal 7745, Fax: [phone]. E-mail: [e-mail]

Publication Dates

• Publication in this collection
  01 Dec 2008
• Date of issue
  Apr 2008