Criminal Behaviors. Impacts Tools and So

CRIMINAL
BEHAVIORS
Impacts, Tools and Social
Networks
Selection of Papers Presented at the
II^ International Congress of the Advanced
High School of Criminological Sciences.
2013 | MILAN | ITALY
Puccia, Puccia, Tosi (eds.)

FDE INSTITUTE PRESS
2
edited by
ANGELO PUCCIA
GABRIELE PUCCIA
MARZIA TOSI
CRIMINAL
BEHAVIORS
Impacts, Tools and Social Networks
FDE INSTITUTE PRESS®

MANTOVA 2014
4
Publisher
FDE Institute Press®
Via Sandro Pertini n. 6
46100 Mantova – Loc. Colle Aperto| Italy
Phone: +39.0376.415683
Fax: +39.0376.413135
E-Mail: crimen@istitutofde.it
Editing
Press UP - Varigrafica Alto Lazio S.A.S.
Di Massimo Adario e C.
Via Amerina - 01036 Nepi (VT)
Copyright © 2014
All rights reserved.
It is prohibited the partial reproduction of text and
illustrations.
People interested in FDE Institute Press® can consult

the website: www.istitutofde.it
CRIMINAL BEHAVIORS
Impacts, Tools and Social Networks
Selection of Papers Presented at the II^ International
Congress of the Advanced High School of Criminological
Sciences.
ISBN (softcover)
978-88-9737-805-1
All rights reserved. No part of this publication may be

reproduced, stored in retrivial system, or transmitted in
any form or any means, electronic, mechanical,
photocopying, recording or otherwise, without prior
written permission of the publisher. Whilist the authors,
editors and publisher have tried to ensure the accurancy
of this publication, the publisher, authors and editors
connot accept responsibility for any errors, omissions,
misstatements, or mistakes and accept no responsibility
for the use of the informationpresented in this work.
© FDE Institute Press 2014

7
TABLE OF CONTENTS
Foreword, by Angelo Puccia………………………………………….11
Welcome from the Honorary of the Congress

CRINVE 2013, by Robert D. Hare…………………………………15
Neuroscience and Penal Trial, by Lorenzo Algeri…..17
Aggressive Behaviour in Psychopathy: a

Neurocognitive Perspective, by Stefano Barlati……49
The Evaluation of Personality Disorders in the

Context of Italian Juvenile Criminal Justice: a
Criminological Analysis, by Raffaele Bianchetti…….141
The Cosmologies of Violence. A Radical

Interactionist Approch, by Adolfo Ceretti, Lorenzo
Natali……………………………………………………………………………..207
Observations on Criminal Versatility Start From

the Clinical Experience at the Intensified
8
Treatment Unit for Authors of Sexual Crime (at

the Milano-Bollate Prison), by Luigi Colombo…....243
Offender Mental Health Developments in

England and Wales: Nothing Endures but
Change, by Andrew Forrester……………………………………..259
Treatment for Sex Offenders in Prison. The

Experience of the Intensified Treatment Unit in
Milano-Bollate Prison, by Paolo Giulini, Laura
Emiletti…………………………………………………………………………...291
Two Philosophical Questions About

Psychopathy, by Luca Malatesti, John McMillan.........315
Personological Features Of White Collar Crime:

Theoretical Backgrounds Of Assessment
Projects, by Isabella Merzagora Betsos, Ambrogio
Pennati, Guido Vittorio Travaini..........................................339
The “Sound” Dimension in Satanic Crimes: an

History of the Infamous “Track”, by Giovan
Battista Ivan Polichetti…………………………………………………..357
9
Neurobiology and Psychodynamics in

Cannibalism: From Mythic Anthropophagus to
Infamous Serial Killer, by Giovan Battista Ivan
Polichetti...................................................................................367
Women in Prison in Italy, by Luisa Ravagnani,

Nicoletta Policek…………………………………………………………….377
Emilia Romagna Guidance on Severe

Personality Disorders, by Michele Sanza……………...411
Treatment of Mentally Ill Offenders Not Guilty

by Reason of Insanity (NGRI) , by Franco Scarpa,
Benedetta Vittoria, Tommasa Agueci…………………………..423
Vulnerability Factor and Infant Traumas in Drug

Addiction. A Psychotherapeutic Group Model
Inside a Penitentiary, by Alessandra Stringi………....437
Imprisoned Motherhood. From Law to Good

Practices, by Marzia Tosi…………………………………………...463
Efficacy Measurement in Penitentiary

Treatment: a Methodology to Meet the
10
Requirements of Current Legislation, by Gian

Piero Turchi, Pinto Eleonora, Anna Girardi, Luisa
Orrù...........................................................................................479
Remembering and Lying in Relation to Crime:

Clinical and Research Implications, by Stefano
Zago, Manuela Fumagalli, Silvia Inglese, Irene Rossetti,
Giuseppe Sartori, Alberto Priori, Andrea Lavazza………...521
FDE Institute of Criminology Mantua……………….565

Angelo Puccia
11
Foreword
Angelo Puccia1
After the first edition in Mantua (2010), FDE

Instutite of Criminology in the 2013 (May, 10-12)
launched in Milan its II^ International Congress
“CRIMINAL BEHAVIORS. Impacts, Tools and Social
Networks”.
Three days conference that had the pleasure to
have Robert D. Hare, Emeritus Professor of
Psychology, University of British Columbia, as
Honorary President (CRINVE 2013). He delighted the
more than 250 participants with a wornderful
opening lectio magistralis on psychopathy construct,
and after this, he gave us further magnific
testimonials about his long research based experience.
More than 70 speeches alternated during that
full-immersion week-end. Plenary sessions with
keynote speakers like Stefan Bogaerts (Tilburg
University), Julia Davidson and Antonia Bifulco
(Kingston University London), Andrew Forrester
(King’s College London), Vittoria Ardino (London
School of Economics), Nuria Querol (Gevha
1
Executive Coordinator, FDE Institute of Criminology of Mantova.
Foreword
12
Barcelona) just to list the European ones. From Italy

important contributions came from the Italian Society
of Criminology, that we thank for its sponsorship,
especially professors Isabella Merzagora Betsos,
Adolfo Ceretti and Carlo Alberto Romano for their
sincere support. Another particular thanksgiving is
due to Vincenzo Caretti (President of PCL-R Italy)
and all his colleagues from Enna, Palermo and Rome
Universities.
Criminal behaviors linked to personality
disorders, like psychopathy or antisocial personality
disorder, are a serious problems for our modern
society in terms of assessment and treatment as well
as for victims safeguard. Many studies are been
conducted by researchers from criminological,
psychological and psychiatric fields on how to better
assess and manage offenders with severe personality
disorders.
The manuscript, as the congress as well,
proposes to academics and practitioners interesting
research and theorethical papers written by some of
the most important speakers presenting in Milan.
I will not singularly intorduce articles hosted
within the volume, I prefer you will go deep inside all
of them in order to appreciate contents and authors’
ideas represented.
As Genaral Coordinator of the Scientific
Programme Committee, I was privileged to be able to
edit this collection, even if it took me and my
assistants Gabriele Puccia and Marzia Tosi a long
Angelo Puccia
13
time to be ready. For me it meant to work closely with

so many serious and high level scientists.
Without the help of the two colleagues
mentioned above and many others such as Stefano
Barlati, Anthony J. Pinizzotto, Giuseppe Sandri, Luigi
Caracciolo, Mauro Bardi, Alessandra Morselli,
Corrado Benatti, Elisa Corbari, Ilaria Squinzani, the
congress, as well as this book, would have not been
possible. I am deeply indebted with my director and
wife Francesca Savazzi. I am grateful for her reliable
and efficient support and the encouragement during
the year of preparation of the congress and during the
most of the work in the Institute of Criminology of
Mantova.
Mantova, 19th December 2014

14
Robert D. Hare
15
Welcome from the Honorary of the

Congress CRINVE 2013
Robert D. Hare1
I had the good fortune of being named

Honorary President of the 2nd International Congress
of Criminological Sciences: "Criminal Behaviours.
Impacts, Tools and Social Networks," organized by
the Advanced High School of Criminological Sciences
at the FDE Institute of Mantova.
The Congress will bring together researchers,
clinicians, mental health, criminal justice and human
resources personnel, and interested members of the
public, to learn about and to discuss the latest theory
and research on antisociality and psychopathy and
their impact on society.
Besides having distinguished speakers and an
excellent program, the Congress will be unique in its
breadth and depth.
1
Emeritus Professor of Psychology, University of British Columbia. Author of
the PCL-R (Psychopathy Check-List – Revised). President of Darkstone
Research Group Ltd.
Welcome from the Honorary of the Congress CRINVE 2013
16
That is, it will address recent advances in

which integration of behavioural genetics,
developmental psychopathology, assessment,
treatment, victimology, neuroscience, and lessons
from clinical practice, the corporate world, and the
legal system helps us to understand and deal with
antisociality and psychopathic traits in both criminal
and noncriminal contexts.
The goal of the organizers is not only to
provide a forum for discussing these advances, but to
foster interdisciplinary and international
collaborative research on understanding and
reducing the consequences to society of antisocial and
psychopathic behaviour.
On behalf of Angelo Puccia, Coordinator of
the Congress, and the members of the Supervisory
Committee, I would like to invite all those with an
interest in the topics and goals of the Congress to join
us on May 10-12, 2013.
What could be better than an important and
interesting scientific meeting that also has practical
implications for society, is located in the wonderful
city of Milan, is accompanied by renowned Italian
hospitality, food and wine, and that offers many
opportunities for research and social interactions with
other participants.
Lorenzo Algeri
17
Neuroscience and Penal Trial
Lorenzo Algeri1
1. Neuroscience: Introductory Considerations
Issues concerning the use of scientific evidence

in criminal trials are extremely relevant today2. In
1
Ph.D | Criminal Lawyer and Expert in Investigative Psychology and
Professor confirmed at the University of Florence.
2
See, F. CAPRIOLI, La scienza “cattiva maestra”: le insidie della prova
scientifica nel processo penale, in Cass. pen., 2008, 3521; Id., Scientific
evidence e logiche del probabile nel processo per il “delitto di Cogne”, ivi,
2009, 1867; C. CONTI, Evoluzione della scienza e ruolo degli esperti nel
processo penale, in Aa.Vv., Medicina e diritto penale, a cura di S.
Canestrari-F. Giunta-R. Guerrini-Padovani, Pisa, 2009, 335-358; EAD., Il
processo si apre alla scienza: considerazioni sul procedimento probatorio
e sul giudizio di revisione, in Riv. it. dir. proc. pen., 2010, pp. 1210; Ead.,
Iudex peritus peritorum e ruolo degli esperti nel processo penale, in Dir.
pen. e proc., Dossier La prova scientifica nel processo penale, a cura di P.
Tonini, 2008, pp. 29-36; P. FERRUA, Metodo scientifico e processo penale,
in Dir. pen. proc., DOSSIER La prova scientifica nel processo penale, a cura
di P. Tonini, Milano, 2008, 17 ff.; D. PULITANO’, Il diritto penale fra vincoli
di realtà e sapere scientifico, in Riv. it. dir. proc. pen., 2006, 802 ff.; G.
UBERTIS, Sistema di procedura penale, I, Princìpi generali, 2a ed., Torino,
2007, 44; P. TONINI, La prova scientifica, in Trattato di procedura penale,
diretto da G. Spangher, vol. II, t. 1, Torino, 2009, 88; Id., Dalla perizia “prova
neutra” al contraddittorio sulla scienza, in Dir. pen. proc., n. 3/2011, 360 ff.
18
recent years we have witnessed a remarkable

development in the neurosciences, which, by
studying the link between brain and human behavior
have brought useful contributions not only in science
but also in the legal field3.
2. The Concept of Insanity According to the

Judgments of the Court of Cassation
The verification of a state of insanity, in order

to evaluate if the subject is imputable or not,
underlies a dispute between legal and scientific laws.
3
On the subject, without limitation, S. BARLATI, La rilevanza delle
neuroscienze in campo forense. L’impatto delle tecniche di neuroimaging
e della genetica comportamentale sul diritto, in Crimen et delictum,
International Journal of Criminological and Investigative Sciences, 2011, p.
56; A. BIANCHI, G. GULOTTA, G. SARTORI, Manuale di neuroscienze
forensi, Giuffrè, Milano, 2009; F. CASASOLE, Neuroscienze, genetica
comportamentale e processo penale, in Dir. pen. proc., n. 1/2012, 110; M.T.
COLLICA, Il riconoscimento del ruolo delle neuroscienze nel giudizio di
imputabilità, in www.penanalecontemporaneo.it, pp. 8 ff.; E. R. KANDEL, J.
H. SCHWARTZ, T. M. JESSELL, Principi di neuroscienze, Casa Editrice
Ambrosiana, Milano, 2003; A. LAVAZZA, L. SAMMICHELI, Il delitto del
cervello, Codice edizioni, Torino, 2012; I. Merzagora Betsos, Il colpevole è il
cervello: imputabilità, neuroscienze, libero arbitrio: dalla teorizzazione alla
realtà, in Riv. it. med. leg. 2011, 175; A. SANTOSUOSSO, Diritto, scienza,
nuove tecnologie, Cedam, Padova, 2011, 218 ff.; A. Stracciari, A. Bianchi, G.
Sartori, Neuropsicologia forense, Il Mulino, Bologna, 2010, pp. 49 ff.;
Sartori, Rigoni, Mechelli, Pietrini, Neuroscienze, libero arbitrio, imputabilità,
in Aa.Vv., Psichiatria forense, criminologia ed etica psichiatrica, a cura di
Volterra, Masson, Milano, 2010, 36 ff.
Lorenzo Algeri
19
In the past, in regards to the concept of

insanity, referred to in Article 88 of the italian penal
code, there were two opposing factions in the
Supreme Court of Cassation: medical and legal
orientation4.
According to the medical orientation the
criminally relevant concept of insanity should be
entirely deduced from medical science, assigning the
importance strictly to mental diseases only.
The extreme interpretation of this reading
affirms that only mental disease derived from organic
or biological sources may be penally relevant.
From this perspective, identifying the organic
cause would enable the placement of the mental
disease into the nosographic classification, developed
by the psychiatric sciences and forensic psychology.
In so doing, identification and interpretation of these
diseases would become easier5.
According to a different reconstruction of the
legal orientation, reference to the nosographic
4
See, for further information, G. PAVAN, L’imputabilità è presupposto della
colpevolezza: considerazioni in ordine al rapporto tra la scelta dogmatica
operata da SS. UU. 25. 1. 2005 n. 9163 e l’estensione dell’infermità ai gravi
disturbi della personalità, in Ind. pen., 2008, p. 308; ID., Sui rapporti fra
disciplina dell’imputabilità e nosografia psichiatrica, Riv. It. med leg., 2003,
p. 659; ma anche T. BANDINI E G. ROCCA, La psichiatria forense e il “vizio di
mente”: criticità attuali e prospettive metodologiche, cit., p. 417.
5
See in this respect, Cass. pen., Sez VI, n. 26614 del 2003, in Riv. pen.,
2004.
20
classification is not enough. It is necessary to

determine the real impact of a mental disease on one's
ability to stand trial6 .
The solution to the age-old debate came only
in 2005 when the [united sections of the court of
Cassation] expressly called upon to settle the dispute
between the two factions, developed and specified
some of the conclusions which were expressed by the
legal orientation, disavowing in this manner, the
radical approach to the medical orientation7.
According to the interpretation of the [united
sections of the court of Cassation],for the purposes of
the applicability of the Articles 88 and 89 of the penal
6
With reference to these topics, see the contributions of G. FIDELBO, Le
Sezioni Unite riconoscono rilevanza ai disturbi della personalità, in Cass.
pen., 2005, p. 1873; PAVAN G., Sui rapporti fra disciplina dell’imputabilità e
nosografia psichiatrica, cit., p. 659.
7
This is the judgment Cass. pen., Sez. un., 8 marzo 2005 (u.p. 25 gennaio
2005), n. 9163, in Dir. pen. proc., 2005, p. 837-853; per un commento della
sentenza si veda: M. BERTOLINO, L’infermità mentale al vaglio delle Sezioni
Unite, in Dir. pen. proc., p. 853; F. CENTONZE, L’imputabilità, il vizio di mente
e i disturbi della personalità, in Riv. It. dir. proc. pen., 2005, p. 247; G.
FIDELBO, Le Sezioni Unite riconoscono rilevanza ai disturbi della personalità,
in Cass. pen., 2005, p. 1873; FORNARI U., I disturbi gravi della personalità
rientrano nel concetto di infermità, in Cass. pen., 2006, p. 274; G. LEO, I
disturbi della personalità nel quadro delle patologie che incidono
sull’imputabilità, in Il Corriere del merito, 2005, p. 585; I. MERZAGORA
BETSOS, I nomi e le cose, in Riv. It. Med. Leg., 2005, p. 403; PAVAN G.,
L’imputabilità è presupposto della colpevolezza: considerazioni in ordine
al rapporto tra la scelta dogmatica operata da SS. UU. 25. 1. 2005 n. 9163 e
l’estensione dell’infermità ai gravi disturbi della personalità, in Ind. pen.,
2008, p. 308.
Lorenzo Algeri
21
code, the concept of disability also includes severe

personality disorders, like neurosis or psychopathy,
provided that the court verifies the consistency,
intensity, importance and seriousness, so as to affect
concretely on the ability of discernment8.
That conclusion has represented a
fundamental turning point about the determination of
the scope of insanity, putting an end to disagreements
which had, until that time, characterized the legal
judgments on the subject.
The court, with the function of ensuring a
uniform interpretation of the law, has implemented
the latest conception of multi-type bio-psycho-social
mental disorder by issuing a judgment that is
especially characterized by a deep scientific
investigation.
Current psychiatric science uses a "circular
model" to illustrate the various causes of mental
illness. These include both biological and non
biological factors9, albeit with possible diversity of
incidence depending on the circumstances. Mental
disorders, with some exceptions, are therefore, multi-
determined.
8
That decision specifies that the notion of infirmity has a more general
meaning than the concept of mental disease and, therefore, is suitable to
include both physical ailments and those of psychological origin.
9
Psychological, situational, socio-cultural and cross-cultural factors can
therefore also be relevant. Per tutti, U. FORNARI, Temperamento, delitto e
follia, in Riv. it. med. leg., 2001, p. 521.
22
3. The Use of Neuroscience in Criminal

Proceedings: the Judgment of the Capacity
of Discernment
In criminal proceedings these studies have

proved useful for the judgment of imputability and
the determination of the penalty in practice,
particularly since the united sections of court of
cassation, in 2005, have expanded the non-
imputability scope to include the personality
disorders in the concept of mental infirmity10.
10
Cass., Sez. Un., 25 january 2005, n° 9163, Raso, in Cass. Pen., 2005, 1851,
with notes of FIDELBO, “Le Sezioni Unite riconoscono rilevanza ai disturbi
della personalità”; in Dir. pen. proc., 2005, 7, pp. 119 ff., con nota di M.
BERTOLINO, Commento alla sentenza delle Sezioni Unite n. 9163, in Riv. It.
Dir. e proc. pen., 2005, 394, con nota di COLLICA, “Anche i disturbi della
personalità sono infermità mentali”. The united sections stated that in
order to recognize full or partial infirmity, even "personality disorders",
which are not always classified on narrow circle of mental disorders, may
fall within the concept of "infirmity", provided that they are substantial,
intense and serious to concretely affect the capacity of understanding and
will, excluding it or decreasing it greatly, and provided that there is an
etiological connection with the criminal conduct, as a result of which the
offense is deemed causally determined by the mental disorder. It follows
that other character anomalies or personality disorders, which do not
show the traits mentioned above, should have no relevance for the
purposes of imputability.
Similarly we consider passional and emotional states, unless they fit,
exceptionally, in a broader framework of illness.
Lorenzo Algeri
23
In this regard, studying the functional

exploration of the brain is of great interest,
that is, the relationship between brain and
behavior and, in particular, between the brain and the
control of aggressive and antisocial impulses.
Long before functional exploration techniques
were available, the observation of some clinical cases
had already indicated the close link between the
frontal lobes of the one part and behavior, including
aggressiveness, of the other.11
The earliest evidence can be traced back to the
nineteenth century, precisely to the famous case of
U.S. miner Phineas Gage, who was described by the
doctor John Harlow in the 1848.
Phineas Gage was a 25 years old foreman who
was involved in a serious accident while he was
working on the construction of a railroad in New
England. While he was squeezing some explosive
powder into a hole to create an explosion in the
ground , he mistakenly touched a rock with the
tamping iron and caused an unexpected explosion.
Gage, incredibly, survived and recovered his
cognitive functions rapidly. However, according to
his coworkers, Gage was no longer himself.
11
Così P. PIETRINI E V. BAMBINI, Homo ferox: il contributo delle neuroscienze
alla comprensione dei comportamenti aggressivi e criminali, in G. GULOTTA,
A. BIANCHI, G. SARTORI, a cura di, Manuale di neuroscienze forensi, Milano,
2009, p. 49.
24
Before the accident he was considered a

cooperative and mild worker but after he recovered
from the acute injury and returned apparently
normal, he exhibited a totally changed personality.
After the accident, he became irreverent, unruly,
vulgar, intolerant, obstinate and capricious, so much
so as to be fired.
No autopsy was made after his death, but his
skull and the piece of iron were kept at the Harvard
Medical School. Recently, Hanna and Damasio of the
'University of Iowa, have resumed investigating the
case using the measurements of Gage's skull and
neuroimmaging techniques to assess the injuries of his
brain: the bar had greatly damaged the cortex of both
hemispheres, especially the frontal lobe. This injury
was the reason that caused the change in behavior
and personality of the man, who had regressed to
become like a child; rude and capricious with a
significant amplification of emotions. That, in light of
the acquisitions of neuroscience indicates that the
cerebral cortex of the frontal lobe plays an important
role in regulating emotional expressiveness12.
Neuroscientific research tools consist of the
techniques of morphological and functional brain
exploration, so-called neuroimaging or brain imaging
12
H. DAMASIO, T. GRABOWSKI, A. GALABURDA, A. R. DAMASIO, The return of
Phineas Gage: Clues about the brain from the skull of famous patient, in
Science, 1994, p. 1102 ff.
Lorenzo Algeri
25
technique13. The methodologies of neuroimaging

reconstruct the structure and function of the brain,in
three dimensions producing, through calculations
processed by a computer, the so-called
"neuroimages". These represent a development of X-
rays through the techniques of imaging and
tomographic techniques, which allow a three-
dimensional reconstruction of the human organ. The
most used techniques are: the electroencephalogram
(EEG), magnetic resonance imaging (MRI), computed
tomography (CT), positron single photon emission
tomography (SPECT), positron emission tomography
(PET). These tools have allowed a detailed knowledge
of the functioning of the nervous system.
A remarkable development in the study of
Functional Magnetic resonace Imaging (fMRI) has
been made in recent years. The technique of fMRI
allows us to locate which areas of the brain are
activated during cognitive tasks, such as recognition
of faces and the evocation of images.
Advances in neuroscience have reopened the
debate between two antithetical philosophical
positions: free will and determinism. We wonder if
the human being is free to determine and to perform
actions for which it is responsible, or whether, on the
13
E. R. KANDEL, J. H. SCHWARTZ, T. M. JESSELL, Principi di neuroscienze,
cit., 363 ff.; M. F. BEAR, B. W. CONNORS, M. A. PARADISO, Neuroscienze.
Esplorando il cervello, cit., 180 ff.
26
contrary, human behavior is determined by the

neural brain circuits. Recent experiments indicate the
existence of specific brain circuits that govern the
control and inhibition of aggressive impulses, circuits
crucially involving, regions located in the frontal
lobes. On this basis, it has been suggested that
precisely these circuits may be compromised in
certain criminals, this hypothesis is supported by the
observation that appreciable morphological and
functional differences exist between the brains of
"normal people" and those of criminals14.
4. Behavioral Genetics
Very recent studies have shown that the

presence of certain alleles of genes involved in the
metabolism of neurotransmitters (such as the MAOA)
may be associated with a significantly increased risk
of developing antisocial behaviors and committing
14
It is necessary that these neuroscientific methods are used in the trial
only where supported by shared and solid scientific basis, achieved
through methodologically correct research,replicated and published in
international magazines,recognized by the entire scientific community and
there must also be a clear and rigorous regulatory framework, about the
application procedures in the forensic field. See S. BARLATI, La rilevanza
delle neuroscienze in campo forense. L’impatto delle tecniche di
neuroimaging e della genetica comportamentale sul diritto, in Crimen et
delictum, International Journal of Criminological and Investigative
Sciences, 2011, p. 56 ff.
Lorenzo Algeri
27
criminal acts.
While certain techniques have made it
possible to identify, the likely perpetrator of the
crime,on the basis of DNA, on the other hand, we
start to understand the relationship between genetic
inheritance and specific personality traits. This subject
is called behavioral genetics and studies the
connection between the influence of one's genetic
profile and one's behavior15.
Studies of the genetic basis of the behavior
carried out through molecular genetics, have shown
that the evolutionary diversity of each individual
finds its origin in the DNA. It is the combination of
different genes that determine the phenotypic
variation that we all know, the facial features, eye
color, height and so on.
The experts agree about a distinction between
causative genes and susceptibility genes, which turns
out to be one of the cornerstones of genetic study The
first ones are genes which, if present, inevitably lead
to the development of the pathology associated with
them, as in the case of some forms of Alzheimer's
15
Così S. Pellegrini, Il ruolo dei fattori genetici nella modulazione del
comportamento: le nuove acquisizioni della biologia molecolare genetica,
in A. Bianchi, G. Gullotta, G. Sartori, Manuale di neuroscienze forensi,
Milano, 2009, p. 69 ff.; See also, A. Forza, Le Neuroscienze entrano nel
diritto penale, in Rivista Penale, 2010, pag. 75 ff.
28
disease16. In the case of susceptibility genes, instead, a

particular allelic variant does not mean that a person
certainly develops the related disease, but it does
mean that the same is more likely to be affected. We
talk, in such circumstances, about a greater "genetic
vulnerability".
The distinction between the two cases, is, then,
clear: in the first case we speak in terms of certainty of
the development of the disease, in the second case in
terms of probability. A specific susceptibility gene is
not the necessary cause of the manifestation of the
disease. The question is whether behavioral genetics
can provide valuable information in a criminal trial. It
is undeniable,that like any other organ in the human
body, even the brain and its development depend, to
some extent, on DNA. It is necessary to clarify
immediately, that genes are not the only ones that
contribute to the cerebral development. Other factors
such as environment, culture and food also influence
cerebral development.
Having affirmed, therefore, that we are not
just our genes, but something much more complex, it
is necessary, however, to take note of the latest
findings of molecular biology. As there are the factors
16
Così S. Pellegrini, Il ruolo dei fattori genetici nella modulazione del
comportamento: le nuove
acquisizioni della biologia molecolare genetica, in A. Bianchi, G. Gullotta,
G. Sartori, Manuale di neuroscienze forensi, Milano, 2009, p. 74 ff .
Lorenzo Algeri
29
that determine our eye color, there are also genes that
may affect our personality and our behavior.
In light of this, it can be argued that if an
individual has, mutations in its genetics, that cause a
susceptibility gene, he has a greater chance of
developing violent behavior,if during its existence,
and especially during the child has been exposed to
stressful events, such as a violent context, family
abuse.
Among the genetic mutations that is
connected to the risk of developing violent behavior,
the best known hypothesis is the case of an anomaly
in that gene involved in the codification of
monoamine oxidase A (MAOA), the principal
enzyme responsible for the metabolism of
catecholamines, molecules that act as
neurotransmitters in the nervous system.
In the early 90s, studies were conducted on
males of a Dutch family, infamous for their violent
behavior and their history of criminality. Geneticists
had noted an extremely rare genetic mutation in the
gene MAOA, which completely inhibited it. Unable,
therefore, to produce the enzyme MAOA, the men of
the family (since that gene is located on chromosome
X) would have been conditioned to behave in an
aggressive and violent manner.This finding should
not lead to erroneous conclusions:it is a very serious
genetic variation, but also very rare. However, this
revelation has prompted scientists to conduct further
empirical investigations in this direction.Their efforts,
today, appear to be rewarded.
30
It is, in fact, found that there are four allelic

variants of this gene:two that determine a more
efficient enzymatic activity of the gene, and two
variants, which, however, have a reduced and low
efficiency enzyme (MAOA-L). The interesting aspect
is the fact that, in both envisaged cases, the subjects
have little tendency to develop violent behavior, if
brought up in a family and cultural environment not
marked by violence, abuse, and/or oppression.If this
trend persists even in those individuals who have a
history of family violence and have a high enzymatic
activity, this is not equally true for those individuals
who have a low enzyme activity and did not grow up
in a healthy, protective environment.
Using brain imaging techniques, some
anatomical and functional differences in some areas
of the brain were also found, as if genetic
polymorphisms were able to affect and condition
developments of neural circuits in the brain17.
In two recent judgments of 2009 and 2011, the
first section of the Court of Assizes of Appeal of
Trieste and the second of the court of Como, the
degree of insanity of the indicted has been assessed
17
See in this respect: P. Pietrini, G. Sartori, Come evolve il ruolo della
perizia psichiatrica alla luce
dell’acquisizione delle neuroscienze, in Guida dir., focus online,
www.guidaaldiritto.ilsole24ore.com, anno I, n. 8 july 2011.
Lorenzo Algeri
31
on the basis of psychiatric examinations, in which

certain neuroscientific techniques have been used18.
18
C. Assise di Appello di Trieste, 18 settembre 2009, n. 5, in Riv. pen.,
2010, 70 ff,. With notes of A. Forza, Le neuroscienze entrano nel processo
penale. Gip Como, 20.05.2011, in Guida al diritto (on line), 30 agosto 2011,
with notes of MACIOCCHI, Gip di Como: le neuroscienze entrano e
vincono in tribunale. For a review of the judgment, see also F. CASASOLE,
Neuroscienze, genetica comportamentale e processo penale, cit., 110 ff.; G.
MESSINA, Il contributo delle neuroscienze nel giudizio sull'imputabilità, on
Il corriere del merito, n. 1/12. The case of Trieste was about a murder
committed by an Algerian, for some time under the care of the Mental
Health Centre, against a Colombian,in reaction to the fact that he mistook
the Colombian for the perpetrator of a previous aggression. The Court of
First Instance had ordered the psychiatric evaluation which reported the
total inability of the subject. This assessment was shared by the technical
consultant of the defense, while it was overruled by the consultant of the
Public Prosecutor, who believed that the ability of discernment of the
accused was only decreased.The judge agreed the observations of the
Public Prosecutions consultant, reducing the penalty pursuant to art. 89,
though not of the maximum.
In the second instance judges of the Court of Assizes of Appeal had
appointed two well-known academic experts in neuroscience.
The Court on that occasion adopted the conclusions of two experts
showing appreciation for the completeness of the investigation and
instrumental techniques utilized.
Particular consideration has been given to the search for genetic
investigations aimed at seeking significant genetic polymorphisms in the
defendant such as to modulate the environmental reactions ,especially
given the exposure to stressful events. In light of such evidence, the judges
decided for the partial infirmity, by applying, this time, the maximum
reduction of the penalty by one third.
In the case of Como, in 2009, in Cirimido (Como), Stefania Albertani killed
her older sister,segregating her in the house and forcing her to take drugs
in doses which caused death. Then she set fire to the corpse. Suspected in
the disappearance of her sister and kept under surveilance by the police,
32
5. Psychopathy and Neuroscience
The case of a psychopathic subject offers the

possibility to verify whether the results of
neuroscience are suitable when it comes to supplying
an explanation regarding the imputability of a person
with this disease19.
during an argument with her mother, she tried to strangle her with a
belt.The arrival of the police saved the mother and led to the arrest of
Stefania.
Later a complex criminal design emerged, in which the defendant was
charged for the kidnapping and murder of her sister. The murder was
preceded by the administration of benzodiazepines, which led the victim
into a state of mental confusion and reactive inability. In addition, she was
charged for suppression and destruction of corpses, and for illicit use of
credit cards belonging to her sister. She was also charged for having
caused a state of mental incapacity in her father by administering drugs to
him , which resulted in hospitalization, attempted homicide of both
parents, having tried to blow their car up and for attempted homicide of
her mother by strangulation.
The Judge for Preliminary Investigations, Luisa Lo Gatto, sentenced
Stefania to twenty years in prison, acknowledging a partial infirmity due to
"alterations" in "an area of the brain that has the function" of controlling
"aggressive actions" and, from the genetic point of view, factors
"significantly associated with an increased risk of impulsive, aggressive and
violent behavior".The decision was supported not only by traditional
psychiatric assessments, but also by neuroscientific analysis that revealed
the morphology of the brain and the genetic heritage of the defendant.
19
It should be noted that the Diagnostic and Statistical Manual of Mental
Disorders (DSM IV) does not contain a definition of psychopathy, but it
contains one related to antisocial personality disorder, whose
Lorenzo Algeri
33
The main characteristic of psychopathy is

related to having anti-social or morally reprehensible
behavior, or rather, to committing crimes with no
apparent sense of guilt, shame or remorse.
Specific elements of the psychopathic
personality are defined and grouped into four
categories: 1 - The interpersonal context (superficial
charm, manipulation capabilities of others,
pathological lying, high self-esteem); 2 - The affective
characterization has strong similarities with the classic descriptions of

psychopathic personality
The first significant scientific studies on the subject date back to the first
half of the last century. See in this respect K. SCHNEIDER, Die
psychopathischen Personlichkeiten, 1923 [trad. ingl. Psychopatic
Personalities, Cassell, London, 1958]; H. M. CLECKLEY, The Mask of Sanity:
An Attempt to Clarify Some Issues about the So-Called Psychopathic
Personality, C.V. Mosby, St. Louis, 1941. Currently, the greatest scholar of
psychopathy is Robert Hare. Among his works, the following are
fundamental: R. HARE, The Hare Psychopathy Checklist-Revised (PCL-R),
Multi.Health Systems, Toronto, 1991; ID., Without Conscience: The
Disturbing World of Psychopaths Among Us, Pocket Books, New York,
1993; R. HARE, C. S. NEUMANN, Psychopathy: Assessment and Forensic
Implications, in L. Malatesti e J. McMillan (a cura di), Responsibility and
Psychopathy, Oxford University Press, Oxford, 2010. With regard to the
research in Italy, see V. CARETTI, G. CAPRARO, La personalità psicopatica,
in “Sistemi intelligenti”, Vol. II, 2010, pp. 229-240, in which psychopathy is
defined as << deviant disorder of development, characterized by a state
of instinctual aggression and the inability to be in a relationship based on
reciprocity and on the comparability of common emotions.Psychopathy
then should be understood as a process, characterized by the continuous
interaction of emotional and behavioral factors that evolve implicitly in the
direction of a particular point of arrival: the permanent loss of human
feeling, to be in the world of humans >>
34
sphere (lack of remorse and callousness, lack of

empathy, dishonesty, failure to accept responsibility);
3 - The scope of the lifestyle (search for thrills,
impulsiveness, extreme selfishness, parasitism, lack of
realistic goals); 4 - The scope antisocial (poor
behavioral control, incidents of juvenile delinquency,
criminal versatility)20. The unifying characteristic of
the psychopathic personality seems to be the total
lack of empathy21.
The main instrument, internationally
recognized for assessing psychopathy is the
Psychopathy Checklist-Revised (PCL-R), developed
by psychiatrist Robert Hare22 .
The test consists of twenty items associated to
various characteristics of the disorder.
The factorial analysis reveals two related but
distinct elements, the first related to affective and
interpersonal aspects, the second to lifestyle and
socially deviant behavior23.
From the perspective of neuroscience, certain
20
R. HARE, Without Conscience: The Disturbing World of Psychopaths
Among Us, Pocket Books, New York, 1993, 33 ff.
21
J. R. MELOY, The Psychopathic Mind: Origins, Dynamics and Treatment,
Jason Aronson, Northvale, 1988.
22
R. HARE, The Hare Psychopathy Checklist-Revised (PCL-R), Multi.Health
Systems, Toronto, 1991.
23
The score goes from 0 to 40, the threshold for the diagnosis of
psychopathy is 30.
Lorenzo Algeri
35
features of brain structure have been highlighted in

psychopath individuals24.
There is evidence, in fact, of certain
morphometric abnormalities found on the brain
structures of the amygdala and ventromedial cortex,
which can be identified already in pre-adolescents
and adolescents with antisocial behavior and that
persist into adulthood with anomalies reported by
neuroimaging studies on the prefrontal cortex on the
superior temporal cortex, the amygdala-hippocampal
complex and the anterior cingulate cortex25 . At a
functional level, in addition, the abnormal activation
of the amygdala in individuals with antisocial
behavior is correlated with the difficulty in
24
S. BARLATI, La rilevanza delle neuroscienze in campo forense. L’impatto
delle tecniche di neuroimaging e della genetica comportamentale sul
diritto, in Crimen et delictum, International Journal of Criminological and
Investigative Sciences, 2011, p. 6 ff.
25
I. BARKATAKI, V. KUMARI, M. DAS, et al. Neural correlates of deficient
response inhibition in mentally disordered violent individuals, in
Behavioral Science and Law, 26, 2008, 51-64; I. GOETHALS, K. AUDENAERT,
F. JACOBS, et al. Brain perfusion SPECT in impulsivity related personality
disorders, in Behavioural Brain Research, 157, 2005, 187-192; Y. YANG, A.L.
GLENN, & A. RAINE, Brain anormalities in antisocial individuals:
implications for the law, in Behavioral Science and Law, 26, 2008, 65-83; R.
de OLIVEIRA-SOUZA, R., HARE, I.E. BRAMATI, et al. Psychopathy as a
disorder of the moral brain: fronto-temporo-limbic grey matter reductions
demonstrated by voxel-based morphometry, in Neuroimage, 40, 2008,
1202-1213.
36
recognizing emotions in facial expressions26;

abnormal activation of the ventromedial prefrontal
cortex correlates with difficulties in reverse learning27
and in the process of evaluation of rewards28. This
phenomenon would cause difficulties in terminating
or modifying behavior in those whose actions have
been socially punished29.
26
R.J, BLAIR, Neurocognitive models of aggression, the antisocial
personality disorders and psychopathy, in Journal of Neurology
Neurosurgery and Psychiatry, 71, 2001, 727-731; Q. DEELEY, E. DALY, S.
SURGULADZE, et al. Facial emotion processing in criminal psychopathy.
Preliminary functional magnetic resonance study, in British Journal of
Psychiatry, 189, 2006, 533-539; M. DOLAN, & R. FULLAM, Face affect
recognition deficits in personality-disordered offenders: association with
psychopathy, in Psychological Medicine, 36, 2006, 1563-1539; A.P. JONES,
A.S. FORSTER, & D SKUSE, What do you think you’re looking at?
Investigating social cognition in young offenders, in Criminal Behavior and
Mental Health, 17, 2007, 101-106; A.A. MARSH, & R.J BLAIR, Deficits in
facial affect recognition among antisocial populations: a meta analysis, in
Neuroscience and Biobehavioral Reviews, 32, 2008, 454-465.
27
E.C. FINGER, A.A. MARSH, D.G. MITCHELL, et al., Abnormal ventromedial
prefrontal cortex function in children with psychopathy traits during
reversal learning, in Archives of General Psychiatry, 65, 2008, 586-594.
28
K. RUBIA, A.B. SMITH, R. HALARI, et al., Disorder-specific dissociation of
orbitofrontal dysfunction in boys with pure conduct disorder during
reward and ventrolateral prefrontal dysfunction in boys with pure ADHD
during sustained attention, in American Journal of Psychiatry, 166, 2009,
83-94.
29
R.J. BLAIR, Neuroimaging of psychopathy and antisocial behavior: a
targeted review, in Current Psychiatry Reports, 12, 2010, 76-82.
Lorenzo Algeri
37
6. Conclusions: Neuroscientific Evidence in

Criminal Proceedings
In conclusion, the question is whether the

person with mental infirmity, whose signs are
detectable with neuroscientific methodologies must,
therefore, be considered incapable of discernment
and, therefore, not imputable.
In order to properly understand what the
boundaries of operations of neuroscientific methods
in criminal proceedings are, it is necessary to point
out that, following the teaching of the united Sections
in 2005, the judgment on imputability winds through
two steps: a first step of diagnostic type and a
subsequent step of functional type30.
First, it is necessary to determine the presence
of a mental disorder in the subject.
Secondly, one must determine whether or not
the illness has affected the individual's ability of
discernment and to what degree.
Moreover, the alteration in mental state must
exist at the time of the event.
In addition, it is necessary that the inability to
discern, depending on the infirmity, affects the
specific fact made by the subject and, therefore, the
mental disorder must also be assessed in relation to
30
M. BERTOLINO, L’infermità mentale al vaglio delle Sezioni Unite, in Dir.
pen. proc., 2005, p. 853 ff.
38
the fact of the case31. We need to identify the

etiological connection as a result of which the offense
may be considered causally determined by the mental
disorder32.
Once admitted, therefore, the abstract
relevance of "personality disorders", the court must
proceed to verify the existence of this disorder in the
individual case and the actual impact of this on the
ability of discernment of the subject.
"Personality disorders" acquire legal relevance
when it is possible to document their actual impact on
the ability of discernment in relation to the crime. In
order to assess the true incidence of the disorder and
thus to define the concept of disability we must prove
the existence of a chronological connection that must
exist between that disorder and crime itself: the first
must exist at the time when the offense was
committed.
However, the judges must determine not only
the legitimacy of the existence of a chronological
criterion, but also an etiological connection33 in
31
F. MANTOVANI, Diritto penale, Padova, 2007, 661-663.
32
Cass. pen., sez. VI, 27 ottobre 2009, n. 43285, in C.E.D. Cass., n. 245253.
33
On the need of an etiological connection still see M. BERTOLINO,
Dall’infermità di mente ai disturbi della personalità: evoluzioni e/o
involuzioni della prassi giurisprudenziale in tema di vizio di mente, in Riv.
It. Med. Leg., 2004, p. 512; T. BANDINI E G. ROCCA, La psichiatria forense e il
“vizio di mente: criticità attuali e prospettive metodologiche, cit., p. 424; G.
Lorenzo Algeri
39
relation to mental disorder and crime, in order to

assume the second is determined by the first. The
existence of a correlation between the disease and the
crime committed is necessary for the declaration of
inputability. In doing so, the united sections of the
court of cassation adopt a concept already known to
psychiatric science34, elaborating an important
criterion that defines the notion of infirmity, that
satisfies on the one hand the general preventive needs
, circumscribing the notion of infirmity, on the other
hand those that guarantee the individual, allowing
the court to make a judgment on the guilt of the
offender that is able to reflect his subjective
components.35 The united sections, well aware of the
complexity involved in the identification of the
etiological connection between the characteristics of a
particular disorder and a crime, specify that these
disorders must be of such consistency, intensity,
importance and gravity to affect, in practice,the
capacity of discernment. It is stated, therefore, that
this shall be a disorder which results in an
AMOROSO, Giudizio di imputabilità e neuroscienze, in Diritto e Scienza,

2012, p. 12.
34
U. FORNARI, I disturbi gravi della personalità rientrano nel concetto di
infermità, in Cass. pen., 2006, p. 274 ff.; ID., Trattato di psichiatria forense,
Torino, 2005 p. 110 ff; G. GULOTTA, Elementi di psicologia giuridica e diritto
psicologico, Milano, 2002, p. 380 ff.
35
See, M. BERTOLINO, L’infermità mentale al vaglio delle Sezioni Unite, in
Dir. pen. proc., p. 853 ff.
40
unmanageable and uncontrollable psychic attitude

that, guiltlessly, makes the subject unable to exercise
the control of his actions36 and, consequently, possess
self-determination. This means that criminal behavior
should find its own origin and motivation in mental
disorder, which, in this way, becomes the element
that affects the behavior. Other forms of disease such
as, for example, the character anomalies and
deviations of character and feeling are however
excluded. These, although belonging to the psychic
scope, do not have the characteristics required by the
Supreme Court so that we can speak of infirmity,
unless they profoundly affect the ability of self-
determination of an individual.
It is time to understand what the actual
contribution of neuroscience is and the role of the
judge in the evaluation of neuroscientific evidence
regarding the judgment of imputability.To diagnose
mental disorder, neuroscience can provide elements
of knowledge, based on the application of scientific
method.
The development of modern technologies of
brain imaging has shed a new light on the
relationship between mind and brain, giving you the
36
See § 15.0 of the judgement. In addition, the particularly severe
conditions that need to be associate with psychopathy, see the research
of: G. FIANDACA, E. MUSCO, Diritto penale. Parte generale, Bologna, 2009, p.
302 ff.; ma anche F. PALAZZO, Corso di diritto penale. Parte generale,
Torino, 2005.
Lorenzo Algeri
41
ability to highlight, the correlated altered brain in the

individual suffering from mental disorder.
Neuroscience offer in this sense not only the
opportunity to make a descriptive diagnosis of the
symptoms of psychological distress, but also an
anatomical diagnosis, understood as the recognition
of the place of injury (anatomical or functional), a
diagnosis of kind, which consists in identifying the
pathological condition, due to known causes, which
might have caused the morbid state (genetic
susceptibility) and, finally, the functional diagnosis,
which allows you to show the consequences of a
pathological behavioral condition , especially in the
field of forensic37.
It's true that neuroscientific techniques, unlike
all the other technical tools, have the ability to probe
various mental operation in an objective, repeatable
and comparable way, so that the obtained data are
characterized by a high degree of reliability and are
able to reduce the margin of subjectivity of the
experts. Currently, it is possible to make an
anatomical diagnosis, at a level of accuracy that was
37
A. FORZA, Le neuroscienze entrano nel processo penale, in Riv. pen.,
2010, 1, p. 75; A. STRACCIARI, B. BIANCHI, G. SARTORI, Neuropsicologia,
Bologna, 2010.
42
previously impossible, and manages to overcome the

conventional approach to this infirmity.38
Thanks to neuro-imaging techniques it is
possible to make in objective form the neuronal
correlates of personality disorder and to measure its
severity and intensity: only severe personality
disorders are, in fact, specific anatomical and
functional relevant alterations.39
However, it should be noted that only the
existence of a correlation between brain function and
human behavior can be discovered through genetic
and neuroscientific evidence, while these results are
not conclusive with respect to the second level of
judgment of imputability, and that is about the
effective incidence of the recognized infirmity on the
capacity of discernment.
Ultimately, the purpose of neuroscience is
similar to that of the diagnostic manuals, such as the
DSM IV. In both cases, these sources of knowledge
which you can tap into to get descriptions of
psychological syndromes, are useful for diagnosis40.
38
See again in L. SAMMICHELI E G. SARTORI, Neuroscienze e processo penale,
cit., p. 3311.
39
In this respect see, A. STRACCIARI, B. BIANCHI, G. SARTORI, Neuropsicologia,
Bologna, 2010, p. 117 ff.; G. SARTORI E S. AGOSTA, Menzogna, cervello e lie
detection, in G. GULOTTA, A. BIANCHI, G. SARTORI, edited by, Manuale di
neuroscienze forensi, Milano, 2009.
40
Some point out, in fact, that the model offered by neuroscience is
purely "descriptive" and not also "explanatory", which merely discover the
Lorenzo Algeri
43
In relation, however, to the second stage of the

proceedings of imputability, which is aimed at
identifying the etiological connection between the
disorder and a certain fact to crime, the judge plays a
key role, having, on one hand, to verify the suitability
of the methodologies used by the expert, and on the
other, to determine whether and how much the
disorder under consideration has affected the ability
of discernment of the defendant.
First, the judge needs to rely on a parametric
system which tests the methodology and scientific
solidity of the new highly specialized evidence.
The legislator does not supply the judge with
specific criteria which indicates when evidence is
scientifically reliable, and consequently when this
evidence may be introduced into the trial. Moreover,
in the presence of innovative methods, the judge must
verify the subsistence of a set of requirements that the
tenet has highlighted invoking the Daubert ruling
delivered by the U.S. Supreme Court in 1993. That
verdict is the basis of the criteria on which the court
must evaluate when a particular method can be
relations between brain function and behavior, drawing attention to the

difference in meaning between "causes" and "correlations". See G.
MESSINA, I nuovi orizzonti della prova (neuro)scientifica nel giudizio
sull’imputabilità, in Riv. it. med. leg., 2012, p. 254; ma anche I. MERZAGORA
BETSOS, Il colpevole è il cervello: imputabilità, neuroscienze, libero arbitrio:
dalla teorizzazzione alla realtà, in Riv. it. Med. Leg., 2011, 1, p. 175.
44
defined scientific. The parameters have been

identified in the provability of the method; in its
falsifiability; in the knowledge of the error rate; and,
finally, must be audited by the scientific community
through publication in professional journals41.
Without prejudice to the general principles to
be followed with regard of scientific evidence we note
that neuroscientific methodologies are not able to
explain the causation but only the correlation
between a specific behavior and the anomaly detected
41
The Daubert criteria has been accepted by the Court. Cass, Sec. IV, 17
September to 13 December 2010 Blaiotta editor, n. 43786, Cozzini in Cass.
pen., 2011, p. 1679, paragraph 16. Subsequent sentence Kumho Tire
Company, Ltd. v.. Carmichael, 526 U.S. 137 (1999) extended the mentioned
criteria to the admission of the experts in subject requiring non-scientific
knowledge. For more insights S. LORUSSO, La prova scientifica, in AA. VV.,
Le prove, a cura di A. Gaito, vol. II, Torino, 2009, 13; P. TONINI, La
Cassazione accoglie i criteri Daubert sulla prova scientifica. Riflessi sulla
verifica delle massime di esperienza, in Dir. pen. proc., 2011, 1341, in which
the author points out that the sentence "Cozzini" not only accepted the
traditional criteria established by the Daubert sentence, but in most
aspects it amplified them.Indeed, in addition to the usual requirements of
verifiability, falsifiability, being subject to the control of the scientific
community, the knowledge of the error rate, the SC added new
parameters of the reliability and independence of the expert, the
consideration of the purposes and the ability to formulate choosing
criteria between the conflicting scientific claims.
By the justification of the judgment it was deduced that, in the event
which there are several conflicting conjectures , the trial court must assess
the degree of confirmation of each of them after having acquired all the
relevant information; if this is impossible, it can not "validate one of the
plausible hypotheses only because he considered some more convincing
than others.
Lorenzo Algeri
45
at the level of the central nervous system, or rather, of

the genetic code42.
One must avoid scientific behavioral
reductionism and the confusion between the plane of
the evaluation of clinical data and the evaluation of
the defendant from the legal point of view.
The court must independently consider
criminal behavior held by the defendant.
In fact, psychiatric analysis, neuroscience
included, do not provide solutions, but only
additional elements of knowledge and understanding
of what happened and in reference to the provisions
of the regulatory framework, play a supporting role
to judicial decisions which are the result of an overall,
logical and coordinated evaluation of the psychiatric
and procedural outcome.
42
See D. A. MARTELL, Neuroscience and the Law: Philosophical
Differences and Practical Constraints, in Behavioral Sciences and Law, vol.
27, 2009, p. 131, ove si afferma: <<It is impossible to image intent. The
determination of criminal responsibility turns on the ability of the trier of
fact to ascertain mens rea: the defendant’s cognitions at the time of the
crime itself that reveal the presence or absence of a guilty mind. The utility
of brain scans is hobbled in this setting because the cognitions occurred at
some point in the past. It is impossible to reconstruct the actual biological
state of the brain at the moment of the formation of the specific intent to
kill, or rape, or steal. Even if brain scans show us holes in the proverbial
Swiss cheese, the technology lacks the capacity to reveal one’s thoughts.
While it may be true, or we may believe, that the mind and the brain are
one, the limits of neuroimaging techniques will never permit us to witness
the formation of intent in vivo>>.
46
Neuroscience, like other psychological and

psychiatric investigation methods should not be
considered to be able to achieve a scientific or
dogmatic certainty but must be valued in order to
achieve the degree of reliability that could help to
convince the judge that he is facing the highest degree
of compatibility between the surveys and the reality
reconstructed during the trial. For example, in the
event that, the existence of a brain tumor in a
defendant is illustrated by a specific method of brain
imaging, the court must properly evaluate the
significance of this diseasein relation to the behavior
of the defendant at the moment of the event, based on
the examination of the overall evidence available43.
Psychopathy represents a pathology in which
numerous personal characteristics are referable. The
judge must carry out an evaluation to understand if
the anomaly of the person's personality has had a
motivating relationship with the criminal act
committed . Consequently, if he deems this to be
positive, then he must establish if the psychopathy is
consistent and serious enough to inhibit his ability to
behave with an awareness of the crime committed44.
43
O. R. GOODENOUGH E M. TUCKER, Law and Cognitive Neuroscience, in
Annual Review of Law and Social Science, 2010, p. 61 ff.
44
diritto, cit., 10, where it is specified that << The brain as an abstract object
of study, does not exist. There is always the brain of a particular subject,
Lorenzo Algeri
47
The same kind of reasoning should be applied in

relation to the results obtained through genetics.
According to the present state of knowledge
there is no evidence that a genetic variant may be
causally related to antisocial or aggressive behavior,
that is, there is no genetic variant that determines the
presence of a certain behavior without a doubt. What
the studies suggest is that having one or more of
allelic variants is associated with a statistically higher
risk of expressing aggressive, impulsive or antisocial
behavior, 27) especially for those who did not grow
up in protective environments during childhood,
compared to those who do not have these allelic
variants.In other words, having one or more of these
genetic variants is neither a necessary nor a sufficient
condition because the subject expresses an antisocial
behavior,but it represents a higher risk factor that this
can happen45.
The judgement of imputability conducted first
through a diagnostic phase and second through a
functional phase, represents a correct assessment
model, both from the point of view of scientific
methodology and from that of personal constitutional
rights.
with its own story and life, intertwined with a certain environmental
interaction. >>.
45
diritto, cit., 10.
48
An evaluation of imputability based solely on

a single profile, such as the cerebral or the genetic,
does not appear constitutionally compatible since it
affects the dignity of the person. An evaluation of
imputability based solely on a single profile such as
the cerebral or the genetic, reduces man to only one of
his profiles. This brings to mind the now obsolete
idea of the classification of criminals according to
what they are like and not what crime was
committed46.
46
F. G. PIZZETTI, Neuroscienze forensi e diritti fondamentali: spunti
costituzionali, Giappichelli Editore, Torino, 2012, 97 ff.
Stefano Barlati
49
Aggressive Behaviour in
Psychopathy: a Neurocognitive
Perspective
Stefano Barlati1
Keywords: Aggressive behaviour; Psychopathy; Antisocial

