Report
on
the
Psychological
Treatment of Crime*
The publication of this important report at a time when the Criminal Justice Bill is before the House and its progress eagerly watched by so many of the public, is singularly opportune. The report gives the result of an investigation carried out at Wormwood Scrubs Prison for a period of four years to ascertain the value of psychological treatment *
By W. Norwood East, M.D., F.R.C.P., and W. H. de B. Hubert, B.A., M.R.C.S.. L.R.C.P. With an appendix by Dr. H. T. P. Young, M.B., Ch.B., on the influences of prison conditions in relation to psychotherapy in prison. H.M. Stationery Office, 2s. 6d.
56
MENTAL WELFARE
in the prevention and cure of crime. In 1932 the Departmental Committee on Persistent Offenders stated in their report that they considered " a certain amount of persistent crime ?as well as first offences with which we are not concerned?is due to abnormal mental factors that there is reason to suppose that certain delinquents may be amenable to " a Medical Psychologist should be psychological treatment" and they recommended that attached to one or more penal establishments" to carry out such treatment in selected cases. The Wormwood Scrubs investigation was undertaken largely as a result of that recommendation. In the Prison Commissioners'-Report for the year 1935, a mental classification of criminals is given?normal, sub-normal, mentally defective, mentally inefficient, psychoneurotics, psychotics (sub-headings being given in each class except the normal). Under the normal " whose general behaviour corresponds to that of the group are included all those offenders is "There no man". doubt," says the Report, "that the tendency to break the law average and acquiesce in certain forms of crime is widespread, and the occurrence of anti-social behaviour cannot be taken to imply abnormality unless the word is used in a very special sense." It is important to note that in the opinion of the authors, the normal group will include at least 80 per cent., that psychotherapy is usually unnecessary in the treatment of the normal offenders, and also for those who do not commit further crime, that in general its application is unsuitable in cases of mental defectiveness, and in the psychoses, and that it is most likely to benefit the mentally inefficient and psychoneurotic groups. The cases dealt with were selected after very careful consideration from those submitted by the medical officers of the prisons as likely to be suitable; in general they were under 40 years of age and serving a sentence of not less than six months, for indecent exposure, homosexual, or abnormal sex crimes, certain cases of arson and other crimes considered to be due to obsession or hysterical reactions or some other remedial condition, and included as suitable were the adolescents who showed pronounced mental instability while in prison. The willing co-operation of the prisoner in the treatment was essential and the greatest caution exercised to prevent prisoners acquiesing in treatment in order to avoid work, and obtain preferential conditions. A perusal of the report makes one realise the need for extreme caution in dealing with the whole question, and avoidance of easy generalisations. Out of 406 cases seen " It should be and investigated, only 214 were approved for treatment. The report states, recognised generally that psychological treatment may be harmful if applied to certain patients, and that to ascertain its suitability, or otherwise, in any case demand* not only a knowledge of psychology but also a scientific knowledge of mental disease and of crime which is only attained after long training as a psychiatrist with experience of criminals." " After giving figures to show that the usual methods of dealing zvith offenders in this country " in a considerable are effective proportion of cases" the authors go on to say the psychological treatment of crime has suffered considerably from over-propagandisation and over-statement. Both are unfaithful servants, for they lead away from truth. A discriminating critic will ref use to accept the statement of a psychologist that a law-breaker was cured of Ins criminal IVv do not believe tendencies as the result of a recent course of psychological treatment. ' the word cure' can be properly tised in this connection until many years have lapsed. IVe shall not use the word 'cured' in this Report in connection zvith our results." .
.
.
.
.
.
.
A Table is
given (para. 69) showing the
cases
approved for
Cases approved
investigated
Borstal group (excluding sex cases) Adolescent group (excluding sex cases) Adult group (excluding sex cases) Homosexuals Exhibitionists Other sexual offenders (perversions) Offenders against women and girls Total
.
treatment as follows :?
Cases Class of Offender
.
63 41 97 79 35 41 50 406
for ...
...
...
...
...
...
...
...
