Understanding and Preventing Violence, Volume 2: Biobehavioral Influences (1994)
Chapter: Psychosurgical Treatment of Violent Offenders
are considered to be suffering from a brain disorder, efforts to treat them would be instituted. Moreover, if violence is an epileptic equivalent, would not violent patients be helped with antiepileptic drugs? Although there is undoubtedly a large literature associated with this problem, we have presented only a small number of representative recent studies. ECT (Schnur et al., 1989) may be efficacious in patients with episodic dyscontrol (or Intermittent Explosive Disorder; American Psychiatric Association (1987) (Table 9).
Monroe (1975) reviews studies of the use of anticonvulsants in the treatment of episodic dyscontrol, concluding that these compounds may be a useful adjunctive treatment. Finally, two studies employ pharmacotherapy in treating the symptoms of aggressive behavior in persons with geriatric problems (De Cuyper et al., 1985) or Huntington's disease (Stewart et al., 1987).
Psychosurgical Treatment of Violent Offenders
Despite the reservations or at least the caution implied or stated by most authors concerning brain-behavior connections in this controversial field, there were three reports of surgical ablations of limbic or limbic-related structures as treatment of violent or aggressive behaviors (Sano and Mayanagi, 1988; Ramamurthi, 1988; Dieckmann, 1988; see Table 10). All involve stereotaxic lesions in the medial hypothalamus (or amygdala, in the case of Ramamurthi). The persons on whom the surgery is performed are violent/aggressive cases (Sano and Mayanagi, 1988; Ramamurthi, 1988) or "sexual delinquents" (Dieckmann, 1988). In addition to the forthright surgical approach, these studies are notable in that they often target young subjects (many of Sano and Mayanagi's cases were under 15 as were most of Ramamurthi's). The numbers of cases reported varied from 14 (Dieckmann et al.) through more than 600 (Ramamurthi); the reports were all favorable, although the follow-up varied in quality. Independent assessments of outcome, as well as untreated control groups, were absent from these reports.
It is difficult to assess these reports, not only for the reasons stated, but because the criteria for assessing or diagnosing violent or aggressive behavior may differ in Japan (Sano and Mayanagi, 1988) and India (Ramamurthi, 1988) from those used in the United States. It is not clear that violence and aggression have unambiguous cross-cultural meaning. What for instance, is the Western equivalent of "wandering tendency," one of the criteria used by Ramamurthi in selecting candidates for surgical therapy? The
