Sexual Predators: Mental Illness or Abnormality? A Psychiatrist's Perspective
Sexual Predators: Mental Illness or
Abnormality? A Psychiatrist's Perspective
James D. Reardon, M.D.*
I.
PSYCHIATRIC INTERPRETATION OF SEXUALLY
VIOLENT PREDATORS
The absence of a psychiatrist on the Governor's Task
Force on Community Protection, which formulated the Washington Sexually Violent Predators Act,1 produced a profound
misunderstanding regarding the diagnosis and treatment of sex
offenders. To correct this situation, the Washington State Psychiatric Association (WSPA) has attempted to educate Washington legislators about deficiencies in the Act presented to
them by the Task Force. The WSPA has testified at legislative
hearings considering passage of the Sexually Violent Predators
statute. Likewise, the WSPA has filed an amicus curiae brief
in the In re Young case now pending before the Washington
Supreme Court, which is considering the constitutionality of
the statute.2
In drafting the statute, the Task Force created and defined
a new mental disorder, "sexually violent predator," declaring it
to be either a form of mental abnormality or a new type of personality disorder.3 The WSPA recognized that the American
Psychiatric Association's Diagnostic and Statistical Manual
III-R4 did not define any type of mental disorder called sexually violent predator. Thus, the WSPA assumed that the legislature was attempting to declare a class of criminals (i.e. sex
offenders) as mentally ill. Because psychiatrists have tradi* James D. Reardon, M.D. is a board-certified psychiatrist specializing in forensic
and institutional psychiatry. He is currently a consultant for the Washington State
Department of Corrections and the Special Offender Center, which is a special prison
for the care and treatment of mentally ill offenders located in Monroe, Washington.
1. WASH. REV. CODE ch. 71.09 (Supp. 1990-91).
2. Amicus Curiae Brief of Washington State Psychiatric Ass'n in Support of
Petitioners, In re Young (Wash. filed Sept. 20, 1991) (No. 57837-1).
3. GOVERNOR'S TASK FORCE ON COMMUNITY PROTECTION, DEP'T OF SOCIAL AND
HEALTH SERVICES, FINAL REPORT 11-21 (1989).
4. AMERICAN PSYCHIATRIC ASS'N, DIAGNOSTIC AND STATISTICAL MANUAL OF
MENTAL DISORDERS, DSM-III-R (3d ed. rev. 1987).
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[Vol. 15:849
tionally defined and treated mental illness, the WSPA was disturbed that a lay body, namely the Washington State
Legislature, was being encouraged to legislate psychiatric diagnosis and treatment. Furthermore, if the legislature were successful in calling sex offenders mentally disordered, it might
expand the definition to include other criminals, such as car
thieves or bank robbers, claiming that they, too, had some
mental abnormality or personality disorder that made them
likely to steal cars or commit robberies.
The WSPA knew that there was no scientifically valid
treatment for these sexually violent predators. Aside from the
fact that this classification includes a heterogeneous group of
child molesters, rapists, and violent criminals, the treatment of
sex offenders had been declining in recent years because of the
lack of success in curing their sexually aberrant behavior.
Indeed, the Washington State Auditor, in 1985, suggested that
sex offender programs in Washington be discontinued because
they were expensive and no more effective than incarceration
in changing offender behavior.5
The WSPA also recognized that a long-term prediction of
dangerousness was scientifically impossible. The prediction of
short-term dangerousness, however, was another matter. Previously, in civil commitment proceedings, the brief periods of
commitment for the mentally ill, averaging seventeen days,
and the clinical need for psychiatric hospitalization encouraged
psychiatrists to err on the side of a liberal interpretation of
short-term dangerousness. As a result, at those civil commitment hearings, psychiatrists generally testified that their
patients were currently dangerous in order to satisfy the
requirements of the law.
By declaring a particularly abhorrent class of criminals,
namely sex offenders, to be mentally disordered, the WSPA
believed the legislators were doing a disservice to those individuals who were truly mentally ill. The concern was stigma.
Mental patients were already stigmatized by a commitment
process that focused primarily on dangerous behavior as the
legal justification for commitment, thereby emphasizing behavior that is often embarrassing, socially disruptive, and at times
illegal (i.e. assaulting family members). Now the mental illness commitment process could be confused with that of con5. LEGISLATIVE BUDGET COMMI'TEE REPORT No. 85-16, SEX OFFENDER PROGRAMS
AT WESTERN AND EASTERN STATE HOSPITALS 68, 72 (1985).
A Psychiatrist'sPerspective
1992]
victed criminals being civilly committed as sexually violent
predators.
The legislature carefully included a disclaimer in the Act's
Findings, stating that commitment of sexually dangerous
predators must not be mistaken for the commitment of mental
patients in need of short-term civil commitment.6 The WSPA
was concerned that the average citizen might not appreciate
the subtle difference between those mentally ill persons being
committed for hospital treatment and those predatory sex
offenders being committed for control, care, and treatment.
A minor, though nagging, concern was economic. The legislature wanted the Department of Social and Health Services
to spend three million dollars a year to care for eleven people
locked up in the special commitment center, using funds that
could be better spent treating the mentally ill at state hospitals
and in the community.
II.
PRESENTING THE PSYCHIATRIC PERSPECTIVE
In 1990, I testified on behalf of the WSPA before the
Washington State Legislature to raise our concerns about the
proposed Sexually Violent Predators statute. Testifying before
house and senate legislative committees was an enlightening
experience, both for me and, I believe, for committee members. My most memorable inquiry was from one memberalso a prosecuting attorney in Eastern Washington-who
asked, "Well, what shall we call them, and where shall we put
them?" I naively responded, "Why not call them criminals and
put them in prison?" "We already do that," responded the legislator. "Then put them on parole for ten years," I added.
My answer, though apparently unresponsive to the needs
of the committee, did produce a pause in the proceedings that
allowed me to make our final point: "Perhaps the criminal justice system should be responsible for the control and care of
sex offenders, who are, after all, convicted criminals."
Our efforts to enlighten the legislature regarding the diagnosis and treatment of mental disorders were futile. The Sexually Violent Predators Act passed unanimously.
6. "In
contrast to persons appropriate for civil commitment under chapter 71.05
RCW, sexually violent predators generally have antisocial personality features which
are unamenable to existing mental illnes (...truncated)