treatment
29 34 27 52 23 27 22 214
MENTAL
WELFARE
57
Part II of the Report deals with Criminal behaviour and general offences and the types
most suited for psychotherapy and illustrative cases are quoted from the various groups set out above, and in Part III the same procedure is followed, and deals entirely with sexual
offences. Seventy-nine illustrative cases are described at some length, and need to be studied with great attention. It would be impossible in this short review to quote. Several of these descriptions which one reads with absorbing interest end with the words "He was not suitable for psychotherapy", or similar negative indications. Others state, "Psychotherapy in this case if as probably successful, or helpful". Other cases are quoted as being suited for special supervision in a suitable institution (such as is recommended later in the report). In connection with the treatment it is pointed out in paragraph 90 (3), that conditions of the prisoners' life in prison were sometimes altered; in some cases supervision on release was carried out by the Central Association for Mental Welfare, and further treatment was given by Dr. Hubert in the department of psychological medicine at St. Thomas's Hospital. Part IV comprises conclusions and recommendations. It is pointed out that as, at the most, any treated case can only have been out of prison four years at the time of writing the report, while the majority have been at liberty for a shorter period and some are still in prison, it is not possible to show the result of the investigation statistically. After discussing the uses of specialised psychotherapy and the psychiatric approach, the authors strongly recommend (para. 164) a special institution for the care, study and treatment of a group? " selected under expert supervision?and would include cases suitable for : (1) psychotherapy combined with more measures general of psychiatric treatment alone, (2) psychotherapy and training or (3) the more general measures alone. The second group would consist of those cases who require observation and investigation because of the presence of features that are unusual, abnormal or the subject of special lines of research. The third group would consist of those who, for other reasons, need the care of a special institution. In general, this latter group would consist of those for whom the institution could supply an environment more suited to their individual requirements than the observation section of an ordinary prison. For example, many offenders whose sentence is preventive and others whose behaviour during sentence is very abnormal would be much more satisfactorily dealt with in such an institution than under ordinary prison conditions although no more than employment and supervision might be practicable." The authors enter a caveat against too ready recommendations for psychotherapy of an offender on bail or on probation unless made by approved medical experts and express the view that in districts where there is a prison or State Remand Home (if these are established as proposed in the Criminal Justice Bill) the Medical Officers should be available for the necessary examinations, and that "if Local Authorities generally established " psychiatric clinics and they were made available for persons on bail or probation it would be of great advantage. While this investigation has only dealt with men and youths, the experience is sufficient to justify a recommendation that a woman psychotherapeutist should be appointed to a woman's prison. At the close of the report, the need for
words
Criminological research is emphasised
in these
:? " Whilst we recommend close co-operation be maintained between the prisons and the special institution we attach much importance to any extension of the psychiatric and psychotherapeutic service to prisons and Borstal institutions being centralised as much as possible. Not only zuill this further develop, but it will promote scientific study by collecting case material together instead of allozving it to remain scattered in different centres."
The value of the Report cannot be over-emphasised, and are due.
grateful thanks
?
to
those
responsible for it ~
T ? Lucy E. Beach.
our
on
the
Psychological
Treatment of Crime*
The publication of this important report at a time when the Criminal Justice Bill is before the House and its progress eagerly watched by so many of the public, is singularly opportune. The report gives the result of an investigation carried out at Wormwood Scrubs Prison for a period of four years to ascertain the value of psychological treatment *
By W. Norwood East, M.D., F.R.C.P., and W. H. de B. Hubert, B.A., M.R.C.S.. L.R.C.P. With an appendix by Dr. H. T. P. Young, M.B., Ch.B., on the influences of prison conditions in relation to psychotherapy in prison. H.M. Stationery Office, 2s. 6d.
56
MENTAL WELFARE
in the prevention and cure of crime. In 1932 the Departmental Committee on Persistent Offenders stated in their report that they considered " a certain amount of persistent crime ?as well as first offences with which we are not concerned?is due to abnormal mental factors that there is reason to suppose that certain delinquents may be amenable to " a Medical Psychologist should be psychological treatment" and they recommended that attached to one or more penal establishments" to carry out such treatment in selected cases. The Wormwood Scrubs investigation was undertaken largely as a result of that recommendation. In the Prison Commissioners'-Report for the year 1935, a mental classification of criminals is given?normal, sub-normal, mentally defective, mentally inefficient, psychoneurotics, psychotics (sub-headings being given in each class except the normal). Under the normal " whose general behaviour corresponds to that of the group are included all those offenders is "There no man". doubt," says the Report, "that the tendency to break the law average and acquiesce in certain forms of crime is widespread, and the occurrence of anti-social behaviour cannot be taken to imply abnormality unless the word is used in a very special sense." It is important to note that in the opinion of the authors, the normal group will include at least 80 per cent., that psychotherapy is usually unnecessary in the treatment of the normal offenders, and also for those who do not commit further crime, that in general its application is unsuitable in cases of mental defectiveness, and in the psychoses, and that it is most likely to benefit the mentally inefficient and psychoneurotic groups. The cases dealt with were selected after very careful consideration from those submitted by the medical officers of the prisons as likely to be suitable; in general they were under 40 years of age and serving a sentence of not less than six months, for indecent exposure, homosexual, or abnormal sex crimes, certain cases of arson and other crimes considered to be due to obsession or hysterical reactions or some other remedial condition, and included as suitable were the adolescents who showed pronounced mental instability while in prison. The willing co-operation of the prisoner in the treatment was essential and the greatest caution exercised to prevent prisoners acquiesing in treatment in order to avoid work, and obtain preferential conditions. A perusal of the report makes one realise the need for extreme caution in dealing with the whole question, and avoidance of easy generalisations. Out of 406 cases seen " It should be and investigated, only 214 were approved for treatment. The report states, recognised generally that psychological treatment may be harmful if applied to certain patients, and that to ascertain its suitability, or otherwise, in any case demand* not only a knowledge of psychology but also a scientific knowledge of mental disease and of crime which is only attained after long training as a psychiatrist with experience of criminals." " After giving figures to show that the usual methods of dealing zvith offenders in this country " in a considerable are effective proportion of cases" the authors go on to say the psychological treatment of crime has suffered considerably from over-propagandisation and over-statement. Both are unfaithful servants, for they lead away from truth. A discriminating critic will ref use to accept the statement of a psychologist that a law-breaker was cured of Ins criminal IVv do not believe tendencies as the result of a recent course of psychological treatment. ' the word cure' can be properly tised in this connection until many years have lapsed. IVe shall not use the word 'cured' in this Report in connection zvith our results." .