Personality Disorder; Neurocognitive Functions;
Neuropsychology.
1. Introduction
The knowledge achieved thanks to the large

development of the neurosciences in the last decades,
are changing the way in which we conceive-
understand our brain, our behavior, and human
nature, with implications that go beyond the mere
scientific and medical area. Since the 19th century it is
known that specific lesions of particular cerebral
cortex’s areas, could compromise certain cognitive
1
Clinical and Forensic Psychiatrist at the Spedali Civili of Brescia.
Criminologist at the FDE Institute of Criminology of Mantua.
Aggressive Behaviour in Psychopathy: a Neurocognitive
Perspective
50
functions and cause the loss of the capability to

modulate our behavior. In the recent years, the
modern methods of brains functional exploration, like
Positron Emission Tomography (PET), Single Photon
Emission Computed Tomography (SPECT) and
Functional Magnetic Resonance Imaging (fMRI),
made possible the study of the cerebral nervous
circuits implicated not only in cognitive processes like
perception, attention, memory and language, but also
in more complex and elusive mental functions like
emotive experience, control of the impulses, moral
evaluation (Yang and Raine, 2009). Recent
experiments prove the existence of specific cerebral
circuits that control and inhibit aggressive impulses,
circuits that crucially involve frontal lobes regions.
On these basis, the hypothesis is that the circuits
themselves could be compromised in criminal
subjects. This hypothesis is supported by the
observation of appreciable morphological and/or
functional differences between “normal” people brain
and that of criminals (Blair, 2010). After the
important progresses in the genetics and molecular
biology areas, many researchers are trying to identify
specific genes associated with behavioral aspects
trying to understand the complex interactions
between genes and environment. As known the
behavior is the final result of the interactions between
genetic inheritance and the specific environment in
which a subject is grown up. Recent studies have
indeed demonstrated that the presence of specific
alleles of genes implicated in metabolism of
Stefano Barlati
51
neurotransmitters (dopamine and serotonin in

particular), could be associated with a significantly
higher risk of developing antisocial behaviors and
predispose to criminal acts (Glenn and Raine, 2008;
Siever, 2008).
2. What is Aggressive Behaviour?
Aggressiveness is an important behavioral

trait (peculiar) observable in many animal species,
humans inclusive. Aggression is subdivided into
affective (also called reactive) or predatory (also
called proactive) aggression (Meloy, 2006). Reactive
aggression is elicited in response to
frustration/threat, while instrumental aggression is
characterized by a goal directed behaviour. Affective
aggression is the mammalian response to a
threatening situation and is therefore not
inappropriate per se. It is enacted instantly as a direct
response to provocation, such as during a verbal
argument that turns into a physical fight.
Physiologically, affective aggression is preceded by
intense autonomic arousal manifested by pounding
heart, racing pulse, shallow breathing, elevated blood
pressure, and muscle tension, preparing the body for
fight or flight. Predatory aggression is usually more
planned and goal directed and is not preceded by
autonomic arousal. It can be a response to
provocation, but it is not acted out directly, rather as
Perspective
52
revenge after a clear cool off period. In animals,

predatory aggression and violence is used to hunt
prey for food and survival (Siever, 2008). Humans can
show lack of empathy and compassion and hunt one
another in order to obtain rewards such as money,
sex, or power. These forms of aggression are
associated with different developmental disorders:
patients with borderline personality disorder are
mostly characterized by reactive aggression, while
psychopathic individuals present marked levels of
instrumental aggression as well as reactive aggression
(Blair, 2001). Predatory aggression is often associated
with crimes such as serial murders or rape. It has
been suggested that predatory aggression is strongly
connected specifically to psychopathy (Barratt and
Felthous, 2003). Importantly however, psychopaths
are thought to act on impulse as well, which is
reflected by the impulsivity item and the poor
behavior control item in the Psychopathy Checklist
Revised (PCL-R) (Hare, 1991; 2003). Individuals with
psychopathy show an increased risk not only for
reactive aggression, but also for instrumental
aggression (Hare et al., 1991; Frick, 2003). There is
something about psychopathy that increases the risk
that the individual will use aggression and other
antisocial behaviours, actions that harm others, to
achieve their goals.
It is important to understand the
neurocognitive models of aggression and relates them
to explanations of the antisocial personality disorders.
It is argued that different forms of neurocognitive
Stefano Barlati
53
model are necessary to explain the emergence of these

different forms of aggression. Impairments in
executive emotional systems (the Somatic Marker
System and/or the Social Response Reversal System,
see below) are related to reactive aggression shown
by patients with “acquired sociopathy” due to OFC
lesions. Impairment in the capacity to form
associations between emotional unconditioned
stimuli, particularly distress cues, and conditioned
stimuli (the Violence Inhibition Mechanism (VIM)
model, see below) is related to the instrumental
aggression shown by persons with developmental
psychopathy. OFC does not ‘‘inhibit’’ reactive
aggression, but rather may both increase or decrease
its probability as a function of social cues present in
the environment. OFC is less obviously involved in
the modulation of instrumental aggression. OFC is
not necessary for those functions such as aversive
conditioning and passive avoidance learning that are
necessary for moral socialization. However, OFC is
involved in response reversal. Impairments in
response reversal are seen in psychopathic
individuals, but it remains controversial whether
impairment in response reversal is associated with
antisocial behaviour (Blair, 2001).
3. Neurobiology of Aggressive Behaviour:

General Considerations
Perspective
54
Not a long time ago mental diseases were

distinguished between organic ones (e.g. dementia)
and functional ones (e.g. depression or psychosis)
depending on whether they present evident
alterations of the cerebral structure, or not. This
distinction simply reflected our incapacity to look
beyond what we can see to the naked eye. The
impression we have is that science advancement is
going to change the observation level more and more,
providing an objective, documentable basis to what,
until recent times, was only based on the phenotypic
aspect, on what can be evaluated to the naked eye. In
this sense, make the observation level more objective
could help to reduce the discretion inevitably
associated with the subjectivity of the interpretation.
The development of technologies which allow to
examine our brain in action, such as fMRI and PET,
reached the point where we can also observe cerebral
phenomena of criminal behavior and distinguish the
cortex areas involved in the deviant conduct. Recent
studies revived the interest about criminal genetics, a
subject considered definitively closed about 60 years
ago with Cesare Lombroso studies’ (Raine and Yang,
2006). On the contrary the subject’s brain’s production
of images while he is stealing, lying, cheating,
allowed the identification of the “cerebral areas of
crime” which are involved in the brain development
and are connected the personal genetic makeup. So,
the question: “are we borned criminals or do we become
Stefano Barlati
55
ones?” has now to do with the development and the

evidences of these studies. Neurosciences try to locate
the biological basis of extreme aggressiveness and
raise the question if the killing instinct exists and, if
it does, if it is also in part determined by some
particular genetic characteristics. Psychiatrists,
criminologists, historians, philosophers,
anthropologists, evolutionism psychologists dealt
with this topic, but only in the last years
neuroscientists and geneticists have begun to
approach this critical and relevant topic. In 1997,
Adrian Raine together with his colleagues of New
York's Mount Sinai school of Medicine a published a
study, that had great resonance. Using PET they
analyzed the brains of 41 American murderers and
found two remarkable characteristics: an higher
excitability of limbic system and a reduced activity in
the prefrontal cortex areas (PFC), in particular in the
orbito-frontal (OFC) one. The increased activity of the
limbic system, which is strictly connected to survival
mechanisms and controls emotive instincts, fear, rage
and disgust, might be related with an evolutionary
advantage. On the contrary, the PFC, considered a
“noble” area of brain and the center of integrative
processes and ability to elaborate knowledge and
control actions associated to the control of emotions,
especially of aggressive drives, might indicate that
this function is decreased in the criminal subjects
(Raine et al., 1997). Have we found out where the
Perspective
56
homicidal instinct “hides”? Other data reinforcing the

thesis of an homicidal drives predisposition, comes
from behavioral genetics studies that try to locate the
genes involved in the determination of some
particular personality traits, such as drugs abuse and
aggressive and antisocial behavior. In the last years,
the genetics research had focused its attention on a
personality disorder that appears to be a direct
emanation of a genetically determined criminal
temperament: the antisocial personality disorder
(Viding et al., 2008). Diagnostic pillars of this
personality disorder are just constantly lying,
cheating and swindling every person we have to deal
with, continuously violating laws, without a sign of
shame or remorse. These are subjects studied all
along by psychiatrists and criminologists, which at
the beginning coined for them the word
“psychopath”, and then “sociopath” (Hare and
Neumann, 2008). For a long time, in fact, it has been
thought that the antisocial conduct’s disorder was
determined by social conditions (so, “sociopath”
subject), nevertheless the recent studies have moved
the attention from social to individual, identifying
relevant neurobiological aspects among the criminal
conduct’s causes. In these subjects, the development
of antisocial conducts is very precocious, it already
appears at the age of about 15 to continue nonstop up
to the age of 50 and more, continuously causing
irresponsibility, irritability, aggressiveness,
Stefano Barlati
57
carelessness and disdain for truth (Crowe and Blair,

2008). Estimates made in the USA state that 1% of the
women and 4% of the men with an age between 30
and 50 years suffer from this disorder (Blair et al.,
2006). The studies about antisocial personality
disorder demonstrated that this disorder is
genetically transmissible and are based also on the
analysis of adopted children (Viding et al., 2008). For
decades adopted children have been observed to
verify if the antisocial conduct’s development could
depend on biological parent, on adoptive parent or on
the environment. Conclusions show that the
antisocial conduct, in men and women indifferently,
is linked to the biological parents, so being genetically
transmitted, and not related to the adoptive parents
and to the environment. These conclusions have been
recently confirmed by studies on identical and non-
identical twins (Viding et al., 2008). All these studies
agree that the genetic conditioning is the main
element in determining the development of deviant
and antisocial conducts. This is already evident in the
teenage phase, markedly helping juvenile criminality,
and the same trend is maintained also in the
adulthood. So it is confirmed the genetic transmission
of the predisposition to antisocial conducts, since
children without criminal parents maintained a
conduct far from crime, even if they were adopted by
criminal parents (socio-environmental aspect). The
highest percent of criminal behaviors was associated
Perspective
58
with subjects with both adoptive and biological

parents convicted for crimes’ commission, with
criminal conducts already emerging in their
childhood. In more recent time, this type of studies
have been also started in important other laboratories
and the results obtained demonstrate that the
conducts and behaviors, even the deviant and
criminal ones, is related to the genetic aspects’
capacity involved in the determination of the quality
and quantity of cerebral neurotransmitters’
production (Anderson and Kiehl, 2011). In particular
seems to be evident an association with a malfunction
of the amygdale, a subcortical structure extremely
important for men’s survival since it is involved in
food’s research, aggressiveness and defense (Glenn, et
al., 2009). Amygdale is the cerebral area answering
stimulus indicating trouble or pain in the others, and
so it is considered essential in holding back subjects
from carry out antisocial behaviors. Consequently,
the subjects with a reduced functionality of this
structure are supposed to have less or none sensibility
in regard to the damages caused toward living
beings, and, in general, are characterized by an
impulsive and/or criminal behaviors. In summary,
the structures most commonly implicated in
antisocial behaviour and in psychopathy are those
that serve functions in the evaluation of emotional
information, including basic processing of threat and
reward contingencies, utilization of this information
Stefano Barlati
59
in the modification of ongoing behavior, and

extension of these contingencies into the realm of
higher cognitive processing. Converging evidence
from a number of imaging modalities and across a
diverse range of populations supports the hypothesis
that psychopathic traits are associated with
abnormalities in the amygdala and orbitofrontal
cortex. In addition, accumulating research supports
the implication of additional brain regions in
psychopathy, prominently the anterior cingulate,
posterior cingulate, hippocampus and temporal pole
(superior temporal gyrus) (Anderson and Kiehl,
2011).
4. Genetic Aspects of Aggressive Behaviour:

General Considerations
In humans, angry facial expressions are

apparent in most infants, also at two months of birth
(Lewis et al., 1990, 1992) or four (Stenberg et al., 1983);
we can see a frequent protestive and aggressive
behavior in response to provocations in infants
(Caplan et al., 1991) and the physical aggression in
order to obtain instrumental goals is frequent in 1- to
3-years olds (Tremblay et al., 1996).
So what about genetics in the human
aggressiveness?
There has been a long behavioural genetic
literature examining genetic influences on aggression
Perspective
60
and antisocial behaviour more generally (Miles and

Carey, 1997; Rhee and Waldman, 2002). The
heritability of physical aggression was estimated to be
around 50% (Brendgen et al., 2005), underscoring that
complex behaviours result from gene-environment
interplays (Meyer-Lindenberg et al., 2006). Several
gene variants may increase susceptibility to violent
behaviour. Except for a minority (Brunner et al.,
1993), these variants are common in the general
population and are not solely implicated in the chain
leading to violence, but together with other genes
and/or interacting environmental factors. This
literature is difficult to interpret for several reasons:
first, any genetic impact is likely to be complex and
may be expressed as a function of an interaction with
environmental factors; second, the current literature
typically treats aggression as a unitary construct,
there is no division between reactive and
instrumental aggression. In this perspective genetic
variation is likely to play a role is in determining the
probability that the individual will learn a specific
behaviour, such as an antisocial strategy. Recent
studies have indeed demonstrated that the presence
of specific alleles of genes implicated in metabolism
of neurotransmitters (dopamine and serotonin in
particular), could be associated with a significantly
higher risk of developing antisocial behaviors and
predispose to criminal acts (Caspi et al., 2002; Glenn
and Raine, 2008; Kim-Cohen et al., 2007).
Stefano Barlati
61
5. Environmental Factors and Epigenetics of

Aggressive Behavior: General
Considerations
In December 2005, a group of 40 researchers

proposed to the USA Government to complete the
European project called “Human Epigenome Project”,
started in 2003. Epigenetics is a genetics’ field and
studies how the environment determines the
expression of the functions of the genes. The
epigenetics’ researchers have contributed to highlight
how the environmental load influences a living
organism’s development, programmed to adapt itself
in order to survive and reproduce. Often it has been
stated that human body has to be considered
biochemical machine programmed by its genes. It is
always been thought that our forces such as artistic or
intellectual capabilities, and our weaknesses too, like
cardiovascular illnesses, cancer or depression,
represent distinctive characteristics pre-programmed
in our genes. Our life’s qualities and deficits, as well
as health and fragilities, were simply a reflex of our
hereditary expression. Epigenetics is one of the most
active and actual research’s areas, is the science of
how our genes are controlled by environment and,
more significantly, by our perceptions of that
environment. The reductionist “claim” that, thanks to
genome’s sequencing, life and human pathologies’
complexity, is nowadays completely solved. On the
Perspective
62
contrary, in the largest part of degenerative

pathologies distressing nowadays humans, like
neoplasia, neurological disorders, cognitive
malfunctions, respiratory pathologies, often, no
specific genes’ alterations have been yet identified.
The hypothesis that epigenetic mechanism are
involved in most of these cases, seems to be
confirmed more and more plausible. We can
immediately guess that, in any case, the epigenetical
causes can be as much devastating as genes’
alteration, since the final result is an altered
expression of the genes present in our genome. The
epigenetic modifications have to be considered
“natural events”: they always existed and likely they
might have been essential for our species adaptation
and evolution. Clearly their improper modifications
could give rise to inauspicious consequences, both on
health and on human behavior.
It is now interesting to make a few comments
about the research on functional polymorphism in the
MAO-A gene. The promoter polymorphism
associated with low expression of the monoamine-
oxydase-A enzyme (MAO-A) gene in vitro (low active
allele MAO-A) is common in population, but it was
found by well conducted study (see above) to predict
higher risk for impulsive violence in association with
a history of severe maltreatment in childhood (Caspi
et al., 2002; Kim-Cohen et al., 2007). The results of this
study emphasize the complex influence of
environmental factors on gene expression. Indeed
both recent animal and human data draw attention to
Stefano Barlati
63
the role of early life experiences in modifying gene

expression via epigenetic mechanisms (see below)
(McGowan et al., 2009). Furthermore the study of
Caspi et al. (2002) suggests that the effects of MAO-A
gene and its interacting genes and/or environmental
factors may differ between ethnic groups (perhaps
partly due to specific gene x gene interactions effects)
(Caspi et al., 2010). Despite terms such as “genes of
violence” still being part of the media and literature
repertoire, it is widely known that genes in fact do
not code for violence, but for proteins. Certain genetic
variations may lead to subtle molecular
abnormalities, which, in association with other
genetic and/or environmental factors, could alter
synaptic plasticity, neural circuits and information
processing, which may in turn influence individual’s
predisposition for violent behaviour (Markowitsch
and Staniloiu, 2011). A promising resource for future
investigations will be neurogenetic analyses that seek
out allelic (and epigenetic) variations that determine
structural and neurochemical abnormalities, which in
turn contribute to divergent brain activity already
reported in neuroimaging studies. This would
certainly provide resources for devising more focused
treatment and intervention strategies. Along these
lines, a recent study of healthy adults showed that
among men, the low activity allele of the MAO-A
gene is associated with differences in brain structure
and function. Importantly, in a task requiring the men
to match angry and fearful faces to a target face, those
who carried the low activity allele, as compared to
Perspective
64
those with the high activity allele, displayed excess

activity in limbic and paralimbic areas (amygdala and
insula) and diminished activity of regions in the
cortex (orbito-frontal and anterior cingulate) that are
known to regulate emotional responses. Further, the
men with the low activity allele showed greater
activation of the amygdala when retrieving aversive
memories and less activity in the dorsal cingulate, a
region involved in the inhibition of previously
learned responses (Meyer-Lindenberg et al., 2006).
These structural abnormalities were associated with
impulsive reactive aggression, which also
characterizes secondary psychopathy and the
impulsive/antisocial facets of the construct (see
below). So we are dealing with hormones,
neurotransmitters, enzymes, endophenotypes and
polymorphisms. It looks very interesting and
promising; but we have to conclude the excursus
reminding that there can be a trap in the study of
genetics. The size of the estimated size of genetic
effects decreases when measuring specific rather than
general behaviors (DiLalla and Gottesman, 1991;
Miles and Carey, 1997), so the behavior genetic effects
of heritability may be overestimated (Bushman and
Huesmann, 2010). We discussed about the last twenty
years of research. Maybe, in the next few years we
will have to make an adjustment in the course of
research in genetics and criminology. Future research
must concentrate on better understanding the
mechanisms of gene-environment interplay and on
translating such understanding to improved
Stefano Barlati
65
intervention programs (Moffitt, 2005a; 2005b).

Quantitative genetic research can also improve the
understanding of different subtypes of antisocial
behaviour and may lead to propose more specific and
tailored interventions.
6. Antisocial Personality Disorder and

Psychopathy: Nosographic Issues
ASPD is a behavioural syndrome

characterized by a pervasive pattern of disregard for,
and violation of, the rights of others (American
Psychiatric Association, 2000). Antisocial personality
disorder is considered a wider diagnostic category
that is related to, but considerably broader than,
psychopathy. The latter is a developmental disorder
(Lynam et al., 2007), defined by the Hare Psychopathy
Checklist-Revised (PCL-R) and is characterized, in
part, by diminished capacity for remorse and lack of
self-control (Hare, 1991; 2003). Psychopathy is a
strong predictor of relapse in violent offences (Dolan
and Doyle, 2000). In 1809, psychopathy was first
introduced as a concept by Phillippe Pinel who
introduced the term: “Mania sans délir”; “Insane
without delirium”. The concept was further developed
by Cleckley in 1976 in the book “The Mask of Sanity”,
(Cleckley, 1976). Currently, psychopathy does not
exist as a DSM-IV-TR diagnosis (American
Psychiatric Association, 2000). Quite often however, it
Perspective
66
is confused with ASPD, which is a defined diagnosis

in DSM-IV-TR. Although there are some overlapping
items between the two diagnoses, they are not
interchangeable, i.e. not all individuals with antisocial
personality disorder are considered psychopaths.
Individuals with ASPD exhibit a stable tendency
towards antisocial behaviour and are characterized
by increased irritability, impulsiveness, deception,
and a failure to conform to social norms. Psychopathy
is a construct related to ASPD, and there is an
ongoing debate on the relationship between the two
constructs. While the diagnosis of ASPD is mainly
based on behaviour, the diagnosis of psychopathy
according to the PCL-R (Hare, 1991; 2003) also
includes interpersonal and affective facets of
personality. In particular, psychopathy has been
related to a general lack of empathy and remorse,
decreased emotional responding, and increased
proneness to antisocial and criminal behaviours.
Thus, some researchers have argued that
psychopathy and ASPD are distinct disorders with a
different pathogenesis, while others regard
psychopathy as a severe form of ASPD. However,
both ASPD and psychopathy are often diagnosed in
forensic samples, with ASPD being diagnosed in up
to 50–80% of prison inmates, while only about 10%
meet criteria for psychopathy (Hare, 2003).
Psychopathy is commonly assessed by use of
the PCL-R, developed by Robert Hare (Hare, 1991;
2003). Hare’s Psychopathy Checklist-Revised (PCL-R)
is the most widely validated and most popular
Stefano Barlati
67
assessment tool. The PCL-R was developed for use in

forensic settings, comprises 20 items, each scored on a
two-point scale, and has a recommended cut-off score
of 30 (out of 40) for designation of psychopathy in
forensic or clinical settings. Several other tools have
been developed for use in non-incarcerated samples,
such as Hare’s Self-Report Psychopathy Scale,
Levenson’s Self-Report Psychopathy Scale and the
Psychopathic Personality Inventory (PPI) each of
which has particular strengths and weaknesses
(Lilienfeld and Andrews, 1996).
Because the PCL-R is assumed to measure
Cleckley’s construct of the psychopath, PCL-R-
defined psychopaths have been considered
homogeneous. However, although it is now accepted
that psychopathy represents a continuous dimension
(Hare and Neumann, 2008), the PCL-R is
multifactorial, two correlated sub-factors being
traditionally identified: Factor 1 and Factor 2. In
Factor 1, personality traits such as superficial charm,
grandiose sense of self-worth, shallow affect, lack of
remorse, and lack of empathy are scored. In Factor 2,
behaviour and life style such as impulsivity, poor
behavioural control, parasitic lifestyle, juvenile
delinquency, and criminal versatility are scored. The
first factor reflects a selfish and callous use of others,
and Cleckley’s core traits of psychopathy. The second
factor reflects socially deviant traits and lifestyle. The
two factors are associated with different patterns of
personality traits and deviant behaviour (Hare, 2003).
Cooke (Cooke et al., 2004), however, recently
Perspective
68
proposed that the optimal PCL-R factor structure

comprises interpersonal, affective and behavioural
sub-factors or facets, while Hare (Hare and Neumann,
2006) argues that the conventional two-factors or a
four-facet model (Cooke's facets plus an antisocial
facet) are equally viable alternatives.
In reference to the PCL-R, some authors
subdivide psychopaths into primary and secondary
psychopaths. The primary psychopaths have more
pronounced psychopathic personality traits scoring
high on Factor 1, and the secondary psychopaths are
displaying antisocial behaviour and lifestyle, scoring
higher on Factor 2 (Lykken, 1995). Primary
psychopaths have a weak Behavioural Inhibition
System (BIS), associated with low fear, risk proneness
and sensation seeking. Secondary psychopaths have a
normal BIS but an overactive Behavioural Activation
System (BAS), which also produces risk-taking and
impulsivity, but additionally, vulnerability to stress.
In this theory, BIS is sensitive to punishment cues,
while BAS responds to reward cues (Lykken, 1995).
These model of psychopathy have emphasized
abnormalities in the integration of emotional response
into behaviour, essentially recognizing aversive
situations and acting to avoid them. This is a
prominent feature of Lykken’s low fear hypothesis,
which suggests that psychopaths (specifically
primary psychopaths) have a subdued fear response,
something that ordinarily promotes avoidance of
dangerous or embarrassing situations in healthy
individuals (Lykken, 1995). Similarly, using Gray’s
Stefano Barlati
69
two-factor Reinforcement Sensitivity Theory (RST)

(Gray, 1981), Fowles suggested that psychopaths have
a weak BIS, leaving a relatively unconstrained
behavioural activation system to run amok,
promoting impulsive behaviour (Fowles, 1980;
Wallace et al., 2009). Using self-report measures to
assess BIS/BAS, Newman et al. (2005), found strong
support for the association of primary psychopathy
with weak BIS and normal BAS. For secondary
psychopathy, there was good support for the strong
BAS part of the hypothesis but support for normal
BIS prediction was inconsistent. In contrast to RST,
Patterson and Newman’s (1993) Response
Modulation (RM) model holds that the poorly
regulated behaviour of psychopaths reflects a failure
to reallocate attention in order to process affective,
inhibitory, and other information while engaged in
goal-directed behaviour. Authors claim that the
allocation of attention resources toward a goal-
directed focus “seems to be relatively exaggerated in
psychopaths” (Patterson and Newman, 1993). This
attention bias has been found in a wide range of
circumstances, including studies demonstrating
perseverating approach responses in the face of
passive avoidance cues, resistance to distraction in
cued flanker tasks and Stroop tasks (Hiatt et al., 2004;
Zeier et al., 2009). As a result, psychopaths are
relatively insensitive to information unless it is an
integral aspect of their pre-potent focus of attention.
Although similar to the weak BIS model proposed by
Fowles, the RM model focuses on the interruption of
Perspective
70
goal-directed behaviour rather than sensitivity to

punishment cues per se.
Damasio’s somatic marker hypothesis has also
been invoked to suggest that psychopaths are
inadequate in their ability to utilize somatic emotional
cues for the purposes of anticipating punishment
(Damasio, 1996).
Furthermore, primary psychopaths are
characterized by lower anxiety and poverty of
emotional expression, and tend to commit crimes that
are fundamentally instrumental in nature; conversely,
secondary psychopaths are more anxious, show more
emotional volatility, and commit more impulsive,
reactionary crimes (Anderson and Kiehl, 2012).
Besides the division into primary and
secondary psychopathy, there is a long history of
dividing the symptoms of psychopathy into subtypes
or classifying different types of psychopaths. In this
respect, psychopathy can be divided into successful
and unsuccessful: criminal activity, although a
common correlate of psychopathy, is not a necessary
component for its definition (Cleckley, 1941). The
putative ‘successful’ (or adaptive or non-criminal)
psychopath, while possessing the core personality
traits associated with psychopathy, either refrains
from traditional criminal activity or possesses
resources that allows to avoid conviction (Gao and
Raine, 2010). It is unclear whether these subtypes are
primarily distinguished by fundamental differences
in the brain (or genetics) or by protective
environmental factors such as socioeconomic status,
Stefano Barlati
71
Intelligence Quotient (IQ), education and parenting. It

is also unclear whether ‘successful’ is a useful term,
because psychopathic traits, at least at the clinical
level, are associated with impairment in multiple
domains of life, including interpersonal problems at
home, work and school and with extended family,
and general impairments in moral sensibility.
Nevertheless, several studies have hypothesized that
successful psychopaths have intact or enhanced
neurobiological functioning that underlies their
normal or even superior cognitive functioning, which
in turn helps them to achieve their goals using more
covert and non violent methods. In contrast, in
unsuccessful, caught psychopaths, brain structural
and functional impairments are hypothesized to
underlie cognitive and emotional deficits and more
overt violent offending (Gao and Raine, 2010). In a
RMIs study, Yang et al. (2005) found that
unsuccessful psychopaths, but not successful
psychopaths, had a 22.3% reduction in prefrontal
gray matter volumes compared with control subjects.
Significant reduced gray matter volume and cortical
thickness/surface shape in the middle frontal, OFC
and the amygdala were found in unsuccessful
psychopaths but not successful psychopaths. Greater
prefrontal and amygdala structural deficits in
unsuccessful psychopaths may predispose them to
poor behavioural control and impaired decision-
making, thus making them more prone to convictions
(Gao and Raine, 2010). In conclusion, preliminary
evidence from the limited body of research to date
Perspective
72
has suggested that better executive functioning,

increased autonomic reactivity, and normal frontal
and amygdala volumes may serve as factors that
protect successful psychopaths from conviction, and
allow them to better achieve their life goals. In
addition, excessive prefrontal white matter and
efficient prefrontal functioning may contribute to the
manipulative and superior deceptive behaviour,
which in turn help them to achieve their goals in a
relatively more covert and nonviolent manner. Gao
and Raine also hypothesized that other
characteristics, including relatively intact emotional
regulation, better decision making capability, and
intact somatic markers, may also enable the successful
psychopaths to succeed in life using more covert non-
aggressive strategies, rather than overt aggressive
approaches. In contrast, reduced prefrontal gray
matter and amygdale volume and reduced heart rate
stress reactivity may predispose to the cognitive and
affective deficits observed in unsuccessful
psychopaths. Finally, fear conditioning deficits and
impaired somatic markers are further hypothesized to
be implicated in the unsuccessful psychopaths’ failure
to detect the cues linked to punishment, predisposing
to risky decision making, which culminates in arrests
and convictions.
Stefano Barlati
73
7. Genetic Aspects of Antisocial Behaviour

and Psychopathy
Growing evidence suggests a genetic

contribution to psychopathy. Early twin, adoption,
and family studies indicated that antisocial behaviour
was heritable (Viding et al, 2008). However, such
studies are difficult to interpret.
Behavioural-genetic studies have shown that
the combination of callous-unemotional traits and
conduct problems is highly heritable as is
psychopathy in adolescence (Viding et al., 2007).
Given the suggestion above of a genetic basis
to the emotional disorder that is the basis of
psychopathy it would be useful to be able to
determine which genes give rise to what sorts of
effects at the molecular level. Several suggestions
have been made, but there are still no reliable data. It
has been suggested that there may be serotonergic
abnormalities in individuals with psychopathy. Some
studies find the usual relationship between reduced
serotonergic response and increased levels of
aggression (Coccaro, 1995), but relationship with the
emotional basis of psychopathy are controversial.
Another research group has argued that the
norepinephrine system may be implicated in the
pathology of psychopathy (Blair, 2003).
Norepinephrine (NE) has a considerable role in the
innervation of the neural systems involved in the
Perspective
74
basic response to threat in both animals and humans.

There have been suggestions that NE is involved in
mediating the impact of aversive cues in human
choice, and NE appears to be selectively involved in
the processing of sad expressions. In addition, there
have been a series of reports that high levels of
antisocial behaviour/conduct disorder are associated
with reduced NE levels (Blair, 2003). However, the
data with respect to psychopathy remains weak and
controversial.
The roles of environmental influences on the
emergence of psychopathy remain unclear. The
genetics studies suggested relatively little influence of
environmental influences. Genetics would determine
the level of emotional dysfunction, while the
environment would influence how this genetically
determined emotion dysfunction was expressed.
More specifically genetics contributes to the
emotional dysfunction that is the basis of the
disorder, then the emotional dysfunction, in turn,
puts the individuals for learning antisocial
behaviours to solve goals. The basic genetic risk for
psychopathy might emerge if an individual possesses
a sufficient number of polymorphisms predisposing
towards reduced emotional and amygdala
responsiveness. Social environmental variables are
likely to have an influence, most importantly
constraining the possibility of alternative behavioural
choices to antisocial behaviour as well as potentially
Stefano Barlati
75
increasing the salience of the rewards the might

accrue through antisocial behaviour. Genetics would
confer a vulnerability to being highly reactive to
stressful environments. Environmental factors, such
as maltreatment during a critical period in
development, would alter the biological stress
reactivity systems making subjects chronically hyper-
reactive to their environments and reinforce or even
initiate their tendency to view others as hostile. In
adulthood, this would result in an individual who
perceives others as threatening. In this view, violence
towards others would be reactive and impulsive, in
response to a feeling of being threatened. Therefore
the genetic contribution may be a prerequisite for the
development of the disorder whilst these other factors
will influence the full presentation.
8. Neuroimaging of Antisocial Behaviour and

Psychopathy
Growing attention to psychopathy has been

accompanied by a exceptional increase in
neuroimaging research on this topic, partly because of
rapidly improving technology and methodological
advances. Recent reviews indicate that the most
common structural and functional abnormalities
observed in the brains of psychopaths are distributed
in frontal and temporal cortical regions (Blair, 2010).
Perspective
76
Many evidence has shown structural and functional

abnormalities in antisocial individuals, and
hypotheses have been presented linking antisocial
behaviour to deficits in the PFC, temporal cortex,
insula, amygdala, hippocampus/parahippocampus,
and anterior/posterior cingulate gyrus (Kiehl, 2006;
Raine and Yang, 2006).
Raine and Yang (2006) in a review article
reported the following results: brain regions
compromised in antisocial, violent and psychopathic
populations include both dorsal and ventral regions
of the PFC, amygdala, hippocampus, angular gyrus,
anterior cingulate and temporal cortex including the
superior temporal gyrus; regions activated during
moral decision-making in controls include the
polar/medial PFC, ventral PFC, angular gyrus,
amygdala and posterior cingulate; brain areas
associated with both moral reasoning and antisocial
behaviour significantly overlap; the rule-breaking,
immoral behaviour of antisocial and psychopathic
individuals may in part be due to impairments in
those brain regions involved in moral cognition and
emotion; while impairments to the moral emotional
system may be primary in antisocial, disruption of
moral cognitive and cognitive-emotional systems are
also possible. In a meta-analytic review, Yang and
Raine (2009) highlighted the significance of prefrontal
structural and functional impairments in antisocial
individuals. More specifically, reductions in the PFC
were particularly marked in the right OFC, right
anterior cingulate cortex (ACC), and left DLPFC.
Stefano Barlati
77
Authors concluded that future brain-imaging

research on antisocial populations could usefully
focus on other ROIs (e.g., amygdala, hippocampus,
insula, angular gyrus) which have been much less
studied to date.
Koenigs et al. (2011) have realized a critical
review of structural and functional neuroimaging
studies aimed at identifying the neurobiological
abnormalities associated with psychopathy. To date,
the results are highly variable. Within the broad array
of data it can be find qualified support for theories
highlighting the importance of emotion-related
circuits in the brain, such as the ventromedial
prefrontal cortex and amygdale or a wider
‘paralimbic’ system, which also includes areas
involved in language and attention orienting.
Alternatively, there are heterogeneous collection of
neuroimaging abnormalities, many of which are
outside the canonical emotion circuits, as evidence for
widespread, context-dependent neural deficits in
information processing or integration. Authors
emphasized the importance of considering the
subtypes of psychopathy. It could be that
psychopaths consist of multiple subtypes (for
example, low anxious vs high anxious; successful vs
un-successful; violent vs non-violent) that have
distinct neurobiological profiles. Neuroimaging data
could provide key evidence to support or refute these
categories, studying more homogeneous subgroups
of psychopathy.
Perspective
78
Other interesting findings in neuroimaging

studies include the following. In contrast to
borderline personality disorder (BPD), functional
studies in ASPD and psychopathy often find
attenuated amygdala responses to emotionally
evocative stimuli. Kiehl et al. (2001) compared neural
responses in individuals with high and low scores on
the PCL-R during an emotional memory task where
the participant processed words of neutral and
negative valence, and they found attenuated
amygdala responses in the high-scoring group. Other
studies have shown that individuals with
psychopathy fail to react to threatening stimuli and
found diminished limbic responses in the context of
conditioned learning. For example, Schneider et al.
(2000) found diminished activation in amygdala in
response to a noxious odor in subjects with ASPD
compared with healthy control subjects and aberrant
activation in amygdala during aversive conditioning.
Similarly, Veit et al. (2002) found that engagement of
amygdala, insula, and OMPFC during aversive
learning, observed in healthy control subjects as well
as individuals with social phobia, was abolished in
individuals with psychopathy, suggesting that
deficits in emotional learning and especially learning
about punishing consequences may be fundamental
to the disorder. Moreover, attenuation of emotional
learning and amygdala responding may serve to
distinguish more instrumental forms of aggression
associated with antisocial/psychopathic pathology
compared with reactive aggression more
Stefano Barlati
79
characteristic of BPD and intermittent explosive

disorder (IED).
Glenn et al. (2009) in a fMRI study found that
subjects with higher psychopathy scores at PCL-R
showed reduced activity specifically in the amygdale
during emotional moral decision-making. In addition,
individuals scoring particularly high on the
interpersonal factor, involving manipulation,
conning, superficiality and deceitfulness, exhibited
reduced activity in each of the other regions of the
moral neural circuit: medial prefrontal cortex,
posterior cingulate and angular gyrus.
The available data strongly support the
suggestion that orbital and ventrolateral dysfunction
are a risk factor specifically for reactive aggression; in
the healthy individual these regions are involved in
regulating the neural systems that mediate the basic
response to threat (which, at its most extreme, is
reactive aggression). These regions appear
dysfunctional in psychopathy and put individuals
with this disorder at heightened risk for
inappropriate displays of reactive aggression.
Moreover individuals who are predominantly
reactively aggressive also show atypically increased
amygdala responses to emotional stimuli. This would
be consistent with suggestions that the risk for
reactive aggression is increased if the basic
responsiveness of the threat system is increased; the
individual is more likely to show reactive aggression
rather than flight/freezing in response to a
threatening/frustrating stimulus. It is well known
Perspective
80
that psychopathy is marked by amygdala

dysfunction. This dysfunction disrupts the ability of
the individual to be socialized and thus puts them at
greater risk of learning antisocial behaviours,
including instrumental aggression, to achieve their
goals. Glenn et al. (2009) suggested that, without such
amygdale activation, individuals may be undeterred
from conning and manipulating others, making
impulsive, irresponsible decisions, and engaging in
criminal behaviour without feeling guilt or remorse.
In addition, reduced functioning in medial prefrontal
cortex, posterior cingulate, and angular gyrus in
individuals high on the interpersonal factor of
psychopathy suggests failure to consider how one’s
actions affect others, failure to consider the emotional
perspective of the harmed other, or a failure to
integrate emotion into decision-making processes.
Such processes are important in determining the
appropriateness of using someone to achieve a goal,
which is central to personal moral dilemmas and
which is impaired in psychopathy.
However, these findings remain
unsubstantiated by significant neuropsychological
findings. It is impossible to determine on the basis of
these imaging results whether the reduced
OFC/vmPFC activity reflects dysfunction in this
region or simply reduced input to this region from
the amygdala. A number of animal studies have
stressed the importance of the interaction between the
amygdala and the OFC/vmPFC. Damage to the
amygdala has a detrimental impact on OFC
Stefano Barlati
81
functioning (Schoenbaum and Roesch, 2005).

Nevertheless, it is important to note that animal
studies also suggest that early amygdala dysfunction
disrupts the appropriate development of the OFC and
vmPFC [34]. Moreover, molecular candidates with
respect to the genetic basis for psychopathy innervate
both the amygdala and the OFC and vmPFC.
9. Neurobiological Models of Antisocial

Behaviour and Psychopathy
Determination of the physiological correlates

of psychopathy has been a concern of empirical
research since at least the 1950s, when it was
recognized that psychopaths fail to show appropriate
autonomic responses to aversive stimuli (Lykken et
al., 1957). However, the biological and environmental
factors responsible for the development and
maintenance of psychopathy remain poorly
understood. Psychophysiological and
neuropsychological research suggest that people with
high scores on the PCL-R, exhibit a variety of
information and emotional-processing deficits (Blair,
1995), which can be theoretically linked to neural
circuits involving prefrontal and temporo-limbic
brain regions. The PFC, with its rich and widespread
brain interconnections, is important in the impulse
control, and the processing and integration of both
emotional and unemotional information. Lack of
Perspective
82
empathy is one of the characteristics of psychopathy.

