Motivated with the case of repeated severe criminal deed of murder, with cases showing similar main features, we describe the case of a patient suffering from alcoholism, with mental, somatic and social complications. The reason for choosing this case was its educational value, due to the repetition of criminal deed of murder with complicated psychodynamic explanation. Through the description of the case, the question arises if we ourselves contribute to the repeating of criminal deed if we do not pay enough attention to it, considering the understanding of its psychopathology and treatment planning.
The main question that arises is: "Who can endanger the security of other people according to the Law concerning the protection of people with mental problems (Zakon o zastiti osoba s dusevnim smetnjama - ZZODS)" According to ZZODS, article 44, a person who was unaccountable at the time of criminal deed will not be released, but the compulsory detention in psychiatric institution will be commanded.1
There is no doubt that consumption of alcohol and alcoholism contributes to the incidence of criminal deeds and increase of violence.2,3 In numerous studies, it has been proved that alcohol leads towards the release of aggressive impulses, crossing over the border of violence and increase of aggression, especially if the person has been set off with something.4 In Russia, the consumption of alcohol is among the highest in the world, so the incidence of homicide is also five times greater compared to USA (the country with highest rate of homicide among the western countries), and two thirds of the perpetrators of criminal deeds have been intoxicated with alcohol at the time of the deed.5
The greatest risk for committing the criminal deeds in persons with mental disturbances exists among the addicts, who frequently also have a co-morbid personality disorder.3,4,6-10,15 In a Swedish study of homicide perpetrators, it has been found that 90% of the perpetrators have some of the mental disturbances, most frequently, in 50% of the cases, addiction (alcohol, drugs) and personality disorder (antisocial, borderline, narcissistic and passive-dependent).9 Each of these disturbances itself carries a risk of violence, while in combination, the risk becomes increased 8-18 times compared to the healthy population.4 Similar has been determined by other studies.12,15
Violent behaviour is defined as an obvious and intentional physically aggressive behaviour aimed against the other person, like hitting, slapping, pushing, choking, throwing things, threatening with weapons, forcing the sexual intercourse, raping, murder, robbery and assault.10 The relation between the perpetrators of violence, i.e. murder and the victim shows that most victims have been killed by the persons they knew, in most cases their intimate partners.11-14 One quarter of the women were killed by their intimate partners and the murder had been preceded with an argument. The risk for the murder of women is particularly high if the partner is strictly-controlling, unemployed, previously convicted, addict and the woman expresses the wish to end their relationship.11,12
We described a patient who has done two very similar murders of his intimate partners in the state of alcohol intoxication. After the first murder, he has been convicted and sentenced to prison, while after the second murder, besides the prison penalty, a security measure of compulsory psychiatric treatment in penal conditions has also been commanded.
The subject has been born in the family of peasants who occasionally consumed alcohol. He was the second child in the family with three children. Psychiatric heredity was negative. His early psychomotor development was normal. He has finished five grades of primary school with success described as "sufficient", repeating the first and the second grade. He has not continued his education, because his parents had enough land, so he continued to work in agriculture. …