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March 11, 2006

Sex offenders – what to do?

Filed under: Forensic Mental Health,Uncategorized — mental1 @ 7:34 pm

eMJA: Legislation in Victoria on sexual offenders: issues for health professionals

Sex offenders are an incredibly heterogenous group and it is by no means clear cut attempting to work out whether it is worth treating them at all let alone whether we should even attempt to treat them. There are even problems with the definition of sexual offenses and indeed it wasn’t that long ago that homosexuality was listed as a sexual disorder in the DSM. How do you compare a full on paedophile with no remorse to a frotteur to someone with a weird fetish? And why is okay to have sexual relations with a 16 year old but not a 14 year old? The age of consent issue is a very tricky one and decidedly cultural.

And should doctors allow themselves to be dragged into the argument and put themselves at risk of medicalising issues that should remain well and truly within the social domain? The problem with medicalising sexual offenses is that it implies there is a suitable cure or management strategy. That is not clear cut.

This issue is a personal one for me. In my children’s wider family there is a convicted paedophile who is currently living in a Caribbean nation who currently cannot return to Europe due to warrants out against him. Fortunately there does not seem to be a history of abuse in our part of the family. The perpetrator almost certainly does not have a mental illness per se. A narcissistic personality disorder is likely but of course that is a diagnosis that does not necessarily stop a person from succeeding in this society. When I think of this person I lapse into punishment mode – but not all sexual offenders are like this one. And certainly not all offenders start off the with heavy duty paedophilia. Perhaps some can be successfully treated with CBT type techniques. But I can’t get past the fact that psychiatrists are not that good at determining dangerousness. So I think it would be a mistake for the courts to come to rely on our opinion when debating wheter an offender is safe to be in the community.

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