There are many different aspects of empathy but it
has been suggested that psychopaths specifically lack
affective empathy (Blair, 2005). Affective empathy
constitutes non-conscious physiological reactions
such as the fight or flight reaction, characterized by
autonomic arousal, which is controlled by the
amygdala. The amygdala plays an important role in
modulating aggressive or submissive behaviours in
social contexts, and is implicated in fear conditioning,
in the ability to recognise facial expressions of fear
and anger and memory for emotional material. The
amygdala is also involved in emotional regulation,
particularly of unpleasant emotions. The amygdale
appears to be a relevant substrate for study of the
callous–unemotional dimension of ASPD and
psychopathy, given its prominent role in fear
conditioning and emotional processing. A
dysfunctional amygdala has been suggested as one of
the core neural correlates of psychopathy (Blair,
2003). Impairments in the amygdale could lead to
deficient emotional learning, which in turn could be
one of the reasons behind the development of
psychopathy (Blair, 2003). Brain lesion studies
indicate that the vmPFC and amygdala have similar
functions, and that disruption of the amygdala–
vmPFC circuit results in deficits in emotional learning
in the widest sense. They differ, however, in their bias
towards positive or negative rewards, and the
amygdala may be particularly associated with
processing of the more basic information on
Stefano Barlati
83
emotions, as compared to the ventromedial cortex,

which has mainly a monitoring and evaluating role.
Modern neuroimaging investigations have
contributed to the development of two prominent
neurobiological theories of psychopathy (Blair et al.,
2006; Kiehl, 2006). Both theories implicate
components of the limbic system, a network of brain
regions supporting the utilization of emotional
information in behavioural regulation. Blair’s model
has primarily emphasized dysfunctions in the
amygdala leading to the development of
psychopathy. The amygdala is a key component
involved in forming associations between
environmental cues, affective states and the activation
of basic threat circuits. More recently, Blair
emphasized the role of both the amygdale and the
ventromedial prefrontal cortex (vmPFC) in ongoing
monitoring of behaviour against established
reinforcement expectancies (Blair, 2007).
Kiehl’s paralimbic dysfunction model (Kiehl et
al. (2006) describes the more widely distributed
abnormalities throughout the brains of psychopaths.
This model is grounded in the study of
cytoarchitectonics, which has identified closely
related regions of the brain based on similarities in
neuronal type, structure and density. The anterior
superior temporal gyrus (temporal pole), anterior
cingulate, posterior cingulate, OFC, insula and
parahippocampal regions are intimately connected to
primary limbic regions including the amygdala,
septal region and substantia innominata. The
Perspective
84
paralimbic system refers to primary limbic structures

and this extended network of brain regions that
seems to provide a transition from subcortical
structures to higher neocortical regions. Kiehl’s model
accounts for evidence that psychopaths show
abnormalities in areas, beyond primary limbic
structures, such as the anterior and posterior
cingulate cortex, the temporal pole, the insula and the
parahippocampal gyrus (Kiehl, 2006; Kiehl et al.,
2001).
Newman’s Response Modulation hypothesis
is a third explicative model, that maybe better
described as a cognitive model of psychopathy. This
model suggests that apparent deficits in the
processing of emotional information by psychopaths
may be attributable to problems in switching
attention to stimuli with emotional salience or
peripheral stimuli in general (Newman and Lorenz,
2003). While the attention of healthy individuals is
occupied automatically and involuntarily by stimuli
that are relevant to species safety and survival, some
evidence suggests that psychopaths have deficiencies
in this allocation of attention, which adversely
impacts the integration of this information into
ongoing behavioural modification. Primary support
for this notion comes in the form of decreased
performance in passive avoidance learning tasks,
diminished interference in a primary task due to
peripherally presented distractors (Newman et al.,
1997) and abnormal modification of startle reflexes in
psychopaths (Newman et al., 2010). If their capacity
Stefano Barlati
85
to attend to emotional information is compromised,

this might help to explain a fundamental reason
behind the apparent failure of psychopaths to
integrate emotional information into higher cognitive
function. Future neuroimaging research in this area is
much needed, since functional anatomical units
supporting different modes of attention are poorly
understood.
Other two models of psychopathy have been
proposed. One is the Damasio’s somatic marker
hypothesis (Damasio, 1996) suggests that people with
psychopathy show deficits in decision-making that
reflect an inability to activate autonomic somatic
states linked to anticipation of rewards and
punishments; the model proposes that the problem is
lying primarily in the vmPFC. The other model is the
“Violence Inhibition Mechanism” (VIM), proposed by
Blair (1995). VIM suggests that the people failing to
display the submission cues, that normally inhibit
aggressive responses, are characterized by difficulties
with empathy. The amygdala is believed to be the key
neural substrate for the mediating empathy. More
recently, Blair et al. (2006) revised the VIM to
encompass the role of the OFC in reactive aggression,
and redefined the model as the “Integrated Emotion
System” (IES).
Perspective
86
10. Neurocpsychological Models of Antisocial

The research on the neuropsychology of

antisocial behaviour in psychopathy centres around
three main models: the frontal lobe dysfunction, the
Integrated Emotional Systems (IES) model, and the
autonomic nervous system dysfunction.
The frontal lobe dysfunction theory has
examined hypotheses of an impaired executive
functioning system, with ensuing cognitive rigidity,
impaired problem-solving ability, and abnormal
attention in individuals with ASPD and psychopathy,
and has suggested that these individuals may have an
impaired ability to recognize contextual cues in their
environment. The frontal lobes are associated with
emotional control and regulation and executive
functioning, including planning, which could lead to
impulsivity, if damaged. Frontal lobe damage can
impact one’s ability to formulate plans, reduce ability
to reason or recognize consequences, limit ability to
maintain concentration and focus on long-term goals,
reduce ability to produce and process language, and
lead to difficulties with behavioural regulation.
Frontal lobe dysfunction has also been shown to lead
to distractibility, lack of guilt sense, periodic mood
disorders, and increased sensitivity to alcohol
(Fitzgerald and Demakis, 2007).
The IES model is more recent and does not
focus solely on the frontal lobe for understanding
Stefano Barlati
87
psychopathy. This theory asserts that these

individuals may be less able to associate stimuli with
punishment and have difficulty in adjusting to
changes and in reinforcement contingencies, lending
support to the characteristic of cognitive inflexibility
among these individuals. This model suggests that an
individual with dysfunction in amygdala and
ventrolateral orbital frontal cortex is unable to form
associations between a stimulus and reinforcement,
especially regarding punishment, which can interfere
significantly with one’s socialization (Blair, 2005). A
person with these types of dysfunctions can be less
likely to learn to avoid, and more likely to learn to
rely on, using characteristic antisocial behaviours to
achieve their goals (Blair, 2005). For example, persons
with psychopathy lesions in the amygdala, have been
shown to impair the effects of aversive classical
conditioning, lower automatic response to cues that
predict shock and impair passive avoidance learning
(Mitchell et al., 2006). Persons with lesions in the
ventrolateral orbital frontal cortex, which is important
in behavioural adaptation in response to
reinforcement contingencies and is associated with an
increased risk of reactive aggression when frustrated,
show intact stimulus reinforcement learning until the
contingency changes (Mitchell et al., 2006). This
supports previous theories that persons with
psychopathy are cognitively inflexible and can
become aggressive when faced with frustrations in
their environment (Blair, 2005).
Perspective
88
The third theory which will be reviewed

proposes that individuals with psychopathy have
differences in their autonomic nervous system, which
leads to their engagement in characteristic antisocial
behaviours. This theory uses the Damasio’s Somatic
Marker Hypothesis and Widom’s research on the
frontal lobe function of psychopaths (Widom, 1978).
This theory suggests that individuals with
psychopathy, who are punished for their behaviours,
may have a lower responsive autonomic nervous
system as compared to individuals who are able to
avoid punishment. Researchers have begun to
examine the differences between unsuccessful (i.e.,
arrested and convicted) and successful psychopaths.
These unsuccessful psychopaths may engage in more
inappropriate behaviours based on misinterpretations
of the contextual cues around them. Those deemed
unsuccessful exhibit significantly lower
cardiovascular reactivity in situations anticipating
emotional stressors, lower skin conductance
conditioning in response to aversive stimuli, and poor
avoidance learning in the face of punishment
(Ishikawa et al., 2001). Those deemed successful
exhibit greater autonomic reactivity than control and
unsuccessful groups, as well as better executive
functioning. These results contradict early research
suggesting that persons with APD have impaired
executive functioning. The Somatic Marker
Hypothesis proposes that individuals base their
choices on their emotional states and that intact
prefrontal and autonomic functioning helps
Stefano Barlati
89
individuals process contextual cues in risky

situations, allowing them to make appropriate
decisions. Ishikawa et al. (2001) reported that
unsuccessful psychopaths are less able to make
appropriate decisions, based on the contextual cues
around them during their commission of
inappropriate acts, therefore leading to an increased
chance of being arrested or receiving punishment for
their behaviour. On the other hand, the successful
psychopaths are able to make appropriate decisions
to avoid punishment because of their increased ability
to process contextual cues. An extremely responsive
autonomic nervous system may reduce the chance
that at-risk individuals will engage in or become
convicted for criminal behaviours.
The gambling task developed by Bechara
(1994) has been used in conjunction with the Somatic
Marker Hypothesis to examine the choices and risks
taken by individuals with psychopathy. In one study
by Losel and Schmucker (2004) prison inmates were
divided into groups according to scores on the PCL-R
and were administered the gambling task for a
monetary incentive based on performance. Those
psychopathic inmates with poor attention performed
poorly and made more risky choices more frequently
than those inmates with higher attention
performance. This perhaps might be due to the lack of
the mechanisms of emotional control thought to
protect individuals from making risky choices.
Authors also hypothesize that the inattentive
Perspective
90
participants lose track of the relevant stimulus in their

focus, which cannot be retrieved because of their
attention deficit and impaired ability to switch
attention focus. This is similar to the results reported
using the Stroop effects. These participants were
unable to compensate for their attention deficiencies
as evidenced by their poor performance on the
gambling task, similar to the unsuccessful
psychopathic individuals studied by Ishikawa et al.
(2001) Their performance may also represent an
impaired ability to learn from punishment. It appears
that some individuals with psychopathy may have
lower functioning attention systems which can
become easily overwhelmed by stimuli, leading them
to lose the sight of the information necessary to make
appropriate decisions this, in turn, might increase the
potential consciousness of receiving punishment
(Losel and Schmucker, 2004).
11. Neurocpsychological Features of Antisocial

Among the neurocognitive approaches to

antisocial behaviour problems, neuropsychological
studies have been the most common and most
affordable even in the context of recent advances in
brain imaging studies. The neuropsychology of
antisocial disorders has been the object of several
Stefano Barlati
91
reviews since Moffitt (1993) developed her theoretical

work in the context of critical reviews of the
neuropsychology of delinquency and of conduct
disorder. These studies, initially identified deficits in
three specific areas: language abilities, executive
function, and cerebral dominance. Research on
psychopathy and ASPD has elucidated important
attention, cognitive, and emotion processing
abnormalities in these syndromes (Blair, 2003; Patrick,
2007). Other neuropsychological characteristics of
persons with psychopathy include cognitive
inflexibility, attention deficits, and an inability to
appropriately process one’s surroundings. In this
review we have taken into account the main literature
findings about executive functions, attention and
emotional processing, including “Theory of Mind”
(ToM), in antisocial behaviour, with particular
reference to psychopathy.
12. Executive Functions
Conflicting results have arisen regarding the

performance of psychopathic subjects on measures of
frontal executive functions, with some data showing
deficits in psychopathic people and others not.
Lynam et al. (1993) suggested that verbal IQ was a
broad index of executive cognitive functioning and
tested this hypothesis by examining the contribution
Perspective
92
of impulsivity in explaining the relationship between

verbal IQ and delinquency. Although impulsivity
was found to be a strong predictor of delinquency,
the relationship between low verbal IQ and
delinquency was not explained by impulsivity. One
alternative suggestion is that verbal deficits are
related to a lower efficacy in dealing with problematic
situations, causing frustration which is expressed as
aggression. This pathway is rehearsed repeatedly
from very early on in life, and so aggressive
behaviour becomes an entrenched learned response
to frustration (Barratt et al., 1997).
Several studies suggest that a select deficit
involving the orbitofrontal system may underlie
psychopathy and antisocial behaviour. To examine
the executive functioning in the frontal lobe,
neuropsychological assessments can be used. The
most commonly used psychometric assessments of
executive functions include the Wisconsin Card
Sorting Test (WCST), Stroop Tasks, Trail Making Test
Part B (TMT-B), and the Category Test.
Early studies reported that persons with
psychopathy showed frontal lobe deficits on the
WCST, Stroop Task and Trail Making (Blair et al.,
2006). Lapierre et al. (1995) found that incarcerated
psychopathic subjects were significantly impaired on
tasks considered sensitive to
orbitofrontal/ventromedial-prefrontal dysfunction, in
comparison to matched control subjects (non-
psychopathic inmates). Psychopathic individuals
performed more poorly on a Go/No-Go task, where
Stefano Barlati
93
they had initially formed an aggressive response

tendency to a particular stimulus and then had to
reverse this response. The psychopathic individuals
were significantly more likely than the comparison
individuals to continue to respond to the stimulus.
Executive dysfunction in psychopathy has
been linked to impulsivity, conceptualized as (lack of)
premeditation and (lack of) perseverance, where lack
of premeditation is likened to the ‘inability to inhibit
previously rewarded behaviour when presented with
changing contingencies’ (Whiteside and Lynam,
2001). The lack of perseverance might be related to
disorders that involve the inability to ignore
distracting stimuli or remain focused on a particular
task (Whiteside and Lynam, 2001). In addition,
executive dysfunction in psychopathy has been
linked to impaired response set modulation – the
‘rapid and relatively automatic (i.e., non-effortful or
involuntary) shift of attention from the effortful
organization and implementation of goal-directed
behaviour to its evaluation’ (Patterson and Newman,
1993). Swann et al. (2009) in a case control study
analyzed impulsivity and response inhibition in
ASPD. Compared with healthy comparison subjects,
subjects with ASPD had greater impulsivity and
increased commission error reaction times. This may
reflect a partial compensation mechanism related to
impaired response inhibition, which becomes more
apparent with more severe ASPD. Rapid-response
impulsivity was assessed using the Immediate
Memory Task (IMT) a continuous performance test.
Perspective
94
These data support a relationship between ASPD and

impaired response inhibition. From these accounts it
could be expected that individuals with psychopathy
would be impaired on a broad range of tasks; many
tasks can be considered to involve inhibition or
response set modulation (e.g., the intra-
dimensional/extra-dimensional (ID/ED) and spatial
alteration/object alteration tasks). In these tasks, there
are two principal measures: first, the number of
response errors/object reversals; second, the number
of ED errors/spatial reversals (e.g., in the ID/ED task,
when the participant responds by choosing one or
other shape (despite the fact that the reward
contingency is based on the lines which accompany
the shapes). Response/object reversal, ED shifting
and spatial alteration would all appear to require the
inhibition of a previously rewarded
behaviour/response modulation. Dinn and Harris
(2000) in a case-control study have found that
psychopaths showed greater neuropsychological
deficits on measures sensitive to orbitofrontal
dysfunction in comparison to control participants.
Performance deficits on the Object Alternation Test
(OAT) may reflect an inability to effectively process
feedback information regarding reward and
punishment (i.e., the inability to successfully employ
punishment cues to guide behaviour). In contrast
ASPD subjects did not demonstrate performance
deficits on classical tests of frontal executive function.
Mitchell et al. (2002) explored performance of adult
psychopathic individuals and controls on the
Stefano Barlati
95
Intradimensional/Extradimensional Discrimination
(ID/ED) task. In the ID/ED task, the participant is
taught to respond to one of two stimuli and then,
having reached a criterion, must reverse this response
so that they respond to the other stimulus (Dias et al.,
1996). The psychopathic individuals were
significantly impaired in response reversal on this
task. Gorenstein (1982) reported that psychopathic
subjects demonstrated performance deficits on tests
of frontal executive function including the WCST (i.e.,
perseverative errors), Necker cube task, and a
sequential matching memory task. A meta-analytic
review of 39 studies by Morgan and Lilienfeld (2000)
lends strong support to the contention that executive
function deficits are associated with psychopathy.
The results from six reasonably well validated tests of
executive functions were included in the meta-
analysis. Specifically, the following tests were
examined: Category Test of the Halstead-Reitan
Neuropsychological Battery (HRNB); Qualitative (Q)
score on the Porteus Mazes Test; Stroop Interference;
TMT-B; WCST- perseverative error score; and Verbal
fluency Tests. The results of the meta-analysis
indicated that there is a robust and statistically
significant relation between psychopathy and
executive functions deficits. Mercer et al. (2005) found
that the experimental group of psychopaths exhibited
more perseverative errors on the WCST, which
requires cognitive flexibility and intact problem-
solving capacity to perform successfully. The results
of a recent study performed by Zeier et al. (2012)
Perspective
96
provide evidence of a significant association between

antisocial attitude, a general construct associated with
both ASPD symptoms and psychopathy scores, and
poor executive functioning as measured by
responsively distracting, inhibitory information.
Other studies used the Stroop Test as their
measure of executive functioning (see below for
Stroop tasks in the attention cognitive domain).
Several studies report that psychopaths showed
significantly higher interference effects on the Stroop
Color Word task (Mercer et al., 2005). Stroop tasks are
used to evaluate conflict monitoring, such that the
subject must reconcile the conflicting and sometimes
irrelevant information being presented to provide
correct responses. Although persons with
psychopathy have initial difficulty maintaining their
attention on Stroop tasks, once their attention is
focused, they are less distracted by irrelevant
information as compared to non-psychopathic
individuals (Hiat et al., 2004). Based on these types of
tasks, persons with psychopathy seem less sensitive
to contextual cues, which could contribute to their
inappropriate behaviour and poor behavioural
regulation. Hiatt et al. (2004) used variations of the
Stroop effect (ie, colour words, colour numbers, and
combinations) and found that persons with
psychopathy were able to use contextual cues if they
were relevant to their goal. Perhaps psychopathy
does not stem from deficits in executive control per
se, since persons with psychopathy may actually have
better executive control than persons without
Stefano Barlati
97
psychopathy, but deficits associated with

psychopathy may be linked to dysfunction in
nonexecutive systems, such as attention. Persons with
psychopathy poorly use contextual cues as a result of
an attention deficit that inhibits the integration of
conflicting information in their context, especially if
the information is not related to their goal (Hiat et al.,
2004).
However, some of these earlier results were
not replicated and some research has found no
differences in the performance on measures of frontal
lobe functioning in psychopathy. These studies
overwhelmingly concluded that neuropsychological
functions, emphasizing cognitive processes, are not
different from non-psychopaths (Blair et al., 2006;
Hare, 1984; Sutker and Allain, 1987). Lapierre et al.
(1995) also found that psychopathic subjects did not
display performance deficits on measures sensitive to
dorsolateral/prefrontal (DLPF) and posterorolandic
function (e.g. WCST and the Mental Rotation Task).
Moreover, Deckel et al. (1996) reported that
performance on tests assessing frontal executive
functioning (e.g. WCST and TMT) failed to predict
antisocial personality disorder classifications. These
tasks require DLPF activation and the employment of
organizational strategies for efficient performance.
These findings suggest that a select orbitofrontal
deficit may be associated with psychopathy.
Other cognitive processes, correlated to
executive functions, involve inhibition control,
working memory, as well as language and general
Perspective
98
memory abilities. Deficits in cognitive and inhibitory

control are important risk factors predisposing
individuals to a chronic antisocial lifestyle. Likewise,
the ability to inhibit pre-potent responses to
contextual cues, in order to maintain one’s goal-
directed behaviour, is commonly regarded as a core
skill needed to inhibit punished responses, delay
gratification, tolerate frustration, abstain from drug
use, and overcome aggressive urges (Zeier et al.,
2012). In a series of studies that contrasted executive
functions, verbal abilities, and tests of cerebral
dominance, Séguin et al. (1995; 1999) found that
working memory was poorest in boys with a history
of physical aggression even after controlling for non-
executive abilities relevant to executive function like
IQ and ADHD. In a review article Séguin et al. (2004)
concluded that problems of motor control such as
those evidenced mainly in physical aggression have
been associated with poor dorsolateral frontal lobe
function. Dorsolateral frontal lobe problems impair
cognitive processing, mainly the working memory
domain. Moreover poor working memory would
affect all stages of executive function. Thus hostile
biases in appraising a problem would be difficult to
reconsider, plans would be difficult to carry out, rules
(even if they are well known) would be difficult to
apply in real time, and monitoring of a plan
(detection and error correction) would be difficult to
achieve.
Several studies examining neurocognitive
function in psychopathy and ASPD reveal broadly
Stefano Barlati
99
frontal deficits, but if the prefrontal cortex can be

fractionated into separate frontal subsystems, these
may be differentially engaged in ASPD subtypes. One
possibility is that ASPD subjects demonstrating core
psychopathic traits and a lack of foresight (e.g.,
difficulty anticipating negative consequences),
planning, and goal-directed behaviour (e.g.,
disorganized offending), should show greater
neuropsychological deficits on tasks considered
sensitive to orbitofrontal dysfunction and on
measures of frontal executive function. Specifically,
core psychopathic personality characteristics may
result from orbitofrontal dysfunction. The additional
involvement of DLPF dysfunction may lead to
antisocial behaviour that combines core psychopathic
characteristics with poor planning and organization,
and difficulty keeping in mind diverse future
consequences. Motivation for this hypothesis is that
the DLPF cortex mediates executive functions, while
the orbitofrontal cortex mediates sensitivity to
dynamically changing reinforcement contingencies,
and thus may be particularly important for
modulating individuals’ response to the social world
and other threat-laden situations.
In this regard, Koenigs et al. (2010) explored
the putative behavioural parallels between
psychopaths and vmPFC lesion patients using two
laboratory decision-making tasks (the Ultimatum
Game and the Dictator Game). In particular, author
addressed the possibility that etiologically distinct
subtypes of psychopathy (primary and secondary)
Perspective
100
might exhibit characteristic patterns of economic

decision-making, and that one or the other subtype
might more closely resemble the vmPFC lesion
patients in their task performance (reduced
Ultimatum acceptance rates and Dictator offers).
Compared to non-psychopaths and secondary
psychopaths, primary psychopaths exhibited
significantly reduced Ultimatum acceptance rates as
well as significantly lower Dictator offers. Secondary
psychopaths did not significantly differ from non-
psychopaths on any aspect of the Ultimatum or
Dictator Games. In both tests, the primary
psychopaths were statistically similar to the vmPFC
lesion patients. These results converge to indicate that
(1) primary and secondary psychopaths do in fact
differ in their economic decision-making performance
and (2) primary psychopaths closely match vmPFC
lesion patients in their economic decision-making
performance.
An elegant study performed by Barkataki et
al. (2005) has achieved interesting findings. The
authors investigated and compared
neuropsychological profiles of individuals with ASPD
and violent and nonviolent individuals with
schizophrenia. The study involved four groups of
subjects: individuals with a history of serious violence
and a diagnosis of APD; individuals with a history of
violence and schizophrenia; individuals with
schizophrenia without a history of violent behaviour
and healthy control subjects. All study groups were
compared on a neuropsychological battery designed
Stefano Barlati
101
to assess general intellectual function, executive

function, attention, and processing speed. Contrary to
the expectations, the ASPD group did not show
deficits in executive function compared to control
subjects or patients with nonviolent schizophrenia,
but did show impairment in processing speed. The
lack of observable significant impairment in executive
function does not support the theory that
dysfunction of the dorsolateral prefrontal cortex is a
core component of ASPD (Raine et al., 2000), and
lends support to the studies reporting executive
functioning parity between ASPD and healthy
individuals (Hare, 1984). These studies advocate
attribution of antisocial behaviour in ASPD to
emotional and/or socialization factors rather than
compromise of executive function, and suggest that
prefrontal cortical dysfunction can serve to facilitate
aggression and violence in ASPD, but is not an
essential prerequisite. Interestingly in this study, the
novel finding of a reduced processing speed in
individuals with ASPD suggests that the impulsive
and risk-taking characteristics of ASPD might be
related to failure to appropriately process data
indicating the presence of danger in adequate time.
This deficit might also be responsible for the
irresponsibility and failure in foresight that are
characteristic of individuals with ASPD, as the
inadequate processing of data may result in the
individual in making maladaptive decisions,
especially in scenarios where the thinking time
available is brief (e.g. within confrontational
Perspective
102
situations). Information processing speed is just one

of several possible measures of impulsivity, and other
neurobiological studies examining antisocial
populations have reported similar deficits in
impulsivity using different methods (Lapierre et al.,
1995) when compared to normal controls.
Furthermore, a functional neuroimaging study
examining impulsivity using a similar motor
inhibition task (Völlm et al., 2004) demonstrated PFC
activation during inhibition in controls and a
displacement of activation to the medial superior
gyrus and anterior cingulate in personality
disordered subjects (including ASPD). This might
suggest that impulsivity is related to PFC dysfunction
and this would require the use of alternative neural
pathways to deal with inhibitory demands. It has
been theorized that poor impulse control in ASPD is
due to impairment in the PFC based on the
observations of reduced metabolism and grey matter
volume in this region (Raine et al., 1997, 2000).
Stanford et al (2003) in a case-control study,
reported that premeditated aggressors did not differ
significantly from normal controls on most measures
of neuropsychological and psychophysiological
functions. These findings are consistent with a
previous work (Barratt et al., 1997). Analysis of
neuropsychological measures yielded only one
significant result. The premeditated aggressors
exhibited significantly more failures to maintain set
on the Wisconsin Card Sorting Test (WCST).
Stefano Barlati
103
In conclusion, there has been much research,

but relatively little consistent agreement among
researchers about the neurobiology and
neuropsychology of psychopathy. It appears that
psychopathy is impacted by brain abnormalities, but
the specifics of the brain dysfunctions remain elusive.
The frontal lobe appears to play a role in the
impairment of successful planning and behavioural
regulation; the amygdala appears to inhibit the
aversive classical conditioning in persons with
psychopathy and ASPD; finally, the autonomic
nervous system can help foster appropriate
interpretation of contextual cues to avoid negative
consequences.
13. Attention
Psychopathy has long been linked to attention

abnormalities (Hare and Jutai, 1983). Attention can be
considered the process by which stimuli are selected
for further processing and control over behaviour.
Stimulus selection is biased by bottom-up sensory-
driven mechanisms (e.g., visual salience), and top
down influences generated outside of sensory cortices
(e.g., executive attention). Emotional attention, the
augmentation of emotional representations within
temporal cortex by input from the amygdala, is
considered to be another form of attention based
processing bias. Emotional stimuli are unconditioned
Perspective
104
and conditioned: stimuli that are either intrinsically

aversive or appetitive or learnt to be aversive or
appetitive. Aversive and appetitive conditioning
involves the interaction of temporal cortex and the
amygdala (LeDoux, 1998).
Executive attention involves mechanisms for
monitoring and resolving response conflict and can
be indexed by response conflict paradigms such as
the Stroop task and its variants. A series of studies
have examined executive attention in individuals
with psychopathy (Blair et al., 2006; Hiatt et al., 2004;
Mitchell et al., 2002; Newman et al., 1997). As already
reported above, in the “executive functions” section,
several studies have indicated that executive attention
is either intact or even possibly superior in
individuals with psychopathy. Thus, individuals with
psychopathy show no indications of the increased
interference on the classic colour-word Stroop task
(Hiatt et al., 2004) or counting Number Stroop tasks
(Blair et al., 2006) – and may show decreased
interference on some colour-word Stroop variants
(Hiatt et al., 2004). Individuals with psychopathy
have also been found to show slightly reduced
interference on a reading Number Stroop task (Blair
et al., 2006) and in a picture-word interference task
(Newman et al., 1997).
Emotional attention can be understood as a
function of the interaction between temporal cortex
and the amygdale. If psychopathy is associated with
amygdala dysfunction, then significantly less
interference by emotional distracters should be seen.
Stefano Barlati
105
Mitchell et al. (2006) examined the extent to which an

emotional distracter presented immediately before
and after very rapidly presented target stimuli
interfered with simple motor responses to these target
stimuli. While the comparison individuals showed
significant interference to both positive and negative,
relative to neutral distracters, the individuals with
psychopathy showed no significant interference to
these distracters. It has been put forward, that in
particular offenders with psychopathy and antisocial
tendencies show reduced amygdale dependent
emotional arousal to affective stimuli and thus show
reduced attention bias for affective stimuli (Blair and
Mitchell, 2009). In this regard a recent study showed
differential modulation of processing of negative
emotion words in offenders with psychopaths versus
offenders with ASPD: psychopaths showed blunted
responding to negative emotion words, while
offenders with ASPD showed enhanced processing of
negative words and showed decreased behavioural
inhibition (Verona et al., 2012). Domes et al. (2012)
investigated whether offenders diagnosed with ASPD
differed from non-ASPD offenders or from healthy
controls in their performance in an Emotional Stroop
Task (EST) using violence-related and negative
words. Offenders with ASPD showed a significantly
stronger attention bias towards violence-related
words compared to healthy controls. In contrast, the
attention bias towards negative or violence-related
stimuli was not different in offenders with ASPD
compared to offenders without ASPD. These findings
Perspective
106
are in line with other studies which showed increased

attention for negative stimuli in criminal offenders
compared to non-criminal controls (Price and
Hanson, 2007; Smith and Waterman, 2003).
Some authors have suggested that
psychopathy reflects an attention impairment (Hiatt
et al., 2004). Evidence suggests that psychopaths fail
to shift attention resources to accommodate
secondary or unattended information while engaged
in goal-directed behaviour. The attention theoretical
perspective particularly reflects the work of Newman
and colleagues who have provided an influential,
attention-based model of psychopathy: the Response
Modulation (RM) hypothesis (see above) (Lorenz and
Newman, 2002; Newman and Lorenz, 2003). This is a
cognitive model which suggests that RM involves “a
rapid and relatively automatic i.e., non-effortful or
involuntary shift of attention from the effortful
organization and implementation of goal-directed
behaviour to its evaluation” (Newman et al., 1997). This
“brief and highly automatic shift of attention … enables
individuals to monitor and, if relevant, use information
that is peripheral to their dominant response set; i.e.,
deliberate focus of attention” (Lorenz and Newman,
2002). Within this view, the core impairment with
respect to psychopathy is thought to relate to reduced
response modulation. According to this view, “the
impulsivity, poor passive avoidance, and emotion-
processing deficits of individuals with psychopathy may all
be understood as a failure to process the meaning of
information that is peripheral or incidental to their
Stefano Barlati
107
deliberate focus of attention” (Lorenz and Newman,

2002). The RM hypothesis is an influential, attention-
based model of psychopathy (Lorenz and Newman,
2002). However, the degree to which the model’s
implicit conception of attention in healthy individuals
is consistent with dominant cognitive neuroscience
views on attention is unclear (Corbetta and Shulman,
2002). In particular, it is unclear how frontal cortex
begins automatically shifting to non-dominant cues
that might suggest a more adaptive response.
Moreover, as shown above, individuals with
psychopathy are unimpaired in shifting attention to
non-dominant cues in attention set-shifting tasks such
as the WCST and the extra dimensional set-shifting
component of the ID/ED task (Blair et al., 2001,
LaPierre et al., 1995, Mitchell et al., 2002) and appear
sensitive to non-task relevant information in classic
colour-word Stroop and counting Number Stroop
paradigms (Blair et al., 2006, Hiatt et al., 2004). In this
respect, the same research group performed other
interesting studies. Baskin-Sommers et al. (2009)
examined the relationship between attention control
and the two major factors of psychopathy in a sample
of male prisoners. Authors found that Factor 1 and
Factor 2 were differentially associated with self-
reported attention control: Factor 1 is associated with
superior attention control, whereas Factor 2 is related
to inferior attention control. This supports the view
that Factor 1 and Factor 2 are related to distinct
functions and may have unique effects on behaviour.
Although Factor 1 and Factor 2 are associated with
Perspective
108
separate etiological mechanisms, these findings

suggest that attention control may contribute to the
symptoms associated with both factors. Zeier et al.,
(2012) examined the unique and interactive effects of
the two main psychopathy factors using a picture-
word Stroop task that has revealed performance
abnormalities in categorically-defined psychopathic
individuals (Hiatt et al., 2004; Newman et al., 1997)
identified with the PCL-R. Although individuals with
primary psychopathy are better able to ignore the
incompatible distracters in this task, their tendency to
maintain a rigid goal directed focus of attention also
has a maladaptive side. When engaged in
inappropriate or even criminal behaviour, their
insensitivity to inhibitory information greatly
impedes the possibility for effective self-regulation.
The results of this study confirmed that selective
attention abnormalities associated with psychopathy
relate specifically to individuals with elevated levels
of both psychopathy factors and appears to be
unrelated to the unique variance associated with
psychopathy Factor 1 or 2. Authors concluded that
these findings corroborates previous evidence
demonstrating reduced processing of peripheral
incongruent information in psychopathic offenders
(Zeier et al., 2009). In another recent study, Baskin-
Sommers et al., 2012 provides powerful support for
the role of attention in moderating the fear deficits of
psychopathic individuals. As in previous study
(Baskin-Sommers et al., 2011; Newman et al., 2010),
psychopathy-related deficits in fear-potentiated
Stefano Barlati
109
startle (FPS) were found only in conditions in which

the threat information was peripheral to the primary
task. This perspective is largely consistent with
several findings showing that psychopaths are adept
at focusing, but have difficulty redistributing
resources once attention is allocated (Jutai and Hare,
1983).
According to the RM hypothesis psychopathic
individuals are predisposed to act on urges once they
become pre-potent because they do not allocate
sufficient top down attention resources to process
bottom-up associations that would otherwise serve to
modify the behaviour. According to this view, the
problematic behaviour of psychopaths reflects a
general deficit in the flexibility of attention that
directly impacts self-regulation and adaptive decision
making, rather than specific drives toward violent
action and reward seeking or a lack of motivation to
avoid punishment (Vitale and Newman, 2009). At a
neuropsychological level, impulsive aggression
involves a problem mobilizing sufficient top down
resources to inhibit strong aggressive urges by
activating alternative responses, particularly when
such urges are fuelled by negative affect (Newman et
al., 2002). In contrast, because instrumental
aggression is intentional, it is not normally attributed
to deficient top down control. Although there is less
consensus regarding the psychobiological substrate of
instrumental aggression, Blair’s (2001) VIM model
suggests that instrumental aggression reflects
psychopaths ‘inability to form associations between
Perspective
110
emotional, unconditioned stimuli (such as distress

cues) and conditioned stimuli.
This dual-aetiology approach appears well
suited to psychopathy. For many investigators, the
two-factor PCL-R model of psychopathy indicates
that psychopathy is an etiologically heterogeneous
syndrome with some salient features of the disorder
(e.g. the interpersonal callousness and shallow affect
associated with PCL-R Factor 1) reflecting one set of
psychobiological processes and other salient features
(e.g. the impulsive behaviour and antisocial lifestyle
associated with PCL-R Factor 2) reflecting other
psychobiological processes. In contrast to this
approach, the RM model suggests that both forms of
violence stem from the same underlying deficit in
response modulation. At this time, it is unclear which
theoretical model will best account for psychopathic
violence. The dual-aetiology approach is consistent
with traditional conceptualizations of reactive and
instrumental violence; however, the RM model offers
an explanation for the impulsive and instrumental
aggression of psychopathic individuals and
acknowledges the potential uniqueness of
psychopathic violence. Authors suggest that the
violent and non-violent, yet impulsive, behaviours of
psychopaths reflect a single, underlying deficit. This
single, underlying deficit is cognitive attention in
nature, and may be understood as a failure of top-
down attention processes to sufficiently activate non-
dominant networks in the face of bottom-up calls for
processing (Vitale and Newman, 2009).
Stefano Barlati
111
14. Emotional Dysfunction
An alternative view suggests that

psychopathy reflects a specific form of emotional
dysfunction (Blair et al., 2005; Kiehl, 2006; Lykken,
1995). Within the emotion theoretical perspective,
there is relative consensus that the amygdala is
dysfunctional (Blair et al., 2005, Kiehl, 2006).
The ability of individuals to process the
emotional expressions of others is important because
it is critical for those aspects of empathy that are
central to socialization. It appears likely that the
selective impairment in the processing of expression
information, seen in individuals with psychopathy,
leads to their difficulties in socialization and thus to
the development of their disorder.
Many studies have reported evidence of
impaired expression recognition in individuals with
psychopathy and individuals with subclinical
psychopathic tendencies (Blair et al., 2001; Dolan and
Fullam, 2006). Moreover, a meta-analysis of this
literature, which included findings from other
predominantly instrumentally aggressive
populations, reported clear evidence of expression
recognition impairment in individuals with
psychopathy (Marsh and Blair, 2007). Across the
studies examining expression recognition, there have
been reports of impairment in the processing of a
variety of expressions in individuals with
psychopathy. However, it should be noted that
Perspective
112
findings of recognition deficits for fearful expressions

are more common than those for sad expressions
(Blair et al., 2001; Dolan and Fullam, 2006). In
addition, the results of the recent meta-analysis found
no evidence of impairment for the recognition of
angry, disgusted, happy or surprised expressions.
Thus, individuals with psychopathy show
impairment in several neuropsychological aspects:
aversive conditioning, generating autonomic
responses to anticipated threat, augmentation of the
startle reflex to visual threat primes, passive
avoidance learning and response reversal. In
addition, individuals with psychopathy show clear
difficulties in empathic responding (Blair, 2006). The
selective nature of the expression recognition
impairment suggests a degree of specificity in the
neural regions that may be dysfunctional in
individuals with this disorder. An impairment in the
processing of fearful expressions has been
particularly associated with damage to the amygdala.
Moreover, meta-analytic work has shown that the
amygdala is significantly more responsive to fearful
relative to other expressions (Murphy et al., 2003).
Amygdala dysfunction was first related to the
development of and an amygdala-centric account of
this disorder has received considerable development
and refinement (Blair, 2001; 2003; 2005; 2007). More
recently, other research groups have also implicated
amygdala dysfunction in psychopathy (Kiehl, 2006;
Viding, 2004). Consistent with these suggestions of
amygdala dysfunction in psychopathy, studies of
Stefano Barlati
113
functional neuroimaging have reported reduced

amygdale activity in response to facial expressions in
psychopathy (Marsh and Blair, 2008). Another study
reported a reduced differential response within
fusiform cortex to fearful expressions relative to
neutral expressions in the individuals with
psychopathy (Deeley et al., 2006). It has been argued
that the impairment in expression processing seen in
individuals with psychopathy is important with
respect to the emergence of the disorder because an
adequate response to the fear and sadness of others is
critical for appropriate moral socialization (Blair,
1995). Considerable recent work has suggested the
importance of emotional responses for moral
development (Blair,1995; Moll et al., 2002). A specific
version of this view suggests that healthy individuals
are predisposed to find the distress of others aversive
and learn to avoid actions associated with this
distress (i.e. acts that harm others) (Blair, 1995). In
addition to its role in responding to expressions, the
amygdala is crucial for stimulus-reinforcement
learning (Davis and Whalen, 2001). This learning
allows representations of conditioned stimuli within
temporal cortex to be linked to emotional responses
mediated by the amygdala and other structures. In
other words, the amygdala allows the individual to
learn the goodness and badness of objects and
actions. The suggestion is that fearful and sad
expressions serve as aversive reinforces and thus the
individual learns to avoid stimuli associated with
these expressions (Blair, 1995; 2007). The basis of care-
Perspective
114
based morality, learning that some actions harm

others and because of this are to be avoided, relies on
the critical roles of the amygdala in stimulus-
reinforcement learning and responding to distress
cues. In psychopathy, aversive conditioning and the
response to others fear are profoundly impaired (Blair
et al., 2001). These impairments mean that the
individual with psychopathy is significantly more
difficult to socialize. Indeed, considerable fMRI work
indicates that vmPFC and, to a lesser extent, the
amygdala has a major role in moral reasoning (Blair,
2010; Moll et al., 2002; Yang and Raine, 2009).
Dysfunction in the amygdala and vmPFC should thus
lead to problems in moral reasoning. Problems with
moral reasoning are seen in individuals with
psychopathy (Blair,1995; 1997). In summary, the
selective impairment in expression processing seen in
psychopathy interferes with socialization and with
the development of moral reasoning.
15. Theory of Mind
Theory of Mind (ToM), the ability to attribute

mental states to others, and empathy, the ability to
infer emotional experiences, are important processes
in social cognition. Different cognitive models were
proposed in an attempt to explain psychopaths’
violation of social rules and the disregard for other
people’s emotions. One explanation is that
Stefano Barlati
115
psychopaths have impaired ToM abilities. ToM refers

to the capacity to make inferences regarding others’
mental states: their knowledge, needs, intentions and
beliefs (Korkmaz, 2011). It was suggested that since
psychopathic individuals are deficient in their ToM
abilities, they are less likely to empathize with the
other, and are thus less likely to inhibit antisocial
behaviours (Richell et al., 2003). Researchers has often
tried to draw parallels of psychopaths’ moral-
reasoning deficit to the concept of the ToM in
children, where children understand other people’s
behaviour not according to reality but according to
what they believe as reality and their feelings toward
this belief. However, inconsistent with this account is
the fact that psychopaths are extremely good
manipulators and deceivers, which indicates that they
are actually quite good at making inferences
regarding other people’s mental states. Indeed,
numerous studies report no impairment in the ability
to represent mental states of others in psychopathy
(Widom, 1978; Richell et al., 2003). Blair et al. (1997)
used a number of ToM tasks developed for adults,
which required the respondents to read 24 stories and
then either interpret the behaviour of the characters
or predict what would happen next. No significant
difference was found in psychopaths’ task
performance compared to no psychopathic controls,
thus suggesting that psychopaths’ do not have a ToM
deficit. Richell et al. (2003) conducted a study using
reading the “mind in the eyes” ToM test, which
required the respondents to identify mental states of
Perspective
116
people depicted by photographs of the eye region

only. The results of this study again provide evidence
that psychopaths do not have a generalized
impairment of ToM. Hence, the moral deficiency does
not stem from the inability to distinguish between
what is moral or immoral; psychopaths are able to
distinguish between the two verbally but are unable
to put these words into action.
It has been recently suggested that ToM is
comprised cognitive (cognitive ToM) as well as
emotional aspects (affective ToM). It has been
speculated that ‘‘cognitive ToM’’ refers to the ability
to make inference regarding other people’s beliefs,
while ‘‘affective ToM’’ refers to inference one makes
regarding others’ emotions. The concept of affective
ToM is quite similar to that of empathy which has
been reported to be deficient in psychopathy (Blair,
1995). Currently there is a lack of a clear distinction
between empathy and ToM concept leading some
researchers to use these terms interchangeably. It had
been suggested that cognitive ToM is a pre-requisite
for affective ToM and is roughly equivalent to the
purely cognitive aspects of empathy (Shamay- Tsoory
et al., 2009).
Since cognitive ToM abilities appear to be
intact in psychopathy, it may be supposed that
impaired affective ToM, rather than a general ToM
deficit may account for the aberrant behaviour
observed in psychopathy. In line with this notion, it
was reported that participants with damage involving
the vmPFC show impaired affective ToM, while
Stefano Barlati
117
presenting with intact cognitive ToM (Shamay-Tsoory

and Aharon-Peretz, 2007). As mentioned several
times in this review, one area in the vmPFC, namely
the OFC has been consistently implicated as
dysfunctional in psychopathy (Blair et al., 2006).
There is ample evidence that the OFC mediates
affective information, emotional stimuli and social
behaviour. It has been found that lesions in the OFC
result in impaired empathy and in deficits of
complex ToM abilities (Shamay-Tsoory et al., 2004).
Taken together, it appears that a dysfunction in the
OFC may underlie impaired social behaviour in
psychopathy. While studies to date have examined
general ToM abilities in psychopaths (Blair et al.,
1995; Richell et al., 2003), their affective ToM abilities
as compared to their cognitive ToM abilities have
been slightly taken into account. In a recent study,
Harari et al. (2010) to assess the emotional and
cognitive aspects of ToM used a task that examines
affective versus cognitive ToM processing in separate
conditions. ToM abilities of criminal offender
diagnosed with ASPD with high psychopathy
features were compared to that of participants with
localized lesions in the OFC or dorsolateral,
participants with non-frontal lesions, and healthy
control subjects. Individuals with psychopathy and
those with OFC lesions were impaired on the
affective ToM conditions, but not in cognitive ToM
conditions, compared to the control groups. Authors
concluded that the pattern of mental impairments in
psychopathy resembles remarkably that seen in
Perspective
118
participants with lesions of the frontal lobe,

particularly with OFC damage, providing support for
the notion of amygdale-OFC dysfunction in
psychopathy.
16. Conclusions and Future Directions
After this complex review of the international

literature about the neurobiological and
neurocognitive findings of aggressive behavior in
general and of psychopathy in particular, we can
draw the following considerations.
At present, too few methodologically sound
neurocognitive and brain imaging studies in those
who have engaged antisocial violence exist for
definitive conclusions to be drawn. Many published
studies need replication using larger, better
characterised samples and more region-specific
cognitive activation paradigms. In addition, more
work is needed to explore the potential significance of
the neuromodulator role of gender on violence.
Regarding the methodological issues, future research
should have the following precautions: increase
sample size, use standard assessment tools, with the
same cut-off thresholds, account factors and subtypes
of psychopathy (i.e. successful vs unsuccessful,
primary vs secondary, and factor elements such as
affective traits and antisocial attitudes), comorbidity
(e.g. substance abuse) and other interventing
Stefano Barlati
119
variables (i.e. intelligence, level of education,

socioeconomic status, gender, and age). It might be
time to look beyond the DSM-IV and focus more on
the complex correlates of specific functional
divergences such as lack of empathy and lack of
impulse control. In risk assessment and in
rehabilitation maybe it would be better to describe
degree of impulsivity and deficiency of empathy in
psychopathic offenders rather than simply
categorizing subjects as having a personality disorder.
When conducting research, it is important to be
precise and to specify what symptoms and which
functions to focus on. Empathic ability could be a
crucial trait that separates the psychopathic subtypes.
Current studies on neural localization of empathy
have pinpointed some specific areas, such as
amygdala and cingulate gyrus. Most likely, there are
overlapping circuits in the brain that are of
importance for social interaction, and theory of mind,
functions that are of great importance for empathic
ability. Future fMRI studies applying connectivity
analysis may increase our knowledge of the cerebral
networks that are important for empathic ability.
Despite the limitations noted, available studies
do point to evidence of subtle structural and
functional deficits in the neural circuits implicated in
impulse control and emotional information
processing, i.e. the prefrontal and temporo-limbic
brain regions. It is to be hoped that greater
understanding of the neurocognitive basis of
psychopathy will be translated into more efficacious
Perspective
120
treatments of this disorder in the near future. As yet,

the clinical importance of these findings remains
unclear, and causal associations between the
observed deficits and development, and maintenance
of psychopathic and antisocial behaviours have yet to
be established. Individual violent behaviour is a
complex behaviour that arises from a dynamic and
likely time-sensitive interplay between genes and
environment. Advances in the field of epigenetic
suggest the possibility of modifying at least some of
the genes’ effects through environmental
manipulations, such as changes in lifestyle habits or
specific psychotherapeutic interventions. A crucial
task for the future is to describe valid
environmentally mediated factors that interact with
genes to increase the risk for individual violent
behaviour. This will benefit from taking multiple
research approaches (both cross-sectional and
longitudinal) and involving several disciplines.
Longitudinal prospective developmental studies,
coupled with genome wide association studies, a
rigorous characterization of the phenotypes (both
behavioural and neuropsychological) and a
broadening of the conceptual understanding of the
environment to encompass elements of the personal
(lifestyle habits), family and socio-cultural
environment are needed to further our understanding
of the gene and environmental factors’ contribution to
the risk for violence and design timely and optimally
tailored preventive and treatment strategies. With the
advent of imaging genomics, more studies should
Stefano Barlati
121
specifically examining the moderator role of genotype

in the development and maintenance of aggressive
behaviours. It is becoming increasingly clear that
understanding the neurobiology of psychopathy goes
far beyond identifying brain regions that may be
involved. Genetics, neurotransmitters and hormones
all impact the functioning of brain structures and
their connectivity. In future research it will be
important to identify how these systems work
together to produce the unique compilation of traits
and behaviours characteristic of psychopathy.
References
AMERICAN PSYCHIATRIC ASSOCIATION, Diagnostic and

Statistical Manual of Mental Disorders, Fourth edition
(Text Revision). American Psychiatric Association,
Washington DC 2000.
ANDERSON N.E, KIEHL K.A., The psychopath
magnetized: insights from brain imaging, in Trends. Cogn.
Sci., 16(1), 2012, pp. 52-60.
BARKATAKI I., KUMARI V., DAS M. et al., A
neuropsychological investigation into violence and mental
illness, in Schizophr. Res., 74(1), 2005, pp. 1-13.
BARRATT E.S., FELTHOUS A.R., Impulsive versus
premeditated aggression: implications for mens rea
decisions, in BEHAV. SCI. LAW., 21(5), 2003, pp. 619-630.
Perspective
122
BARRATT E.S., STANFORD M.S., KENT T.A., FELTHOUS

A., Neuropsychological and cognitive psychophysiological
substrates of impulsive aggression, in Biol. Psychiatry,
41(10), 1997, pp. 1045-1061.
BASKIN-SOMMERS A.R., CURTIN J.J., LARSON C.L. et al.,
Characterizing the anomalous cognition-emotion
interactions in externalizing, in Biol. Psychol., 91(1),
2012, pp. 48-58.
BASKIN-SOMMERS A.R., CURTIN J.J., NEWMAN J.P.,
Specifying the attentional selection that moderates the
fearlessness of psychopathic offenders, in Psychol. Sci.,
22(2), 2011, pp. 226-234.
BASKIN-SOMMERS A.R., ZEIER J.D., NEWMAN J.P., Self-
reported attentional control differentiates the major factors
of psychopathy, in Pers. Individ. Dif., 47(6), 2009, pp.
626-630.
BECHARA A., DAMASIO A.R., DAMASIO H., ANDERSON
S.W., Insensitivity to future consequences following
damage to human prefrontal cortex, in Cognition, 50,
1994, pp. 7-15.
BLAIR R.J., A cognitive developmental approach to
mortality: investigating the psychopath, in Cognition,
57(1), 1995, pp. 1-29.
BLAIR R.J., Neurocognitive models of aggression, the
antisocial personality disorders, and psychopathy, in J.
NEUROL. Neurosurg. Psychiatry, 71(6), 2001, pp. 727-
731.
Stefano Barlati
123
BLAIR R.J., Neurobiological basis of psychopathy, in BR. J.

Psychiatry, 182, 2003, pp. 5-7.
BLAIR R.J., Responding to the emotions of others:
dissociating forms of empathy through the study f typical
and psychiatric populations, in Conscious. Cogn., 14(4),
2005, pp. 698-718.
BLAIR R.J., The amygdala and ventromedial prefrontal
cortex in morality and psychopathy, in Trends. Cogn. Sci.,
11(9), 2007, pp. 387-392.
BLAIR R.J., Neuroimaging of psychopathy and antisocial
behavior: a targeted review, in Curr. Psychiatry Rep.,
12(1), 2010, pp. 76-82.
BLAIR R.J., JONES L., CLARK F., SMITH M., The
psychopathic individual: a lack of responsiveness to distress
cues?, in Psychophysiology, 34(2), 1997, pp. 192-198.
BLAIR R.J., MITCHELL D.G., Psychopathy, attention and
emotion, in Psychol. Med., 39(4), 2009, pp. 543-555.
BLAIR R.J., PESCHARDT K.S., BUDHANI S. et al., The
development of psychopathy, IN J. CHILD. PSYCHOL.
Psychiatry, 47(3-4), 2006, pp. 262-276.
BRENDGEN M., DIONNE G., GIRARD A. et al., Examining
genetic and environmental effects on social aggression: a
study of 6-year-old twins, in Child Development, vol. 76,
(4), 2005, pp. 930-946.
BRUNNER H.G., NELEN M., BREAKEFIELD X.O. et al.,
Abnormal behavior associated with a point mutation in the
Perspective
124
structural gene for monoamine oxidase A, in Science, vol.