.
.
.
.
.
.
A Table is
given (para. 69) showing the
cases
approved for
Cases approved
investigated
Borstal group (excluding sex cases) Adolescent group (excluding sex cases) Adult group (excluding sex cases) Homosexuals Exhibitionists Other sexual offenders (perversions) Offenders against women and girls Total
.
treatment as follows :?
Cases Class of Offender
.
63 41 97 79 35 41 50 406
for ...
...
...
...
...
...
...
...
treatment
29 34 27 52 23 27 22 214
MENTAL
WELFARE
57
Part II of the Report deals with Criminal behaviour and general offences and the types
most suited for psychotherapy and illustrative cases are quoted from the various groups set out above, and in Part III the same procedure is followed, and deals entirely with sexual
offences. Seventy-nine illustrative cases are described at some length, and need to be studied with great attention. It would be impossible in this short review to quote. Several of these descriptions which one reads with absorbing interest end with the words "He was not suitable for psychotherapy", or similar negative indications. Others state, "Psychotherapy in this case if as probably successful, or helpful". Other cases are quoted as being suited for special supervision in a suitable institution (such as is recommended later in the report). In connection with the treatment it is pointed out in paragraph 90 (3), that conditions of the prisoners' life in prison were sometimes altered; in some cases supervision on release was carried out by the Central Association for Mental Welfare, and further treatment was given by Dr. Hubert in the department of psychological medicine at St. Thomas's Hospital. Part IV comprises conclusions and recommendations. It is pointed out that as, at the most, any treated case can only have been out of prison four years at the time of writing the report, while the majority have been at liberty for a shorter period and some are still in prison, it is not possible to show the result of the investigation statistically. After discussing the uses of specialised psychotherapy and the psychiatric approach, the authors strongly recommend (para. 164) a special institution for the care, study and treatment of a group? " selected under expert supervision?and would include cases suitable for : (1) psychotherapy combined with more measures general of psychiatric treatment alone, (2) psychotherapy and training or (3) the more general measures alone. The second group would consist of those cases who require observation and investigation because of the presence of features that are unusual, abnormal or the subject of special lines of research. The third group would consist of those who, for other reasons, need the care of a special institution. In general, this latter group would consist of those for whom the institution could supply an environment more suited to their individual requirements than the observation section of an ordinary prison. For example, many offenders whose sentence is preventive and others whose behaviour during sentence is very abnormal would be much more satisfactorily dealt with in such an institution than under ordinary prison conditions although no more than employment and supervision might be practicable." The authors enter a caveat against too ready recommendations for psychotherapy of an offender on bail or on probation unless made by approved medical experts and express the view that in districts where there is a prison or State Remand Home (if these are established as proposed in the Criminal Justice Bill) the Medical Officers should be available for the necessary examinations, and that "if Local Authorities generally established " psychiatric clinics and they were made available for persons on bail or probation it would be of great advantage. While this investigation has only dealt with men and youths, the experience is sufficient to justify a recommendation that a woman psychotherapeutist should be appointed to a woman's prison. At the close of the report, the need for
words
Criminological research is emphasised
in these
:? " Whilst we recommend close co-operation be maintained between the prisons and the special institution we attach much importance to any extension of the psychiatric and psychotherapeutic service to prisons and Borstal institutions being centralised as much as possible. Not only zuill this further develop, but it will promote scientific study by collecting case material together instead of allozving it to remain scattered in different centres."
The value of the Report cannot be over-emphasised, and are due.
grateful thanks
?
to
those
responsible for it ~
T ? Lucy E. Beach.
our