262, 1993, pp. 578-580.
BUSHMAN B.J., HUESMANN R., AGGRESSION, IN B.J.
BUSHMAN, R. HUESMANN, Handbook of social
psychology, JOHN WILEY & SONS, Inc., 2010.
CAPLAN M., VESPO J., PEDERSON J., HAY D.F., Conflict
and its resolution in small groups of one-and two-year-
olds, in Child Development, 62, 1991, pp. 1513-1524.
CASPI A., HARIRI A.R., HOLMES A. et al., Genetic
sensitivity to the environment: the case of the serotonin
transporter gene and its implications for studying complex
diseases and traits, in Am. J. Psychiatry, 167(5), 2010, pp.
509-527.
CASPI A., MCCLAY J., MOFFITT T.E. et al., Role of
genotype in the cycle of violence in maltreated children, in
Science, vol. 297, 2002, pp. 851-854.
CLECKLEY H., The Mask of Sanity, St. Louis, MO,
Mosby, 1941.
CLECKLEY H., The Mask of Sanity, St. Louis, MO,
Mosby. 5th ed., 1976.
COCCARO E.F., KAVOUSSI R.J., HAUGER R.L.,
Physiological responses to d-fenfluramine and ipsapirone
challenge correlate with indices of aggression in males with
personality disorder, in International Clinical
Psychopharmacology, 10, 1995, pp. 177-179.
CONGDON E., LESCH K.P., CANLI T., Analysis of DRD4
and DAT polymorphisms and behavioral inhibition in
Stefano Barlati
125
healthy adults: implications for impulsivity, in American

Journal of Medical Genetics part B: Neuropsychiatric
Genetics, 147B, 2008, pp. 27-32.
COOKE D.J., MICHIE C., HART S.D., CLARK D.A.,
Reconstructing psychopathy: clarifying the significance of
antisocial and socially deviant behavior in the diagnosis of
psychopathic personality disorder, in J. Pers. Disord.,
18(4), 2004, pp. 337-357.
CORBETTA M., SHULMAN G.L., Control of goal-directed
and stimulus-driven attention in the brain, in Nat. Rev.
Neurosci., 3(3), 2002, pp. 201-215.
CRAIG I.W., HALTON K.E., Genetics of human aggressive
behavior, in Hum. Genet., 126, 2009, pp.101-113.
CROWE S.L., BLAIR R.J., The development of antisocial
behavior: what can we learn from functional neuroimaging
studies?, in Dev. Psychopathol., 20(4), Fall, 2008, pp.
1145-1159.
DAMASIO A.R., The somatic marker hypothesis and the
possible functions of the prefrontal cortex, in Philos. Trans.
R. Soc. Lond. B Biol. Sci., 351(1346), 1996, pp. 1413-
1420.
DAVIS M., WHALEN P.J., The amygdala: vigilance and
emotion, in Mol. Psychiatry, 6(1), 2001, pp. 13-34.
DECKEL A.W., HESSELBROCK V., BAUER L., Antisocial
personality disorder, childhood delinquency, and frontal
brain functioning: EEG and neuropsychological findings,
in J. Clin. Psychol., 52(6), 1996, pp. 639-650.
Perspective
126
DEELEY Q., DALY E., SURGULADZE S. et al., Facial

emotion processing in criminal psychopathy. Preliminary
functional magnetic resonance imaging study, in Br. J.
Psychiatry, 189, 2006, pp. 533-539.
DILALLA L.F., GOTTESMAN I.I., Biological and genetic
contributions to violence – widom’s untold tale, in
Psychological Bulletin, 109, 1991, pp. 125-129.
DINN W.M., HARRIS C.L., Neurocognitive function in
antisocial personality disorder, in Psychiatry Res., 97(2-3),
2000, pp. 173-190.
DOLAN M., DOYLE M., Violence risk prediction. Clinical
and actuarial measures and the role of the Psychopathy
Checklist, in Br. J. Psychiatry, 177, 2000, pp. 303-311.
DOLAN M., FULLAM R., Face affect recognition deficits in
personality-disordered offenders: association with
psychopathy, in Psychol. Med., 36(11), 2006, pp. 1563-
1569.
DOMES G., MENSE J., VOHS K., HABERMEYER E.,
Offenders with antisocial personality disorder show
attentional bias for violence-related stimuli, in Psychiatry
Res., 2012, Dec 19 [Epub ahead of print].
FERGUSON C.J., BEAVER K.M., Natural born killers: the
genetic origins of extreme violence, in Aggression and
violent behavior, 14, 2009, pp. 286-294.
FITZGERALD K.L., DEMAKIS G.J., The neuropsychology of
antisocial personality disorder, in Dis. Mon., 3(3), 2007,
pp. 177-183.
Stefano Barlati
127
FOWLES D.C., The three arousal model: implications of

Gray’s two-factor learning theory for heart rate,
electrodermal activity, and psychopathy, in
Psychophysiology, 17, 1980, pp. 87-104.
GAO Y., GLENN A.L., SCHUG R.A. et al., The
neurobiology of psychopathy: a neurodevelopmental
perspective, in Can. J. Psychiatry, 54(12), 2009, pp. 813-
823.
GAO Y., RAINE A., Successful and unsuccessful
psychopaths: a neurobiological model, in Behav. Sci. Law.,
28(2), 2010, pp. 194-210.
GLENN A.L., RAINE A., The neurobiology of psychopathy,
in Psychiatr. Clin. North. Am., 31(3), 2008, pp. 463-475.
GLENN A.L., RAINE A., SCHUG R.A., The neural
correlates of moral decision-making in psychopathy, in
Mol. Psychiatry, 14(1), 2009, pp. 5-6.
GORENSTEIN E.E., Frontal lobe functions in psychopaths,
in J. Abnorm. Psychol., 91(5), 1982, pp. 368-379.
GOTTSCHALK M., ELLIS L., Evolutionary and genetic
explanations of violent crime, in C.J. FERGUSON, Violent
crime. Clinical and social implications, Sage
Publications Inc. 2010.
GRAY J.A., A critique of Eysenck’s theory of personality, in
A Model for Personality (H.J. EYSENCK ed.), Springer-
Verlag 1981, pp. 246–276.
HARARI H., SHAMAY-TSOORY S.G., RAVID M,
LEVKOVITZ Y., Double dissociation between cognitive and
Perspective
128
affective empathy in borderline personality disorder, in

Psychiatry Res., 175(3), 2010, pp. 277-279.
HARE R.D., Performance of psychopaths on cognitive tasks
related to frontal lobe function, in J. Abnorm. Psychol.,
93(2), 1984, pp. 133-140.
HARE R.D., The Hare Psychopathy Checklist-Revised,
Toronto, ON: Multi-Health Syst., 1991.
HARE R.D., The Hare Psychopathy Checklist-Revised,
Toronto, ON: Multi-Health Syst. 2nd ed., 2003.
HARE R.D., HART S.D., HARPUR T.J., Psychopathy and
the DSM-IV criteria for antisocial personality disorder, in
J. Abnorm. Psychol., 100(3), 1991, pp. 391-398.
HARE R.D., NEUMANN C.S., Structural models of
psychopathy, in Curr. Psychiatry Rep., 7(1), 2005, pp. 57-
64.
HARE R.D., NEUMANN C.S., Psychopathy as a clinical
and empirical construct, in Annu. Rev. Clin. Psychol., 4,
2008, pp. 217-246.
HIATT K.D., SCHMITT W.A., NEWMAN J.P., Stroop tasks
reveal abnormal selective attention among psychopathic
offenders, in Neuropsychology, 18(1), 2004, pp. 50-59.
ISHIKAWA S.S., RAINE A., LENCZ T. et al., Autonomic
stress reactivity and executive functions in successful and
unsuccessful criminal psychopaths from the community, in
Journal of Abnormal Psychology, 110, 2001, pp. 423-432.
JUTAI J.W., HARE R.D., Psychopathy and selective
attention during performance of a complex perceptual-
Stefano Barlati
129
motor task, in Psychophysiology, 20(2), 1983, pp. 146-

151.
KIEHL K.A., A cognitive neuroscience perspective on
psychopathy: evidence for paralimbic system dysfunction,
in Psychiatry Res., 142, 2006, pp. 107-128.
KIEHL K.A., SMITH A.M., HARE R.D. et al., Limbic
abnormalities in affective processing by criminal
psychopaths as revealed by functional magnetic resonance
imaging, in Biol. Psychiatry, 50(9), 2001, pp. 677-684.
KIM-COHEN J., CASPI A., TAYLOR A. et al., MAOA,
maltreatment and gene-environment interaction predicting
children’s mental health: new evidence and a meta-analysis
MAOA, maltreatment G x E interaction, in Molecular
Psychiatry, 11, 2007, pp. 903-913.
KOENIGS M., BASKIN-SOMMERS A., ZEIER J., NEWMAN
JP., Investigating the neural correlates of psychopathy: a
critical review, in Mol. Psychiatry, 16(8), 2011, pp. 792-
799.
KOENIGS M., KRUEPKE M., NEWMAN J.P., Economic
decision-making in psychopathy: a comparison with
ventromedial prefrontal lesion patients, in
Neuropsychologia, 48(7), 2010, pp. 2198-2204.
KORKMAZ B., Theory of mind and neurodevelopmental
disorders of childhood, in Pediatr. Res., 69(5 Pt 2), 2011,
pp. 101R-108R.
LAPIERRE D., BRAUN C.M., HODGINS S., Ventral frontal
deficits in psychopathy: neuropsychological test findings,
in Neuropsychologia, 33(2), 1995, pp. 139-151.
Perspective
130
LARSSON H., ANDERSHED H., LICHTENSTEIN P., A

genetic factor explains most of the variation in the
psychopathic personality, in Journal of Abnormal
Psychology, 115, 2006, pp. 221-230.
LEDOUX J., Fear and the brain: where have we been, and
where are we going?, in Biol. Psychiatry, 44(12), 1998, pp.
1229-1238.
LEWIS M., SULLIVAN M.W., ALESSANDRI S..M.,
Differences in shame and pride as a function of children’s
gender and task difficulty, in Child Development, 63, 1992,
pp. 630-638.
LEWIS M., SULLIVAN M.W., ALESSANDRI S..M.,
Violation of expectancy and frustration in early infancy:
the effect of loss of control, in Developmental Psychology,
26 (5), 1990, pp. 744-753.
LILIENFELD S.O., ANDREWS B.P., Development and
preliminary validation of a self-report measure of
psychopathic personality traits in noncriminal populations,
in J. Personal. Assess., 66, 1996, pp. 488-524.
LORENZ A.R., NEWMAN J.P., Deficient response
modulation and emotion processing in low-anxious
Caucasian psychopathic offenders: results from a lexical
decision task, in Emotion., 2(2), 2002, pp. 91-104.
LÖSEL F., SCHMUCKER M., Psychopathy, risk taking, and
attention: a differentiated test of the somatic marker
hypothesis, in J. Abnorm. Psychol., 113(4), 2004, pp. 522-
529.
Stefano Barlati
131
LYKKEN D.T., A study of anxiety in the sociopathic

personality, in J. Abnorm. Soc. Psychol., 55, 1957, pp. 6-
10.
LYKKEN D.T., The Antisocial Personalities, New York,
Erlbaum, 1995.
LYNAM D.R., CASPI A., MOFFITT T.E. et al., Longitudinal
evidence that psychopathy scores in early adolescence
predict adult psychopathy, in J. Abnorm. Psychol., 116(1),
2007, pp. 155-165.
LYNAM D., MOFFITT T., STOUTHAMER-LOEBER M.,
Explaining the relation between IQ and delinquency: class,
race, test motivation, school failure, or self-control?, in J.
Abnorm. Psychol., 102(2), 1993, pp. 187-196.
MARKOWITSCH H.J., STANILOIU A., Neuroscience,
neuroimaging and the law, in Cortex, 47(10), 2011, pp.
1248-1251.
MARSH A.A., BLAIR R.J., Deficits in facial affect
recognition among antisocial populations: a meta-analysis,
in Neurosci. Biobehav. Rev., 32(3), 2008, pp. 454-465.
MELOY J.R., Empirical basis and forensic application of
affective and predatory violence, in Aust. N. Z. J.
Psychiatry, 40(6-7), 2006, pp. 539-547.
MCGOWAN P.O., SASAKI A., D’ALESSIO A.C. et al.,
Epigenetic regulation of the glucocorticoid receptor in
human brain associates with childwood abuse, in Nature
Neuroscience, 12, 2009, pp. 342-348.
Perspective
132
MERCER K.D., SELBY M.I., MCCLUNG I.C., The effects of

psychopathy, violence, and drug use on neuropsychological
functioning, in American Journal of Forensic Psychology,
23 (3), 2005, pp. 65-86.
MEYER-LINDENBERG A., BUCKHOLTZ J.W.,
KOLACHANA B. et al., Neural mechanisms of genetic risk
for impulsivity and violence in humans, in Proc. Natl.
Acad. Sci. USA, 103(16), 2006, pp. 6269-6274.
MILES D.R., CAREY G., Genetic and environmental
architecture of human aggression, in Journal of Personality
and Social Psychology, 72(1), 1997, pp. 207-217.
MITCHELL D.G., COLLEDGE E., LEONARD A., BLAIR R.J.,
Risky decisions and response reversal: is there evidence of
orbitofrontal cortex dysfunction in psychopathic
individuals?, in Neuropsychologia, 40(12), 2002, pp.
2013-2022.
MITCHELL D.G., FINE C., RICHELL R.A. et al.,
Instrumental learning and relearning in individuals with
psychopathy and in patients with lesions involving the
amygdala or orbitofrontal cortex, in Neuropsychology,
20(3), 2006, pp. 280-289.
MOFFITT T.E., Adolescence-limited and life-course-
persistent antisocial behavior: a developmental taxonomy,
in Psychol. Rev., 100(4), 1993, pp. 674-701.
MOFFITT T.E., Genetic and environmental influences on
antisocial behaviors: evidence from behavioral-genetic
research, in Advances in Genetics, 55, 2005(a), pp. 41-
104.
Stefano Barlati
133
MOFFITT T.E., The new look of behavioral genetics in

developmental psychopathology: gene-environment
interplay in antisocial behaviors, in Psychological
Bullettin, 131, 4, 2005(b), pp. 533-554.
MOLL J., DE OLIVEIRA-SOUZA R., BRAMATI I.E.,
GRAFMAN J., Functional networks in emotional moral and
nonmoral social judgments, in Neuroimage, 16(3 Pt 1),
2002 Jul., pp. 696-703.
MORGAN A.B., LILIENFELD S.O., A meta-analytic review
of the relation between antisocial behavior and
neuropsychological measures of executive function, in Clin.
Psychol. Rev., 20(1), 2000, pp. 113-136.
MURPHY F.C., NIMMO-SMITH I., LAWRENCE A.D.,
Functional neuroanatomy of emotions: a meta-analysis, in
Cogn. Affect. Behav. Neurosci., 3(3), 2003, pp. 207-233.
NEWMAN J.P., LORENZ A.R., Response modulation and
emotion processing: implications for psychopathy and other
dysregulatory psychopathology, in Handbook of Affective
Sciences (R.J. DAVIDSON et al. eds), Oxford University
Press, 2003, pp. 904–929.
NEWMAN J.P., CURTIN J.J., BERTSCH J.D., BASKIN-
SOMMERS A.R., Attention moderates the fearlessness of
psychopathic offenders, in Biol. Psychiatry, 67, 2010, pp.
66-70.
NEWMAN J.P., MACCOON D.G., VAUGHN L.J., SADEH
N., Validating a distinction between primary and
secondary psychopathy with measures of Gray's BIS and
Perspective
134
BAS constructs, in J. Abnorm. Psychol., 114(2), 2005, pp.

319-323.
NEWMAN J.P., SCHMITT W.A., VOSS W.D., The impact of
motivationally neutral cues on psychopathic individuals:
assessing the generality of the response modulation
hypothesis, in J. Abnorm. Psychol., 106, 1997, pp. 563–
575.
NI X., SICARD T., BULGIN N. et al., Monoamine oxidase a
gene is associated with borderline personality disorder, in
Psychiatr. Genet., 17, 2007, pp. 153-157.
PATRICK C. J., Getting to the heart of psychopathy, in H.
HERVE & J.C. YUILLE (Eds.), Psychopathy: Theory,
research, and social implications, Hillsdale, NJ: Erlbaum,
2007, pp. 207-252.
PATTERSON C.M., NEWMAN J.P., Reflectivity and
learning from aversive events: toward a psychological
mechanism for the syndromes of disinhibition, in Psychol.
Rev., 100(4), 1993, pp. 716-736.
PRICE S.A., HANSON R.K., A modified Stroop task with
sexual offenders: Replication of a study, in Journal of
Sexual Aggression, 13(3), 2007, pp. 203-216.
RAINE A., LENCZ T., BIHRLE S. et al., Reduced prefrontal
gray matter volume and reduced autonomic activity in
antisocial personality disorder, in Arch. Gen. Psychiatry,
57(2), 2000, pp. 119-127
RAINE A., BUCHSBAUM M., LACASSE L., Brain
abnormalities in murderers indicated by positron emission
tomography, in Biol. Psychiatry, 42(6), 1997, pp. 495-508.
Stefano Barlati
135
RAINE A., YANG Y., Neural foundations to moral

reasoning and antisocial behavior, in Soc. Cogn. Affect.
Neurosci., 1(3), 2006, pp. 203-213.
RICHELL R.A., MITCHELL D.G., NEWMAN C., Theory of
mind and psychopathy: can psychopathic individuals read
the 'language of the eyes'?, in Neuropsychologia, 41(5),
2003, pp. 523-526.
SCHNEIDER F., HABEL U., KESSLER C., Functional
imaging of conditioned aversive emotional responses in
antisocial personality disorder, in Neuropsychobiology,
42(4), 2000, pp. 192-201.
SCHOENBAUM G., ROESCH M., Orbitofrontal cortex,
associative learning, and expectancies, in Neuron, 47(5),
2005, pp. 633-636.
SÉGUIN J.R., Neurocognitive elements of antisocial
behavior: Relevance of an orbitofrontal cortex account, in
Brain Cogn., 55(1), 2004, pp. 185-197.
SÉGUIN J.R., BOULERICE B., HARDEN P.W. et al.,
Executive functions and physical aggression after
controlling for attention deficit hyperactivity disorder,
general memory, and IQ, in. J. Child. Psychol. Psychiatry,
40(8), 1999, pp. 1197-1208.
SÉGUIN J.R., PIHL R.O., HARDEN P.W. et al., Cognitive
and neuropsychological characteristics of physically
aggressive boys, in J. Abnorm. Psychol., 1995, 104(4), pp.
614-624.
SHAMAY-TSOORY S.G., AHARON-PERETZ J., Dissociable
prefrontal networks for cognitive and affective theory of
Perspective
136
mind: a lesion study, in Neuropsychologia, 45(13), 2007,

pp. 3054-3067.
SHAMAY-TSOORY S.G., AHARON-PERETZ J., PERRY D.,
Two systems for empathy: a double dissociation between
emotional and cognitive empathy in inferior frontal gyrus
versus ventromedial prefrontal lesions, in Brain, 132(Pt 3),
2009, pp. 617-627.
SHAMAY-TSOORY S.G., TOMER R., GOLDSHER D. et al.,
Impairment in cognitive and affective empathy in patients
with brain lesions: anatomical and cognitive correlates, in
J. Clin. Exp. Neuropsychol., 26(8), 2004 Nov., pp. 1113-
1127.
SIEVER L., Neurobiology of aggression and violence, in The
American Journal of Psychiatry, 165, 2008, pp. 429-442.
SMITH P., WATERMAN M., Role of Experience in
Processing Bias for Aggressive Words in Forensic and
Non-Forensic Populations, in Aggressive Behavior, 30,
2004, pp. 105-122.
STANFORD M.S., HOUSTON R.J., MATHIAS C.W. et al.,
Characterizing aggressive behavior, in Assessment, 10(2),
2003, pp. 183-190.
STENBERG C., CAMPOS J., EMDE R.N., The facial
expression of anger in seven-month-old infants, in Child
Development, 54, 1983, pp. 178-184.
SUTKER P.B., ALLAIN A.N. JR., Cognitive abstraction,
shifting, and control: clinical sample comparisons of
psychopaths and nonpsychopaths, 96(1), 1987, pp. 73-75.
Stefano Barlati
137
SWANN A.C., LIJFFIJT M., LANE S.D. et al., Trait

impulsivity and response inhibition in antisocial
personality disorder, in J. Psychiatr. Res., 43(12), 2009,
pp. 1057-1063.
TIIHONEN J., ROSSI R., LAAKSO M.P. et al., Brain
anatomy of persistent violent offenders: more rather than
less, in Psychiatry Res., 163(3), 2008, pp. 201-212.
TREMBLAY R.E., BOULERICE B., HARDEN P.W. et al., Do
children in Canada become more aggressive as they
approach adolescence?, in Human Resources Development
Canada. Growing up in Canada: National Longitudinal
Survey of Children and Youth, Ottawa, Ontario, Statistics
Canada, 1996, pp. 127-137.
VEIT R., FLOR H., ERB M. et al., Brain circuits involved in
emotional learning in antisocial behavior and social phobia
in humans, in Neurosi. Lett., 328(3), 2002, pp. 233-236.
VERONA E., SPRAGUE J., SADEH N., Inhibitory control
and negative emotional processing in psychopathy and
antisocial personality disorder, in J. Abnorm. Psychol.,
121(2), 2012, pp. 498-510.
VIDING E., On the nature and nurture of antisocial
behavior and violence, in Ann. NY Acad. Sci., 1036, 2004,
pp. 267-277.
VIDING E., FRICK P.J., PLOMIN R., Aetiology of the
relationship between callous-unemotional traits and
conduct problems in childhood, in Br. J. Psychiatry Suppl.,
49, 2007, pp. 33-38.
Perspective
138
VIDING E., LARSSON H., JONES A.P., Quantitative genetic

studies of antisocial behaviour, in Philos. Trans. R. Soc.
Lond. B. Biol. Sci., 363(1503), 2008, pp. 2519-2527.
VITALE J.E., NEWMAN J.P., Response perseveration in
psychopathic women, in J. Abnorm. Psychol., 110(4), 2001,
pp. 644-647.
VÖLLM B., RICHARDSON P., STIRLING J., Neurobiological
substrates of antisocial and borderline personality disorder:
preliminary results of a functional fMRI study, in Crim.
Behav. Ment. Health., 14(1), 2004, pp. 39-54.
WALLACE J.F., MALTERER M.B., NEWMAN J.P., Mapping
Gray's BIS and BAS Constructs onto Factor 1 and Factor
2 of Hare's Psychopathy Checklist-Revised, in Pers.
Individ. Dif., 47(8), 2009, pp. 812-816.
WALTERS G.D., WHITE T.W., Heredity and crime: bad
genes or bad research?, in Criminology, 27(3), 1989, pp.
455-485.
WHITESIDE S.P., LYNAM D.R., Understanding the role of
impulsivity and externalizing psychopathology in alcohol
abuse: application of the UPPS impulsive behavior scale, in
Exp. Clin. Psychopharmacol., 11(3), 2003, pp. 210-217.
WIDOM C.S., A methodology for studying non-
institutionalized psychopaths, in R.D. HARE, D.
SCHALLING (Eds.), Psychopathic behavior: Approaches to
research, Toronto, Wiley, 1978, pp. 71-84.
YANG Y., RAINE A., Prefrontal structural and functional
brain imaging findings in antisocial, violent, and
Stefano Barlati
139
psychopathic individuals: a meta-analysis, in Psychiatry

Res., 174(2), 2009, pp. 81-88.
YANG Y., RAINE A., LENCZ T. et al., Volume reduction in
prefrontal gray matter in unsuccessful criminal
psychopaths, in Biol. Psychiatry, 57(10), 2005, pp. 1103-
1108.
ZEIER J.D., BASKIN-SOMMERS A.R., HIATT RACER K.D.,
NEWMAN J.P., Cognitive control deficits associated with
antisocial personality disorder and psychopathy, in
Personal Disord., 3(3), 2012, pp. 283-293.
ZEIER J.D., MAXWELL J.S., NEWMAN J.P., Attention
moderates the processing of inhibitory information in
primary psychopathy, in J. Abnorm. Psychol., 118(3),
2009, pp. 554-563.
140
Raffaele Bianchetti
141
The Evaluation of Personality

Disorders in the Context of Italian
Juvenile Criminal Justice: a
Criminological Analysis
Raffaele Bianchetti1
Keywords: Personality disorders, Liability, Social

dangerousness, Treatment, Italian Juvenile Criminal
Justice.
1. Introduction
The present work intends to contribute, within

the ongoing evaluation of the adequacy of social
responses to juvenile delinquent behavior, to the
general and collective reflection on the means of
prevention and treatment of personality disorders in
1
Clinical Criminologist. Fellow Researcher, Chair of Criminology and
Criminalistic at the University of Milan.
The Evaluation of Personality Disorders in the Context of
Italian Juvenile Criminal Justice: a Criminological Analysis.
142
minors and adolescents2. In particular, the following

investigation, starting with the examination of a
symbolic court case, wants to highlight, from a purely
criminological point of view, the fact that the clinical-
forensic investigations in terms of imputability and a
danger to society, have had on the various judicial
decisions and the consequences that prolonged
observations of the personality of the minor offender
(pursuant to art. 9 d.P.R. 448/88)3, produced in the
2
This contribution is a revision with updates and an adjustment, for
editorial purposes, of the report submitted to the 2nd International
Congress of the advanced high school of criminological sciences (CRINVE)
titled «Criminal Behaviors. Impacts, Tools and Social Networks», held in
Milano from the 10th to the 12th of May 2013. The original version of this
work, however extended compared to the elaborate which was presented
at the conference, is published in the legal journal called «Cassazione
Penale». Therefore, although not reported in detail in the few synthetic
excerpts described below, please refer to R. BIANCHETTI, Prevenzione e
trattamento in ambito minorile: aspetti di criminologia applicata e di
giustizia penale in sede di valutazione di disturbi della personalità, in
Cassazione Penale, 11 (2013), pp. 4191-4215.
3
Art. 9 d.P.R. 448/88, governing the «Findings on the personality of the
minor», provides in its first paragraph, that «the public prosecutor and the
judge acquire elements of the conditions and personal resources, family,
social and environmental impact of a minor in order to ascertain the
eligibility and the degree of responsibility, to assess the social significance
of the fact as well as have the appropriate criminal and civilian measures».
This rule, as a shining example of expression of the intent of d.P.R. n. 448
of 22.9.1988, by which in Italy, the new provisions on criminal proceedings
against juvenile offenders have been approved, is – in a nutshell – the
result of «a modern personological conception, with a pragmatic and
functional approach, of psycho-social inclination and oriented to a
Raffaele Bianchetti
143
application of certain legal institutions, the criminal

law and the Italian juvenile criminal procedural law,
in relation to a person with personality disorders.
Therefore, for the purposes of carrying out this
analysis, it was decided to operate in the following
way: at first, we took due care to recall some point in
the epistemological aspects of psychiatric diagnosis,
focusing in particular on those directly relevant to
personality disorders; then, it was decided to address
some issues – among many – that such disorders
arouse in clinical-forensic, especially on the legal and
social dangerousness of the individual; finally, it was
considered necessary to carry out, during the
discussion of the selected court case, some
criminological considerations regarding the
assessment of the personality, diagnostic accuracy
and adequacy of the prognostic assessment. The
intention was to verify and, therefore, to present how,
in respect of an offender suffering from a severe
personality dysfunction it is actually possible to
reach, in the difficult balance between the needs of
preventive social defense and needs for treatments
constitutionally guaranteed, a sensible application of
certain legal institutions relevant to the Italian system
of juvenile justice.
psychological-juridical meaning» (F. PALOMBA, Il sistema del processo

penale Minorile, Milano, 2002, p. 73).
144
2. Psychiatric Diagnosis and Social Control
We will start, therefore, with the psychiatric

diagnosis.
As it is known, the diagnosis in medicine,
namely the proper identification of the pathological
event as the undisputed foundation of any further
course of treatment, it is a complex evaluation
process, ritualized and essentially aimed at the
treatment of the patient. This is, especially in
psychiatry, generally labeling and strongly influenced
by institutional container of reference4 and diagnostic
system employed during the process5. Nevertheless,
4
According to Goffman, the conditioning of the diagnostic process
depends largely on the institutional organization in which it takes place,
on the internal hierarchical dynamics, on the overall layout of the rules in
force, on the culture of its operators on the issues of health and disease.
For an in depth analysis of this topic see E. GOFFMAN, Asylums. Essays on
the social situation of mental patients and other inmates, New York, 1961
(trad. it. Asylums. Le istituzioni totali: i meccanismi dell’esclusione e della
violenza, Torino, 1968, p. 33 ss).
5
According to Allen Frances, the psychiatric diagnosis is just a way to see
the patient through the ‘grid’ of a particular diagnostic system. The
question, therefore, lies in the analysis of the type of system used since, in
psychiatry, there is not only one way to make the diagnosis, but there are
many [A. FRANCES, DSM in philosophyland: curiouser and curiouser, in
Bulletin of the association for the advancement of philosophy and
psychiatry, 2 (2010), pp. 21-25]. For an in depth analysis of the diagnostic
and the different models used in that context see, among many, U.
FORNARI, Trattato di psichiatria forense, Torino, 2008.
Raffaele Bianchetti
145
this is also a cognitive, descriptive and prescriptive

process widely used in the so the called ‘developed’
societies since, in addition to being useful, it
constitutes, according to some academic, a powerful
and effective tool for social control6. Through
psychiatric diagnosis it is possible indeed to include
or exclude people from services, the carrying out of
certain activities or full exercise of certain rights.
Consider, for example, the ‘weight’ that a positive
diagnostic evaluation plays nowadays in the
administrative, social, health and legal system, and on
the reverberations that those labels have in the
existence of the individual: the finding of a
pathological condition in an individual may, in fact,
influence the right to recognition of a disability (for a
pension or other forms of aid), access to a particular
treatment (intra-hospital or external), the reduction of
the extent of a sentence in light of his/hers
compromised condition of being imputable.
Consider, however, conversely, the limits of
this approach. That is that, this diagnostic process – as
6
With regard to the spread of the paradigm of medicalization as
extended paradigm of social control, see, among many: G. DI CHIARA,
Sindromi psicosociali. La priscoanalisi e le patologie sociali, Milano, 1999;
N. ROSE, Governing the Soul. The shaping of the private self, London, 1999;
M. FOUCAULT, La politica della salute nel XVIII secolo, in Archivio Foucault.
Interventi, Colloqui, Interviste. 2. 1971-1977, in A. DAL LAGO (edited by),
Poteri, saperi, strategie, Milano, 1997, p. 196 ss; R. CASTEL, L’ordre
psychiatrique. L'âge d’or de l’aliénisme, Paris, 1977 (trad. it. L’ordine
psichiatrico. L’epoca d'oro dell’alienismo, Milano, 1980).
146
described above – actually has little to do with the

concrete experience of the patient, with the real
difficulties and problems experienced by the
individual, since, as Saraceno noted, psychiatric
diagnosis has been playing for too long, a prominent
activity of stigmatization of its patients, intended
primarily to «give precedence to certain labels or
concepts of nosography» in function of «the changing
needs for social control»7.
Even Robert Castel, in some of his
deliberations, considers the diagnosis in the so-called
‘care practices’, as a tool that, other than
understanding the hardships and the concrete needs
of the person, mainly classifies, divides and
prescribes preformed treatment regimens8. According
to this perspective, the psychiatric discipline can be
considered, in a nutshell, as a sort of ‘paraphernalia’
that came in use is some criminal justice systems –
including the Italian one – by which it becomes
7
B. SARACENO, G. GALLIO, Diagnosi, ‘common language’ e sistemi di
valutazione nelle politiche di salute mentale, in M. COLUCCI (edited by), La
diagnosi in psichiatria, Milano, 2013, pp. 21-22. On this topic see also P.
BROWN, The name game: toward a sociology of diagnosis, in The journal of
mind and behavior, 3-4 (1990), p. 385 ss.
8
Psychiatry, says the French sociologist, performs then «explicit functions
of control and social defense» (CASTEL, L’ordine psichiatrico, cit., pp. 88-
143). On this topic cfr., additionally, F. MARONE, Soggetti, protocolli e tigri
di carta, in COLUCCI (edited by), La diagnosi in psichiatria, cit., p. 235 ss; M.
FOUCAULT, Sourveiller et punir. Naissance de la prison, Paris, 1975 (trad. it.
Sorvegliare e punire. Nascita della prigione, Torino, 1976).
Raffaele Bianchetti
147
possible to effectively manage, protect and treat those

with problems and/or socially dangerous, according
to the current systematic logic of bio political
government of populations9.
3. Diagnosing Personality Disorders: a

Controversial Issue
In line with what has just been said, it is also

of the same opinion Vittorio Lingiardi who, in his
interesting analysis on the diagnostic sense,
recognizes the fact that «the diagnosis of mental
9
The medicalization of the theory and practice of psychiatry has further
reinforced the current system of mental health: rather than to cure the
sick, some scholars argue, «we have more to do with populations to
regulate, control, improve» [R. MAYES, A.V. HORWITZ, DSM-III and the
revolution in the classification of mental illness, in Journal of the history of
the behavioral sciences, 3 (2005), p. 226 ss]. On this subject, with regard to
criminal law profiles of this issue, see, among many: M. PELISSERO,
Pericolosità sociale e doppio binario. Vecchi e nuovi modelli di
incapacitazione, Torino, 2008; A. MANACORDA, Malattia mentale,
imputabilità e pericolosità sociale: dalla rilettura dei contributi alla
proposta di rilettura dei problemi, in G. CANEPA, M.I. MARUGO (edited by),
Imputabilità e trattamento del malato di mente autore di reato, Padova,
2005; A. MANNA (edited by), Imputabilità e misure di sicurezza, Padova,
2003; J. PARIS, Contesto sociale e disturbi della personalità. Diagnosi e
trattamento in una prospettiva bio-psico-sociale, Milano, 1997; G. PONTI, I.
MERZAGORA, Psichiatria e giustizia, Milano, 1993; O. DE LEONARDIS, G. GALLIO,
D. MAURI, T. PITCH (edited by), Curare e punire. Problemi e innovazioni nei
rapporti tra psichiatria e giustizia penale, Milano, 1988.
148
conditions plays a role now too relevant within our

society», given the effects that it produces within the
«real world»10. In fact, if on one hand we have
witnessed in recent years, an ever growing number of
diagnostic categories11, a steady epidemiological
increase of mental disorders12 and their ever-
10
V. LINGIARDI, La politica delle diagnosi: la personalità narcisistica dentro
e fuori al DSM-5, in Atti del XVI Congresso nazionale della Società
psicoanalitica italiana (SPI): Denaro, potere e lavoro fra etica e narcisismo
(Roma, 25-27 May 2012), pp. 251-261.
11
The diagnostic categories listed in the Diagnostic and Statistical Manual
of Mental Disorders (DSM) of the American Psychiatric Association (APA)
increased from 265 (DSM-III, edition of 1980) to 365 (DSM-IV-TR, edition
of 2005). It has recently been published and distributed, also in Italy, the
DSM-5, which is the updated version of that manual; inside you can count,
between categories, subcategories, specifications and other conditions
that can be the object of clinical attention, 645 coded ratings (AMERICAN
PSYCHIATRIC ASSOCIATION, Manuale diagnostico e statistico dei disturbi
mentali - DSM-5, Italian edition, Milano, 2015).
12
For example, between 1987 and 2007, in the adult population of the
United States, the percentage of those who have been assisted for
psychiatric problems has increased from 1 American every 184 to 1 every
76. During the same period of time, among children, the increase was
pretty significant, 35 times [cfr. M. ANGELL, L’epidemia di malattie mentali e
le illusioni della psichiatria, in Psicoterapia e Scienze Umane, 2 (2012), pp.
263-282]. And yet, from the epidemiological point of view: according to
projections from the World Health Organization, mental disorders, if not
properly faced, are destined to become, by 2020, the second leading
cause of disability in the world (WORLD HEALTH ORGANIZATION, The World
Health Report 2001-Mental Health: New Understanding, New Hope,
Genève, 2001, p. 37 ss).
Raffaele Bianchetti
149
increasing medicalization13, on the other hand we are

now witnessing – albeit with some difficulty – the
significant enlargement of the boundaries of
application of psychiatric knowledge in the field of
regulation bio-securitarian of the community14.
According to Wakefield, the tendency is to
pathologize more and more the norm, i.e. a set of
common behaviors that, while not coded as diseases,
are in fact deemed dangerous and disturbing for the
life and health of the society15.
13
It is no coincidence, says Angell, the United States, psychiatry has
received, due to the use of drugs, in recent years, more subsidies from the
pharmaceutical companies than any other branch of medicine (ANGELL,
L’epidemia di malattie mentali, cit., p. 276 ss). However, there are those
who argue the opposite, noting that «the increase in the consumption of
psychotropic drugs in the world depends not so much by the companies
that produce them or by the doctors who prescribe them, but it rather
depends on the increasing incidence of psychiatric disorders in society»
[M. BLOND, F.S. BERSANI, M. VALENTINI, Il DSM-5: l’edizione italiana, in Rivista
di Psichiatria, 2 (2014), p. 59].
14
M. FOUCAULT, Les anormaux, Cours au collège de France, 1974-1975,
Paris, 1999 (trad. it. Gli anormali. Corso al Collége de France 1974-1975,
Milano, 1999, p. 110 ss).
15
J.C. WAKEFIELD, Patologizzare la normalità: l’incapacità di individuare i
falsi positivi nelle diagnosi dei disturbi mentali, in Psicoterapia e Scienze
Umane, 3 (2010), pp. 300-308. To understand the extent of the
phenomenon just described we can use an example. Currently, by
convention, are considered as pathological minimum values of arterial
pressure greater than 90; if we decided to lower the threshold and decide
that any value from 85 or higher should be considered pathological, from
one day to the other the number of people with high blood pressure
would increase of tens of millions, increasing tenfold the financial benefits
150
Among these conducts find a place, albeit on a

thin line, disorder or abnormalities related to the
sphere of personality that, from their ‘origin’, have
represented a complex theme, articulated and largely
discussed16. They pertain – in a nutshell – the ways in
of the pharmaceutical industry of anti-hypertensive. This, in fact, is

happening in psychiatry too: the bar of objective distinction between case
and non-case, according to Rose, is arbitrarily shifted down «thanks to the
complicity between medicine and industry, and thanks to media coverage
of mental illness that pervades the daily life of individuals, taking
possession of all the phenomena of normal psychological and social
suffering and transforming them into diseases». According to that A., in
fact, «all this is psychiatrised and for each suffering there is a diagnosis»; in
this way, the identified ‘targets’ are no longer the absolute peaks of
lunacy, but the vast repertoire of the failings of everyday life: unhappiness,
inefficiency, incompetence, maladjustment, antisocial behavior (ROSE,
Governing the soul, cit., p. 88 ss). Of a different view, however, are those
who argue that «in a discipline like psychiatry, in which there are no
objective markers of disease and in which the very concept of disease is
closely related to social dynamics and subjective suffering, any diagnostic
threshold that is established to define a disorder is, by its very nature open
to criticism». Therefore, the idea of a trend towards medicalization of
normal physiological psychic experiences must be rejected, since it is true
the opposite: «it is not the psychiatrists or psychologists who want to
categorize people by giving them labels; on the contrary, it is that the
people who are sick are requesting recognition of their suffering, to see
given a name to their discomfort and thus have access to care» (BIONDI,
BERSANI, VALENTINI, Il DSM-5, cit., p. 58). Of the same opinion is also M. MAJ,
Introduzione all’edizione italiana, in AMERICAN PSYCHIATRIC ASSOCIATION,
Manuale diagnostico, cit., p. XII ss.
16
The central issue of the debate lies in the series of conditions, always
observable in the individual, that since the eighties of the XX century have
gained their nosographic relevance, first by attracting speculative interest
of clinicians and then – most recently – that of the jurists. The issue is still
Raffaele Bianchetti
151
which some people perceive the world with which

they normally relate, the way in which they live
feelings and respond to physic inputs. In essence,
according to the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5), personality disorders
have as their essential characteristic of being «being a
constant pattern of inner experience and behavior
that deviates markedly from the expectations of the
individual’s culture»17.
unresolved and pertains the definition of the boundaries that identify what
can be considered characteristics or ‘peculiarity’ of an individual, from
those aspects that can be described as ‘disease’ of personality and, finally,
from the overt psychic disease. Cfr., among many, the contributions from:
K. SCHNEIDER, Psicopatologia clinica, Roma, 2004; O.F. KRENBERG, Severe
Personality Disorders: Psychotherapeutic Strategies, 1984, New Haven,
London (trad. it. Disturbi gravi della personalità, Torino, 1985); E. KAHN,
Psychopathic peronalities, New Haven, 1931; E. KRÄPELIN, Psychiatrie: ein
lehrbuch für studierende und ärzte, II-IV, Barth, 1915; E. FEUCHTERSLEBEN,
Lehrbuch der ärztlichen seelenkund, Wien, 1845.
17
AMERICAN PSYCHIATRIC ASSOCIATION, Manuale diagnostico, cit., p. 747.
After more than approximately ten years since the previous edition (DSM-
IV-TR) is now available also in Italy the updated version of the Diagnostic
and Statistical Manual of Mental Disorders, named DSM-5. This
publication, which has been the subject of many criticisms in the course of
his long ‘gestation’, presents, albeit below expectations, few new
developments. While maintaining a basically conservative approach, that is
to say that the structure is similar to the previous version, the new text
shows, for example, the disappearance of the multi-axial assessment, the
different nosographic positioning of certain psychiatric disorders, a new
formulation of the approach to the assessment and diagnosis of
personality disorders. Basically in DSM-5, the diagnosis of such disorders,
rather than being totally innovative, represents the result of some
compromises resulting from the deep scientific conflicts occurring in the
152
This model can manifest itself in ways of

perceiving and interpreting themselves or the events
(cognitive area); in the intensity, instability, and
emotional appropriateness (affective area), or even in
controlling the impulses or interpersonal functioning
(relational area). The rigidity, non-adaptive and
pervasive aspect of this disorder, which can not be
confused with the problems associated with the
various expressions of religion, politics or morals that
field. In fact, the Manual includes two completely different ways to classify
these disorders: an official one, which is identical to the previous, and an
alternative one, consisting in proposing new models and classification
tools. The first, in a nutshell, takes the categorical perspective, according
to which «personality disorders are qualitatively distinct clinical
syndromes»; the second, however, employs the dimensional perspective,
according to which «personality disorders represent maladaptive variants
of personality traits that merge imperceptibly into normality and among
them» (AMERICAN PSYCHIATRIC ASSOCIATION, Manuale diagnostico, cit., p.
748). In essence, Dimaggio observes, the essential evaluation of a
personality disorder can now be performed by using the dimensional
model, based on the impairment of the functioning of the domain of
oneself (which are reflected in the dimensions of identity and self-
direction), the interpersonal domain (impairment of ability of empathy and
intimacy), together with the presence of pathological traits (G. DIMAGGIO, I
disturbi della personalità nel DSM-5: Osservazioni e livello di
funzionamento, in State of Mind. Il giornale di scienze psicologiche, 2
Giugno, 2014, www.stateofmind.it). Of a different view, however, is
Lingiardi Vittorio, who argues that «the announced revolution failed»: the
revision process of today’s Manual, which lasted for more than a decade
and involved around 1.500 designeted designated experts in 39 nations,
«has produced, at the end, a non change» in the diagnosis of personality
disorders [V. LINGIARDI, Dare un senso alla diagnosi, in COLUCCI (edited by),
La diagnosi in psichiatria, cit., pp. 128-131].
Raffaele Bianchetti
153
give life to individuals with different cultural origins,

appears to be present in a wide variety of personal
and social situations, where it determines a significant
distress to the individual or to his environment. In
addition, it is customary, inflexible and stable over
time, meaning that the behavioral abnormalities,
which start in adolescence or early adulthood, result
in a true lifestyle with not unusual trespassing into
illegality.
The diagnosis of a personality disorder
requires a long-term assessment of functioning
patterns of the individual, the analysis of the stability
of traits of personality over time and in different
situations18. The categories in which it inflects can be
applied not only to adults, but also to children or
adolescents, only – it is specified in part of the
doctrine – in those relatively unusual cases in which
the details of the individual maladaptive personality
traits appear to be pervasive, persistent, and probably
18
To make a correct diagnosis, in fact, the recommendation to the
clinician is to conduct two or more interviews with the person of concern,
and to space out the meetings. On the other hand, to understand the
functioning of the personality of an individual, we must start from the
premise that «personality traits are consistent pattern of perceiving,
relating to and thinking about the environment and oneself that are
manifested in a wide range of social and personal contexts»; only when
the traits are rigid and non-adaptive, and therefore cause a «significant
functional impairment or subjective distress» – even if often the attitude of
the person is ego-syntonic – they are symptoms of a personality disorder
(AMERICAN PSYCHIATRIC ASSOCIATION, Manuale diagnostico, cit., p. 749).
154
not limited to a particular stage of development or

another mental disorder19. In particular, with regard
to the antisocial personality disorder20, which is
characterized by a chronic pervasive pattern of
disregard for and violation of laws and the rights of
others, some academics argue that it can not be
diagnosed in individuals under the age of 1821,
19
You should keep in mind that the traits of a personality disorder that
appears in childhood often don’t persist unchanged until adulthood. To
diagnose a problem of this kind, in an individual under the age of 18, the
traits should be recognized as constant for at least one year (AMERICAN
PSYCHIATRIC ASSOCIATION, Manuale diagnostico, cit., pp. 749-750). Also take
into consideration that in light of the clinical data and scientific evidence
emerged in the field of epidemiological research and analysis, disorders
usually first diagnosed during infancy, childhood or adolescence, have
recently been placed in so-called «neurodevelopmental disorders»
(AMERICAN PSYCHIATRIC ASSOCIATION, Manuale diagnostico, cit., p. 35 ss).
20
Otherwise referred to as psychopathy, sociopathy or dissocial
personality disorder. In general, the literature on childhood uses the term
antisocial, avoiding to label the subjects of young age with a more
definitive and stigmatizing term.
21
«For this diagnosis, the individual must be at least 18 years (Criterion B)
and must have a history of some symptoms of conduct disorder before
the age of 15 (Criterion C)». Among the specific behaviors that «are
characteristic of conduct disorder» there are: «attacks on people or
animals, destruction of property, fraud or theft, and serious violations of
rules» (AMERICAN PSYCHIATRIC ASSOCIATION, Manuale diagnostico, cit., p.
764). A different view is offered by the Psychodynamic Diagnostic Manual
(PDM), where in the section on personality disorders in children and
adolescents is found a description of the antisocial (sociopathic)
personality disorders. From that section can be inferred that «children and
adolescents with severe antisocial tendencies show a certain degree of
lack of respect for others' rights and their violation, as well as a remarkable
Raffaele Bianchetti
155
because in addition to being somewhat premature

and risky22, with the passing of time it is a disorder
that can become less and less evident, or even go into
remission as the individual becomes an adult23.
3.1. Personality Disorders and Clinical-Forensic

Context: the Reorganization of the Topic in
the Italian Jurisprudence
tendency to lie, coupled with a lack of remorse. The lack of respect can be
expressed in the form of periodic outbursts of anger, when rules and limits
are imposed, or through more obvious and pervasive antisocial acts.
Antisocial children and adolescents may be wary and suspicious, and
therefore they need to assert their power over other people in a direct or
manipulative way, with the goal of getting what they want. Most of the
antisocial children have not developed a sufficiently intimate and stable
relationship with the primary caregivers and, therefore, did not develop
even a minimal degree of empathy or concern for other people» [V.
LINGIARDI, F. DEL CORNO (edited by), Manuale Diagnostico Psicodinamico
(PDM), Milano, 2008, pp. 235-236].
22
So they consider it B.B. LAHEY, R. LOEBER, J.D. BURKE, B. APPLEGTAE,
Predicting future antisocial personality disorder in males from a clinical
assessment in childhood, in Journal of consulting and clinical psychology,
73 (2005), pp. 1011-1021; cfr., in addition, T.E. MOFFITT, Adolescence-
limited and life course-persistent antisocial behavior: a developmental
view, in Psychological review, 100 (1993), pp. 674-701.
23
The remission of the disorder is then statistically more evident in the
subjects involved in criminal behavior and prone to drugs use. Cfr.
AMERICAN PSYCHIATRIC ASSOCIATION, Manuale diagnostico, cit., p. 766 ss.
156
Therefore, as we have seen, if the diagnostic

clarification of the issues addressed above is still a
pending discussion and of a strict clinical relevance24,
what is important for our purposes – namely that of a
forensic examination of the topic – is the change that
took place in the context of the historical evolution of
the concept of personality disorder, with a record of
an almost exclusive social evaluation to one of a
certain relevance in terms of psychopathology.
Today, in fact, although the topic is still a
harbinger of considerable controversy in the clinical-
forensic field, it is no longer sustainable tout court, as
it was in recent times, the assertion that personality
24
In the clinical setting, in fact, it still is matter of discussion and
investigation the ability to accurately diagnose these disorders [v., among
many, D.J. KUPFER, M.B. FIRST, D.A. REGIER, A research agenda for DSM-V, in
American Psychiatric Association, 1 (2002), pp. 15-22], on what may be
considered the most appropriate methodologies and evaluation strategies
[see, among many, WALLERSTEIN N., What is the evidence on effectiveness
of empowerment to Improve health?, in
http://www.euro.who.int/Document/E88086.pdf, 2007; J.F. CLARKIN, K.N.
LEVY, M.F. LENZENWEGER, O.F. KERNBERG, The Personality Disorders
Institute/Borderline Personality Disorder Research Foundation randomized
control trial for borderline personality disorder: Rationale, methods, and
patient characteristics, in Journal of Personality Disorders, 18 (2004), pp.
52-72], as well as on the very concept of personality disorder from its very
essence and its role within psychiatry [cfr., on this regard, the contributions
of T.A. WIDIGER, J.R. LOWE, A dimensional model of personality disorders,
Proposal for DSM-IV, in Psychiatric clinics of north America, 31 (2008), pp.
363-379; N.S. ENDLER, N.L. KOCOVSKI, Personality disorders at the crossroads,
in Personal Disorder, 16 (2002), pp. 487-502; J. PARIS (edited by), Il
disturbo borderline di personalità. Eziologia e trattamento, Milano, 1995].
Raffaele Bianchetti
157
disorders are not only strictly among mental illnesses,

but rather between the anomalies of character and
personality25.
25
The attitude that has characterized, along the course of the twentieth
century, the scope of forensic psychiatry in relation to personality
disorders has been to an almost completely closeness to any possibilities
to reach a ‘clear’ assessment of not imputability of the subject’s author
crime affected by these issues. Many, in fact, were the verdicts of the
Supreme Court, unanimous to exclude the clinical relevance of the
«anomalies of character and temperament», the «deviations of character
and feeling», the «psychopathic personalities», the «psychoneurosis», the
«maladjusted personality», the «sexual perversion» and «any abnormalities
that may not be a consequence of clinically proven illness» (cfr., among
many, Sez. VI, 7.4.2003, n. 24614, Spagnoli, CED 225560; Sez. I, 4.6.1991, n.
7523, Catalano, CED 187794; Sez. II, 9.5.1983, n. 10379, Dottori, CED
161523). Greater openness in jurisprudence, however, is found in some
other decisions of the Court of Cassation, where they also recognize that
the neuroses and psychopathies, under certain conditions, may affect the
ability of discernment [cfr., for example, Sez. VI, 12.4.2007, Cirillo, n. 21867,
CED 236697; Sez. I, 4.3.1997, n. 3536, Chiatti, CED 207228 e in Rivista
Penale, 3 (1997), p. 766 ss]. With regard to the different explanatory
paradigms of mental illness and the incidence of certain disorders in terms
of traceability of the subject offender, see, among many: M. BERTOLINO, Il
‘breve’ cammino del vizio di mente. Un ritorno al paradigma
organicistico?, in Criminalia, 2 (2008), p. 325 ss; M.T. COLLICA, Vizio di
mente: nozione, accertamento e prospettive, Torino, 2007; F. CENTONZE,
L’imputabilità, il vizio di mente e i disturbi di personalità, in Rivista italiana
di diritto e procedura penale, 1 (2005), p. 247 ss; M. BERTOLINO,
Dall’infermità di mente ai disturbi della personalità: evoluzione e/o
involuzione della prassi giurisprudenziale in tema di vizio di mente, in
Rivista italiana di medicina legale, 2 (2004), p. 508 ss; A. MANNA,
L’imputabilità fra diritto penale e psichiatria, in A. MANNA (edited by),
Verso un codice penale modello per l’Europa: imputabilità e misure di
sicurezza, Padova, 2002, p. 3 ss; A. CERRETTI, I. MERZAGORA, Questioni
sull’imputabilità, Milano, 1994; L. ABBATE, La nosografia psichiatrica: stato
158
In fact, in the Italian jurisprudence, the

fundamental shift from a succession of opinions and
conflicting judicial decisions, which eventually
increased, over time, the confusion on the subject of
mental disorder, has been imprinted by the Supreme
Court which, with sentence of the Joint Sections n.
9163, 25.1.2005, stated that «even personality
disorders, such as those typically derived from
neurosis or psychopathies, even when they do not fit
within the typical clinical nosology (...) may constitute
proper matter able to exclude or greatly diminish, in
an autonomous and specific way, the ability of
discernment of the individual for the purposes of
articles 88 and 89 of the c.p. (...)26, provided that they
are of consistency, intensity, relevance and
seriousness that actually affect the same (...). It must,
therefore, be a disturbance factor capable of
determining (and in fact has led to) a state of
uncontrollable and unmanageable (either wholly or in
attuale e sviluppi futuri, in F. FERRACUTI (edited by), Trattato di criminologia,

medicina criminologica e psichiatria forense. La psichiatria forense
speciale, XVI, Milano, 1990, p. 97 ss.
26
For the Italian Penal Code the offender can not be condemned, and
therefore not be responsible for the crime committed, if, at the time the
offense, he was, because of infirmity, unable of discernment (art. 88 c.p.);
or, he can be held responsible for the offense, but the sentence is reduced,
if, again due to infirmity, his ability of discernment was, at that time,
greatly diminished, but not completely ruled out (art. 89 c.p.). See, among
many, G. MARINUCCI, E. DOLCINI, Manuale di Diritto Penale. Parte generale,
Milano, 2012, p. 355 ss.
Raffaele Bianchetti
159
great measure) psychic structure, such that, without

guilt, the individual is unable to exercise control over
his acts»; in other words, must be a condition under
which the subject is not able to «exercise freely self-
determination»27. And this – it should be clearly
stated – without distinguishing minimally if the
mentioned effect can be seen in an adult or a minor.
27
The sentence also states that «it is necessary that between mental
disorder and crime there should be is a causal link to suggest that the
second is determined by the first (...). The examination and assessment of
the etiological link results, then, necessary in order to approve not only the
existence of the mental disorder, but the same real components connoting
the crime (...), through an approach that is not abstract and hypothetical,
but real and individualized, in specific reference, therefore, to the same
sphere of possible or not, self-determination of the person who is held
responsible of the specific offense» [Sez. un., 25.1.2005, n. 9163, Raso, CED
230317 e in Diritto Penale e Processo, 7 (2005), p. 837 ss; cfr., also, Sez. V,
16.1.2013, n. 9843, Picini, CED 255226; Sez. VI, 27.10.2009, n. 43285,
Bolognani, CED 245253; Sez. II, 2.12.2008, n. 2774, Di Gaetano, CED
242710; Sez. V, 9.2.2006, n. 8282, Scarpinato, CED 233228; Sez. I,
22.11.2005, n. 1038, Volonté, CED 233278 e in Rivista italiana di medicina
legale, 1 (2005), p. 373 ss]. On this regard, see also the doctrinal
contributions of S. FERRACUTI, G. SANI, Disturbi di personalità e imputabilità,
in V. VOLTERRA (edited by), Psichiatria forense, criminologia ed etica
psichiatrica, Milano, 2010, p. 180 ss; U. FORNARI, I disturbi della personalità
rientrano nel concetto di infermità, in Cassazione Penale, 1 (2006), p. 273
ss; M. BERTOLINO, L’infermità mentale al vaglio delle sezioni unite:
Cassazione penale, Sez. Un., 8 marzo 2005 (u.p. 25 gennaio 2005), n. 9163,
in Diritto Penale e Processo, 7 (2005), p. 837 ss.
160
4. Epidemiology of Personality Disorders in

Adolescence and Risk-Related Behavior
Let’s leave now, for sake of brevity, these

interesting aspects and focus instead on what is the
main subject of our article. Let's start, then, from the
assumption that personality disorders in our society
exist and are, in fact, quite common28. They normally
manifest at the end of the adolescence presenting
themselves by mood instability, relational insecurity,
emotional instability, and with great difficulty, by the
individual, to establish and especially to maintain any
28
From the epidemiological point of view, the number of individuals who
have this type of problem has increased significantly in recent years,
especially in individuals of young age. In fact, Silvio Bellino – director of
the Center for personality disorders of the Psychiatric Clinic of the Hospital
Molinette (TO) – argues that personality disorders affect teens on a
massive scale, showing up early (15-16 years of age) and heavily
influencing the rest of the their existence. The general estimates, although
approximate, indicate that even the most severe disorder, the one of
borderline personality, is present in 2-3% of the population while, if we
also consider the milder forms, the overall percentage of personality
disorders rises to 15 -20% of the total (S. BELLINO, C. RINALDI, Trattamento
dei disturbi di personalità, in A.C. ALTAMURA, F. BOGETTO, M. CASSACHIA, G.
MUSCETTOLA, M. MAJ, Manuale di terapia psichiatrica, Roma, 2012, p. 299
ss). I addition see, among others, A. NOVELLETTO, E. MASINA (edited by), I
disturbi di personalità in adolescenza. Borderline, antisociali, psicotici,
Milano, 2003; J.R. MELOY, The psycopathic mind: origins, dynamics and
treatment, Northvale, N.J., 1988.
Raffaele Bianchetti
161
kind of relationship with others29. Those who are

affected have a high probability to enact risky
behaviors, deviant and pre-criminal acts30; to digress
in the use/abuse of psychotropic substances; to
implement illegal conduct of considerable gravity31.
Consider also the fact – as mentioned above –
that if the diagnostic aspect of these disorders in
adults is complex, this is even more for those who are
29
Consult, on the topic, R. LORENZINI, S. SASSAROLI, Attaccamento,
conoscenza e disturbi di personalità, Milano, 1995.
30
«The boy or the girl begin to implement risky behaviors: reckless
driving, sexual promiscuity with many disorderly and intimate relationships
of short duration (...). Easy, also, are the arguments and physical fights
because the young tends to be aggressive» (M.A. PLANT, M.L. PLANT,
Comportamenti a rischio negli adolescenti. Alcol, droghe e sesso, Trento,
1996, pp. 48-71).
31
PLANT, PLANT, Comportamenti a rischio, cit., p. 84 ss. Consult also on
these topics: S. BELLINO, P. BOZZATELLO, C. RINALDI, E. BRIGNOLO, G. ROCCA, F.
BOGETTO, Impulsività e aggressività reattiva: un’analisi fattoriale in pazienti
con disturbo borderline di personalità, in Italian journal of psycopathology,
17 (2011), p. 389 ss; A. MAGGIOLINI, A. CICERI, C. PISA, S. BELLI, Disturbi
psicopatologici negli adolescenti sottoposti a procedimenti penali, in
Infanzia e adolescenza, 3 (2009), p. 139 ss; A. NOVELLETTO, D. BIONDO, G.
MONNIELLO, L’adolescente violento. Riconoscere, prevenire l’evoluzione
criminale, Milano, 2000; G. DE LEO, P. PATRIZI, Trattare con adolescenti
devianti, Roma, 1999; O.F. KRENBERG, Aggression in Personality Disorders
and Perversion, 1992, New Haven, London (trad. it. Aggressività, disturbi
della personalità e perversioni, Milano, 1993); L. STRUNIN, R. HINGSON,
Alcohol, drugs and adolescent sexual behaviour, in Iternational Journal of
the Addictions, 27 (1992), p. 129 ss; J.E. DONOVAN, R. JESSOR, F.M. COSTA,
Structure of problem behavior in adolescence and young adulthood, in
Journal of Consulting and Clinical Psychology, 53 (1985), p. 899 ss; D.
MATZA, Becoming deviant, Englewood Cliffs, N.J., 1969.
162
still children or adolescents. And this is because the

patterns of personality are still being formed32, and
also because there are inherent limitations to the
conduct of diagnostic activities on people who, by
definition, have not acquired stable identity profiles
yet, but are rather characterized by a dynamic
dimension of personality, which is typical of the
developmental age.
It is then understandable – at this point – the
topic that we want to deal with in here, highlighting
certain relevant criminological issues and analyzing
on the sidelines some reflections and, in conclusion,
the examination of a symbolic court case.
The core of the issue is basically this: the
clinical uncertainties mentioned above affect
considerably the field of forensic psychiatry, as well
as the scope of juvenile justice in our country,
especially where there are situations in which, on the
diagnostic level, the overlap of symptoms of
personality disorders and the difficulty of creating a
well-defined differential diagnosis generates an even
32
Cfr., among many, G.O. GABBARD, Psychodynamic Psychiatry in Clinical
Practice. The DSM-IV Edition, 1994, Washington (trad. it. Psichiatria
psicodinamica. Nuova edizione basata sul DSM-IV, Milano, 2005); O.F.
KRENBERG, La diagnosi della patologia narcisistica in adolescenza, in
NOVELLETTO, MASINA (edited by), I disturbi di personalità in adolescenza, cit.;
G.V. CAPRARA, A. GENNARO, Psicologia della personalità, Bologna, 1999; D.W.
WINNICOTT, The Family and Individual Development, 1965, London (trad. it.
La famiglia e lo sviluppo dell’individuo, Roma, 1982).
Raffaele Bianchetti
163
more problematic nature of the ‘ordinary’ in fully

understanding what was the mental state of the
individual at the time the crime was committed, and
that, on a prognostic level, more and more
complicated and tiring scheduled treatments
procedures, and assessments of social dangerousness
of the subject are required. Procedural situations –
those just described – that are not so much sporadic
and in fact put to test in the criminal practice, the
actual possibility of a sensible balance between the
needs of prevention and social defense and
treatments, care and protection of the health of the
minor offender.
5. Qualitative Survey of Casuistic Type:

Examination of an Emblematic Court Case
For the purposes of this qualitative survey, a

court case has been identified, selected and analyzed,
a case that unlike the others, provided both
completeness and richness of content to the
consideration that it is intended for this analysis.
Abundant, in fact, is the documentation that we got to
work with; the clarifications that have been provided
by some legal practitioners and technical consultants
164
involved within the judicial affair, which we had the

opportunity to interview33, have been precious.
5.1. Facts and Measures

5.1.1. The Facts of the Case
Titius, a seventeen year old of Moroccan

origin, committed in July 2008, in complicity with
another person of legal age (Caius, a series of crimes,
including a kidnapping for ransom with consequent
victim's death, aggravated robbery and crime of
sexual group violence.
He, in fact – we learn from the legal
documentation – at about 5:30 am, approached on a
street in Milano, a viado (Brazilian transsexual
prostitute) named Sempronius, requesting certain
sexual performances. Such performances – refers
Mevius, friend and colleague of Sempronius in the
prostitution activity – were in fact denied by the
33
The choice of the case was carried out, following a comparative
assessment, on the basis of direct consultation and duly authorized by a
variety of case files. The semi-structured interview, which was carried out
with some of the ‘actors’ in this court case, has allowed us to highlight
aspects, as well as clarify the details, that the formal technical documents
only report. We wish to thank, for the helpfulness, the magistrates who
have joined the initiative, the Chairman of the Juvenile Court of Milano,
the lawyer of confidence of the person directly involved and some
technical advisors appointed at the time.
Raffaele Bianchetti
165
Brazilian, since the Moroccan did not have the

advanced payment of € 30 compensation.
That refusal, says Mevius – heard repeatedly
by the judicial authority – caused at first a violent
reaction by Titius who, suddenly, began «kicking and
punching the face and body» of Sempronius, and then
by both the attackers that «yanked him and beat him
violently», wounded him in the face with a utility
knife, pinned him, forced him in the backseat of their
car – the one used to reach the site – and departed
quickly on the vehicle. One of the two boys (Caius) sat
next to the victim, «to control and prevent him from
escaping», while the other (Titius) started driving the
car. After few minutes, the attackers came back to
retrieve the victim’s handbag that had remained on
the ground during the scuffle, to then leave again
with the victim – the witness added – «still keeping
him immobilized in the back seat».
Following the reports of the incident by
Mevius, the discovery of the car – then found to be
stolen –, the investigations and technical verifications
carried out, Titius was located and stopped by the
police in the early days of August while he was
returning home (to a community that he had been
living in for quite some time). Shortly thereafter, the
Judicial Police found, on the ring road west of Milano,
a few hundred meters from the entrance of a service
area, the body of Sempronius «in an advanced state of
decomposition».
Over the course of several questionings, Titius
reported that he had proposed to his friend Caius to
166
steal a car to get to a place where they could steal the

proceeds to those who exercise prostitution. The
choice of the victim was random; the escalation of
violence was unexpected.
While comparing statements from Caius, Titius
admitted that the original intention was «to steal
money to buy cocaine», he also admitted having used
the drug before the facts, and that he punched and
kicked the victim. He also claimed to have bought
more cocaine «with the 60 euro taken from the purse
of the viado» to have consumed it, that he then
cleaned himself up from the blood, that he had
hidden the dirty clothes and of having «stolen two
cars», a first one before and one after the assault. He
denied, however, to have sexually assaulted the
victim, but admitted that he had left the body lifeless
on the side of the road, specifically «in a cornfield a
few feet from the guardrail».
5.1.2. The Disciplinary Action at First Instance
The Juvenile Court of Milano, in assembly

with three judges, with judgment of 19.10.2009, found
Titius responsible of the crimes ascribed to him,
united by the bond of continuation, after applying
considering the commutation of sentence granted
Raffaele Bianchetti
167
under the penal decree (summary judgment)34 and

because of the minor age (within the meaning of art.
98 c.p.)35, sentenced the subject to 12 years in prison36;
it was also applied on a provisional basis, the security
measure of juvenile justice to be carried out in the
forms of employment in the community for a period
of 237 years, taking into account, among other things,
34
The summary trial is a special procedure, with diminishing nature,
provided by the Italian Code of Criminal Procedure. It is governed by artt.
438 ss c.p.p. Cfr., among many, E. ZAPPALÀ, V. PATANÈ, Procedimenti speciali,
in G. DI CHIARA, V. PATANÈ, F. SIRACUSANO (edited by), Diritto processuale
penale, Milano, 2013, p. 557 ss.
35
Regarding the imputability of a minor offender the Italian Penal Code
prescribes, in accordance with art. 98 c.p., that «is attributable who, at the
time of the crime, was of age fourteen, but not yet eighteen, if he had the
capacity for discernment; but the sentence is reduced».
36
G.u.p. Trib. Min. Milano, 19.10.2009, unpublished, pp. 19-20. As stated
at the beginning of this work, to get more details about the case and for a
more detailed discussion on the topics addressed below, please refer to
BIANCHETTI, Prevenzione e trattamento in ambito minorile, cit., p. 4191 ss.
37
According to art. 223 c.p. the «Hospitalization of children in a
reformatory» consists of a special security measure for minors. The
measure has taken over the years a completely residual role, as it is
applicable only in the case of intentional crimes for which the law
prescribes imprisonment (no longer applicable to minors) or imprisonment
of not less than, but in the maximum of 9 years, and in the case of the
crimes committed or attempted, ruled by art. 380, co. 2, letter. e), f), g), h),
c.p.p. and sexual abuse. According to the art. 36, co. 2 and art. 22 d.P.R.
448/88, the measurement is now applied via coercive custody of the child
to an educational community. On this point, cfr. F. ZAVATARELLI, sub art.
223. Ricovero dei minori in un riformatorio giudiziario, in E. DOLCINI, G.
MARINUCCI, Codice penale commentato, Milano, 2011; in addition, see also
what mentioned in the footnotes, n. 55, 73 e 74.
168
«the objective seriousness of the offense and of the

moral condition of the family of Titius»38.
5.1.3. Grounds of Complaint and the Outcome

of Appeals
Against this measure several reasons for

complaint were presented during the appeal.
However, both the Juvenile Court on the provisional
application of the security measure (ex art. 37 of
d.P.R. 448/88) and the Court of Appeals Juvenile
Section with two different pronunciations confirmed,
in a nutshell, the criminal responsibility and the social
dangerousness of the subject. Basically, the first
judicial authority reconfirmed in full the suitability of
the security measure applied on a provisional basis,
due to the high profile of social dangerousness of
Titius39; the appeal confirmed, with a first provision,
the criminal liability of the boy, but reduced the
38
G.u.p. Trib. Min. Milano, 19.10.2009, unpublished, p. 20. As for the moral
condition of the boy’s family see also what described in section 5.2.3; on
the other hand, in regards to the conditions for the provisional application
of the security measure, see note n. 64.
39
The Juvenile Court, in assembly with four judges, confirmed in fact, the
provisional application of the security measure as it believed that «the
personality of the accused, as described by the designated expert, is the
bearer of a danger to society and needs a specific containment and
adequate treatment» (Trib. Min., 17.11.2009, unpublished, pp. 5-6).
Raffaele Bianchetti
169
length of the sentenced time in prison (9 years

detention)40, and, with another provision, confirmed
the social danger of the same. Actually, with the latter
decision, the Court, in partial reform of the first-
instance judgment, evaluated the social
dangerousness of the offender still current, albeit
diminished, by virtue of the treatments to the
individual during the time of detention: as a matter of
fact, the measure of detention in a juvenile
reformatory was replaced with that of ‘monitored
freedom’ for a period of not shorter than one year and
a half41.
Let’s see now, in detail, the basic elements
considered for decisions made, omitting for sake of
brevity, some other interesting legal digressions that
could take us away from the main topic.
5.2. Elements of the Decision of the Court of

First Instance: Criminal Records, Notes
From Forensic and Clinical Evaluations
40
The Court of Appeal Juvenile Section worked, in fact, a recalculation of
the sentence in this way: «15 years - art. 98 c.p. = 13 years and 6 months -
art. 62 bis c.p. = 9 years and 6 months for a total of 4 + years art. 81 c.p.v.
c.p. = 13 years and 6 months – 1/3 for the trial procedure = 9)» (C. App.
Sez. Min. Milano, 15.7.2010, unpublished, pp. 29-30)
41
C. App. Sez. Min. Milano, 29.9.2011, unpublished.
170
We will therefore focus our attention

primarily on those aspects that interest us here,
namely those of applied criminology regarding the
observation of the personality and the reverberations
of such assessments on the application of certain legal
institutions and we remark, immediately, that Titius,
either for previous judicial processes or because of the
prolonged institutionalization, was found to be
‘known’ to the Services of the Administration of
juvenile Justice and Local Government and the
Authority of juvenile court.
5.2.1. Records of Criminal Relevance
He counts, in fact, criminal records against

him since 2004, for illegal possession of drugs and
aggravated theft in complicity with other people;
appears to have been placed several times (about 14)
in different therapeutic communities, from which he
often voluntarily walked away, and that he was the
recipient of a judgment of nonsuit, because he was
considered non imputable due to him being under
fourteen years of age at the time of the facts42, and to
be the recipient of a similar verdict in 2005 as a result
42
G.i.p. Trib. Min. Milano, 23.11.2005, unpublished.
Raffaele Bianchetti
171
of extinction of the crime due to successful

completion of diversion time (8 months)43.
5.2.2. The Notes of Juvenile Services and

Assessments by Psycho-Social Health
Agencies
Copious are also the reports by juvenile

services and psycho-social care assessments carried
out on him over the years, and especially during the
last court case currently under consideration.
Broad is, therefore, the material available from
which we infer, in summary, that Titius was
diagnosed, during the course of time, with problems
of different nature and gravity. Initially, the Clinical
Department of Developmental Neuroscience,
Università degli Studi di Pisa, where he was
hospitalized for severe self-injurious actions (bilateral
cuts on the surface of the thigh with the need to
suture), was diagnosed with a «conduct disorder and
a mood disorder in a subject with a history of drug
use and alcohol»44. Later, in July 2008, the Unit of
Child and Adolescent Neuropsychiatry (U.O.N.P.I.A.)
43
G.u.p. Trib. Min. Milano, 4.11.2005, unpublished.
44
Report of discharge of 23.8.2007 of the Department of Clinical
Neurosciences of Developmental age IRCCS - Stella Maris Foundation –
Università degli Studi di Pisa, pp. 3-4.
172
Hospital Policlinico of Milano diagnosed by means of

interviews and cognitive and personality tests, that
Titius was suffering from «personality disorder and
antisocial disorder related to drug use»45.
Following further psychological assessment in
July 2009 (MMPI-246 and SCID-II47) by some
specialists of the Complex Operative Unit of Clinical
Psychology of the Hospital San Carlo Borromeo of
Milano, Titius turned out suffering from a «mood
disorder of cyclothymic type with the prevalence of
hypomanic traits over those openly of depression, as
well as substance dependence and antisocial
personality disorder»48.
Finally, accordingly to its competencies, the
Juveniles Unit of the Service Area Criminal Prisons
and Local Health Authority of Milano, diagnosed
45
Clinical report of 10.7.2008 Child and Adolescent Neuropsychiatry Unit
(U.O.N.P.I.A.) Hospital Policlinic of Milano, p. 2.
46
Minnesota Multiphasic Personality Inventory (MMPI-2) is a psycho-
diagnostic test in which you have to answer a numerous series of
standardized questions. Cfr., among many, F. GIBERTI, R. ROSSI (edited by),
Manuale di Psichiatria, Padova, 1996.
47
Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) is a
psycho-diagnostic test that is also based on verbal communication of the
person who is required to provide the examples of the statements made
and some insights on the answers given. See, among many, GIBERTI, ROSSI
(edited by), Manuale di Psichiatria, cit.
48
Relation of psychological assessment of 4.7.2009 of the Department of
Mental Health, Complex Operative Unit of Clinical Psychology, San Carlo
Borromeo Hospital of Milano, p. 5.
Raffaele Bianchetti
173
Titius as a patient with problems of «addiction in a

psychopathological evident profile»49.
5.2.3. The Designated Expert Appraisal of First

Instance
The complexity of the case and the need for

further investigations on the personality of the child
pushed the Juvenile Court to give designated expert’s
the tasks to assess, from a psychiatric-forensic and
criminological point of view, some aspect, including
the criminal responsibility of Titius – both in terms of
his maturity and the presence or absence of infirmity,
and if were such as to exclude or greatly diminish the
ability – and his danger to society; the designated
expert was also required to provide information
about the educational interventions most suitable and
appropriate, taking into account the psychological
conditions found in the boy. The exam of the
documents, interviews with designated experts, some
psycho-diagnostic assessments (Rorschach projective
test of personality and Raven’s Matrices)50, as well as
49
Report of the Juvenile Operative Unit of the Criminal Service Area and
Prisons of the Local Health Authority of Milano, 22.5.2009, p. 5.
50
This is also a case of two psycho-diagnostic examinations: the first, i.e.
that of Rorschach, is a psychological projective personality test; the
second, the so-called matrices or Raven Progressive Matrices, is a test
174
a multiple comparison with prison workers that dealt

with the individual, convinced the technical advisor
to the judge to consider Titius, although suffering
from dysfunctional psychological and behavioral
aspects, fully attributable for what committed and
socially dangerous.
First of all, the Assessor had to re-consider the
clinical diagnosis of the case. Through a detailed
analysis of the symptoms of the boy and an analytical
identification of the non complete compliance to the
diagnostic criteria required for the nosographycal
frameworks mentioned above, he recognized, that it
was more appropriate to consider Titius as a person
with «a failure of personality rather than suffering
from a certain ‘type’ of personality disorder» and
that, if he had not been adequately treated, he would
have been «at serious risk of deterioration and
stabilization»51.
This «failure – as stated in the report by the
designated expert – goes back to the early teens; it is
the product of serious lack of primary affection
(mother in Morocco with a new family and a careless
father) and appears to be induced by the painful and
angry not elaborated perception of severe feelings of
abandonment (...). He made an early, prolonged and
used to measure non-verbal intelligence Cfr., among many, GIBERTI, ROSSI

(edited by), Manuale di Psichiatria, cit.
51
Designated expert’s report 14.10. 2009, p. 12.
Raffaele Bianchetti
175
massive use of psychotropic substances (cocaine,

alcohol and hashish), with purely compensatory
function (because there are not discernible signs or
symptoms on him related to chronic intoxication by
drugs, such as cognitive/ideational alterations,
neither there were, during the period of his detention,
withdrawal symptoms or severe craving)»52.
As for Titius’s psychic state during the period
and the time at which the offense happened, the
designated expert thought that the boy, even if he
was «involved and moved by the discomfort (...) and
that he was in a state of craving for drugs», he was
fully capable of discernment. There weren’t, in his
opinion, «symptoms of psychiatric illness or chronic
intoxication by substances, or signs of immaturity in a
legally relevant sense». In this regard, he wanted to
point out, in terms of the trails of causes, that if «it is
true that even the prominent failures of the
personality may lead to assume a mental
defectiveness» it is equally true, like in this case, that
«no hypothesis can be put forward to correlate these
failures with the offense committed»53.
As far as the social dangerousness of the
individual, the technical advisor to the judge
52
Designated expert’s report 14.10.2009, p. 13. For non-experts should be
noted that the term craving shows the strong and compelling need by a
person, to assume a particular substance.
53
Designated expert’s report 14.10.2009, p. 13.
176
considered the minor socially dangerous. We read, in

the report of the 14.10.2009: even if Titius «appears to
have acquired in the course of the detention, the
ability to contain transgressive behavioral
manifestations and to have given an important role,
albeit ambivalent to institutional figures, he still
appears not able to act sufficiently reflective
regarding his own previews experiences, nor capable
of a deep processing of the crime committed».The
psychological fragility that led the boy to the use of
drug, the inability to make projects and impulsivity
expressed «show his dangerousness to society», since
the boy, «if left alone, without any treatment and
assistance, could have repeated acts of self-hetero-
aggressive non containable»54.
In regards to the potential treatments, the
Assessor thought that Titius would require an
environment in which he could experience a
reduction of both emotional and legislative resonance
and a psychotherapeutic treatment55.
54
Designated expert’s report 14.10.2009, p. 13. The designated expert
pointed out during the hearing – once again – the full capacity of
discernment due to the absence, at the time of the facts, both of an illness
and of a condition of immaturity, legally relevant; he stressed, the
existence of conditions of social danger of the boy. Minutes of the hearing
on 19.10.2009, p. 2 ss.
55
The assessments by the designated experts – as written in the judgment
of first instance – endorsed the judgment that, during the process, the
Board had reached internally, at the same time. In particular, with regard
to the imputability of the boy, was deemed inadequate in the «direct
Raffaele Bianchetti
177
5.3. Elements of the Decision of the Juvenile

Court Regarding the Application of the
Security Measure of Imprisonment
The Juvenile Court, called upon to decide in

accordance with art. 38 d.P.R 448/88 on the
confirmation of the application of the security
measure56, endorsed the prior assessment about the
correlation between the characteristics of disturbed personality of the boy

and the offenses subject of the trial»; instead, with regard to the social
danger of the individual, it was identified the full satisfaction of the
requirements by the law for the application of the security measure (G.u.p.
Trib. Min. Milano, 19.10.2009, unpublished, p. 18 ss).
56
Artt. 38 and 39 d.P.R. 448/88 rule cases of definitive application of
security measures by the juvenile court. In particular, the first article
determines the shape of the protocol of the procedure that is established
by the application of the measure in case it has been issued an earlier
judgment of acquittal for minors under the artt. 97 and 98 c.p. and if there
has been a request for provisional application of the measure by the
Public Prosecutor (P.M.). The second rule, on the other hand, regulates the
application of security measures carried out directly in the hearing. In
detail, the art. 38, co. 1 of d.P.R 448/88 establishes that the juvenile court
proceeds to judgment on the social danger according to the protocols
provided by art. 678 c.p.p. in regards of monitoring, or with the in a
hearing not open to the public set by the Chairman of the Board, prior the
appointment of a defender for the child, in case he doesn’t have one. The
decision is taken by sentence, and is effective immediately, after having
heard the minor, the operator of the parental responsibility, any custodial
and juvenile services, in order to ensure comprehensive protection of the
right to defense and to acquire, for the hearing agent, further elements of
178
social danger of the boy: in particular regarding

«Titius’s inability to empathize with the suffering of
others and with his, and for the dehumanization of
the victim and his objectification (he described it as
the “viado”, “transvestite”, “that one”)»57.
It didn’t emerge, in the opinion of the Court,
any significant cue for critical processing on the
events that occurred: the boy produced a narrative
version of the events while minimizing his
responsibilities; he maintained an ego-syntonic and
alloplastic position, highlighting «predatory
inclinations for the achievement of his personal
gratifications»58.
knowledge relevant to the assessment of the real hazard constituted by

the boy. The court may take, during the trial, a series of temporary
measures against the child, in particular «may amend or withdraw the
measure applied in accordance with art. 37, co. 1, or apply it provisionally».
The second paragraph. of art. 38 d.P.R 448/88, then, states that «with the
sentence the juvenile court shall apply the security measure if the
conditions prescribed in art. 37, co. 2, are in existence», or if there is the
presence of that «high danger», of type selective and restrictive, required
by the regulation. In case of application of no security measure, the
juvenile court may however indicate which civil actions (pursuant to art.
330 ss c.c.) appear to be appropriate in the specific circumstances of the
child. For a discussion on this point see, among many, E. MARIANI, Le
misure di sicurezza per i minorenni: peculiarità, procedimento e
applicazione (artt. 36, 37, 38, 39, D.P.R. 22.9.1988, n. 448), in G.F. BASINI, G.
BONILINI, M. CONFORTINI (edited by), Codice di famiglia, minori e soggetti
deboli. Codice commentato, II, Torino, 2014, p. 4998 ss.
57
Trib. Min., 17.11.2009, unpublished, p. 3.
58
It is written in the provision: «a danger to society is not tautologically
derived from the gravity of the acts committed by the boy (...) but it is
Raffaele Bianchetti
179
5.4. Conduct in Prison and Reports by the

Juvenile Penal Institutes (I.P.M.)
During the detention Titius participated in

school and work activities, he even established a
relationship with a girl but was responsible, on
14.3.2010, of an episode of severe disciplinary
relevance (assaulted a police officer in Prison causing
him injuries). For this reason he was transferred to the
I.P.M. of Bari, where he remained for about 3 months.
In this context he maintained a correct behavior, with
a good communicative and emotional availability
towards the caregivers.
However – it is written in the report of I.P.M.
19.5.2010 ‘N. Fornelli’ of Bari – «the brief professional
analysis conducted, detected the presence of certain
sections of marked personological dysfunction (...)
consistent with the personality of the accused, thoroughly described by

the designated expert’s report». In fact, the designated expert perceived,
in Titius, «a failure of personality (...) at serious risk of deterioration and
stabilization», but not yet at the intensity «to be risen to the rank of
psychiatric illness, that constitutes a true mental disorder». This
dysfunction, however, continues the Board, is relevant in the evaluation of
social dangerousness of the boy, «since his personality turns out to be
highly oriented towards being antisocial and appears therefore in need of
a containment in both affective and normative sense» (Trib. Min.,
17.11.2009, unpublished, p. 4).
180
poor ability to tolerate frustration, a tendency to

inability of controlling impulses»59.
When back in Milano, Titius restarted
diligently the path previously taken, to the point that
the I.P.M. ‘C. Beccaria’ noticed in him «signs of a slow
but visible evolution»60.
59
The educator, in the report-observation of 19.5.2010, stated that Titius
«necessitated persistent actions of containment and emotional support (...)
also in order to better manage the complexity of his personal and
environmental situation (...). During few moments he showed a strong
need for reassurance and attention by the adult serving as reference,
mood instability, traits of anxiety in relation to the continuation of him
being removed from the context of Milano, and showed and irritability in
relation to alleged disappointment regarding his expectations of returning
to that prison» (Report-observation of I.P.M.‘N. Fornelli’ of Bari of
19.5.2010, p. 2).
60
Precisely these words are used in the note for update: «the serious
episode of which he was the protagonist seems not to have accounted for
the guy a reason to permanently withdraw from the personal journey
undertaken, indeed it appeared like an extra reason to reflect even more
on his difficulties and the criticality of his emotional and behavioral sphere.
While Titius [nda] has continued to study to pass the exams for admission
to the third year of high school (tests that, by the way, he has passed with
good results), he also, on the other hand, showed to be more aware of his
own circumstances. The evolutionary path slow, but visible, that the
operators had already pointed out in the report presented to the Court in
May 2009 at the hearing at first instance, seemed to have continued in the
direction of a bigger awareness by Titius [nda] of his difficulties, especially
in managing his aggressive impulses, when they take over» (update notes
by I.P.M.‘C. Beccaria’ in Milano on 14.7.2010, p. 2).
Raffaele Bianchetti
181
5.5. Elements of the Decision of the Court of

Appeal Juvenile Section: the Designated
Expert Appraisal and Appreciation of the
Evolutionary and Treatment Path
5.5.1. The Second Degree of the Evaluation by

Designated Experts
During the Appeal was again reassessed the

social danger of the boy by further technical
assessment by designated experts. That document
shows, in a nutshell, an experience of Titius of life in
prison characterized by «sadness», «boredom» and
«loneliness»61. Even the story of the attack on the
prison guard was dictated – according to the story
told by the boy – by previous antipathy towards that
person («he used to pick on the weak») and by the
fact that the agent was abusing violently his «brother
in law» (that’s how he called the brother of the girl
with whom he was having a relationship). At that
point – to use his words – «anger» prevailed and he
«lost control» [said: «I vented (...) that gesture made
me wrong (...) but he deserved it (...) I did the right
61
Designated expert report dated 25.3.2011, p. 4.
182
thing»; and then added: «Now I wouldn’t do it again,

knowing the consequences»]62.
The designated expert confirmed, once again,
the absence of psychiatric disorders in Titius, but he
insisted on the presence, in the light of the
improvements that Titius had with the therapeutic
work undertaken, of dysfunctional personality
aspects. Aspects which, in the opinion of the
designated expert of the Court, «are signs of the
fragility of the person to such a degree as to indicate
that without an ongoing psychological therapy,
without a reassuring frame and environmental
legislation, he would devolve to feelings of
emptiness, anger and of anomie, with real risks of
fallbacks to use of (...) substances that will facilitate
criminal acts»63.
5.5.2. The Appreciation of the Evolutionary

Path and Treatments
The Court of Appeal of Milano, after extensive

discussion, felt that although there were still
«elements indicative of a certain social
62
Designated expert report dated 25.3.2011, pp. 4-5
63
Designated expert report dated 25.3.2011, p. 10.
Raffaele Bianchetti
183
dangerousness» of the boy, this was «now more

muted than at the beginning of criminal episode»64.
In view of this, the Board, taking into account
the fact that the «detention in juvenile justice-
placement in a community at the end of the sentence,
would be meaningless for several reasons – also
because in any case after 21 years of age the sentence
should be converted to ‘monitored freedom’ on an
agricultural colony or nursing home under art. 223,
co. 2 c.p. – he felt able to apply immediately – in lieu
of a security measure sentence – ‘monitored freedom’
for a period of not shorter than one year and a half»65,
64
C. App. Sez. Min. Milano, 29.9.2011, unpublished, p. 4.
65
The provisional application of a security measure is subject to the
fulfillment of two conditions, specifically indicated in art. 37, co. 2 of d.P.R.
448/88: first, by virtue of the reference to art. 224 c.p., the judge must take
into account the «gravity of the moral condition of the family in which the
minor lived»; second, the evaluating the judging agent must consider
whether «for the specific terms and circumstances of the offense and the
personality of the offender, there is a real danger that he can commit
crimes involving the use of weapons or other means of personal violence
or directed against collective security or constitutional order, or other
serious organized crimes». This conjecture represents the most significant
innovation that the discipline of 1988 has made, in Italy, in terms of
security measures. The current wording of the provision, in fact, requires
the judge to verify, on one hand, the seriousness of the offense – that can
not be inferred simply from the charge towards the minor, but must be
assessed with reference to the specific terms and circumstances in which
the offense happened – and on the other hand, on the personality of the
child, in addition to the real danger that he could commit the crimes
mentioned above, perfecting a sort of «qualified dangerousness» [S.
LARIZZA, Il diritto penale dei minori. Evoluzione e rischi di involuzione,
184
referring to the supervising judge the task of

identifying the most appropriate requirements based
on «the future needs of social security based on the
outcome of the path taken by the young, carefully re-
evaluated»66.
Padova, 2005, p. 176; and, cfr. on the topic C. PANSINI, Processo penale a
carico di imputati minorenni, in G. GARUTI (edited by), Trattato di
procedura penale, VII, Torino, 2011; S. GIAMBRUNO, Lineamenti di diritto
processuale penale minorile, Milano, 2004].
66
Thus, the Court, in partial reform of the sentence of the Juvenile Court
of Milano issued on 17.11.2009, appealed by Titius, substituted «the
measure of the reformatory/placement in the community, with that of
‘monitored freedom’ for a term of 1 year and 6 months» (C. App. Sez. Min.
Milano, 29.9.2011, unpublished, p. 5). It should be noted, in this regard,
that the jurisdiction of Juvenile Courts in function of the judiciary
surveillance extends up to when the age the offender is of twenty-five,
according to art. 3, co. 2 of d.P.R. 448/88. As for the security measures, the
art. 24 d.lgs. n. 272/1989, prescribes that they «are carried out according
to the rules and in the modalities listed for minors also towards those who,
in the course of the execution, turned 18 but not twenty-one year of age.
The execution remains competency of the staff of juvenile services». The
recent change made by art. 5 d.l. 26.6.2014, n. 92, converted with
amendments by l. 11.08.2014, n. 117, has also extended the above
mentioned limit of age to twenty-five years, «provided that, for those who
have already completed the twenty-first year, are not present particular
reasons of safety assessed by the competent court, also taking into
account the purpose of re-education». Cfr., on the topic, ZAVATARELLI, sub
art. 223., cit.; M.A. ZUCCALÀ, Le misure di sicurezza per i minorenni, in E.
PALERMO FABRIS, A. PRESUTTI (edited by), Diritto e procedura penale minorile,
Milano, 2011; S. DI NUOVO, G. GRASSO, Diritto e procedura penale minorile:
profili giuridici, psicologici e sociali, Milano, 2005.
Raffaele Bianchetti
185
6. Some Concluding Remarks
Having reached the end of this examination,

in the light of referrals in terms of psychiatric
diagnosis, treatment and social control of adolescent
subjects suffering from personality disorders, it is
now possible to make some concluding
considerations, paying particular attention to certain
aspects specifics to applied criminology, as part of the
Italian juvenile justice.
Undoubtedly this study, carried out by
examining this case report, allowed to highlight, as
well as some critical points in the doctrinal debate
regarding the assessment of the personality of the
minor offender with severe personality disorders, the
unique aspects of how, in judicial rulings, finding the
balance between the need for social defense and
protection of the health of the individual has been
difficult. Several, in fact, were the legal institutions
involved within this criminal proceedings, with the
aim of mitigating, to the possible extent and in the
primary interest of the child, the repressive,
preventive and treatments needs. However, there are
still many uncertainties67.
67
In the area of juvenile justice, says De Leo, every choice made during
the course of the trial of boy, must be inspired by the pursuit of interests,
educational needs and to protect the child (G. DE LEO, La devianza
minorile: il dibattito teorico, le ricerche, i nuovi modelli di trattamento,
186
For sure, the case just presented has placed at

the ‘center’ of the debate – once again – some issues of
considerable interest, on which further considerations
are needed.
In primis it (re)surfaced in all its complexity
and potential the diagnostic issue, especially in the
forensic medical examination stage, about the
existence or not, in childhood, of a overt personality
disorder, the level of severity and whether it has an
impact on the profile of imputability of the criminal
offender. In particular emerged the presence, and not
so isolated, of a certain risk of incurring, in cases
similar to this, in drifting in the diagnosis and
disconnections in the treatments prescribed, that
Roma, 1998, p. 223 ss). The legislation of 1988 offers «a juvenile justice
system focused more on prevention rather than repression, on the use of
educational tools, rather than traditional punishments, on a deeper
analysis and on a greater appreciation of the personality of the minor, on
the social environment in which the minor lived, rather than the fact of the
offense, on an ever more pronounced specialization of the juvenile judge,
which must have diverse knowledge, utilize different tools compared to
the ones from the adult court since the fundamental mission is to get the
minor back into society» (LARIZZA, Il diritto penale dei minori, cit., p. 7). The
d.P.R. n. 448/88 originated, in fact, a juvenile jurisprudence that is not
limited only to provide sanctions against the offender, but is also
concerned with meeting the needs and the necessities of the minor, and
trying to identify legal agents and operational tools that could lead to
such fulfillment. For these reasons, the minor offender is put at the center
of the process, seen as a person with a personality in development,
potentially able to make different choices and to build alternatives of life.
On the Topic, G. ASSANTE, P. GIANNINO, F. MAZZIOTTI, Manuale di diritto
minorile, Roma-Bari, 2007.
Raffaele Bianchetti
187
would only result into a disadvantage for the boy,

both in terms of health and his socio-integrated
existence68. This shows also the extremely delicate but
definitely preponderant role that the juvenile court
authority must necessarily play in the assessment and
in the ongoing monitoring of these evolutionary paths
and treatments, especially where behavioral
prognosis is shown to be highly uncertain, but at the
same time, undoubtedly necessary69.
68
We refer, in this case, the multiplicity of diagnoses and socio-
therapeutic prescriptions that have taken place over the years: sometimes,
some of these were diverging, sometimes even inaccurate Consider, for
example, the long-term effects of an incorrect treatment, since it is based
on erroneous assumptions, and the existential repercussions that a too
stigmatizing process, be it medical or legal, could lead to the ‘career’ of an
individual. See, relatively to the factors facilitating the development of so-
called ‘criminal careers’ and the so-called ‘contingencies career’, GOFFMAN,
Asylums, cit. Also, see the interesting study of D.P. FARRINGTON, The
development of offending and antisocial behavior from childhood: key
findings from the Cambridge study in delinquent development, in Journal
of Child Psychology and Psychiatry, 36 (1995), p. 929 ss.
69
As for the prediction of criminal behavior, its limitations and difficulties,
please note that it is done according to a scheme of reasoning culturally
influenced, which is based, in turn, on a strong statistical criterion.
However, the prognostic evaluation in Italian criminal system is
indispensable, both in regards the criminological treatment intra and extra
prison, and in regard to the possible application of security measures. On
this aspect, we have to point out that the current approach of clinical
criminology is driven by the awareness that interventions targeted to the
re-integration in the society are able to provide positive results only when
the subject shows a willingness to be helped to solve his problems of
social coexistence. It is therefore necessary that the detainee questions his
previous values and past conduct, that is willing to embrace changes, that
188
Secondly, the topic of the determination of the

minor’s personality manifested in all its interference
and heavy impact during the length of the trial and in
the identification of the treatments70. This topic
characterized, in fact, the whole judicial history of the
boy and has weighted, relentlessly, on the application
of certain legal institutions of criminal law and
him himself looks for support and help for a life that is socially integrated,
and it is also required that he is conscious of the presence in his person of
psychopathological problems and the correlated importance of continuity
in social and health assistance for himself. Cfr., on the topic, E. CALVANESE,
La fase esecutiva della condanna: permeabilità ed incertezza dei confini
del carcere, in Studi in Ricordo di Giandomenico Pisapia, III, Milano, 2000,
p. 419 ss.
70
It is well known, even internationally, that measures taken in criminal
trial involving minors, must all meet the principle of individualization of
the judicial intervention, as these tend to be aimed at the establishment of
an educational program appropriate to the resources and needs of the
child, in other words to his personality. In fact, to fully implement the
above mentioned purpose, «a summary knowledge of the subject and a
superficial analysis of his personality are not enough, but, instead, in-
depth investigations are required» to ascertain the existence or not of his
ability plead at the time of commission of the offense and to identify the
most appropriate response in relation to personal and social difficulties
that he has shown when committing the offense (A. PENNISI, La giustizia
penale minorile: formazione, devianza, diritto e processo, Milano, 2004, p.
262). The information on the minor, pursuant to art. 9 d.P.R. 448/88, must
be collected from the first moment in which he gets into contact with the
criminal justice system and then periodically updated to capture the
changes that occur over time on his personality. Cfr., on the topic, G.
GIOSTRA (edited by), Il processo penale minorile. Commento al D.P.R.
448/1988, Milano, 2009; P. GIANNINO, Il processo penale minorile, Padova,
1997.
Raffaele Bianchetti
189
juvenile proceedings in force in Italy71. Essential

appeared, also, the effectiveness of careful, serious
and prolonged observation of the indicted minor,
especially when he was found to be affected by
disturbances of the personality, which if not properly
treated, it would have exposed him – to use the
words of the designated expert – «at serious risk of
deterioration and stabilization»72.
71
Consider, for example, in the application of the measure of pre-trial
detention (ex art. 22 and 23 d.P.R. 448/88), or on the provisional
application of the security measure of detention in house of correction (ex
art. 223 c.p.) or that of ‘monitored freedom’ (ex art. 228 ss c.p.).
72
Designated expert’s report, 14.10.2009, p. 12. In this regard – in
addition to what said above in notes n. 2 and 69 – please recall that art. 9
d.P.R. 448/88 requires that the Public Prosecutor and the judge acquire
elements on the conditions and personal, familiar, social and
environmental resources of the minor. It is a matter of psychological
and/or criminological investigations which must include the study of traits
of personality, such as stable dispositions that characterize individuals, and
analysis of the changes produced in the characteristics of individuals by
the interactions they have with situations and social context. This research,
from a methodological point, must therefore take into account both the
structural and dynamic prospective of the subject being examined, by
investigating personal and family background of the minor, the conditions
in which he is at the time of trial, and the resources that he can and will
have available. The resulting evaluation must therefore be two-fold, in the
sense that the requested work, with respect to the present, operates in
diagnostics key and, relatively to the future, in prognostic key. Cfr., on the
topic, R. BIANCHETTI, La personalità del minorenne: gli accertamenti
esperibili e le finalità processuali (art. 9, D.P.R. 22.9.1988, n. 448), in BASINI,
BONILINI, CONFORTINI (edited by), Codice di famiglia, minori e soggetti
deboli, cit., p. 4902 ss.; in addition, DI NUOVO, GRASSO, Diritto e procedura
penale minorile, cit.
190
Directly related to the assessment of the

subject’s personality during developmental age is
then the matter, and at the same time the necessity, of
a continuous and systematic adaptation of the
program of treatments and an ongoing evaluation of
the social dangerousness of the subject in relation to
the overall evolution of his personality. This was clear
in the path made by the subject during jail sentence73,
and in the application by the juvenile authorities of
the measure of safety in terms of reformatory (first)
and ‘monitored freedom’ (later) 74. Substantial, in this
73
Updating Notes of I.P.M. ‘C. Beccaria’ in Milano on 14.7.2010, p. 3.
74
Art. 36 of d.P.R. 448/88 indicates as security measures applicable to
minors, the juvenile court detention and ‘monitored freedom’, recalling as
the procedure for execution, the rules prescribed for precautionary
measures. In detail, the juvenile reformatory has a secondary role, as
applicable only in specific circumstances detailed in 233 c.p. (see note n.
36); ‘monitored freedom’ however, became the ‘ordinary safety measure’,
applicable to all types of crimes. It can be executed in two ways, based on
the decision of the supervising judge, according to the specific
circumstances of the offense and the personality of the child: provisions or
in home stay. The provisions consist of imposing – after consulting the
agents having parental responsibility – the obligations inherent work,
study, and, in any case, for any activity that is deemed useful for the
achievement of the purposes of re-education and relapse prevention. They
involve – for the necessary activities of support and control – custody of
the child to the services of the administration of juvenile justice and
services institutions that collaborate with the local authorities, as well as
frequent informal contacts with the supervising judge, who has been
assigned with the task of providing instructions on how to execute the
measurement. The at home stay, however, can be executed through the
vigilance by the persons in whose home the child must remain at, in
Raffaele Bianchetti
191
sense, was the consideration made by the Court of

Appeal of Milano, of a social dangerousness «muted
compared to the time of the criminal incident», such
as to justify the application – in place of the security
measure of placement in a controlled community – of
‘monitored freedom’, leaving to the judge of
surveillance the task of identifying the most
appropriate requirements, taking into account «the
future needs of social security based on the outcome
of the path taken by the boy, carefully re-evaluated»75.
interventions to support and control carried by the juvenile services, in any

inspections required by the judge. On the topic A.C. MORO, Manuale di
diritto minorile, Bologna, 2008; in addition, R. RICCIOTTI, La giustizia penale
minorile, Padova, 2007.
75
C. App. Sez. Min. Milano, 29.9.2011, unpublished, p. 5 In relation to the
application of security measures against underage individuals, the Italian
doctrine tried to redefine the discipline, with the intent to meet the
personal and educational needs of the minor. In this sense it tried, through
operational action, to replace the old model of paternalistic control with
one based on the paradigm of accountability, in which the control of
behavior, in freedom or in restricting measure, it is expressed in a sort of
«continuous self-assisted monitoring, able to support individual paths to
reflect on their own behavior in order to consciously exit the criminal
justice system and functional to his (re)socialization» [P. PATRIZI, Psicologia
e processo penale, in A. QUADRIO, G. DE LEO (edited by), Manuale di
psicologia giuridica, Milano, 2005, p. 260]. However, in practice, some
problems and concerns arise. For example, with regard to the security
measure of house of correction (ex art. 223 c.p.) pursuant to art. 36, co. 2
of d.P.R. 448/88 questions are posed about the real operational capacities
of care communities. There are those who observe, in fact, that the
coercive custody of minor in structures based on the consent of the
subject it is likely to make the measure not completely understood by the
minor and, therefore, at the same time not very functional to the pursuit of
192
Finally, but not less important, is the topic of

the effective collaboration of all caregivers involved,
whether they are strictly involved in the process of
the trial or not76. Many, in fact, are those who have
original intent. For these reasons, but not only, in reality we are witnessing
many times to the fact that communities prefer to receive only minor
assigned on a voluntary basis, rather than those assigned ex voluntate
iudicis, and this is for therapeutic reasons and for structural inadequacy
[cfr., on the topic, U. FORNARI, Misure di sicurezza e doppio binario: un
declino inarrestabile?, in Rivista italiana di diritto e procedura penale, 2
(1993), p. 569 ss; E. ROLI, La ambiguità del processo minorile tra
educazione e punizione, in Questione giustizia, 3 (1989), p. 889 ss].
However, with respect ‘monitored freedom’ (ex art. 228 ss c.p.), which
should resolve, pursuant to the combined provisions of art. 23 r.d.l. n.
1404/34 and 55 ord. penit., in a ‘monitored freedom’ and ‘assisted
freedom’ by social services for the execution of the provisions ordered by
the judge, its partial ineffectiveness became obvious. In fact, the frequent
shortcomings in the organization and in the link between social services
and prisons often have weakened, as for the adults, the moment of re-
socialization in favor of that of a mere control similar to the one provided
by the police , «depriving the child of intelligent educational opportunities
and help towards models against a disordered, and often criminal life» [DI
NUOVO, GRASSO, Diritto e procedura penale minorile, cit., p. 456; and, R.
RICCIOTTI, Aspetti discutibili della giustizia penale minorile, in Critica penale,
1-2 (1997), p. 46].
76
In this regard it should be recalled that, in compliance with the large
body of international information – especially the Recommendation n.
20/1987 of the Council of Europe that pointed to the states member the
need to allocate to juvenile justice professionals with experience and
professionalism, by encouraging the adoption of measures aimed at
ensuring that everybody involved in the different phases of the trial
(police, lawyers, social workers) have specific training in the field of the
rights of minors and juvenile delinquency – the entire jurisdiction of the
juvenile justice must focus on the principle of specialization. This is
Raffaele Bianchetti
193
interacted with the boy, at different times and for

different purposes, in this court case. Many are those
who have played a significant role for him, existential
reference, or a merely transient and instrumental role.
The fact is, that this case has highlighted the
importance, in the context of the celebration of
juvenile justice, of synergistic, coherent and consistent
presence of the ‘agents’ involved through the process,
whether they are legal practitioners or health and
social services ones, since only in this way, in similar
cases to this one, it is believed possible to actually
implement an intervention that is both effective in
rehabilitation and special-key preventive and
balanced between the need for care and protection of
the individual and the protection and defense of the
community77.
reflected not only by the composition of the bodies involved in criminal

proceedings but also by the other parties involved in various capacities in
the juvenile justice process: the judicial police (ex art. 5 d.P.R. 448/88); the
juvenile services (ex art. 6 d.P.R. 448/1988); the public defender (ex art. 11
d.P.R. 448/88).
77
Currently Titius has been held for about 3 years at a House of
Detention, and is benefiting from the first prize leave, ex art. 30 ter ord.
penit., in order to take part in some cultural activities and treatments
outside prison. In addition, the psychotherapeutic process is continuing
with the support of a psychologist and, with the agent in charge of drug
abuse situations: within the Institute, is handling the issues related to the
use of drugs. As for his social dangerousness, assessment necessary for
the purposes of granting certain alternative measures to detention or the
actual implementation of security measures, it should be noted that the
surveillance judge, specifically regarding ‘monitored freedom’, will have to
194
References
ABBATE L., La nosografia psichiatrica: stato attuale e

sviluppi futuri, in FERRACUTI F. (edited by), Trattato di
criminologia, medicina criminologica e psichiatria forense.
La psichiatria forense speciale, XVI, Milano, 1990.
AMERICAN PSYCHIATRIC ASSOCIATION, Manuale
diagnostico e statistico dei disturbi mentali – DSM-5,
Italian edition, Milano, 2015.
ANGELL M., L’epidemia di malattie mentali e le illusioni
della psichiatria, in Psicoterapia e Scienze Umane, 2
(2012), p. 263 ss.
ASSANTE G., GIANNINO P., MAZZIOTTI F., Manuale di
diritto minorile, Roma-Bari, 2007.
BELLINO S., BOZZATELLO P., RINALDI C., BRIGNOLO E.,
ROCCA G., BOGETTO F., Impulsività e aggressività
chose the ‘form’ (provisions or at home stay). This decision will be made
based on the operational feasibility of the same and the ability to respond
effectively with such a measure, on the one hand, to the degree of injury
dangerousness of the case, and on the other hand, to the pedagogical and
educational needs of the individual. This perspective, as previously stated,
is logically related to the presence of a valid and intelligent support by
social services that allow, in fact, the creation of «legal and psychologically
trade-offs valid between an existence, bound by detailed provisions, and a
life of relationship-directed by the individual» (ZUCCALÀ, Le misure di
sicurezza per i minorenni, cit., p. 361).
Raffaele Bianchetti
195
reattiva: un’analisi fattoriale in pazienti con disturbo

borderline di personalità, in Italian journal of
psycopathology, 17 (2011), p. 389 ss.
BELLINO S., RINALDI C., Trattamento dei disturbi di
personalità, in ALTAMURA A.C., BOGETTO F.,
CASSACHIA M., MUSCETTOLA G., MAJ M., Manuale di
terapia psichiatrica, Roma, 2012.
BERTOLINO M., Dall’infermità di mente ai disturbi della
personalità: evoluzione e/o involuzione della prassi
giurisprudenziale in tema di vizio di mente, in Rivista
italiana di medicina legale, 2 (2004), p. 508 ss.
BERTOLINO M., Il ‘breve’ cammino del vizio di mente. Un
ritorno al paradigma organicistico?, in Criminalia, 2
(2008), p. 325 ss.
BERTOLINO M., L’infermità mentale al vaglio delle sezioni
unite: Cassazione penale, Sez. Un., 8 marzo 2005 (u.p. 25
gennaio 2005), n. 9163, in Diritto Penale e Processo, 7
(2005), p. 837 ss.
BIANCHETTI R., La personalità del minorenne: gli
accertamenti esperibili e le finalità processuali (art. 9,
D.P.R. 22.9.1988, n. 448), in BASINI G.F., BONILINI G.,
CONFORTINI M. (edited by), Codice di famiglia, minori e
soggetti deboli. Codice commentato, II, Torino, 2014, p.
4902 ss.
BIANCHETTI R., Prevenzione e trattamento in ambito
minorile: aspetti di criminologia applicata e di giustizia
penale in sede di valutazione di disturbi della personalità,
in Cassazione Penale, 11 (2013), p. 4191 ss.
196
BIONDI M., BERSANI F.S., VALENTINI M., Il DSM-5:

l’edizione italiana, in Rivista di Psichiatria, 2 (2014), p. 59
ss.
BROWN P., The name game: toward a sociology of
diagnosis, in The journal of mind and behaviour, 3-4
(1990), p. 385 ss.
CALVANESE E., La fase esecutiva della condanna:
permeabilità ed incertezza dei confini del carcere, in Studi
in Ricordo di Giandomenico Pisapia, III, Milano, 2000.
CAPRARA G.V., GENNARO A., Psicologia della
personalità, Bologna, 1999.
CASTEL R., L'ordre psychiatrique. L'âge d'or de
l'aliénisme, Paris, 1977 (trad. it. L’ordine psichiatrico.
L’epoca d’oro dell’alienismo, Milano, 1980).
CENTONZE F., L’imputabilità, il vizio di mente e i disturbi
di personalità, in Rivista italiana di diritto e procedura
penale, 1 (2005), p. 247 ss.
CERRETTI A., MERZAGORA I., Questioni
sull’imputabilità, Milano, 1994.
CLARKIN J.F., LEVY K.N., LENZENWEGER M.F.,
KERNBERG O.F., The Personality Disorders
Institute/Borderline Personality Disorder Research
Foundation randomized control trial for borderline
personality disorder: Rationale, methods, and patient
characteristics, in Journal of Personality Disorders, 18
(2004), p. 52 ss.
Raffaele Bianchetti
197
COLLICA M.T., Vizio di mente: nozione, accertamento e

prospettive, Torino, 2007.
DE LEO G., La devianza minorile: il dibattito teorico, le
ricerche, i nuovi modelli di trattamento, Roma, 1998.
DE LEO G., PATRIZI P., Trattare con adolescenti devianti,
Roma, 1999.
DE LEONARDIS O., GALLIO G., MAURI D., PITCH T.
(edited by), Curare e punire. Problemi e innovazioni nei
rapporti tra psichiatria e giustizia penale, Milano, 1988.
DI CHIARA G., Sindromi psicosociali. La psicoanalisi e le
patologie sociali, Milano, 1999.
DI NUOVO S., GRASSO G., Diritto e procedura penale
minorile: profili giuridici, psicologici e sociali, Milano,
2005.
DIMAGGIO G., I disturbi di personalità nel DSM-5:
osservazioni e livello di funzionamento, in State of Mind. Il
giornale delle scienze piscologiche, 2 giugno 2014,
www.stateofmind.it.
DONOVAN J.E., JESSOR R., COSTA F.M., Structure of
problem behavior in adolescence and young adulthood, in
Journal of Consulting and Clinical Psychology, 53 (1985),
p. 899 ss.
ENDLER N.S., KOCOVSKI N.L., Personality disorders at
the crossroads, in Personal Disorder, 16 (2002), p. 487 ss.
FARRINGTON D.P., The development of offending and
antisocial behaviour from childhood: key findings from the
198
Cambridge study in delinquent development, in Journal of

Child Psychology and Psychiatry, 36 (1995), p. 929 ss.
FERRACUTI S., SANI G., Disturbi di personalità e
imputabilità, in VOLTERRA V. (edited by), Psichiatria
forense, criminologia ed etica psichiatrica, Milano, 2010,
p. 180 ss.
FEUCHTERSLEBEN E., Lehrbuch der ärztlichen seelenkund,
Wien, 1845.
FORNARI U., I disturbi della personalità rientrano nel
concetto di infermità, in Cassazione Penale, 1 (2006), p.
273 ss.
FORNARI U., Misure di sicurezza e doppio binario: un
declino inarrestabile?, in Rivista italiana di diritto e
procedura penale, 2 (1993), p. 569 ss.
FORNARI U., Trattato di psichiatria forense, Torino, 2008.
FOUCAULT M., La politica della salute nel XVIII secolo, in
Archivio Foucault. Interventi, colloqui, interviste. 2. 1971-
1977, in DAL LAGO A. (edited by), Poteri, saperi,
strategie, Milano, 1997.
FOUCAULT M., Les anormaux, Cours au collège de France,
1974-1975, Paris, 1999 (trad. it. Gli anormali. Corso al
Collége de France 1974-1975, Milano, 1999).
FOUCAULT M., Sourveiller et punir. Naissance de la
prison, Paris, 1975 (trad. it. Sorvegliare e punire. Nascita
della prigione, Torino, 1976).
FRANCES A., DSM in philosophyland: curiouser and
curiouser, in Bulletin of the association for the
Raffaele Bianchetti
199
advancement of philosophy and psychiatry, 2 (2010), p. 21

ss.
GABBARD G.O., Psychodynamic Psychiatry in Clinical
Practice. The DSM-IV Edition, 1994, Washington (trad.
it. Psichiatria psicodinamica. Nuova edizione basata sul
DSM-IV, Milano, 2005).
GIAMBRUNO S., Lineamenti di diritto processuale penale
minorile, Milano, 2004.
GIANNINO P., Il processo penale minorile, Padova, 1997.
GIBERTI F., ROSSI R. (edited by), Manuale di Psichiatria,
Padova, 1996.
GIOSTRA G. (edited by), Il processo penale minorile.
Commento al D.P.R. 448/1988, Milano, 2009.
GOFFMAN E., Asylums. Essays on the social situation of
mental patients and other inmates, New York, 1961 (trad.
it. Asylums. Le istituzioni totali: i meccanismi
dell’esclusione e della violenza, Torino, 1968).
KAHN E., Psychopathic peronalities, New Haven, 1931.
KRÄPELIN E., Psychiatrie: ein lehrbuch für studierende
und ärzte, II-IV, Barth, 1915.
KRENBERG O.F., Aggression in Personality Disorders and
Perversion, 1992, New Haven, London (trad. it.
Aggressività, disturbi della personalità e perversioni,
Milano, 1993).
KRENBERG O.F., La diagnosi della patologia narcisistica in
adolescenza, in NOVELLETTO A., MASINA E. (edited by),
200
I disturbi di personalità in adolescenza. Borderline,

antisociali, psicotici, Milano, 2003.
KRENBERG O.F., Severe Personality Disorders:
Psychotherapeutic Strategies, 1984, New Haven, London
(trad. it. Disturbi gravi della personalità, Torino, 1985).
KUPFER D.J., FIRST M.B., REGIER D.A., A research agenda
for DSM-V, in American Psychiatric Association, 1
(2002), p. 15 ss.
LAHEY B.B., LOEBER R., BURKE J.D., APPLEGATE B.,
Pedicting future antisocial personality disorder in males
from a clinical assessment in childhood, in Journal of
consulting and clinical psychology, 73 (2005), p. 1011 ss.
LARIZZA S., Il diritto penale dei minori. Evoluzione e
rischi di involuzione, Padova, 2005.
LINGIARDI V., Dare un senso alla diagnosi, in COLUCCI
M. (edited by), La diagnosi in psichiatria, Milano, 2013.
LINGIARDI V., DEL CORNO F. (edited by), Manuale
diagnostico psicodinamico (PDM), Milano, 2008.
LINGIARDI V., La politica delle diagnosi: la personalità
narcisistica dentro e fuori al DSM-5, in Atti del XVI
Congresso nazionale della Società psicoanalitica
italiana (SPI): Denaro, potere e lavoro fra etica e
narcisismo (Roma, 25-27 maggio 2012), pp. 251-261.
LORENZINI R., SASSAROLI S., Attaccamento, conoscenza e
disturbi di personalità, Milano, 1995.
Raffaele Bianchetti
201
MAGGIOLINI A., CICERI A., PISA C., BELLI S., Disturbi

psicopatologici negli adolescenti sottoposti a procedimenti
penali, in Infanzia e adolescenza, 3 (2009), p. 139 ss.
MAJ M., Introduzione all’edizione italiana, in AMERICAN
PSYCHIATRIC ASSOCIATION, Manuale diagnostico e
statistico dei disturbi mentali – DSM-5, Milano, 2015.
MANACORDA A., Malattia mentale, imputabilità e
pericolosità sociale: dalla rilettura dei contributi alla
proposta di rilettura dei problemi, in G. CANEPA, M.I.
MARUGO (edited by), Imputabilità e trattamento del
malato di mente autore di reato, Padova, 2005.
MANNA A. (edited by), Imputabilità e misure di
sicurezza, Padova, 2003.
MANNA A., L’imputabilità fra diritto penale e psichiatria,
in MANNA A. (edited by), Verso un codice penale
modello per l’Europa: imputabilità e misure di sicurezza,
Padova, 2002.
MARIANI E., Le misure di sicurezza per i minorenni:
peculiarità, procedimento e applicazione (artt. 36, 37, 38,
39, D.P.R. 22.9.1988, n. 448), in BASINI G.F., BONILINI
G., CONFORTINI M. (edited by), Codice di famiglia,
minori e soggetti deboli. Codice commentato, II, Torino,
2014, p. 4998 ss.
MARINUCCI G., DOLCINI E., Manuale di Diritto Penale.
Parte generale, Milano, 2012.
MARONE F., Soggetti, protocolli e tigri di carta, in
COLUCCI M. (edited by), La diagnosi in psichiatria,
Milano, 2013.
202
MATZA D., Becoming deviant, Englewood Cliffs, N.J.,

1969.
MAYES R., HORWITZ A.V., DSM-III and the revolution in
the classification of mental illness, in Journal of the history
of the behavioral sciences, 3 (2005), p. 226 ss.
MELOY J.R., The psycopathic mind: origins, dynamics and
treatment, Northvale, N.J., 1988.
MOFFITT T.E., Adolescence-limited and life course-
persistent antisocial behavior: a developmental view, in
Psychological review, 100 (1993), p. 674 ss.
MORO A.C., Manuale di diritto minorile, Bologna, 2008.
NOVELLETTO A., BIONDO D., MONNIELLO G.,
L’adolescente violento. Riconoscere, prevenire l’evoluzione
criminale, Milano, 2000.
NOVELLETTO A., MASINA E. (edited by), I disturbi di
personalità in adolescenza. Borderline, antisociali, psicotici,
Milano, 2003.
PALOMBA F., Il sistema del processo penale minorile,
Milano, 2002.
PANSINI C., Processo penale a carico di imputati
minorenni, in GARUTI G. (edited by), Trattato di
procedura penale, VII, Torino, 2011.
PARIS J. (edited by), Il disturbo borderline di personalità.
Eziologia e trattamento, Milano, 1995.
Raffaele Bianchetti
203
PARIS J., Contesto sociale e disturbi della personalità.

Diagnosi e trattamento in una prospettiva bio-psico-
sociale, Milano, 1997.
PATRIZI P., Psicologia e processo penale, in QUADRIO A.,
DE LEO G. (edited by), Manuale di psicologia giuridica,
Milano, 2005.
PELISSERO M., Pericolosità sociale e doppio binario. Vecchi
e nuovi modelli di incapacitazione, Torino, 2008.
PENNISI A., La giustizia penale minorile: formazione,
devianza, diritto e processo, Milano, 2004.
PLANT M.A., PLANT M.L., Comportamenti a rischio negli
adolescenti. Alcol, droghe e sesso, Trento, 1996.
PONTI G., MERZAGORA I., Psichiatria e giustizia,
Milano, 1993.
RICCIOTTI R., Aspetti discutibili della giustizia penale
minorile, in Critica penale, 1-2 (1997), p. 46 ss.
RICCIOTTI R., La giustizia penale minorile, Padova, 2007.
ROLI E., La ambiguità del processo minorile tra educazione
e punizione, in Questione giustizia, 3 (1989), p. 889 ss.
ROSE N., Governing the Soul. The shaping of the private
self, London, 1999.
SARACENO B., GALLIO G., Diagnosi, ‘common language’
e sistemi di valutazione nelle politiche di salute mentale, in
COLUCCI M. (edited by), La diagnosi in psichiatria,
Milano, 2013.
SCHNEIDER K., Psicopatologia clinica, Roma, 2004.
204
STRUNIN L., HINGSON R., Alcohol, drugs and adolescent

sexual behaviour, in Iternational Journal of the Addictions,
27 (1992), p. 129 ss.
WAKEFIELD J.C., Patologizzare la normalità: l’incapacità
di individuare i falsi positivi nelle diagnosi dei disturbi
mentali, in Psicoterapia e Scienze Umane, 3 (2010), p. 300
ss.
WALLERSTEIN N., What is the evidence on effectiveness of
empowerment to improve health?, in
http://www.euro.who.int/Document/E88086.pdf,
2007.
WIDIGER T .A., LOWE J.R., A dimensional model of
personality disorders, Proposal for DSM-IV, in Psychiatric
clinic of north America, 31 (2008), p. 363 ss.
WINNICOTT D.W., The Family and Individual
Development, 1965, London (trad. it. La famiglia e lo
sviluppo dell’individuo, Roma, 1982).
WORLD HEALTH ORGANIZATION, The World Health
Report 2001-Mental Health: New Understanding, New
Hope, Genève, 2001.
ZAPPALÀ E., PATANÈ V., Procedimenti speciali, in DI
CHIARA G., PATANÈ V., SIRACUSANO F. (edited by),
Diritto processuale penale, Milano, 2013.
ZAVATARELLI F., sub art. 223. Ricovero dei minori in un
riformatorio giudiziario, in DOLCINI E., MARINUCCI G.,
Codice penale commentato, Milano, 2011.
Raffaele Bianchetti
205
ZUCCALÀ M.A., Le misure di sicurezza per i minorenni,

in PALERMO FABRIS E., PRESUTTI A. (edited by), Diritto
e procedura penale minorile, Milano, 2011.
206
Adolfo Ceretti, Lorenzo Natali
207
The Cosmologies of Violence.

A Radical Interactionist Approch
Adolfo Ceretti1 and Lorenzo Natali2
Keywords: Violent cosmologies, violentization, radical

interactionism, qualitative method, phantom-community,
domination, soliloquy.
1. Introduction
General interest in the topic of violence has

always been great. Whenever violent crimes are
particularly savage, the “meaning” of violent
behaviours for the individuals involved – actors,
victims or simple spectators – becomes a central yet
difficult question to be answered: fine tools of
interpretation and engagement are required.
This paper approaches this question using
some “sensitizing concepts” (see Blumer, 1954: 7),
1
Full Professor of Criminology, University of Milano-Bicocca.
2
Research Fellow at the Deartment of Criminology of the University of Milano-
Bicocca.
208
which have been introduced in criminology from the

radical interactionist approach of Lonnie Athens
(2007; 2013) – reinterpreted in turn by the authors of
this paper in the book Cosmologie Violente (Ceretti-
Natali 2009) – and which are intended as guides to a
better understanding of the dynamics of atrocious,
brutal crimes.
It is well known that Athens has constructed
his theory, originally based on more than a 100 in-
depth interviews with violent actors, over the course
of some decades. This paper shows specific reflections
of Athens’ observations in the narrative flows of some
interviews with violent actors we conducted in 2008
(Ceretti & Natali 2009).
The interviews, directly carried out by us to
test the research method developed by Lonnie Athens
and to outline the sensitizing concept of “violent
cosmologies”, will be labelled using the letters of the
alphabet (from A to G). The interviews, lasting on
average approximately four hours each, took place at
the Penitentiary of Milano-Opera (Italy) and were
fully recorded, transcribed and written down.
All the people interviewed had been
definitively given very severe sentences for extremely
serious crimes (homicide and sexual violence/sexual
abuse), of which they had already declared
themselves guilty during the trial. We decided not to
learn beforehand the happenings and the attending
legal proceedings. For us it was important, above all,
to bring forth the “personal and relational truth” that
each actor let emerge in his narrarive. During our
209
interviews one of the aims was to help the

interviewees to bring into the “narrative flow” the
“interior representations” of the violent dynamics
that brought them to prison. To obtain this result it
was important to propose and develop with them
issues not always strictly linked to their crime, but
highly significant within their “cosmology”:
friendship, love, gender identity, sex, their
relationship with their parents (nearly always
problematic), with their peers, with the other guilty
parties, and also with their own bodies, with drugs
and, finally, with their ideas of the future. The
interviewees – all males, as it proved too difficult to
obtain consent from female convicts for these
interviews – were guaranteed anonymity for their
stories.
Following Athens’ formulation, we have taken
from the “narrative flows” different “scenes” – well
aware that editing is always an interpretative practice
directed by some theory. These “scenes” have
contributed – as we said – to corroborate his basic
hypotheses and to develop ours. The case indicated
by the letter Z refers to the transcription of an
interview with an expert, when one of us took part in
it, few years back. All the subjects we have
interviewed are going through their prison sentences,
with the help of psychologists, psychiatrists and
criminologists. They were chosen with the help of the
“Equipe di Osservazione e Trattamento” (“Special
Team for Observation and Treatment”) at the
Penitentiary of Milano-Opera, on the basis of the
210
relevance that their path of “violent life” could have

for our research and not as representatives of an
hypothetical sample. Consistently with these
assumptions we carried out an intensive study on an
extremely small number of cases, in favour of an “in
depth” investigation rather than of an “extensive”
one (Cardano, 2003, p.18).
It is our conviction that an approach through
the narration of real stories puts us in a position to
discover the deeper traces of people’s symbols and
value systems, including the violent ones. As Lois
Presser writes: “Although use of offenders’ ‘own’
stories has a venerable tradition in criminology,
criminologists have not exploited the potential of
stories to theorize the etiology of crime” (Presser
2009: 178). In this direction, we will introduce the
reader to the concept of “violent cosmologies,” a term
we use to reflect Athens’ theories of both the
formation of violent individuals, and how they
interact with their “cosmoses,” their worlds, and
themselves. Our theoretical approach shares some
common points with what Presser calls a
“constitutive view of narrative”, a conceptualization
of narrative which suggests that “experience is
always known and acted as it has been interpreted
symbolically” (Presser 2009: 184): “The constitutive
view emphasizes one’s use of language for self-
awareness, which harks back to early writing in
symbolic interactionism […]. On this view, through
linguistic expression we make ourselves known, to
others and to ourselves” (Presser 2009: 185). To adopt
211
this narrative perspective also means to circumvent

“the question of whether would-be offenders truly
believe their stories or only tell them (to self or others)
to enable harmful conduct. […]. Unlike other
explanatory variables in criminology, we need not
treat the stories that promote offending behaviour as
real or true in order to recognize their role” (Presser
2009: 190; see also Presser 2012: 5).
2. Cosmology and Violence
How can we observe violent acts and their

perpetrators? In what emotional overtones and in
what inner verbal expressions might a violent actor
engage before, during, and after performing a violent
act?
Our answers are anything but immediate, and
depend on the ideas of “world” and “cosmology”, in
their mutual interaction:
The world, as we know it, is a socially
constructed reality, and as such, appears to us
through our “negotiations” with others. As a matter
of fact, we gradually create an entire cosmology,
against which our social negotiations take place, and
by which they are legitimated. (Inghilleri, 2005).
“Cosmology” – a term that in our proposal
gains a meaning that does not belong directly to
Athens’s theoretical approach – becomes a
“sensitizing concept” (see Blumer, 1954: 7) directed at
212
reassigning a meaning to (violent) human behavior

beyond any rigid and formal distinction between
normality and psychic suffering3. According to our
perspective, each violent act, each example of
physical aggression or bodily attack, no matter how
“crazy” and bloodthirsty it is, implies a “cosmology.”
This perspective allows us to explain even the most
atrocious homicidal act, not as the product of a
mental disorder, moral disease, loss of reason, but
rather in terms of a different order of meaning.
We adopt the term “cosmos” because its
meaning differs from the term “world” in a subtle yet
significant way. While the latter is associated with a
notion of visibility, of clarity, we dare say, of
transparency, the term “cosmos” or “universe”
maintains a dark space of non-visibility, of non-
acknowledgement, as we perceive but a part of the
“cosmos,” “that [part] which is directly accessible to
our experience, and may not presume to exhaust the
direct or indirect observation [of the cosmos], even at
the scientific level” (Sanguineti, 2002).
In combining these brief premises with the
“radical interactionist” paradigm (Athens, 2007a;
Athens, 2013), and with other theoretical
contributions which cannot be grouped under this
3
These notions are based on the theoretical principles developed by
Minkowski in his works, especially in Vers une cosmologie. Fragments
philosophiques (1936).
213
label, we will attempt to explore the “reflexive”

dimension in which human beings ground their
representations of the world and try to make their
ways in it, actively constructing their own violent
behavior4.
In our proposal, it is the acknowledgement of
the qualitative processes and of the ties interlacing the
lives of violent actors and their worlds of reference –
often joined into relationships of “domination” – that
allow us to overcome the pretension that “violent
people” are generally “disorganized” individuals,
whose “brutal” actions and disturbing deeds would
indicate pathologies. The main studies conducted by
authoritative researchers in this field prove the
existence of a moderate yet meaningful correlation
between “violence” and “mental disorder.” In spite of
this correlation, violence is not “created” from the
disease, but it is somehow a characteristic of
temperament or personality that predates the illness
itself (Biondi, 2005: 118).
4
Unlike “symbolic interactionism,” “radical interactionism” (Athens, 2007:
Athens, 2013) acknowledges the principle of “domination” as a
“cornerstone” of society and its basic institutions. This principle replaces
Mead’s principle of “sociality,” supplying a highly persuasive explanation
about the origins and the daily workings of our symbolic interactions.
Moreover, in “radical interactionism,” the notion of the “phantom
community” replaces the more traditional one of the “generalized other.”
This allows Athens to understand and explain violent behavior, taking into
account the biographical uniqueness and the “creativity” of the individual.
214
We may therefore represent violent actors as

individuals oriented toward an “organized eachness”.
Based in this “eachness” is that internal moral
support for violence we call “violent cosmology”
which, as will be shortly seen, is the invisible thread
that ties together all the phantom companions that
comprise what Athens (1997; 2007) labels a “violent
phantom community”.
In our perspective, “Everyone is the midpoint
of the world, absolutely everyone; and the world is
precious only because it is full of such midpoints.
That is the meaning of the word ‘human’: each person
a midpoint next to countless others, who are
midpoints as much as he” (Canetti, 1976: 43). The
meanings of anybody’s “experiences” are always
personal: “It is an adhesion to life, a form of desire and
network of resonances which ‘mean something’ only to
me” (Jedlowski, 2008: 177). Human beings, besides
being the center of their worlds, also have a world. It
is their personal experiences of this world that
actually constitute their uniqueness.
In this sense, we can speak of each human
being as having an “unrepeatable subjectivity” which
can be highlighted by investigating the relational field
– both social and psychological – which he or she is
“thrown into” from birth.
3. Reflexivity and the Unconscious

215
In keeping with the previous stated aims of

the paper, we try now to describe, again with the help
of some interviews, what an interior monologue is,
what a reflexive decision is, and to what extent we
can say that we are the creators of who we are and of
our actions, including the violent ones.
Let us begin with some questions. In what
manner do people soliloquize, what do they tell
themselves when they decide to behave the way they
do - for example, in performing violent acts? Who
filters the orders, and who directs destructive
behavior?
Athens’ theoretical perspective (1992; 1997)
contains innumerable elements which seem to prove
that the inner processes that lead to such acts are
made conscious by that symbolic process whereby the
actor provides himself with self-indications and
assesses – no matter how quickly and always in a
“fallible” manner – if and how certain elements –
beliefs, ideas, desires, or states of affairs – concern
him, and he decides what to think, to say and to do in
a given situation. It is this internal monologue –
which does not have a psychological but rather a
relational nature (Archer, 2003: 94) – that confers
meaning upon one’s actions.
4. Case A: Homicide
216
After I hit him… I heard the transvestite yell:

“Lo mato`, lo mato`!” – “He killed him , he killed him”
– and I told him: “Vete, vete! You have nothing to do
with this…I have nothing against you, before I do
something strange…”. Because then I started thinking
again…After luckily telling him to get lost, and when
he had already gone, I told myself: “Damn! I should
have killed him as well, so there would not have been
any witnesses”. Then I stopped for a minute, I really
stopped my mind…I stopped everything and said:
“Shit, I killed him!”, in my mind: “I killed him!”. I had
the knife in my hand and I held it with two fingers, as
if it was something to put away, like a precious
object… I looked around and said: “Here it’s all
finished!” I went to the Carabinieri (Police) with the
knife in my hand, holding it with two fingers.
I understood that situation badly… and so I
responded with more harm, with even more violence
and anger, in fact…and fear…and with a clear mind,
rational as I am today, if I had taken back my cocaine
he would not have stopped me from leaving.
The states of mind and the emotions that
accompany our daily lives – those we consider
normal – do not change in their essence, from our
viewpoint, not even when they lead up to, and occur
during, brutally violent acts. Instead, the redefinition
of the inner landscape which forms the backdrop for
the unfolding of aggressive dynamics takes place
through the acceleration that the inner
monologues/soliloquies of the violent actors undergo
when they dramatically interpret the situation they
217
are thrown into, “listening to” and “responding to”

their inner experiences that are about to hurl them
into the immediacy of the act (Ceretti and Natali,
2009: 326). These inner conversations can be viewed
as a “re-awakening,” as “an intermittent return of the
subject to the materials stored in his or her memory,
capable of deciphering some traits. This reawakening
is not a final ‘unveiling’, but part of a process of
elaboration and re-orientation to which the individual
can subject his or her life, thus revisiting its legacies”
(Jedlowski, 2008: 145-146).
We said earlier that a human being is a
“cosmos” – a cosmos he himself creates, a cosmos that
generates meaning, where his reflexive deliberations
are activities of which the actor is largely aware, and
in which the judgments, the opinions, the praises and
the warnings of the internalized “others,” who advise
or order how to translate all this into (violent) acts,
occur. “The crucial point in this representation of the
experience is the idea of a contact between the subject
and himself, which is occasionally established and
allows him, if elaborated, to direct action. This contact
is not truly a proper ‘reflection’: it is a ‘listening’ to
one’s presence” (Jedlowski, 2008: 11).
The epistemic-methodological lens we create
to investigate the “reflexive” processes of “violent
actors” does not, however, downplay the role the
unconscious can play in the plotting of violent acts.
As “integral psychic individuals” we are – in fact – in
contact with the unconscious, which manifests itself in
this reflexive process between the lines of conscious
218
speech. Today we are more and more aware of the

connection between the unconscious and conscience.
This relationship implies a mutual presupposition, a
reciprocal non-inference – not a genetic connection. It
is not the unconscious that produces a conscience, nor
conscience that reproduces an unconscious: rather, it is
the synergy between the conscious and the
unconscious that makes of us what we are (Barone
2004).
The problem no longer consists of
understanding how the emotional, instinctual and
unconscious spheres have impacts on “conscience”
and “reason,” but rather of understanding how they
base themselves on uncertain and relatively known
foundations with regard to their cognitive learning
and organizational processes of the world. If the field
of conscience can potentially expand itself infinitely,
in practice, it simply always finds its limits in the
unknown. We cannot be reflexive about unconscious
or unknown matters (see Archer, 2003: 50), as all the
“workings” of the unconscious, as long as they
remain unconscious, are outside our control and
cannot be reflected upon or evaluated directly: they
are stopped, in short, on the thresholds of
“soliloquy.”
5. Case Z: Homicide
219
The explanations I gave myself I do not know if

they are right or wrong, they are explanations that for
the moment for me were… for me were quite good, I
am not able to judge them. When they seemed suitable
for me somehow I made them my own. One of the
explanations is that surely I did not…I was not well,
there are no other explanations for my…
Obviously there has not been any
premeditation or thought before, otherwise I
wouldn’t… wouldn’t feel so distressed, well, I would
not feel this pain that is with me all the time. There is
no ‘why’, there might be clearly psychiatric reason
about it, about what happened to me, about what…
about how I acted at that time… I am not able to…to
give the reason… I am not a doctor, I only know that
surely I was not in my usual conditions, because I am
a person that detests any kind of violence, so
wouldn’t.
Truly I do not think I have an answer, I think I
was really beside myself.
I do not think there is a rational answer, an
answer that can rationalized according to what
happened at that moment. I honestly think there isn’t
one. I do not think there can be a valid explanation.
This is my answer.
All these observations clearly lead to the
conclusion that nobody can come up with a
discursive self-definition merely by using the forms
he finds most suitable. The issue reaches well beyond
the problem of the unconscious. We are the creators
of ourselves and of our stories in a flow of events and
220
circumstances that transcend us, and not all of which

we can monitor (Athens, 1995a: 254; Harcourt, 2006:
125; Athens 2013). We recall here Dewey’s body-mind
complex: we are intelligent machines, creative and
capable of self-adjusting by innovating within a
limited register of possible responses. Gerald Myers
(1986) talks about a peculiar aptitude of the “body-
mind complex” to answer the questions we ask
ourselves as a result of our encounters with the
external world. The knowledge of ourselves is the
outcome of a process based on the reflexive
negotiations with other social actors, within
situational contexts also structured in terms of
domination.
6. Phantom Communities and Surroundings
The worlds men and women experience, the

events that befall them, the significant people they
have met, all of which have left palpable traces on
their bodies and inside them, lasting “evidence” – as
it were – of their passages, tell their story, ask to be
listened to and acknowledged. We all recount
ourselves, continually and incessantly, and when we
converse with ourselves, we try to impose some
order, a structure, upon that multiverse of shouting,
of images and representations – some of them long
deposited and filed in our minds – that ask to be
understood, listened to, and, at times, rigidly obeyed.
221
As Presser (2009: 179-180) remarks, self-narratives

and stories help us make meaning, they forge a sense
of coherence that experience lacks and they are
oriented toward a plot. Therefore, a “cosmology” is
also the construction of a narrative plot directed
above all to ourselves: the actions serving as a
counterbalance to this cosmology are congruent and
“taken” from the words we use to tell ourselves about
these “encounters” and confer meaning upon them
(Ceretti and Natali, 2009: 328). “Everyone [in fact] is
not a chance combination of elements but an organized
system of meanings. Since meanings tend to be self-
sustaining, each person is constantly striving to move
themselves in decisive directions” (Shibutani, 1961:
285).
That being said, how can an “organized
system of meanings,” a narrative plot, orient itself in
violent directions? In order to reply to this unsettling
question, Athens elaborates on the sensitizing concept
of the “phantom community,” which could loosely be
described as the interlocutor who plays the leading
role in our soliloquies (Athens, 1994: 521). According
to Mead’s theory, the main interlocutor of the self is
the “Me” – the generalized voice which is the chorus
of the actual inhabitants of the entire corporeal
community that individuals assume during the
course of social interactions (See also Bodei 2013: 154).
However, in Athens’s view, the phantom community
plays this role. That is to say, the phantom
community is composed by the inhabitants of a real
or imaginary community whose attitudes we
222
normally take for granted and in front of which each

of us tries to maintain or improve his or her
reputation (Athens, 2007: 150; Athens 2013: 13-16). In
short, while the “generalized other” may be depicted
as a Greek chorus giving a voice to a unanimous
stable community, the phantom community more
resembles a “parliament,” represented by as many
opinions as there are significant speakers internalized
in the course of our lifetime. It is therefore a
distillation of past and present experiences, as
interpreted by the individual social actors in the
course of their individual biographies, derived from
their personal stories of participation in social acts
(Athens, 2007: 150).
Deriving from different social experiences and
different stages in life, the various “phantom
companions” who constitute the phantom
community continue to supply their “advice” in a
“parliament” which we routinely consult, and to
which we anchor ourselves in every situation.
Although this inner conversation with our phantom
communities precedes and accompanies the
interpretation of a given situation, it does not refer
simply to the immediacy of a context. Indeed, the
phantom community refers to something far more
deeply rooted – to that unbroken sense of the self
operating within neural circuits repeatedly used
when adopting other people’s attitudes, in the course
of time and distilled “moral reasoning,” “moral
maxims,” and guidelines to refer to when
undertaking actions (see Athens, 2007: 153-154; see
223
Haidt & Bjorklund 2008). To say this with different

words, through these processes “[w]e offer reasons
for our actions that make sense to our real, imagined
and potential interlocutors, including ourselves”
(Presser 2009: 180). In this perspective it is useful to
distinguish interpretations from narratives:
“interpretations are fundamentally concerned with an
event or situation; narratives are more
comprehensive” (Presser 2009: 188).
As “characters in search of an author,” our
phantom companions will crowd around the point
where the answer to the compelling question lies:
“What are we going to do?”
7. Case G: Sexual Assault and Homicide
I don’t even know why I took out the knife,

only at once everything went wrong… at once things
were serious…the time then is short, fractions of a
second, time is out of control…you have no time to
think, reflect or say: “Why? What am I doing?”. It’s as
if I were not there… At one point, though, I sort of felt a
voice telling me to stop, but there was also another
voice telling me that the damage was already done
and that I could not stop, could no longer draw back.
It was my inner voice telling me: “Stop, stop! What are
you doing!?” while another voice was saying: “You
have done it now: you can’t stop here”. This last voice
was still mine, but more evil. The nastier voice was
224
telling me that I could not stop and should kill her:

“Finish her off”, it ordered. This voice immediately
overcame the one that telling me: “Stop! What are you
doing?” or even “Run!”. Other things are
“embedded” more deeply inside me and they are
things that I cannot get out…
When we speak in our minds, like the
interviewee, we do so by talking to other interlocutors
– specific individuals or embodiments of social rules –
of whom we imagine hearing judgments, opinions,
praises, warnings, suggestions, exhortations, calls and
orders. However, the words we attribute to them are
nothing but a reformulation of ours, in a constant
semantic shift. It is in the interstices of these processes
that deliberations, as well as the planning of future
actions, including highly deviant ones, emerge.
Since society is a good deal less normatively
homogeneous than the concept of a “generalized
other” implies, the subject has more degrees of
freedom, and therefore also takes on the burden of
determining whose expectations to endorse
personally, and by what measures he will satisfy
them (Archer, 2003: 142).
Bearing in mind this complexity, if in the
course of life the Self – that “prism,” that center of
convergence, refraction and orientation fed by the
“phantom community” – through which we construe
ourselves and the external world “reflexively” (but
never altogether “transparently”) – is not made to
shift dramatically towards a violent value and
symbolic composition, the actor will be able to
225
continue to address such statements as: “Do not

associate with people like these!” However, after
embarking on what Athens (1992; 2003) defines as a
“process of violentization,” having internalized brutal
“phantom others” and having become the custodian
of principles definitely antithetical to “civil” rules, an
individual may, by echoing the words of his
“phantom community,” utter to himself such
thoughts as: “Cut him to pieces, without pity!” Such a
dramatic shift may take place also through an
“education in violence,” capable of triggering flashes
of resentment, disgust and intolerance towards
“another from oneself” – perceived as “evil,”
“inferior” or “diabolical”.
It is in such intermittencies that the social
feeling of “hatred,” meaning by this a relatively stable
and deep-rooted tendency to perceive the others and
their gestures as “diabolical,” festers. “Hatred” is
always preceded and accompanied by a dynamic of
demonization of the enemy and by the compelling
desire to affirm one’s reasons for “domination.” By
engaging in self-conversation, those who cast a
hateful glance are unable to see the face of the other,
because something terrible has already happened to
their ability to feel: we basically react to anybody we
believe is harming us or wishes to harm us by
“cancelling” his or her person. When we act in this
way, we go well beyond the distinction between
“right” and “wrong” or between “good” and “evil.”
Our aim is to emphatically affirm that set of values
which our own (malignant) corporeal community
226
defines in opposition to an “enemy.” “Cancelling” the

enemy means attacking his body because you hate the
“universal” he represents, as it belongs to a specific
ethnic or religious group (De Monticelli, 2003: 243-
248), or a given criminal organization.
Hatred for black people, for the “others”,
emerges starkly in this interview:
8. Case F: Homicide
While he was talking I was thinking: “See these

shitty people who come here in Italy and want to mind
their own business… here in Italy… it’s not right”. I was
angry because he wanted to rape that girl. That was
what triggered it… but I did not mean to kill him…
the heat, the real evil came on later…
By now everything had started. Something
was taking place that I had not reckoned on but can
happen, even though it does not mean it has to… I
was trying not to let it happen…because I am not the
executioner who goes around killing people… even
though many times I put myself in situations when I do
judge people…It’s happened right in this case… a
judgment was made because he is black. First, he is
black… this is a founded belief I have about them.
They are animals and I am a person. It may seem a
contradiction, because you say things about blacks
and then you listen to Bob Marley’s music…but to be
227
Jamaican is another thing… he is not a real black…the

blacks are animals. I see it also when it comes to Arabs
and Moroccans. They make you racist. Even if the last
are white they suck all the same because of how they
behave, because they are not men who take a stand.
Then when you take them one at the time they prove
themselves utter fools. I, on the contrary, with others
or on my own… I am always the same … because this
is what I am, this is my attitude. These people, on the
contrary, when they are a pack… and you start
shooting at them they turn into sheep and run away
from even one person. For me they are not men. They
are animals. I am not talking about all blacks, I am
talking about these animals here that are happy only
in a pack. That’s exactly what I hate! Because if I have
to do you a mischief I don’t come at you in a pack, I
come…I as a person, and as such I come and hurt
you…be it evil or good.
Also on such occasions, the actor is
uninterruptedly engaged in a process of “inner
conversation,” which, in terms of reflexivity, is
unrivalled (see Archer, 2003: 44). Therefore, weaving
the plot of one’s “identity,” whether individual or
social, means making the “inner conversation” flow
towards a narrative reference point around which
other internalized “phantom others” gather: “Thus,
people’s social identities, including their genders, are
by-products of their ongoing soliloquies with
228
phantom others rather than vice versa” (Athens, 2005:

645).
9. Role-Taking and Interpreting the Situation
Let us, therefore, in keeping with Athens,

discount the idea that there are social and individual
variables that necessarily “condition” one to make
“deliberations” that transcend the “eachness” of any
individual. It is through “reflexivity” that we become
“active agents”: that is to say, people who have some
power of determining their own lives, of self-
assessment, and of taking personal responsibility.
“Inner reflexivity” clearly selectively mediates
cultural contexts, as well as the structural and
dominative restraints of the corporeal communities to
which an individual belongs. In other words, the Self
reflexively transforms what is “internal” into
“external” and what is “external” into “internal”
(Donati, 2006: 24).
The person, then, is both “generated” and
“generating.” In our opinion, this is one of the most
relevant original images of symbolic interactionism:
not only an unveiling of the processes whereby the
“inner worlds” are constructed, but also recognition
of the fact that the “eachness” of such worlds
depends on the interplay between them.
But how does this interplay concretely occur?
Mead’s theory focused on the “meaningful
229
language,” which is based on abstractions that people

make when assuming the attitudes of others – and of
which they would be automatically aware in that
moment – has been dropped by Athens. Indeed,
Athens has clearly pointed out that our assumptions
of others’ attitudes (“role-taking”) necessitate that we
wait for other people’s replies to our words, as we can
never directly take on their roles: the meaning
attributed to a given gesture is ultimately always a
meaning of ours, and the expectations in terms of
behaviour deriving from it will be ours as well.
Assuming other people’s attitudes leads to
knowing the definitions of the “others” and their
states of mind, and potentially to sharing them and
empathizing with them – which means imagining
and sharing the thoughts, the feelings, and the
experiences of other people, adopting their
perspectives, blurring the boundaries between “us”
and “them.”
But empathy, as we all know, does not
correspond to “role-taking.” When a “violent actor”
assumes the victim’s viewpoint in order to attribute
meaning to their gestures, they do not necessarily feel
and understand the life experiences of their
interlocutors. This aspect emerges overwhelmingly
when the analysis includes the clinical issue of
“psychopathy.”
According to the most prominent researchers,
“psychopathy” is currently defined as an affective
disorder that actually entails a diminished capacity to
empathize and, as a result, a deficit in the ability to
230
engage in “moral reasoning” (see Blair et al., 2005).

“Psychopaths” are generally viewed as people
capable of committing brutal crimes without
experiencing any “feelings of guilt.”
There is now solid scientific evidence that
people suffering from such pathologies are not
necessarily unable to engage in “role-taking” activities:
to some extent, perpetrating brutal crimes always
entails an ability to anticipate the moves of the
potential victim and to interpret his or her gestures.
Compared to other “violent actors,” psychopaths
always observe their victims with great detachment,
sometimes with great insight, but always refraining
from any form of emotional identification with them
(Shibutani, 1961: 317). What is being discussed is not,
therefore, the serious emotional anesthesia, the
absolute impossibility to “feel” what a normal person
feels, although these traits are undeniably typical of
“psychopaths.” However, also from within the
definite enclosure created by this “psychic disorder,”
each of them can address to the others, as well to
himself or herself, “meaningful” words directed at
“interpreting situations” (Athens, 1997).
Once again, we may refuse and/or modify the
“definitions” towards which others try to direct us, as
we always have the option of transcending the
immediacy of situations, of interpreting them, and of
accessing moral maxims and indications for action
provided by our “phantom community.”
However, the point is that we will never be
able to fully assume “other people’s roles.” This
231
happens exactly because of the “eachness” of the

qualitative connections established with the
“perspective backgrounds” and the “social worlds,”
and of the most spontaneous components of the self.
These are exactly the processes that lead interlocutors,
in the most varied contexts, to ask themselves
questions such as, “What is on his mind?” Let us now
adopt some of Athens’ sensitizing concepts and
consider another interview.
10. Case C: Homicide
The author, in a dialogue with his own

“phantom community”, tries to assume the “attitude
of the victim”, someone belonging to organized
crime, imagining his reactions if he had found himself
in that role.
I could see myself in the situation because I saw,
thought…I had imagined how it could end. Get near…
perhaps he, seeing the weapon, would be frightened
and not react. The moment there was a physical
contact, because he shoved me, I brandished the
weapon to frighten him. I thought: “Perhaps he will
be frightened and get into the car, go away and never
show himself again or he might try to reason… or he
might understand that what he has done is wrong,
because he has not given me what he should have
given me”. On the contrary, everything went in a
completely different way from what I imagined. My action
232
was meant to frighten him and make him understand

this kind of thing: “You want to hurt someone who can
do the same to you”. I only wanted to frighten him, to
make him believe that I also was the kind of person
who would possibly react in a certain manner… That
was my intention, not to end up shooting him…My
intention was to make him understand I could react like
him. But no way… At that moment I lost it…because I
did not expect such a reaction. It was like telling him:
“Stop! Let’s talk, let’s try to reach an agreement…”.
But no way. He was talking half Arabic and half
Italian, and I did not understand much. I had put
myself in his shoes…if someone faces me and points a
weapon at me… in fear I would stop, freeze. I thought he
would do the same. But no, this man wanted anything but
reasoning…completely the opposite of what I had thought.
An unexpected reaction… because I had already worked
out how he would react… instead he reacted
immediately. And there it’s a question of moments,
seconds. It was the first time it had happened to me, it
had turned out like this… I had not reckoned on
doing such a thing… I was ill at ease in that
background…if it’s not your background you cannot
fit…
Then I looked around me and said: “What’s
happened?”, I could not believe I had shot him.
11. Emotions and Role-Taking

233
As situations flow, the actors involved express

their feelings and place themselves in emotional
context. The symbolic interactionists had already
pointed out that the interior conversation is never
interrupted, not even when the discussion gives
shape to the actor’s emotions and feelings. As Presser
(2012: 8) states: “Our emotions rest on interpretations
of self/other/situation. We talk ourselves into feeling
resentment, anger, or anything else […]”. This kind of
assumption recalls Mead’s theory of the Self and
Blumer’s interpretation of this theory (1969): if we are
able to “indicate to ourselves” a number of “social
objects” – physical or intangible, for example, a
feeling – we can engage in continuous “emotional
work.”
When Norman Denzin (1984) developed a
symbolic interactionist’s theory of emotions, he
clearly stated that “emotions” are “social objects”
derived from the flow of our actions. We recognize
them while interpreting them. Besides experiencing
emotions bodily in a non-reflexive way (accelerated
heartbeat, sweating), we essentially make “reflexive”
experiences of them. Hence, we use them to help
define, to help confer meaning, to help organize, and
to help monitor physical feelings that would
otherwise go undefined and, thereby, remain diffuse
and amorphous (Athens, 1994). The inner states and
impulses that take part in the emotive experience do
not constitute it because definitions and
interpretations of those physiological states are
needed to confer on them an “emotional
234
meaningfulness” or, conversely, establish their

irrelevance.
There is, at any rate, a wide range of modes to
express emotions (see Mills and Kleinman, 1985: 313
onwards). In some situations, social actors will
suspend their “reflexive” and self-indication activity,
entering a “non-reflexive and emotional” state that
overpowers them. An example close to our field of
inquiry is that of the emotional lives of those who are
subjected to “violent retaliation,” and experience that
condition of apathy and bodily insensitivity that
defuses any form of active resistance. In such
circumstances, this blunting of emotion helps the
individuals to “remain” in oppressive relationships
that are apparently impossible to escape.
12. Case G: Sexual Abuse and Homicide
I am totally in the dark…I was not myself that

night. No matter who was there, it would anyway
have ended in a knife fight. She was there but it could
have been any other person… The fact is this: that
night I was the one who was not there, I was not myself. I
acted but was not in command of my body, could see
what was happening but it was not I who
commanded my body. I could not stop. My body was
moved by anger… anger from years and years of putting
up with it… anger, frustration… I had reached the limit.
I worked, I was kind of the head of the family, I
235
brought home the money… but no one considered

me… I did it because I had to… the others expected it,
that I did… I have never been thanked, praised or
anything… I have never been given a gift in my life…
rather I have been kicked in the ass for others… but
gifts never.
This anger has always been there in a corner of my
mind… every day I had to swallow a wrong, day after
day… for ten years… How could I keep swallowing?
I should have slapped her [the fiancée, not the victim
of the crime] but I did not have the courage… with
women I cannot be… that was the only time I have
been violent with a woman…
13. Social Worlds and Reflexivity
During the flow of intense emotional

activities, in which we ask for acknowledgement and
converse with our phantom communities, we find
elements capable of channeling our élan within
socially structured “cosmologies.” As a matter of fact,
all these processes do not take place in a vacuum, but
rather under the “heavenly vault” in which the “I-
world relationship” occurs.
It is our biography, operating in a “living
present” – which includes past, present and future,
memories and expectations – that defines how deeply
and to what extent the duties, the rules, the status and
the social roles are “internalized” by the single social
236
actor. Each individual is oriented towards his own

social “world” and the key to explain the relationship
between agency and structure lies in this
“cosmological” relationship.
Every social world, every corporeal
community, is never the model that directly and
transparently informs the “phantom communities” of
those who inhabit them. And being “authentic,”
finding the key to one’s “authenticity” does not mean
blindly adhering to the modality created by the
dominating models in a specific “corporeal
community”: one does not become “oneself” simply
by embracing an absurd “phantom community”
prevailing in some “social worlds,” but because one
judges the phantom community reflectively
“consistent” with the whole of one’s evolving
“cosmology.”
The last interview sequence selected illustrates
this fine theoretical consideration in a concrete way.
14. Case A: Homicide
A phrase that annoys me is: “They dragged

me into it”. Nobody drags you into anything. In my
opinion in life … modern Italian life…nobody drags
anybody into anything. In Sierra Leone they drag in the
children (soldier), they are dragged in, they give them
237
cocaine. There you are eight, they do drag you in…

but when you are twenty five nobody drags you in.
I have done things in the drug scene that have
caused people to stare and say: “That’s not possible/
that’s impossible”. A guy told me: “F**k, I don’t have
the money to do up, if I pledge this watch?”. And I
answered: “See, don’t pledge anything, I have my
dose … It was ten thousand liras then, it cost very
little in the Eighties. You party, then when you have
the money, you give it back.” And the others: “You’re
crazy”. And I: “No, he wants to bang, let him bang!”.
And they: “But you have some?”. I: “No, I don’t. I’ll
bing tonight or tomorrow!”. The others were
gobsmacked because heroin it’s like a magnet, it’s
something that pulls you… even if you wanted to
refuse it, you shiver, you feel ill, your nose runs, you
laugh even at crap. When one is wanting a trip and
needs a fix… he sweats, begins … I have always had a
relationship with heroin that made me say: “I have to
beat this thing”. And in fact the day it happened I
said: “Now I’ll beat you, you have beaten me till now,
now I will beat you and won’t bang anymore”. But
this is a talk between me and an object, not between me and
a person, there has not been anyone who made me a heroin
addict…
15. Conclusion
If it is true that the mystery of violence is to be

found in its “observation,” we can conclude that
238
analyzing some interviews with violent actors helps

us to discover and better understand the deeper
traces of people’s symbols and value systems,
including the violent ones.
In this direction, we have introduced the
concept of “violent cosmologies”, a notion directed at
reassigning meaning to violent human behavior
beyond any rigid and formal distinction between
“normality” and psychic suffering. The crucial point
in this representation of violence is the idea of a
contact between the violent actor and himself/herself,
which allows him to direct action. As we suggested,
this internal process has a deeply relational nature
(Archer, 2003: 94).
By focusing on self-narrative as a guide to
(violent) behaviour (see Presser 2009: 181) and trying
to reassign a meaningful dimension to a phenomenon
– that of criminal violence – which has always been
investigated by human scientists, but still remains
shrouded in a halo of incomprehensibility, we hope
that the theory propounded by Athens may
contribute to a knowledge and an understanding of
the qualitative processes and the symbolic worlds in
which a social actor moves when he or she prepares,
interprets, plans, and finally performs a brutal act.
References
239
ARCHER, M.S. (2003) Structure, Agency and the Internal

Conversation. Cambridge: Cambridge University
Press.
ATHENS, L. (1992) The Creation of Dangerous Violent
Criminals. Urbana: University of Illinois Press.
ATHENS, L. (1994) ‘The Self as a Soliloquy’, The
Sociological Quarterly 35 (3): 521–532.
ATHENS, L. (1995a) ‘Mead’s Visions of the Self: A Pair of
“Flawed Diamonds”’, Studies in Symbolic Interaction 18:
245-61.
ATHENS, L. (1995b) ‘Dramatic Self Change’, The
Sociological Quarterly 36 (3): 571–586.
ATHENS, L. (1997) Violent Criminal Acts and Actors
Revisited. Urbana: University of Illinois Press.
ATHENS, L. (2002) ‘Domination. The Blind Spot in
Mead’s Analysis of the Social Act’, Journal of Classical
Sociology 2 (1): 25–42.
ATHENS, L. (2003) ‘Violentization in Larger Social
Context’, in L.H. ATHENS and J.T. ULMER (Eds) Violent
Acts and Violentization. Assessing, Applying, and
Developing Lonnie Athens’ Theories. Oxford: Elsevier
Science & Technology Books.
ATHENS, L. (2005) ‘Violent Encounters. Violent
Engagements, Skirmishes, and Tiffs’, Journal of
Contemporary Ethnography 6 (34): 631-678.
240
ATHENS, L. (2007) ‘Radical Interactionism. Going Beyond

Mead’, Journal for the Theory of Social Behaviour 37 (2):
137-165.
ATHENS, L. (2013) ‘“Radical” and “Symbolic”
Interactionism: Demarcating Their Borders’, Studies in
Symbolic Interaction, 41: 1-24.
BARONE, P. (2004), Lo junghismo. Sfiguramento e resti
della vita psichica. Raffaello Cortina, Milano.
BIONDI, M. (2005) ‘La dimensione aggressività-violenza
(A-V)’, in P. PANCHERI (Ed.) Psicopatologia e terapia dei
comportamenti aggressivi e violenti. Firenze: Scientific
Press.
BLAIR, J., MITCHELL, D., BLAIR, K. (2005) The
Psychopath. Emotion and the Brain. Malden: Blackwell.
BLUMER, H. (1954) ‘What is Wrong with Social Theory?,
American Sociological Review 19: 3-10.
BLUMER, H. (1969) Symbolic Interactionism, Perspective
and Method. Englewood Cliffs, New Jersey: Prentice–
Hall.
BODEI, R. (2013) Immaginare altre vite. Realtà, progetti,
desideri. Milano: Feltrinelli.
CANETTI, E. ([1976] 1979) The Conscience of Words.
New York: The Seabury Press
CARDANO, M. (2003), Tecniche di ricerca qualitativa.
Percorsi di ricerca nelle scienze sociali. Roma: Carocci.
241
CERETTI, A. AND NATALI, L. (2009) Cosmologie violente.

Percorsi di vite criminali. Milano: Raffaello Cortina.
DE MONTICELLI, R. (2003) L’ordine del cuore. Etica e
teoria del sentire. Milano: Garzanti.
DENZIN, N. (1984) On Understanding Emotion. San
Francisco: Jossey-Bass.
DONATI, P. (2006) ‘La conversazione interiore. Un nuovo
paradigma (personalizzante) della socializzazione.
Introduzione all’edizione italiana’, in M. ARCHER (2003)
La conversazione interiore. Come nasce l’agire sociale.
Gardolo (TN): Erickson 2006.
HARCOURT, B. (2006) Language of the Gun. Youth, Crime
and Public Policy. Chicago and London: The
University of Chicago Press.
HAIDT, J. AND BJORKLUND, F. (2008), ‘Social
Intuitionists Answer Six Questions About Morality’, in
Moral psychology (vol.2). The cognitive science of
morality: Intuition and diversity. MIT Press.
INGHILLERI, M. (2005) ‘Il linguaggio come strumento del
cambiamento nella psicoterapia interattivo-cognitiva’,
URL (september, 2010):
http://psicologiaclinica.splinder.com/post/19799159
/il-linguaggio-come-strumento-del-cambiamento-
nella-psicoterapia-interattivo-cognitiva
JEDLOWSKI, P. (2008) Il sapere dell’esperienza. Fra
l’abitudine e il dubbio. Roma: Carocci.
242
MILLS, T. AND KLEINMAN, S. (1985) ‘Emotions,

Reflexivity, and Action: An Interactionist Analysis’, in K.
PLUMMER (1991) (Ed.) Symbolic Interactionism.
Foundations and History. Aldershot: Elgar Publishing,
vol. II.
MINKOWSKI, E. (1936) Vers une cosmologie. Fragments
philosophiques. Paris: Aubier-Montaigne.
MYERS, G.E. (1986) ‘Introspection and Self-knowledge’,
American Philosophical Quarterly 23 (2): 199-207.
PRESSER, L (2009) ‘The narratives of offenders’,
Theoretical Criminology 13: 177-200
PRESSER, L (2012) ‘Getting on top through mass murder:
Narrative, metaphor, and violence’, Crime Media Culture
8: 3-21.
SANGUINETI, J.J. (2002) ‘Universe’, in G. TANZELLA-
NITTI, P. LARREY and A. STRUMIA (Eds), URL
(September, 2010): http://www.inters.org INTERS –
Interdisciplinary Encyclopedia of Religion and Science.
SHIBUTANI, T. (1961). Society and Personality. An
Interactionist Approach to Social Psychology. Englewood
Cliffs, New Jersey: Prentice-Hall.
Luigi Colombo
243
Observations on Criminal Versatility

Start From the Clinical Experience at
the Intensified Treatment Unit for
Authors of Sexual Crime (at the
Milano-Bollate Prison)1
Luigi Colombo2
Keywords: versatility, sex offender, violence.
1. Versatility is not Serial Repetition
Serial repetition can be linked to versatility.

But serial repetition presupposes always a definite
dangerous scheme of action; instead versatility
consists of a series of acts prejudicial of different
seriousness.
1
For the completed presentation of this work I refer to Paolo Giulini-Carla
Maria Xella (a cura di), Buttare la chiave? La sfida del trattamento per gli
autori di reati sessuali, Raffaello Cortina editore, Milano, 2011.
2
Psychoanalyst, group conductor of the Intensified Treatment Unit
located at the Milano-Bollate Prison.
Observations on Criminal Versatility Start From the
Clinical Experience at the Intensified Treatment Unit for
244 Authors of Sexual Crime (at the Milano-Bollate Prison)
Serial repetition does not express always that

mere disinterest towards the other person – proto-
narcissism, as it is called with a rather pretty
expression– that characterises psychopathy. It is a
behaviour that requires an alternative clinical
interpretation.
For exemple, seriality can be the result of a
clinical pyschotic-type condition, that is diagnosable
in axis° according to the criteria of DSM (IV° and
following) regarding psychotic disorders.
For example, Ivan (a fictitious name) that was
being treated at the Intensified Treatment Unit, repeated
sexual violence according to a constant scheme: on the
railway line that he takes home, he searches out a woman
travelling alone, in a railway carriage without any other
passengers; he approaches her and using a knife as a mode
of threatening her, he forces her to carry out fellatio on him.
He often apologises at the end of this episode. He has never
used the knife to injure the victim. In general he disappears
before the arrival of police but at a certain point he returns
to the scene of the crime when police arrive. When he is
arrested he will incriminate himself with regard to
numerous other crimes.
While in jail Ivan will develop a delirium of
persecution; there won’t be any more relapses but
subsequently some years after release from prison, he
will attempt suicide by throwing himself under a
Luigi Colombo
245
train; he will be saved and will start residential

psychiatric treatment that is still ongoing 3.
Evidently, Ivan’s serial repetition is
psychopathic-type. If anything, it expresses serious
problems of the subject, a sort of devastation whose
previous episodes can be easily summed up in a few
words. The medical practitioners will undoubtedly
know the mother of the person concerned , a woman
affected by a very serious yet well organised
paranoiac delirium (diagnosed by a psychiatric
service such as this sort, besides being clearly
detectable; it was not possible to know his father since
he had died of cancer a few years before, a man
described as always present in family but never
violent.
2. Versatility and Relapse
4
Situated at the prison of Milan-Bollate.
5
It is important to note the assessment of full possession of one’s
faculties carried out by a famous criminologist considered to be of
ascribable. It is clear that, in cases such as this, the issue raised by Ponti
regarding inadequacy recurs, in the light of knowledge of current clinical
pyschology, of the dichotomy between health and illness that is the
prerequisite of an evaluation of this kind; yet this is outside of the
circumscribed perspective of this intervention.
The notion of versatility must also be

distinguished from that of relapse as it is defined by
penal regulations with the notion of specific relapse.
The relapse of the sexual criminal is rather the
repetition of a tendency that can be materialised into
a series of crimes with a range of extent of damage
that is unknown by the judicial authority, or it may
be that he has hesitated in all those actions, as is the
case for example in behaviours of accosting the victim
during early stages of the criminal '“approach“ that
were not completed due to unforeseeable
circumstances, environmental protection or because
of the reaction of the victim. Ultimately it can be
noted that the life of a person that has committed a
sexual crime is a dissemination of features that will
manifest themselves in the crime. The occurrence of
the crime seems to have been then the suitable
juncture that has provided the chance of a tendency
that is constantly present. For these reasons, the
information provided spontaneously in the treatment
report can be insufficient, and highlights the need to
also acquire additional de latu information with
recourse to other sources such as parents of relatives.
A man whom I shall call Enrico at the age of 44
rapes two girls aged 6 and 8, daughters of a very poor
family in a region of the South, in which he was hosted
during his holidays. Enrico send them designs and gifts
resulting in the judge of the court of criminal appeals
strongly denouncing the child content as though it had
involved a perfect conjunction of a criminal strategy aimed
at assuring the girls’ trust and his own unfathomable.
Luigi Colombo
247
When this crime occurs, Enrico is already within the

system of the judicial authority, he is in fact awaiting
completion of a trial concerning the sexual abuse of his own
daughter. This little girl stayed with him during the
periods agreed with her mother, whom he had divorced. In
a way not clearly explained by the lawsuit, the eldest son
was also involved in this event. In addition, he had been
married before to a girl who was barely aged 14, while he
was 26. Everyone knew that during the phase of “courting”
of the young girl, he had also already courted the little
girl’s cousin, aged 12, resulting in a small scandal among
relatives. It is clear that here, it is not only a matter of
relapse and repetition that does not involve any
psychopathic elements. There is also a constant
theme, a scheme of the desire that cannot impose
itself in Enrico’s life to the detriment of his victims.
More generally, it is pointed out that a
perverted tendency can remain dormant, or fraught
with less specific decisions that then result in a
decisive and perhaps typical manner in sexual crime
and in particular of a pedophilic-type. Moreover, this
is typical of the sexual drive. The emblematic case is
that of the person who has committed a crime and
then, for many years, marriage, work and familiar
balance satisfy an inner need that suppresses the
drive, to then commit again after 20 years in
circumstances of absence of work or in retirement. In
these cases it seems that there is no true marked
sexual preference, as in Enrico’ case, but rather a sort
of inner economy that in case of need is repeated in
reaction to the surge represented by the crime.
In a series of cases, the repetition of tendency,

just as it has manifested itself in the history of the
subject, is constituted by behaviours that have a link
of inherence with the following sexual crime even if
they are not of the same kind. For example, a person
whose life is characterised by a stable couple relationship,
yet strongly characterised by an extremely important
polymorphic sexual component, involving the female
partner, has never been directly involved in
criminologically defined situations. In this case,
polymorphism can intensify in terms of
dissemination of features and actions (that is the
typology of actions, of partners, of the number of
partner changes and so on) with living and existential
conditions determined by circumstances or events or
by life periods of time bringing about an escalation of
the behaviour; now at a certain point the subject aims
to seek out a young girl, putting himself, but without
wanting to, at the risk of being arrested.
3. Versatility is not Even Criminal

Polymorphism
The term polymorphism can be attributed to

behaviours in which there is a dissemination of a
variety of perverted actions, also since childhood but
with the inability to manipulate the other person,
rather an incapability to restrain his own problems
within the relationship of love, of friendship, of
Luigi Colombo
249
work. These two conditions are different. The first

one shows similarities with an “attitude”, the second
one is a set of problems. Polymorphism is actually a
disorder in the clinical sense of the term and of the
DSM; the anti-social disorder characterises the
tendency to have deviant behaviours.
It must therefore be said that the greatest
number of relapses after treatment falls into this
category. It deals with cases in which, however,
following treatment had already been invalidated by
objections, probably determined by a further clinical
causality involving in any case a reduced ability to
assess reality appropriately.
Giuseppe abused women several times with a well-
defined technique; he has a marked mythomaniac ability;
his tendency is such that he also displays forms of well
organised cruising, methodic even if uncontrollable. He
relapses in sexual and polymorphous crime within the
criminal field having also committed petty crimes in a work
environment or small transgressions that have been
damaging for other persons. Both sexual violence and
mythomaniac manifestations are organised in a narrative
manner.
We cannot say that he’s a truly versatile criminal;
above all he completely lacks emotional indifference, even if
his strategy is present, repetitive and after a while becomes
clearly visible. He is not grandiose; he has also a deflected
mood.
In another case, involving someone that I shall call
Antonio, the issue concerns violence perpetrated against
prostitutes. He has committed to their detriment at least 4
Clinical Experience at the Intensified Treatment Unit
250 for Authors of Sexual Crime (at the Milano-Bollate
Prison)
specific recidivisms of sexual violence. The reason is

obviously that they have cost too much; he vents his will
towards them, to have a woman without involving the
desire of the woman. When it has happened in the past – he
recounted – he often argued with other men, who wanted
to steal his woman etc. ; he had previously committed
crimes for illegal gun licences, the possession of weapon
etc. he has clearly paranoiac tendencies, that from his
parents’ relationship, date back to his teenage years when,
for example, he used to wander around his city in the
middle of August with a leather jacket or he was unable to
use means of transport because this caused him a high level
of distress.
Francia acts obsessively, with adults as well as
with children. Over time the latter have apparently become
more “interesting”. He has committed specific relapses of
sexual violence. Previously, since adolescence, he has
committed a very different series of crimes, in particular
breaking into apartments. He commits crimes when he has
a hypomanic mood; he shows mood disorder even if not
particularly marked.
These examples represent three of the five
relapses occurred after the treatment at the Unit of
Bollate. The other two cases of relapse represent cases
with a pedophilic-type deviant sexual preference.
4. Sexual Violence Without Recidivism and

Repetition
Luigi Colombo
251
In most cases sexual violence has been an

isolated episode in a person that shows traits or
appearance of normality with regard to social,
working and familiar integration. However, even in
these cases we need to be careful to observe if it really
deals with an isolated episode that doesn’t presume
any tendency or if it involves an isolated event
because up to that point the author hasn’t had the
confidence or hasn’t found the right circumstances to
act.
However, in the absence of prior criminal-type
elements prior to the the crime in question (this is
verified by institutional sources, by a patient’s
historical reconstruction and with the analysis of
criminal genesis) it can be stated that the crime has
been the consequence of a vulnerability of the author
of the crime to sexual type stimuli. It is also clear how
these stimuli have prevailed with regard to a
previous state of depression, of deep inhibition and of
social and individual marginalisation that, at their
starting phase have led to an intense and unresolved
state of anger. The explanatory scheme or pattern that
is commonly encountered from in-depth knowledge
of cases can be outlined as this sequence: 1) a state of
depression or feeling of ostracisation, 2° a state of
anger, 3° a transformation of anger in sexual
aggression (as sexualisation of anger).
It is clear that these cases are more accessible
to therapy.
Authors of Sexual Crime (at the Milano-Bollate Prison)
252
5. Notion of Versatility
Criminal versatility has a specific value just

because it is not restricted to serial repetition (which can
involve a psychological “substratum”); it does not show
similarities with the notion of tendency to repetition in the
case of sexual violence; it also distinguishes itself from the
notion of polymorphism, which is a particular case of its
own, in the sense that a psychopath can have polymorphic
behaviours, but in the polymorphism of an anti-social
disorder there is no psychopathy.
In light of this, again following the research

commenced in the 20th century by Hare, it must be
said right away that the value of this definition is not
to commit the mistake of defining with the term
psychopathy a psychological profile that is
particularly inclined to committing bloody, cruel and
inhuman crimes. The prototype of Hannibal the
cannibal is not a good example and his representation
probably does not coincide with that of a
psychopathic criminal (it is the same Hare who states
this) but rather a psychosis (not a delirium4) whose
6
I make a distinction between psychosis and delirium : I follow the
position in fact formulated by Jacques Lacan in his teaching of
psychoanalysis, in particular in his essay D'un question préliminaire à tout
traitement de la psychose, in Jacques Lacan, Ecrits, Ed. De Seuil, Paris,
1966, pp.531-583. Here Lacan follows the tradition of French classic
Luigi Colombo
253
nucleus is more than likely characterised by the

destruction of the knowledge of the other, in the
portion reduction of a menu7.
Psychopathy “is a constellation of personality
traits”8, whose core consists of an attitude to act in a
completely egosyntonic and selfish manner, focused
on one’s own needs. The nucleus of this constellation
is the total indifference towards the other, more
exactly an indifference to the desire of the other
person. This indifference produces in the subject not
so much the tendency to act against the other person
psychiatry in which psychosis and delirium are already distinguished, as is

the case with de Clerambault; tradition revisited by Freud in which
delirium is a symptom, terminal formation of a condition belonging to a
libidic structure.
7
I consider that this is concealed in the beautiful expression in the Italian
cinematographic reduction in which Hannibal Lector expresses: “I ate the
official responsible for the census with a good bottle of Chianti“ -
unfortunately I’ve never read the novel.
8
Hilton Nz, Harris Gt, Rice Me, (2001), 'Predicting violence by serious wife
assaulters', in Journal of Interpersonal Violence, nr.16, pp. 408-423.
9
Vincenzo Caretti, Adriano Schimmenti, editors of the volume and authors
of the Introduction in R.D. Hare, La psicopatia. Valutazione diagnostica e
ricerca empirica, Astrolabio, Rome, 2009.
10
With this difference I refer to the formulation of Lacan.
11
Despite what would occur in correctly established psychoanalysis, in
which the psychoanalyst declines any acquisition – essentially avoiding
judging and initiating “fluctuating attention”.
according to a perverted and detrimental scheme, but

to act without considering the other person, and to
act in a violent way when the other person interposes
himself as a barrier, at whatever level this might be
manifested. It is clear that if this organisation of
personality is accompanied by sadism, this is source
of extreme violence. However, sadism is not always
present.
It is moreover probable that in the intimate
interaction, the psychopathic subject expresses a
damaging and violent potential that depends on his
inability to realise his drive having as a limit the other
person’s good. The other person’s good implies
attention and sensitivity for the other’s desire – an
element that is absent in the psychopath. The good of
the other person is a form of slavery.
This is the factor that radically separates
psychopathy from psychosis meant as psychotic
disorder. And in this sense it is closer to perversion,
as Caretti and Schimmenti noted in the introduction
to the volume by Hare9.
I believe that the issue is inconclusive if
psychosis as structure, that is as mental functioning,
distinguished from psychosis as disorder, cannot be
co-present in the framework of psychopathy in a
hidden form10.What also remains unresolved is the
matter of whether Cleckley’s observations relating to
the presence of psychopaths in the psychiatric-
residential field is data that must also be interpreted
in terms of dual diagnosis. We observed the rest of
the emergence of psychotic symptoms in sexual
Luigi Colombo
255
offenders who have been affected by therapeutic

work.
Hare points outs that a psychopath’s
versatility is not only the ability to commit perverted
or truly violent actions of a different kind but also to
commit actions of reduced victimogenous intensity or
that also cause indirectly damage to the other person.
Proto-narcissism results in the psychopath
establishing apparent relationships while actually
completely ignoring the desire of the other person. He
never really forms a bond but, so to speak, ties the
other person to himself. It is to be highlighted that
this inclination involves in a particular manner the
operator that, with his desire to create an alliance, it is
actually the case that it is he himself who creates an
alliance to the psychopathic user while the latter has
merely repeated yet another episode of deceit.
The desire of the other that drives persons to
compete against each other, to compete for the same
object of love, to inhibit themselves, to use substances
in order to overcome shyness - perhaps doesn’t exist
at all for the psychopath.
In order to diagnose psychopathy it can be
useful to retrace the data “in hand” analytically, also
in the form of a thorough cross-examination and also
using sources brought by other persons11, the story
of intimate relationships, of parenthood, of choices
involving their own interests may reveal situations in
which the subject finds himself, and those that must
be diagnosed are actually links or the mere
appearance of links or make-believe links. In other
words, diagnosis must more specifically consider the

absence of any difficult or problematic link.
I consider that this trait must always be used
along with that of versatility to diagnose as far as is
possible, through the anamnestic method reported
above, the presence of a psychopathy that
differentiates this condition from other profiles linked
to criminal tendencies or actions.
References
CARETTI, V., SCHIMMENTI, A., Introduzione (2009) in

R.D.Hare (2009) La psicopatia. Valutazione diagnostica e
ricerca empirica, Astrolabio, Rome.
GIULINI, P., XELLA, C.M. (a cura di) (2011) Buttare la
chiave? La sfida del trattamento per gli autori di reati
sessuali, Raffaello Cortina editore, Milano.
HARE, R.H. (2009) La psicopatia. Valutazione diagnostica
e ricerca empirica, Astrolabio, Roma.
HARE, R.H., NEUMAN, C.S. (2009), in Blaney, P.H.,
Millon, T. (2009), Oxford Texbook of Psychopathology,
Oxford university Press, New York-Oxford.
HILTON, N., HARRIS, G., RICE, M. (2001) 'Predicting
violence by serious wife assaulters', Journal of
Interpersonal Violence, 16: 408-423.
Luigi Colombo
257
LACAN, J. (1966) D'un question préliminaire à tout

traitement de la psychose, in Jacques Lacan (1966) Ecrits,
Ed. De Seuil, Paris.
258
Andrew Forrester
259
Offender Mental Health

Developments in England and Wales:
Nothing Endures but Change
Andrew Forrester1
1. Abstract
Offender healthcare services have developed

considerably in England and Wales over the last 20
years, following an initial focus on improvements
within prisons. More recently, the development of
liaison and diversion services within court and police
custody have become a national priority. In this
paper, the background to these changes is examined
and a service case example from South London is
used to illustrate the effects on the ground, while also
recognising that the available evidence indicates
variations across geographical areas. The underlying
conceptual drivers are discussed, as are their
1
Consultant and Honorary Senior Lecturer in Forensic Psychiatry, Department
of Forensic and Neurodevelopmental Science, Institute of Psychiatry, King’s
College London
Offender Mental Health Developments in England
and Wales: Nothing Endures but Change
260
implications. As new terms are drawn within

offender health, an area marked by rapid
developments in recent years, we can now state, with
more than just a degree of certainty, and with some
additional cautious optimism, that nothing endures but
change.
Keywords: Offender; mental health; police; court; prison;

integration.
2. Introduction and policy background
Court liaison and diversion services have been

introduced into new areas, or developed where they
already operated, in a number of countries over the
last few decades. In general terms, their aim has been
to assist in identifying people who present with
mental illness in criminal justice systems, to provide
timely specialist evaluations to the courts and to
ensure that those who are mentally ill can be diverted
away from prison custody to hospital or other
therapeutic care where appropriate. Over the same
period, the prison population has risen substantially
throughout the world (Walmsley, 2011), with
resultant pressure inside many criminal justice
systems given the high levels of mental health
morbidity that have been well established in the
prison literature for at least several decades (e.g.
Brooke, Taylor, Gunn, & Maden, 1996; Fazel &
Andrew Forrester
261
Seewald, 2012). Although court liaison and diversion

services have developed at different speeds and times
in different countries, sometimes with differing
judicial or health aims (James, 2006), an historically
unifying theme has been the absence of dedicated
funding; at least until the Clinton Government backed
US mental health courts with legislation and
substantial funding from 2000 (Steadman, Davidson,
& Brown, 2001). Until fairly recently, it was mostly
accepted that liaison and diversion court services
could, as a minimum, assist in providing care that
some people with mental health problems would not
otherwise have received (James, 1999), or in
providing the courts with enhanced decision making
for issues such as competency to stand trial (Stafford
& Wygant, 2005; Watson, Hanrahan, Luchins, &
Lurigio, 2001). However, there was a recognition that
the services that had been introduced fell short of a
robust standard of research evidence which
demonstrated their effectiveness (Schneider, 2010).
Since then, a longitudinal study in which individual
outcomes from mental health courts were compared
with a treatment-as-usual control group and found to
exhibit lower rates of arrest and incarceration at 18-
months, has provided clear evidence of effectiveness
as regards public safety (Steadman, Redlich,
Callahan, Robbins, & Vesselinov, 2010).
In England and Wales, court liaison
and diversion services were introduced in the early
1990s (Joseph, 1990). Although the concept took off
quickly (James, 1999), onward service developments
262
soon became dependent upon the good will and

foresight of local clinicians (who, in time, came to be
referred to as ‘champions’), in the absence of
dedicated funding or an agreed national specification
framework (e.g. James & Hamilton, 1992). It is
therefore unsurprising that by the end of the first
decade of provision, many schemes struggled with
resources and lacked an apparent strategy for their
onward development (James, 1999), despite emerging
evidence of substantial morbidity within court
attendees (Shaw, Creed, Price, Huxley, & Tomenson,
1999) and within police detainee populations
(McKinnon & Grubin, 2010). Nonetheless, the need
for more coherent service development received
policy support when national reviews of available
services found them to be lacking in consistency and
in need of a co-ordinated approach that could allow
clinicians to work across the various limbs of criminal
justice pathways to assist in ensuring joined-up care
(Home Office, 2007; Department of Health, 2009).
This policy position found further support when the
Offender Health Research Network compared
operations across a number of court liaison and
diversion sites and, confirming lack of consistency,
recommended the introduction of a national
framework to develop, deliver, fund and operate
services (Offender Health Research Network, 2011). A
Department of Health sponsored evaluation of a
Mental Health Court pilot at two English sites
(Winstone & Pakes, 2010) added support for sector
diversification within liaison and diversion services
Andrew Forrester
263
by suggesting that a multi-agency approach could be

used; thereby recognising that one agency, acting
alone, might not be able to cater for the complex
admixture of health, social care and criminal justice
needs presented within the populations accessing
such services.
These developments set the scene for
the central prioritisation of offender health services
that has followed. However, in much the same way as
variations have emerged in prison mental health
service delivery (Forrester, Exworthy, Olumoroti,
Sessay, Parrott, Spencer & Whyte, 2013) in the period
following their incorporation into the National Health
Service, so the same variation is evident within liaison
and diversion services (Srivastava, Forrester, Davies
& Nadkarni, 2013). This indicates that local areas
have interpreted, and translated, these services in
different ways. As such, local case examples become
useful, and one such example (arising from services
developed in a part of South London) is presented
below to assist in providing an illustration, and
thereby a fuller picture.
3. An Example of Local Developments from

South London
It is clear that offender mental health

(sometimes also referred to as criminal justice mental
health) is an area in which there have been
264
considerable changes in recent years, and that most of

these changes have driven by policy, rather than
arising through research learning. Additionally, these
services have largely developed in a piecemeal
manner, in the absence of clear national templates
(Srivastava, Forrester, Davies & Nadkarni, 2013).
In 2008, the local National Health Service
(NHS) mental health provider (South London and
Maudsley NHS Foundation Trust) obtained a contract
to provide mental health services at what was, at the
time, the local remand prison (Her Majesty’s Prison
Brixton). These services began in May 2008 and as
they developed it became clear to the operating team
that it would be both useful and necessary to also
offer services into the main local feeder Court
(Camberwell Green Magistrates’ Court). It was
thought that this would allow cases to be identified
and reviewed as early in the criminal justice pathway
as possible, as well as offering a route through which
acutely mentally ill defendants could be diverted to
hospital if this was required. Having identified this
pathways need, the team amalgamated its service
provision with the existing service in the local
Magistrates’ Court, and integrated its delivery with a
voluntary sector partner (Together), which, co-
incidentally, had received funding to provide some
Court services.
This new integrated provision (comprising
both statutory and voluntary sector partners) had
become established by 2009. In the subsequent
period, it became clear to the operating team that
Andrew Forrester
265
defendants arriving at court from police custody were

presenting with needs that had not been met.
Therefore, the next drive was to move even earlier in
the pathway in order to identify people with mental
disorders in the local police station (at Brixton).
Therefore, working with a range of partner
organisations (including the Metropolitan Police and
the Local Authority), grant funding was obtained to
enable the development of a mental health team
operating in both police custody and in the local
court. In keeping with the aims of its the grant
funding, this team was intended to have a primary
research and evaluation function, as well as being
involved in service delivery (assessment, liaison and
diversion). Subsequently, the first cohort of police
detainees to be referred to the new service were
evaluated, and an assessment of the prevalence of
mental health problems, and the unmet needs of a
cohort of detainees, was completed (yet to be
published). In the period since then, although the
former local prison has become a resettlement prison,
the liaison and diversion services operating in police
and court areas have continued to develop year-on-
year (largely because they have since attracted
mainstream funding, allowing their introduction
across neighbouring South London boroughs).
As these services have developed, this has also
enabled the introduction of innovative new
approaches within local offender healthcare, most of
which have been funded by grant monies. These have
become possible because of the new energy in this
266
area, and they have spanned a number of aspects of

the offender pathway. They have included, for
example, mental health work in prison reception
areas (Brown, Cullen, Kooyman & Forrester, 2014),
improving the transfer of acutely mentally ill
prisoners to hospitals (Forrester, Exworthy, Chao,
Slade & Parrott, 2013), improving services for
prisoners with mental health problems upon release
from prison (Jarrett, Thornicroft, Forrester, Harty,
Senior, King, Huckle, Parrott, Dunn & Shaw, 2012)
and developing new services for men who are at very
high risk of developing psychosis in prisons (Jarrett,
Craig, Parrott, Forrester, Winton-Brown, Maguire,
McGuire, & Valmaggia, 2012).
In summary, as one local example of
developments within criminal justice mental health, it
is possible to see how local services have advanced
over the last seven years, as well as identifying the
key features that have under-pinned this advance.
These key features have been:
 The development of a pathways
approach (working across the limbs of the criminal
justice system – police stations, courts, prisons - in
accordance with policy)
 The central role of integration (by
working alongside multiple other agencies to enable
person-centred services)
 The introduction of innovation
(thereby creating a culture of continuous
improvement through learning from research and
evaluation)
Andrew Forrester
267
4. Now, and in the Future
In recent years, the Health and Social Care Act

2012 has brought about large-scale reorganisation to
the National Health Service in England and Wales, as
well as introducing the process of competitive
tendering to some areas, and extending its remit in
others. Healthcare in prisons has been particularly
affected by these changes, as addictions were in the
period before this, with prison healthcare providers
being required to submit to regular procurement
processes to ensure that a range of organisations,
across a range of health industry sectors, have the
opportunity to compete and to provide. At the
ground level, this requirement to tender services has
caused considerable instability and has, in all
probability, adversely affected the recruitment and
retention that is so needed in these difficult areas
which struggle to attract high quality staff. In the next
few years, this same tendering process will also be
extended to liaison and diversion work, as services
which are delivered in police custody move over to
full National Health Service commissioning (in the
same way that the prisons moved to National Health
Service provision in a process that began almost 20
years ago). However, this competitive tendering is
more likely to be of benefit to liaison and diversion
services than it has been to the prisons, mainly
because their delivery is currently patchy across the
268
country (Srivastava, Forrester, Davies & Nadkarni,

2014). As such, any process through which the
quantity of provision is boosted and given priority
status is likely to be helpful at this point.
As these new services unfold, the
concept of integration is likely to remain centre-stage,
with some arguing that offender health pathways are
ideally positioned to model co-ordinated care for
uptake across other health and social areas (Till,
Exworthy, Forrester, 2015). As the delivery of
integration takes hold, with the idea that person-
centred care should be at its core (Monitor, 2015), so it
is likely to become clearer that the original conceptual
driver for prison healthcare (the concept of
equivalence), is gradually being replaced by new ideas
(Till, Forrester & Exworthy, 2014; Exworthy, Samele,
Urquia & Forrester, 2012). Equivalence brought with it
the idea that “those charged with the medical care of
prisoners and detainees have a duty to provide them with
protection of their physical and mental health and
treatment of disease of the same quality and standard as is
afforded to those who are not imprisoned or detained”
(United Nations, 1982). As such, it has been useful in
ensuring improvements from a low starting base.
However, the new direction of travel takes us beyond
equivalence (Exworthy, Wilson & Forrester, 2011) into
more complex territory in which connectedness
(across pathways, sectors and providers), competition
(through procurement) and public health outcomes
are likely to be the new drivers.
Andrew Forrester
269
As these new terms are drawn within

offender health, an area marked by rapid
developments in recent years, we may now be in a
position where we can state, with more than a just
degree of certainty, albeit with some additional
cautious optimism, that nothing endures but change
(Heraclitus, 500BC, in Laertius, 1925).
References
BROOKE, D., TAYLOR, C., GUNN, J., MADEN, A. (1996)

Point prevalence of mental disorder in unconvicted male
prisoners in England and Wales. British Medical Journal,
14, 313, 1524-1527.
BROWN, K., CULLEN, A., KOOYMAN, I., & FORRESTER,
A. (2015). Mental health expertise at prison reception. The
Journal of Forensic Psychiatry & Psychology, 26(1), 107-
115.
DEPARTMENT OF HEALTH (2009) Lord Bradley’s review
of people with mental health problems or learning
disabilities in the criminal justice system. Department of
Health: London.
EXWORTHY, T., SAMELE, C., URQUIA, N., & FORRESTER,
A. (2012). Asserting prisoners’ right to health: progressing
beyond equivalence. Psychiatric Services, 63(3), 270-275.
EXWORTHY, T., WILSON, S., & FORRESTER, A. (2011).
Beyond equivalence: prisoners’ right to health. The
Psychiatrist, 35(6), 201-202.
270
FAZEL, S., & SEEWALD, K. (2012) Severe mental illness in

33588 prisoners worldwide: systematic review and meta-
regression analysis. The British Journal of Psychiatry,
200, 364-373.
FORRESTER, A., EXWORTHY, T., CHAO, O., SLADE, K., &
PARROTT, J. (2013). Influencing the care pathway for
prisoners with acute mental illness. Criminal Behaviour
and Mental Health, 23(3), 217-226.
FORRESTER, A., EXWORTHY, T., OLUMOROTI, O., SESSAY,
M., PARROTT, J., SPENCER, S., & WHYTE, S. (2013).
Variations in prison mental health services in England and
Wales. International Journal of Law and Psychiatry,
36(3), 326-332.
HOME OFFICE (2007) A Report by Baroness Jean Corston
of a Review of Women with particular vulnerabilities in the
Criminal Justice System. Home Office: London.
JAMES, D.V., HAMILTON, L.W. (1992) Setting up
psychiatric liaison schemes to magistrates’ courts: problems
and practicalities. Medicine, Science and the Law, 32,
167-176.
JAMES, D.V. (1999) Court diversion at 10 years: can it
work, does it work and has it a future? The Journal of
Forensic Psychiatry, 10(3), 507-524.
JAMES, D.V. (2006) Court diversion in perspective.
Australian and New Zealand Journal of Psychiatry,
40, 529-538.
JARRETT, M., CRAIG, T., PARROTT, J., FORRESTER, A.,
WINTON-BROWN, T., MAGUIRE, H., MCGUIRE, P., &
Andrew Forrester
271
VALMAGGIA, L. (2012). Identifying men at ultra high risk

of psychosis in a prison population. Schizophrenia
research, 136(1), 1-6.
JARRETT, M., THORNICROFT, G., FORRESTER, A., HARTY,
M., SENIOR, J., KING, C., HUCKLE, S., PARROTT, J.,
DUNN, G., & SHAW, J. (2012). Continuity of care for
recently released prisoners with mental illness: a pilot
randomised controlled trial testing the feasibility of a
critical time intervention. Epidemiology and psychiatric
sciences, 21(02), 187-193.
JOSEPH, P. (1990) Mentally disordered offenders: diversion
from the criminal justice system. Journal of Forensic
Psychiatry, 1, 133-8.
LAERTIUS, D. (1925 translation). Diogenes Laertius:
Lives of Eminent Philosophers. Loeb Classical Library
no. 185, translated by Hicks, R. D.
MCKINNON, I., & GRUBIN, D. (2010) Health screening in
police custody. Journal of Forensic and Legal Medicine,
17 (4), 209-212.
MONITOR. (2015). Enabling integrated care in the NHS.
Accessed at: https://www.gov.uk/enabling-
integrated-care-in-the-nhs on 24th January 2015.
OFFENDER HEALTH RESEARCH NETWORK (2011) Liaison
and diversion services: current practices and future
directions. Offender Health Research Network:
Manchester.
272
SCHNEIDER, R. (2010) Mental health courts and diversion

programs: a global survey. International Journal of Law
and Psychiatry, 33(4), 201-206.
SHAW, J., CREED, F., PRICE, J., HUXLEY, P., &
TOMENSON, B. (1999) Prevalence and detection of serious
psychiatric disorder in defendants attending court. Lancet,
353, 1053-56.
SRIVASTAVA, S., FORRESTER, A., DAVIES, S., &
NADKARNI, R. (2013). Developing criminal justice liaison
and diversion services: research priorities and international
learning. Criminal Behaviour and Mental Health, 23,
5, 315-320.
STAFFORD, K.P. & WYGANT, D.B. (2005) The role of
competency to stand trial in mental health courts.
Behavioral Sciences and the Law, 23(2), 245-258.
STEADMAN, H.J., DAVIDSON, S., & BROWN, C. (2001)
Mental health courts: their promise and unanswered
questions. Psychiatric Services, 52(4), 457-458.
STEADMAN, H.J., REDLICH, A., CALLAHAN, L., ROBBINS,
P.C., & VESSELINOV, R. (2010) Effect of mental health
courts on arrests and jail days: a multisite study. Archives
of general psychiatry, 68(2), 167-172.
TILL, A., EXWORTHY, T., & FORRESTER, A. (2015).
Integration and offender mental health. The Journal of
Forensic Psychiatry and Psychology, 26(1), 11-21.
TILL, A., FORRESTER, A., & EXWORTHY, T. (2014). The
development of equivalence as a mechanism to improve
Andrew Forrester
273
prison healthcare. Journal of the Royal Society of

Medicine, 107 (5), 179-182.
UNITED NATIONS. (1982). A/RES/37/194. Principle of
Medical Ethics.
WALMSLEY, R. (2011) World Prison Population List
(ninth edition). International Centre for Prison Studies.
University of Essex: Essex.
WATSON, A., HANRAHAN, P., LUCHINS, D., & LURIGIO,
A. (2001) Mental health courts and the complex issue of
mentally ill offenders. Psychiatric Services, 52(4), 477-
481.
WINSTONE, J., & PAKES, F. (2010) Process evaluation of
the mental health court pilot. Ministry of Justice
Research Series 18/10. Ministry of Justice: London.
274
Gian Luca Giovannini
275
The Objective and Coded Causes for

the Exclusion of the Offense
Gian Luca Giovannini1
Keywords: penal exlusion, liability, rights
1. Introduction
The vast area of so-called criminal law

“liability" currently includes three distinctive figures.
In particular:
- the objective causes of exclusion of the fact of
crime, or cause of justification (that then make it “not
illicit ab origin”);
- the excuses (affecting the subjective element
of the offense and therefore making void the guilt);
- the causes of no punishment (all those
situations to which the legislator himself did not
consider it appropriate the application of the
punishment. Typical example is the article 649 p. c. ).
1
Phd in Forensic Sciences, Univerity Tor Vergata of Rome.
The Objective and Coded Causes for the Exclusion
of the Offense
276
Whatever, however, the distinction that you

prefer, you must never leave aside of their common
denominator: the concept of illegality. In a very strict
sense it can be defined as "the contrast between the
fact and the entire legal system" (Petrocelli-Carnelutti-
Antolisei and more).
In particular, referring mainly to the objective
causes of exclusion of the offense or causes of
justification, the penal code provides for six cases
from the article. 50 to the article. 54.
2. Art. 50 P.C. - The Consent of the Rightholder
The vast majority of the doctrine is oriented to

recognize the foundation of this “scriminante” in
renunciation, by the subject holder of the right
"breached", the protection of the good law.
You must, however, draw some of the basic
elements so that in practice then, you are not faced
with a case that only apparently may seem due to the
rule in question.
First of all it must encompass only the rights
available. There is not a definition precise of law
available, the doctrine (Mantovani, Fiandaca-Musco)
and oriented to identify as such those that are not
protected as belonging to the community or because
assets of the individual are protected regardless of his
will. By way of example are negotiable rights, the life
277
and the interests of the State protected from crimes

against the Public Administration.
Another fundamental requirement of this
“scriminante” and the nature of the consensus. This,
according to the doctrine and the dominant law, is a
legal act in the strict sense, and cross-reference. Not
only that, but it must be free from any constriction
and expressed only by him who that in addition to
enjoy the full capacity to act, is also the proprietor of
the law that must be "infringed".
A typical example of consent of the having
law and what it sees in the so-called "consensus
sports" or the "risk allowed". The issue of
responsibility and sports has been repeatedly subject
to analysis by the doctrine and jurisprudence. In
order to better understand the concepts, we must
analyze the concept of "risk sport." This concept
embraces both athletes that organisers of sporting
events. Both the subjects, in their business activities in
the world of sports, have obligations arising from
both federal regulations that the canons of prudence
provided by article 2043 C.C.. A reminder of the rule
of conduct laid down by the civil code must
necessarily be analyzed simultaneously with the act
of private autonomy of acceptance of the risk arising
from the exercise of the same in respect of the rules
sports techniques, with which the subject they
undertake a determined sporting activity. The
acceptance of this risk involves a shift in the threshold
of responsibility for example of the athlete; the art.
of the Offense
278
DC 2050 specifies the concept of dangerous activities

and through its interpretation is possible to quantify
the possible liability for criminal acts committed by
sportsmen. In the context of the article referred to
above are included certain activities, for which even
the court has held that that we should make reference
to a greater likelihood of damage by virtue of the
means used in the conduct of the sport itself, such as
for example: motor racing, cycling, motorcycling.
Other classification with respect to sporting activities
dangerous, covers the contact sports or violent for
which it is necessary to carry out a distinction
between willful misconduct or negligent. There is
wilful conduct at the time of violent event not
covered in sports practiced. We talk about instead of
negligent conduct at the time in which there is a clear
violation of a rule of the game by placing in be violent
behavior but that outsiders, which are in a context of
racing game. As regards the individual responsibility
of the athlete, it should be noted that in the case of
illegal, the same will have to answer is from a
sporting point of view on the basis of individual
regulations, and from the point of view of the
ordering of the state where the same sort recognizes a
particular importance of the conduct detrimental. In
this respect, the law defines the sport illicit when the
sports activity is considered only the means to
commit voluntarily a damages against an opponent.
On the basis of this consideration law, emerges the
279
concept of "risk allowed" which rises a parameter of

judgment for the determination of the tortious
conduct. In this sense is clear that those who practice,
for example the sport of boxing, where the peculiarity
of the violence is the main feature, the yardstick in
evaluating a potential offense is based on the normal
due diligence held by average sports that will act in
accordance with the regulation and the principles of
loyalty and prudence. Therefore, in this case, the
"Boxer" will respond by way of guilt only if his
behavior is not consistent with the regulations and
the principles set out above. By analyzing one of the
most common sports and popular such as the soccer
you can say that tendentially violence is excluded
from this discipline. This statement might however be
easily challenged saw the characteristic of "contact
sports". To identify and then a behavior of violent
game, it is necessary to analyze the conduct in the
context of the soccer game and its regulations.
According to the law were illicit also relevant for the
ordering of the state, those behaviors that are
voluntarily contrary to regulations and identifying
the sport as an excuse for committing an offense or
damage to the opponent. For example in the case
where a player strikes violently an opponent
committing a foul, in the context of a contrast of
game, such conduct will be of relevance and therefore
punished by sporting sort but will not be considered
relevant in state under the concept of "risk allowed".
of the Offense
280
By synthesizing the conduct of a footballer can be

considered lawful when will follow the rules of the
game defined by regulationsand at the same time
does not exceed the "risk allowed".
3. Art. 51 - Exercise of a Right or Fulfillment of

a Duty
Foundation of this rule, as regards both the

exercise of a straight that the fulfilment of a duty and
the principle of non-contradiction. This is because if a
rule of law by a party shall grant the right or
obligation to a behavior, on the other hand cannot
predict even a punishment in the case of execution of
conduct laid down.
This is being discussed in doctrine on the term
"right". From a narrower interpretation (Antolisei)
sees this term strictly connected only to subjective
right is passed (Mantovani, Fiandaca-Musco ) to a less
compressed that sees this term comprising each legal
power to act (whether it be a subjective right
potestative right, faculty or power). It still remain
outside the legitimate interests.
However, it should be borne in mind that to
return to the inside of the case of this scriminante is
necessary to make it clear that the existence and the
exercise of the right are not sufficient. In fact need
that even the conduct concretely by the agent, unless
281
explicitly provided and allowed by the same standard

that highlights the right above.
The source of this right does not fall within the
principle of the binding nature, in the sense that it can
be the most varied by the law to the regulation.
Special notes for this scriminante and its
nature of objective, in the sense that also detects and
where not known from the subject agent. An
emblematic case of this cause of justification is the so-
called exercise of the right to chronicle. The latter is a
public law subjective as peculiarity of the wider right
to freedom of expression.
Thanks to the case law over time, you are
highlighted those that are considered the limits for
the exercise of the right to chronicle. In particular, it is
important that there is the social utility of the
information, that this information is true (within the
limits) and that the facts are exposed in a civilised
way, not exceeding the respect for the person.
Other cases for the exercise of the right you
can find in the so-called “ius corrigenda” parent on
their own children and in “offendicula” (objects used
in defense of the property). Also in this case there are
limits objective and subjective that case by case
should be evaluated by the judge.
Always the same article then discipline the
fulfilment of a duty. Also for the latter is also the legal
basis is the principle of non contradiction. The main
difference between this and the previous affording is
that while for the exercise of the right assumes the
possibility of choice on the part of the subject agent,
of the Offense
282
in the fulfilment of a duty the behavior is imposed to

the subject by the law.
This duty can be born or by a legal rule or by a
legitimate order of the Authority (public official or
person providing a public service). On that last point
need some clarifications. First of all, it is necessary
that there be between those who emit the order and
who must follow the order, a ratio of hierarchical
relationship of public law. Then it is necessary that
the order is legitimate under both the formal aspect
(jurisdiction of the authority that issued) that
substantial (not to be contrary to the rules) and above
all that the order has relevance to the service both of
the authority that the person who will run it.
In the case of execution of an order that does
not have these requirements, the scriminante not
detect.
4. Art. 52 - Legitimate Defense
About the basis for this justification there are

different approaches doctrinal. According to a first
theory (Padua) in this scriminante is the principle of
the prevailing interest, in the sense that the interest of
the attacked prevails over that of the aggressor. A
second doctrinal approach instead (Mantovani)
identifies the principle of the so-called balance of
interests, while according to a third theory (Fiandaca)
you would recognize a residue of self-defense
283
delegated by the State that it would be impossible, for

issues of immediacy, to ensure the safety of the
citizen.
In legitimate defense will show two
fundamental elements: the aggression and the
reaction.
A long time now both doctrine that the case
law are concordant with the literal interpretation of
the regulatory text in the illustrate the respective
characters highlights which must all be present
simultaneously; the only one of the following
requirements impair scriminante.
In particular as regards the aggression are
distinguished the following elements:
1) The object of the offense must be a right. By law,
in this case, we do not mean only the subjective
rights, but also any interest protected by legal rules.
Thus fall fully not only personal rights, but also and
those economic and moral. Not only that, but the
holder of such a right attacked may also be a third
compared to each other aggressor-attacked. It is the
classic case of "salvage defensive".
2) The injustice of the offense. For injustice of the
offense is meant that should not be imposed
(Mantovani) from any rule of law. To put it in terms
statutory offense must quit out of the principle of the
article. 2043 Of the d.c. This injustice can be derived
not only from a human being but also from an
animal.
3) The danger must be current. Put in simple
terms for current a danger (likelihood of damage)
of the Offense
284
must be imminent, for example happen very little

before the reaction. A danger that is not current, but
that is past, or that and the future, it makes to come
less than one of the fundamental requirements of the
aggression and then the scriminante in question.
4) The danger should not be been deliberately
caused by the subject that it defends. This above
imminent probability of damage must not be that
because a behavior on the part of the subject that then
it will defend itself. This means that those who
practice will or will participate directly in a brawl, for
example, will not oppose his defense have attacked
one of the participants as the behavior of the agent
was compelling reason of the other person's reaction
and then of others in jeopardy of the right of the
subject.
However, as regards the reaction:
1) The existence of the duress. With this element
we want to put an emphasis on the fact that there is a
conflict of interests in the attacked which must be in
the alternative to react or to be offended. I would not
have chosen to protect his right from the hazard
current of an unjust damage. Precisely for this reason,
the law does not consider as "legitimate defense" the
behavior of those who, despite the existence of all the
basic elements of which we are dealing, however, had
the opportunity to flee… or had an alternative to
confrontation.
2) The need to defend itself. Hand in hand with
the constriction points to the need. While the
285
constriction is an element more passive (the subject

was undergoes) the need to own reaction of the latter
that is necessary for the protection of the right
threatened. Then the subject to the act of the reaction
will be forced to take the decision to defend
themselves for the need of the protection of his right.
Then a necessary reaction and the one suitable to
neutralise the offense.
3) The proportionality of the reaction with the
offense. Second authoritative doctrine (Mantovani) this
fundamental element represents the application of the
principle of balance of interests. In fact this exists
where the evil caused by the attacked proves to be
less than, equal to, or proportionally greater than that
would have caused the aggressor. So if someone has
not behaved is attacked with bare hands and is
reached by a shot of a firearm, it appears difficult
illustrate the proportionality between the pipes. Even
if we must always catapult the circumstances to the
concrete fact. It is put for example the case of a band
of some people who, not armed, have kidnapped and
beaten a woman inside the home threatening him
with death if it is not working in confessing where he
held the jewels; and that this woman was
experiencing severe beatings and torture. In this case
it would be illogical not to fall within the scope of the
scriminante of legitimate defense than that of her
husband holding the weapon fire exploding a blow
against one of the criminals by hitting it to death.
of the Offense
286
5. Art. 53 - Legitimate Use of Weapons
One of the problems that has always

accompanied this particular affording is if you can
consider yourself or should be considered in the same
manner as the exercise of a right or in the fulfilment
of a duty - the answer seems to be already in the same
article. 53 And when he pushed "without prejudice to
the provisions contained in the two previous
articles… .. ". This confirms the subsidiary nature of
the rule in question. This form of justification is
defined as "their own" in the sense that it can be
invoked only by members of the police forces or from
any public official authorized to the port of weapons
for the exercise of their functions ( ..in order to fulfill a
duty of his office) in order to counter a resistance
(physical or otherwise) or a violence that, given the
timeliness and driftnet, barriers between the public
official, and their public duty. The norm then
provides specifically provides for the offenses for
which the provision in question operates irrespective
and other words, in order to prevent the
consummation of crimes for a massacre, shipwreck,
submergence, aviation area disaster, murder, armed
robbery and kidnapping. There is a case in which,
however, also a private individual may fall within
this circumstance, when you use the weapons that
holds regularly at the express request of the public
287
official in order to lend him assistances and when the

latter is in the exercise of its functions. When we talk
about weapons one should not think only of firearms,
but also to all those objects designed to offend used,
for example, in the case of public order, by the public
safety or to the use of the means of "physical
coercion" (handles) in the execution of a measure pre
trial detention staff.
6. Art. 54 - State of Necessity
According to a doctrine more recently

(Fiandaca-Musco, Romano) this scriminante would be
based on the principle of the balance of interests, in
the sense that the interest of one would prevail on the
interest of the other; but we will show the terms.
As for the legitimate defense, you must make
a very clear distinction, in the sense that it must
necessarily locate the two load-bearing elements and
then sketch the individual and their respective
characteristics. These are the situation of danger and
the action necessary detrimental.
In particular as regards the situation of danger
are distinguished the following characteristics:
1) The relevance of danger, as well as for the
legitimate defense. That is the danger must be
imminent and neither past nor future.
2) The subject matter of the danger must be a
serious harm to the person. Then it will exclude the
of the Offense
288
patrimonial rights, but include all those which relate

to the person as such, and therefore also the moral
damage.
3) The agent does not have him caused the
danger and does not have a particular legal duties to
expose themselves to the same (for example, a
fireman or a policeman).
Instead, as regards the tortious action
required.
1) This must be in ways more than absolutely
necessary in order to be saved that they do not leave
any choice for the agent.
2) Forced, in the literary sense of the term, that
the subject is in front the of the alternative if put in
place the damaging action or undergo himself the
severe damage to the person.
3) Proportionate to the danger.
Special figures of this scriminante are "the
forcing psychic" that hangs when the subject agent
creates the tortious action as forced by the threat of
others, and the "relief of need" in the sense that, to
assist a person, if neither neglects another.
References
AA.VV. “Compendio di diritto penale; parte generale e

speciale” XIII Edizione- Gruppo editoriale Simone.
FERNANDO MANTOVANI “Diritto Penale” IV Edizione-
Cedam.
289
FABRIZIO RAMACCI “Corso di Diritto penale I” G.

Giappichelli Editore.
FABRIZIO RAMACCI “Corso di Diritto penale II” G.
Giappichelli Editore.
AA.VV. “Diritto Penale-Parte Generale” XIX Edizione-
Gruppo editoriale Simone.
290
Paolo Giulini, Laura Emiletti
291
Treatment for Sex Offenders in

Prison. The Experience of the
Intensified Treatment Unit in Milano-
Bollate Prison
Paolo Giulini1, Laura Emiletti2
Keywords: Sex-offender treatment, treatment field,

restorative justice and “benevolent control”.
1. The Project
According to the latest statistical data by Istat

(the Italian Central Statistics Institute)3, in Italian
1
Clinical Criminologist, Coordinator Responsible for the Intensified
Treatment Unit for Sex Offenders at Milano-Bollate Prison, Honorary Judge
at Milan Juvenile Court, Adjunct Professor at Università Cattolica del Sacro
Cuore di Milano.
2
Psychologist, specialised in Criminology and Forensic Psychiatric Science
and specialising in psychoanalytical psychotherapy. Since 2009 she has
been responsible for the Psycho-diagnostic Services of the Intensified
Treatment Unit for Sex Offenders at Milan Bollate Prison and for Milan
Council’s District Criminological Centre.
Treatment for Sex Offenders in Prison. The Experience of
the Intensified Treatment Unit in Milano-Bollate Prison
292
prisons 2352 inmates have been arrested for sex

offences (1466 Italians and 866 non-Italians). Of these
1241 have undergone final judgment.
Yet the social response is not related to the
number of crimes, but to a subjective feeling of
insecurity. Public opinion is characterized by
ambivalent necessities, i.e. by the psychological need
for revenge and indemnification on the one hand, and
of the offender's expiation on the other and often
wants the offender to be chased away, repressed,
isolated from society. From this point of view any
other approach to the offence that is not restrictive is
considered to be pointless and inadequate, not
proportionate to the damage that has been suffered.
Treatment ideology is often regarded as
permissivist, as an attempt to minimize the
seriousness of the event-offence, the responsibility
and the guilt of the offender.
In actual fact, custodial sentences have been
proven to be unsatisfactory and inadequate as the
sole form of defence and compensation towards
victims and society in general, if it is understood from
a mere indemnifying point of view. We have to think
about other levels of intervention strategies and
prevention, including a rehabilitating approach,
3
Istat data, 2006. In the last Istat report about 2011, of 66.897 inmates the
5.4% are held for sexual violence (Istat data, 2012).
293
centered on the treatment of sex offenders, with a

view to their reintegration into social life.
This project was presented by the Association
Centro Italiano per la Promozione della Mediazione4 and
initially jointly financed by Lombardy Regional
Council and the Province of Milan; the project began
in 2005, and now, in the 2013, we are carrying out the
seventh edition. It provides for a specific
rehabilitating intervention operating with a logic of
synthesis, combining sentence and treatment, which
need to be considered complementary and not
alternative to each other. The attempt is to reduce
both risks of recidivism (to protect society) and
individual suffering (to protect the person). This is a
challenge aimed at demonstrating that a scientific and
systematic rehabilitation approach is an ethical and
effective way of protecting the community, reducing
victims and preventing deviant behaviors. The
starting point is the acknowledgement of the
anomalies and peculiarities characterizing sex
offenders. These anomalies and peculiarities must be
taken on, knowing that different psychopathological
profiles, specific personality features and complex
behavior dynamics can be found at the basis of sex
offences, following an etiological model aimed at the
4
Italian Centre for the Promotion of Mediation, CIPM.
294
multifactoriality of aggressive behaviors, and needing

specific and diversified interventions.
This method of intervention integrates into a
criminological view, at the centre of which we find
the event-offence and the possibility of recidivism,
and it originates from a cognitive-behavioral
theoretical reference, where sex offences are
conceived as a sexualisation of aggressiveness.
The therapeutic approach provides for
psychological interventions aimed at obtaining
evolutionary changes of personality and behavior,
structured as group meetings together with
individual consultations. The aim is to use the period
of detention to elaborate the committed offence and
begin a process of cure that starts from the awareness
of the offence and of the dynamics underlying it and
from the offender's assumption of responsibility.
2. The Construction of the Treatment Field
The project provided for the constitution of a

section for attenuated custody, where an intensive
treatment programme could be undertaken, in
accordance with art. 115, paragraph 4, Presidential
Decree 230/2000, according to which «for convicts
and inmates who are not relevantly dangerous, for
whom particularly significant treatment interventions
are proven to be necessary, a regime of attenuated
custody can be implemented, either in autonomous
295
institutes or in sections of the institute assuring a

wider execution of treatment activities... Convicts
with relevant physical and psychic pathologies […]
can be assigned to autonomous institutes or sections
of an institute assuring a regimen of intensified
treatment... The suitability of treatment programmes
aimed at rehabilitation is assessed with appropriate
methods of evaluation research.»
A separate section for attenuated custody was
necessary in order to obtain an environment where
one could work with privacy and serenity, and where
during detention a quality of life adequate to the
treatment and to the specificity and difficulty of the
work being carried out could be guaranteed. Here 71
convicts were taken in during the three year project.
The Intensified Treatment Unit is a place
physically separated from the other sections and
reserved for convicts who decided to participate in
the Project. Here not only spaces but also the social
workers and prison officers are specifically assigned
to the Unit. It is a place where attention is primarily
focused on the quality of life and on the suitability of
the environments and spaces to treatment,« in a
context of sharp penal differentiation so as to allow,
for particular types of inmates, forms of care in which
both people and environments become part of
treatment» (Di Mauro, Giulini, Vassalli, 2003, p. 441).
The decision to use a separate section, where
there is no possibility to meet or contact common
convicts, or other inmates who are no longer engaged
in a work of revision and critical re-elaboration of the
296
offence, springs from the necessity to guarantee

convicts a greater sense of security and serenity.
These are fundamental elements for a living and
treatment environment where the dignity of the
subject comes first. Through the formula of
attenuated custody the convict obtains a sense of
responsibility as regards his behavior and his
decisions, because the low levels of surveillance leave
a higher degree of discretion, self-management and
freedom of movement inside the section and the
institute. This allows the Unit’s team to ratify a
treatment pact with each convict. With his signature
the convict commits himself to respecting the
regulations of the Unit and possibly to proposing
modifications or extensions to these regulations, and
to starting an individual process of reflection, self-
criticism and criticism of the offence he has
committed. The process is divided into modules. This
model provides for a division of the year into three
modules or evaluation phases, representing stages
and evolutionary lapses, that the subject must go
through in the course of treatment. On the one hand
they mark individual growth as regards the aims of
the project, on the other they mark the continuity of
the commitment as regards regulations and common
life within the Unit.
The treatment lever behind the voluntary
nature of adherence to the Project and of the
signature of the contract by convicts is represented by
life and custody conditions in the Unit, different and
better than those of protected sections in other
297
institutes, and by the regime of autonomy

characterizing the Unit. Moreover, general
opportunities and treatment opportunities provided
by the Project are important, because they ensure that
custody actually becomes not merely a moment of
restriction, but also one of re-socialization, and that it
is not a synonym for hibernation inside Protected
Sections.
3. The Selection and Evaluation Phase
Convicts are assigned to the Unit following

their request to join the Project, which is aimed at
adult sexual aggressors who have undergone final
judgment. At first only requests from those who
demonstrated a minimum acknowledgement of their
offence and of their deviant sexual problems were
received. Subsequently the Project was also extended
to total deniers, as long as they presented
requirements of treatability, on the basis of
criminological, clinical and psycho-diagnostic
evaluations.
The preliminary evaluation phase takes place
in the protected sections of the Institutes where the
convicts are in custody, before the potential transfer
to the Unit, through a consultation during which
certain data are recorded: socio-demographic data,
the legal position and the individual position of the
298
subject as regards the offence. After the selection and

transfer to Bollate prison, the central moment of the
work is individual assessment, aimed at obtaining a
valid and exhaustive description of the functioning
and of the personality features of the subject, and at
evaluating actual treatability.
The assessment phase is considered to be
essential for the observation of the convict, in order to
obtain the deepest possible knowledge of the subject’s
personality and consequently plan personalized
forms of intervention5. Psycho-diagnostic activity is
not limited to this first evaluation phase, but
continues throughout the Project. Indeed, two further
tools are used to complete the observation of the
convict, the report on phantasmatic activity and the
team report on manifest variables.
The former is a computer questionnaire that
each convict completes every day at the same time.
Questions refer to stressful events, negative emotions
connected to stressful events and consequent sexual
fantasies (divided into deviant and non-deviant,
invasive and non-invasive). The monitoring of
5
The tools employed include projective tests, narrative tests, tests of level,
self-administered questionnaires and actuarial scales; in particular the
following tests are administered: The Rorschach test, The Blacky Pictures,
TIPE, WAIS-R, Culture Fair or Eta-Beta, MCMI-III or MMPI-2, SCL-90, TAS-
20, SAC, CISS, Bumby scales (Rape and Molest), PCL-R, Static-99 and Risk
Matrix 2000, denial grid.
299
deviant phantasmatic activity aims at checking the

effectiveness and the results of the treatment, both for
an individual feedback for the subject and for an
evaluation internal to the project, as well as for
research activity.
The team report on manifest variables is a
computer tool to evaluate every single convict
according to 5 variables. Every two months all the
social workers evaluate each convict according to
these. Each variable is divided into five levels:
adherence to the Unit’s rules, request for help, anger
management, basic social ability techniques, sense of
responsibility towards the offence and aggression
cycle. This is the first application in Italy of an
evaluation tool by a therapeutic team within a
community.
The psycho-diagnostic team then carries out
re-tests of the Rorschach test, which complete the
final evaluation of the treatment together with the
two former tests, detecting possible evolutionary
passages or difficulties and dysfunctional aspects that
are still present. The re-test phase is essential to
evaluate data before and after the treatment for each
convict, and it allows to examine the effectiveness of
the processes proposed within the intensified
treatment Unit.
Although sex offenders present different
personological and psychopathological profiles, in
accordance with the international literature, some
300
common aspects in all sex offenders can be outlined:

i.e. relational deficits, empathy deficits, cognitive
distortions, use of denial and minimization
mechanisms with regard to their offence. There are
other aspects where differences and individual
variables can be found, i.e. the extent to which the
examination of reality is compromised, the presence
of traumatic events in the subject’s medical history,
the quality, intensity and ability to control emotions,
the subject’s intellectual level.
Generally psychological interventions that are
aimed at obtaining evolutionary changes in
personality and behavior tend to proceed on two
different levels. On the one hand we have the direct
treatment of psychic and behavior functioning and
processes, which are more strictly correlated to the
violent action: these interventions are mostly
behavioral and they are recommended for the
treatment of compulsive symptoms. On the other
hand, we have the treatment of profound
psychological dynamics, which are not directly linked
to the offence, i.e. psychotherapeutic, psychodynamic
and cognitive techniques, both individually and as a
group; it is recommended for subjects whose deviant
sexual behavior isn't ascribable to compulsive aspects,
but rather to a precocious deviant personality
structure.
With both kinds of interventions a psycho-
pharmacological support can be used. Frequently
sexual aggressiveness is the epiphenomenon of an
301
Axis I or Axis II mental pathology. In these cases

pharmacological intervention is aimed mainly at
containing psychiatric symptoms (i.e. compulsivity,
anxiety, mood disorders, psychotic episodes) that
may interfere and compromise therapeutic work.
4. Staff
The working methods used during the project

are derived from a mainly criminological vision and
from a cognitive-behavioral model; from this point of
view the intervention focuses on the event-offence
and on potential recidivism. The cognitive-behavioral
model interprets the offence as a sexualisation of
aggressiveness (and not the other way round). In the
structuring of the treatment the acquisition of further
social competences and abilities on the one hand, and
the understanding of anticipatory processes of the
offence on the other, are both crucial to preventing
recidivism.
The Bollate project follows these treatment
guidelines, yet the team has a multidisciplinary
character and uses both psycho-dynamic and socio-
educational methods. The multi-skill team, where
different methods and forms of knowledge coexist,
works with an eye to constant integration and the
enrichment of know-how. The work team gathers for
an internal meeting every two weeks, which gives
302
them the opportunity to confront each other and

discuss both individual cases and the progress of the
project. Thus the single professionals have the
opportunity to explain and discuss possible doubts or
problems. The Unit’s team, external to the other
professionals in the Institute, constantly interfaces
with the latter in meetings for reflection and training
and when assessing individual cases. With regard to
the organization of the observation activity, it has
been established that the Unit’s team should be part
of the Observation and Treatment Group (G.O.T.) and
report on the progress of the cases, so that during
institutional meetings it becomes easier to understand
the criminological and intrapsychic aspects that led
the convict to committing the offence. The
institutional educator assigned to the Unit is the
intermediary between the Unit and the other
professionals who take care of the convicts: they are
part of the prison’s education section, of the judiciary
surveillance and of the offices of external penal
execution. The prison officers are also constantly
involved in the work of the Unit; officers who serve in
the Unit have been selected among those who made
an explicit request, so that only staff who is
authentically motivated to work with this particular
type of convict works in the Unit. Once they have
been selected, these officers take part in specific
training and awareness meetings, in order to make
the Unit a serene and motivating workplace for all,
convicts, officers, professionals.
303
5. The Intervention
The treatment setting is mainly group therapy;

a working procedure that offers opportunities for
indirect learning, confrontation and mutual support.
Dialogue between participants is made possible by
conductors, who avoid putting themselves on the
same plane as them and whose purpose is to allow
them to speak freely, although from time to time they
try to liven up the debate; conductors facilitate the
circulation of debate.
A central factor in group work is the
alternation between individual aspects, i.e. the single
person's own aspects, and group aspects, those
common to all. This alternation is natural and occurs
spontaneously within the group, but the conductors
sometimes intentionally enter the debate to refer back
to something one subject told the group to stress how
an individual experience can be common to other
people inside the group. Or, with an opposite process,
they may isolate specific aspects of a subject to point
out important peculiar aspects. The body of
knowledge coming from the experience of the
Canadian Pinel Institute in Montreal is introduced in
the conduction of the groups. This scientific tradition
is expressly referred to (also with the support of a
304
supervisor's periodic visit to Italy6) in order to

identify and name in a non-judgmental way typical
aspects emerging from work with sexual aggressors,
such as for example denial and minimization
strategies and risk factors in general. Thus a space
focused on sex offenders has been set up, managed by
Dr. McKibben, to whom staff can refer to, aware that
they are not bearers of autonomous knowledge or
operating practices in the field. Thanks to the
continual reference to a “third party”, therapists can
intensely and critically review their work, without
becoming accusative and contributing to the creation
of an atmosphere of trust and productive work.
Participation in groups is compulsory and is
regulated by a contract, signed by subjects, which
states the aims of the group, the rules and the
working methods. For the individuals involved the
signing of the contract is both a request for
commitment and responsibility and a show of trust in
their possibilities and potential. The contract ratifies a
sort of “alliance” between staff and convict. The
definition of procedures, schedules and contents
6
This is the Canadian Criminologist André McKibben, who has directed for
years research and treatment at the Pinel Institute and subsequently in
April 2009 was commissioned by his country's Minister of Justice to start
the first experience of “therapeutic prison”: around fifty sex culprits
underwent a 16-month programme in a prison entirely dedicated to the
treatment, the Rocher-Percé Penal Institute in Gaspésie, a remote region in
Northern Quebec.
305
constitutes the frame within which group work must

be confined.
Subject cannot be passive receivers of the
contents of the treatment; but must commit
themselves to participating actively and positively,
being open to dialogue and exchange, so that they
may obtain some benefits and improvements, not
only as regards the contents of the group work, but
also for the development of new abilities, of their self-
awareness and self-confidence (Bandura, 1997). The
group is a very powerful multiplier of maturing
processes, it takes advantage of interactions between
participants and is characterized by high levels of
dynamism.
The treatment provides for the integration of
different procedures not all of which are specifically
related to sexual offences. Together they aim at
preventing recidivism, also through an improvement
of the person's quality of life and lifestyle: «indeed,
sex offenders are chronically dealing with difficulties
concerning different areas of their lives. In the same
way as in quite different pathologies, such as
alcoholism or diabetes, for instance, for which there is
no cure but there can be remission» (Aubut et coll.,
1993, p. 153).
Therefore, there are no claims of compete and
durable recovery. The treatment is conceived as a
proposal made to the person, who is given the
opportunity to understand, redefine and therefore
modify the meaning he has been giving to his
existence up to that moment, an opportunity to re-
306
elaborate his offence and thoroughly understand its

dynamics and consequences.
Different professionals and different theoretic
tendencies have made the structuring of an articulate
treatment programme possible. This is what
characterized the team and what opened the door to
diversified educational and clinical work.
The calendar regulating the weekly
organization of the Unit is given to all convicts; it
includes all programme activities and has to be
followed precisely by staff and users alike, because
concentration and continuity of interventions are two
fundamental aspects for the success of the treatment.
Activity centres around three socio-
educational groups, complemented by other types of
intervention, such as individual psychological and
criminological in-depth consultations and other
physical, creative and expressive activities, in order to
make the treatment as complete and effective as
possible, especially by keeping in mind individual
variability and heterogeneity of problems and needs,
as mentioned above7. Audio-visual equipment has
often been used within group work: i.e. films or
documentaries dealing with violence, sexual
7
Weekly activities include a group on communication and social abilities,
a group on recidivism prevention, a group on conflict management (for all
these groups participation is compulsory), the section assembly, the
activation of working skills, sexual education, physical activity, art-therapy,
EMDR.
307
aggression and victimization have been shown with

the purpose of offering food for thought and
elaboration opportunities concerning the matters
under discussion and the personal histories of
subjects.
As mentioned before, the aim of the treatment
is to reduce the risk of episodes of recidivism, also by
identifying deviant sexual fantasies and anticipatory
factors that precede the criminal event, by developing
the most suitable and effective coping strategies and
stress and anger management strategies and through
ability and social skills training and the correction of
cognitive distortions. Marshall defines programmes
like these “aggression-related”: they provide for a
series of “aggression-specific” activities linked with a
series of characteristics that are typical of sexual
aggressors.
The treatment intervention as such proceeds
with an intensified rhythm of work just after the
three-month evaluation period, when those who are
eligible for treatment are selected. Intensive treatment
lasts ten months, with a break after five months for a
further evaluation and the selection of those users
who will stay in the Unit until the scheduled
completion of the process. During the two months
preceding discharge from the convicts' Unit, re-
testing is carried out and subjects are given the results
of their assessment activities, including the report on
phantasmatic activity and the team report on
observable variables. They are also informed on their
308
vulnerability as regards recidivism risks, and on

resources that can be activated to cope with it.
After the phase of intensive care the convicts
who have been treated in the Unit are transferred to
the common sections of the prison and are assisted by
the treatment team for a further four months, with
therapeutic groups, in order to favour and monitor
their integration in those sections.
This phase is considered to be an integral part
of the treatment project for two specific aims and
purposes. The first challenge concerns the demolition
of a prison subculture, according to which any
contact between sex convicts and the so-called
“common” convicts entails an aggressive and
punitive act against the former. In fact, other convicts
refuse any type of life in common with sex convicts.
Therefore the prison administration has created
special prison sections that are isolated and separated
from the rest of the prison, the so-called “protected
sections”, for convicts who have been accused or
sentenced for sex offences, together with other
categories of convicts who need protection, for
example police informers, convicts who were
members of police forces and transsexuals.
The attempt to demolish this subculture is also
a form of treatment for the population of common
convicts, because it increases the assimilation of the
principle of legality, as there is no hierarchy among
offences and every convict must have access to equal
rights during the execution of the sentence. Yet the
current protected regime, where sex convicts serve
309
out their sentence, is often a factor of collusion with

other dysfunctional or even psychopathological
aspects underlying the behaviors of sex offenders.
Suffice it to think that many among these subjects are
deprived at the level of communicative and relational
skills and often do as much as they can to obtain a
sort of isolation, reproducing the basic climate of their
malfunctions and deviances.
In this case it is important that the sex convict
who has undergone treatment experiences what he
has learnt during the intensified treatment,
particularly any time he comes into contact with
possible frustration and relational experience, marked
by refusal and mistrust. He must be able to generalize
what he has learnt, in order to mediate and manage
his impulsive reactions, using adequate coping
strategies and checking in a practical way and with
the help of the social workers the value of his
acquisitions and of his new resources, aiming at
increasing his self-esteem.
Yet stigmatization and refusal of sex offenders
are present also within free society: so sex offenders
must activate the ability to reintegrate socially, i.e.
they must take responsibility for the destructive
aspects of their past behaviors, without victimizing
attitudes, aiming at remediation, in a more
resourceful and aware relationship with the others.
For this reason many sex offenders who have
undergone treatment also after the sentence or during
an external sentence execution must be taken care of
with continuity. This is why the team that has been
310
working at the intensified treatment Unit at Bollate

prison has taken active steps to create a specialized
Service in the community to manage and treat violent
and sexually violent behaviors. In March 2009 the
Safety Department of Milan City Council officially
instituted the District Criminological Centre, thus
legitimizing the specificity of the interventions of
evaluation and treatment that had been activated
within the Service for Social and Penal Mediation of
the Safety Department itself. The idea derives from an
operative tradition and methodological process in
violence prevention that confronts the management
of situations of conflict to prevent their escalation and
the ensuing detrimental outcomes of possible acting-
outs as sole outlets for the conflict. This also with
clinical-estimative and treatment interventions for
subjects involved in conflicts.
Thanks to the interest in prevention and to the
clinical structuring, interventions for the cure and
control of violent behaviors have evolved and have
become more structured and specialistic. At present
at the District Criminological Centre a constant
activity of psycho-diagnostic evaluation is carried
out, together with four weekly therapeutic groups for
sex convicts and individual care with different clinical
tools, such as EMDR and Finn's Therapeutic
Assessment (Finn, 2007).
A challenge that is more and more important
for this Service is the ability to structure intervention
protocols aimed at preventing possible acts of
secondary victimization after the sentence has been
311
served. Such acts can occur particularly within

families, when victims risk encountering their
tormentors; the latter may not be able to reveal their
responsible truth and therefore damage it all the more
with cumbersome guilty feelings that definitely
cancel out any attempt to solve the devastating
trauma suffered by the victim of sexual abuse.
Therefore an authentic treatment field has been
developed, to which the sex convict is introduced not
only for the treatment intervention, but also to favour
an alliance with an external pivotal resource, with the
aim of “benevolent control” on the quality of one's
interpersonal relationships, particularly those
pertaining to the sphere of sexuality.
From this perspective the Mediation Service of
Milan City Council launched a restorative justice
experience originating in the social practices of
Canadian Mennonite pastors, by constituting the
“Circles of Support and Accountability,” (Goulet,
2009). Some citizens belonging to voluntary
associations occupied in the detention field are
selected, trained and supervised by professionals
from the treatment team and by social workers of the
Service for Mediation: the aim is creating a Circle for
each convict who has taken part in the treatment, who
according to the team may need to be accompanied in
the community after the sentence has been served.
For each Circle three volunteers are trained. First they
meet and acquaint themselves with the convict in
prison, just before he is released; then they decide
whether they want to sign a contract that binds them
312
to track the ex-convict for a one-year period once he is

no longer in custody. Thus the convict becomes the
chief member of the Circle and in turn commits himself
to attending once a week the other three members
and turning to them in times of hardship; he is also
taken care of at the Criminological District. It is
basically the actuation of a mechanism of benevolent
control, prompting the former convict at risk of
recidivism to continue treatment and supporting him
informally rather than clinically.
6. Project Evaluation and Non-Treatment

Activities
The project has been set up and is supervised

by the Philippe Pinel Institute of the University of
Montreal, an institution which has been dealing with
similar treatment interventions for sex offenders for
years.
Furthermore, every year the Research Centre
on Education Technologies at Milan’s Università
Cattolica del Sacro Cuore (Director Prof. Paola di Blasio)
coordinates the evaluation activity through a
qualitative gathering of treatment data and through
the observation of activities.
Moreover, the team deals with various
research activities, also in cooperation with other
specialists, on characteristic features of sexual
aggressors and of intra and extra-mural treatment
313
work with this particular typology of subject, aiming

at developing and implementing theoretical
knowledge and comparing it with existing
international experience and literature.
Lastly, we must underline the training work
carried out by our staff in favour of other
professionals, working in other detention institutes or
in services that deal with taking care of sex offenders.
Their aim is to reproduce similar experiences in other
structures too and making the work with these
convicts even more useful and effective, both for the
sex offender convicts themselves and for society; it is
conscientiously conducted by trained staff who are
aware of the peculiarities characterizing sex offenders
and their deviant behaviors.
References
AUBUT J. ET COLL. (1993), Les agresseurs sexuels. Théorie,

évaluation et traitement, Les Editions de la Chenalière,
Montréal.
BANDURA A. (1997), Self-efficacy: the exercise of control,
Freeman, New York.
DI MAURO S., GIULINI P.G., VASSALLI A. (2003), Un
detenuto ibernato: l’autore di reato sessuale tra tutela dei
diritti e prospettive di difesa sociale, in GATTI U., GUALCO
B., eds., Carcere e Territorio, Giuffrè, Milan.
314
GOULET J.J. (2009), “Les cercles de soutien et de

responsabilité pour agresseurs sexuels, Communication at
the 5th International Francophone Congress on sexual
aggression”, Montreal, 11th-13th May.
FINN S. (2007), In our clients’ shoes: Theory and
techniques of Therapeutic Assessment, Earlbaum,
Mawah, NJ.
Luca Malatesti, John McMillan
315
Two Philosophical Questions About

Psychopathy
Luca Malatesti1, John McMillan2
Keywords: psychopathy, antisocial personality disorder,

antipsychiatry, responsibility, values, moral understanding.
1. Introduction
Psychopathy has attracted considerable

philosophical interest over the last twenty years.
Philosophers have tended to engage with two
philosophical issues that psychopathy presents. The
first concerns the moral responsibility of those
classified as psychopathic.3 The philosophical debate
about moral responsibility and psychopathy is
shaped by the assumption that having the capacity
for moral understanding is a necessary condition of
1
Assistant Professor of Philosophy, University of Rijeka, Croatia.
2
Director of the Bioethics Centre, University of Otago, New Zeland.
3
For an online bibliography, see Malatesti and Baxter 2010.
Two Philosophical Questions About Psychopathy
316
being held morally responsible.4 So, this debate

involves the philosophical problem of establishing
which psychological faculties are necessary for moral
understanding and then assessing whether or not
psychopaths possess these faculties.
The second philosophical problem, which is
less debated but is arguably just as important, is
about the construct validity and status as a ‘disorder’
of psychopathy. Scientific research on the
psychometric features of psychopathy, its clinical
efficacy, its capacity to predict recidivism and its
anatomic, physiological, genetic causes and correlates
are relevant to solving this problem. However,
another dimension of the debate involves the
supposed value-ladenness of psychopathy. As a type
of antisocial personality disorder, psychopathy stands
out because psychopathic behaviour and its inferred
personality traits deviate from those which are
socially desirable. In addition, despite many
speculative hypotheses and promising research, there
is no agreement on the neural correlates and causes of
psychopathy. Moreover, psychopathy does not
appear to be dysfunctional from the perspective of
biology. Thus, it could be argued that psychopathy is
based upon grounds that are too shaky for it to be
considered a genuine mental disorder.
4
See Malatesti and McMillan 2010.
317
The aim of this paper is to survey both of these

debates, to explain their principal lines of inquiry and
to indicate some relevant directions for further
investigation. In particular, we argue that there is an
important connection between these two discussions.
We maintain, in fact, that a central requirement for
conferring the status of mental disorder upon
psychopathy should be evidence of an associated
absent or diminished ability for moral responsibility.
This suggestion has important consequences for how
the social response to psychopathy is framed. This
discussion cannot be based upon a division of labour
where scientists offer an independent account of
psychopathy as a mental disorder and philosophers
then investigate how this affects the moral status of
the person so classified. Instead, the investigation has
to be a joint effort. We maintain that the pivotal
theme for this joint investigation is constituted by the
functional impairments included in the diagnosis of
psychopathy and those empirically associated with it.
It is only by investigating whether and how these
impairments undermine the responsibility of
psychopaths that we can, at the same time, establish
whether psychopathy is a mental disorder.
In this paper we will proceed as follows. First,
we will illustrate the general lines of the shape of the
problem of value-ladenness of psychiatric diagnosis
and how this is reflected in the specific case of
psychopathy. In this section we will argue that the
diagnosis of psychopathy is, and has to be, value
laden. However, we will show that this does not
318
mean that we should reject psychopathy as a mental

disorder. Instead, we will argue that the robustness of
this construct emerges from our shared practices of
holding people morally responsible. Then we will
give a summary of the contemporary philosophical
discussion on the moral responsibility of
psychopaths. Although we will signal that there is a
significant convergence among contemporary
philosophers that psychopaths lack or have a
diminished moral responsibility, they often rely upon
different accounts of moral responsibility. Moreover,
we will maintain that a central part of this debate has
been based on certain empirical results that have been
recently challenged. Finally, that, in any case, the
issue of the moral responsibility of psychopathy is
placed within general philosophical debates that
should be considered open.
2. Psychopathy: Values in the Diagnosis
Robert Hare refined the concept of

psychopathy described in the seminal work of
Hervey Cleckley.5 Hare’s Psychopathy Checklist-
Revised (PCL-R) is a diagnostic tool that aims to
5
Cleckley 1976.
319
establish how a subject scores on different dimensions

of behaviour and personality.6
The PCL-R is used to evaluate a subject on 20
items: (1) glib/superficial charm, (2) grandiose sense
of self-worth, (3) need for stimulation/proneness to
boredom, (4) pathological lying, (5)
conning/manipulativeness, (6) lack of remorse or
guilt, (7) shallow affect, (8) callous/lack of empathy,
(9) parasitic lifestyle, (10) poor behavioural controls,
(11) promiscuous sexual behaviour, (12) early
behavioural problems, (13) lack of realistic long-terms
goals, (14) impulsivity, (15) irresponsibility, (16)
failure to accept responsibility for one’s own actions,
(17) many short-term marital relationships, (18)
juvenile delinquency, (19) revocation of conditional
release, and (20) criminal versatility. The PCL-R is
applied via semi-structured interviews and intensive
study of the history of the subject. For each element in
the list, there is a score ranging from 0 to 2 points; the
maximum total score is thus 40 points. When a subject
scores 30 or more points he/she is considered
psychopathic.7
The PCL-R has been used as a unifying
diagnostic tool in scientific research. Several studies
support the existence of significant correlations
6
Hare and Neumann 2010.
7
This cut-off value is usually adopted in North America; in Europe, a value
of 25 is often used.
320
between high scores in the PCL-R and functional

impairments.8 There is a constellation of functional
impairments related both to emotional and cognitive
spheres that appear to be correlated with
psychopathy. These impairments can be more or less
related to the two principal dimensions of the
construct: the first dimension has to do with
personality traits that are related to emotions, and the
second concerns antisocial behaviour.9
Items in the PCL-R are individuated via folk-
psychological descriptions of behaviours and ways of
thinking that are deviant from ones that are
preferable on the basis of epistemic, moral, and
societal norms. Thus, it could be concluded although
the diagnosis might imply that a psychopath is an
antisocial or immoral individual, it does not show
that he is mentally ill.
Psychiatric diagnoses can be defended against
objections about their value-ladenness by pointing
out that there is a difference between diagnoses that
are merely value-laden and those that track some
departure from an “objective” standard. One way to
spell out this suggestion is by focussing on the causes
of the supposed symptoms. According to Thomas
Szasz, for example, the genuine status of illness or
disorder should be conferred to those behaviours and
8
Blair, Mitchell, and Blair 2005.
9
Cooke, Michie, and Hart 2006, Blair, Mitchell, and Blair 2005.
321
mental states that are caused by objective departures

from neurological anatomical and physiological
standards.10 This characterisation of mental illness, at
least in Szasz’s view, would mean that many mental
illnesses are in fact merely problems of living.
Secondly, it would place proper disorders in the
domain of neurology.
If we adopt Szasz’s account of mental illness
or disorder, psychopathy does not represent a mental
disorder.11 There are, in fact, several theoretical
proposals that aim at integrating neurological and
neuropsychological data and theories about the
causes of antisocial behaviour and affective
abnormalities, and the specific functional deficits
observed in psychopaths as characterised by PCL-R.
However, despite the undeniable role that PCL-R has
played in organising and unifying empirical studies
and theorizing, a widely accepted theory of the neural
causes of psychopathy is not in sight. In particular, it
seems that so far, brain image studies offer a limited
knowledge of the neural causes of psychopathy.12
Thus, because we lack an account of the neural causes
of the symptoms associated with a disorder, we
cannot determine whether these neural causes are
departures from anatomic or physiological norms as
10
Szasz 1960.
11
See Szasz 2003, and for a penetrating commentary Adshead 2003.
12
Raine and Yang 2006, p. 27.
322
required by Szasz. However, we can question Szasz’s

requirement.
The objectivist model of mental illness appears
to be based on confusing the ‘objectivity’ of a disorder
and what is required for considering something
robust enough as a category for it to be a mental
disorder. There is, however, an interesting connection
between the objectivist tendency of Szasz, and the
need for a firm “anchorage” of psychiatric diagnosis
while acknowledging its value-ladenness. For
example, Christopher Boorse bases his account of
mental illness on the distinction between disease and
illness.13 The notion of “Disease” is used as a concept
that can lump together a series of different physical
disorders (diseases in the ordinary sense, disabilities,
injuries, wounds etc.). Diseases are objective
dysfunctions that constitute departures from
biological functions of the organism. On the other
hand, Boorse recognises that illness is a term that
belongs to the practice of medicine and indicates a
serious disease that has incapacitating effects that
make it undesirable. The notion of illness is thus
value-laden. In particular, according to Boorse, a
disease is an illness only if it is serious enough to be:
1. Undesirable for its bearer. 2. A title for special
treatment. 3. A valid excuse for normally criticisable
behaviour.
13
Boorse 1975.
323
Boorse thus recognises that the value laden

nature of mental illness is legitimate; it just reflects
the value-laden nature of illness in general. So, he
acknowledges the value laden nature of illness while
Szasz tries to explain it away. Our view is that this
must be correct because otherwise we could not
account for the possibility of advances in psychiatry
in understanding mental disorder, something that
Szasz cannot acknowledge.
However, it is important to note that in the
case of two level accounts such as that advanced by
Boorse, psychopathy would not qualify as mental
disorder. In fact, according to evolutionary
explanations of antisocial personality disorders,
psychopathy could, from an evolutionary
perspective, represent an adaptive trait and not a
mental disorder.14 Instead of entering into this
specialist debate about the evolutionary
underpinnings of psychopathy and antisocial
personality disorder, we can consider whether
recurring to biologically specified functions is a good
general strategy to determine what a mental disorder
is.
Many have found the idea that mental
disorders can be objectively grounded in biological or
evolutionary dysfunction problematic. First of all
there is the pragmatic issue that our current
14
See Mealey 1995, Krupp et al. 2012.
324
knowledge about the evolution of mind and its

specific faculties is not well developed and contested.
Thus, the ultimate decision on what should be
included in psychiatric classification would have to
be postponed until we will be able to determine these
functions. This clearly has very high practical costs.15
Secondly, it has been argued convincingly that
biological dysfunctions are neither necessary nor
sufficient for having a disease.16
Our position on this issue is that it is
reasonable to conclude that the concept of mental
illness is sensitive to evaluative judgments.
Establishing the type of normative judgments that are
involved and those that should be involved in these
judgements is an important general philosophical
problem deserves further philosophical attention.17
We claim that the disorder status of psychopathy can
be revealed by focusing upon how the specific
cognitive and behavioural profile of psychopaths,
which are also suggestive of neural correlates and
causes, departs from standards that are based on
societal values.18 This is especially so when the focus
is upon a question such as moral responsibility,
15
For a version of this criticisms, see Bolton 2008, pp. 160-61.
16
See Cooper 2007, pp. 31-34.
17
A pioneering and seminal work on this area is Fulford 1989. Notable, for
its openly foundational normative approach, is Megone 1998.
18
For a recent survey, see Blair 2013.
325
which is critical for how we should respond to those

falling under this concept. We have suggested that
the diminished or absent capacity for moral
responsibility is one of the normative judgments that
is often implicit within the notion of mental
disorder.19 The practice of holding people responsible
is based on folk-psychological practices of describing
explaining and predicting behaviour that is relevant
to values. These practices might reveal that the ways
in which psychopaths behave is different from the
behavioural traits of other people and be relevant to
establish the disorder status of psychopathy.20
3. The Moral Responsibility of the

Psychopath
As we have already indicated, investigating

the moral responsibility of psychopaths involves
touching upon two problematic areas where the
contribution of philosophy appears to be relevant.
First, the preconditions of moral responsibility have
to be explicated in terms of underlying psychological
capacities. Elaborating accounts of moral
responsibility falls within the domain of philosophy.
There are several philosophical accounts of the
psychological faculties, deemed to be central in
19
Malatesti and McMillan 2014.
20
We argue for this point in more detail in Malatesti and McMillan 2014.
326
ordinary or philosophical accounts of moral

responsibility, and these are usually spelled out in
general terms by means of folk psychological notions
or their refinements. Secondly, it has to be
investigated whether and how the functional and
neurological peculiarities of psychopaths undermine
their moral responsibility. There are empirical results
pointing to statistically significant, varied, and subtle
functional impairment in psychopaths and
hypotheses concerning their underlying neural
causes.
The traditional view of moral responsibility is
that actions must be voluntary in order for an agent to
be morally responsible. These actions will vary along
a broad spectrum from those which clearly are not
caused by the will of the agent (involuntary actions)
and those where there are weaker reasons for
questioning the control that an agent has over that
action (nonvoluntary actions).21 However, in all of
these cases, if an action or behaviour is judged to be
nonvoluntary or involuntary, it means we have a
reason for questioning whether the agent is fully
morally responsible for that action or behaviour.
Some philosophical accounts of moral
responsibility hold that moral understanding is a
requirement for deeming an agent morally
21
See Feinberg 1986, p. 104.
327
responsible.22 Without offering a complete

characterization of what constitutes moral
understanding, it is enough to point to a minimal
necessary requirement for ascribing such an
understanding. An agent possesses moral
understanding when they are capable of
understanding the nature of the action they are
performing. If someone is incapable of recognizing
the normative force of a morally significant action we
would be warranted to describing them as being
incapable of grasping that moral knowledge. When
someone is incapable of understanding the moral
significance of actions it is safe to assume that,
whatever the subservient underlying faculties, this
gap in moral knowledge will be reflected in the
agents’ reasoning about the permissibility of
performing certain types of action in certain contexts.
Many philosophers who are interested in the
issue of the psychopaths’ moral understanding have
focussed on experimental studies concerning their
performance in the moral/conventional distinction
task.23 In these experiments, the participants are
presented with vignettes involving transgressions
and have to evaluate and compare them in terms of
their gravity and permissibility. Ordinarily, subjects,
22
See, for instance, Fischer and Ravizza 1998, pp. 69-73.
23
An example of this approach is Levy 2007, for a survey, see Malatesti
2009.
328
and even children older than four year, would judge

that the transgressions that infringe the rights and
interests of others are graver and less permissible
than those to for the social order. For example,
subjects would distinguish on the basis of their
gravity and permissibility hitting a person from
talking in class. These results are taken to show that
individuals draw a distinction between moral and
conventional norms. Some studies show that
psychopathic offenders, differently from non-
psychopathic ones, do not draw such a distinction.24
To address the issue of the moral
understanding of psychopaths, philosophers have
investigated whether these results can be explained in
terms of incapacity. In fact, different moral theories
would acknowledge that if psychopaths are incapable
to distinguish moral and conventional norms, they
would lack moral understanding. The resulting
philosophical discussion is characterised by a
polarization with respect to the relation of moral
judgment with emotive and rational faculties.
Sentimentalist maintains that certain emotive
capacities are central for moral judgement.
Rationalists, instead, account for moral
understanding in terms of certain rational capacities.
Philosophers in both camps have advanced
arguments for concluding that certain functional
24
Blair 1995; Blair et al. 1995.
329
impairments of psychopaths show that they lack the

mental capacities that their theory deem necessary for
drawing the conventional moral distinction and,
hence, possessing moral understanding.25 However,
this whole debate appears to rest on a problematic
assumption. Recent empirical research seems to
indicate that there is not enough evidence to conclude
that psychopaths cannot perform normally in the
conventional moral task.26 Thus, the debate we have
considered above, being hostage of empirical
research, will have to be revised on the light of these
empirical studies.27 In addition, we would like to
stress also some general philosophical problems that
require further investigation.
First of all, sentimentalism and rationalism as
sketched here might not represent all the plausible
positions on moral understanding.28 Moreover, even
if we accept this disjunction as exhaustive, further
steps might be required to establish that psychopaths
are not morally responsible. Even if we can establish
25
Amongst the sentimentalists Nichols 2002, while Kennett 2010 is an
example in the rationalist camp.
26
See Dolan and Fullam 2010 and Aharoni, Sinnott-Armstrong, and Kiehl
2012.
27
For two recent attempts to assess psychopaths’ moral responsibility
without focussing on the conventional/moral task, see Levy 2013, and
Ayob and Thornton 2014.
28
For instance, there are Aristotelian alternatives. Moreover,
sentimentalism and rationalism can take different forms.
330
that psychopaths are incapable of moral

understanding, because these faculties are impaired,
we will still have to investigate whether these
impairment are such that they undermine their moral
responsibility.
While many philosophers have offered
arguments for the conclusion that psychopaths are
not morally responsible, it is important to place these
claims within a general philosophical debate that
should be considered open. Specifically, research
should be carried forward along several dimensions.
Two important dimensions concern the individuation
and characterization of the psychological capacities
that should underlie ascriptions of moral
responsibility. Philosophers have so far put an
emphasis on the capacity of moral understanding and
control. However, it is important to stress that both
the assumption that these exhaust the capacities
necessary for moral understanding and the particular
analyses of these capacities, some of which offered by
the authors here, have been challenged.
Some philosophers have argued that although
the responsibility of psychopaths is undermined by
deficits in moral understanding and control, we
should still judge them morally responsible. For
instance, Patricia Greenspan concedes that
psychopaths’ limitations in feeling moral emotions,
such as guilt based on empathy with their victims,
331
undermine their capacity of self-control and thus their

free will.29 However, when psychopaths intend harm,
the manifested bad qualities of their will, warrant in
us reactive attitudes such as hatred, scorn and
contempt. Greenspan draws upon some of Peter
Strawson’s remarks about the significance of reactive
attitudes for attributing moral responsibility and
argues that psychopaths should be treated as if they
are morally responsible.
There is no doubt that some of the actions of
psychopaths will be make them subject to reactive
attitudes such as blame and outrage, however, a
deeper analysis is required. As Ronald de Sousa and
Douglas Heinrichs argue, a better understanding of
psychopathy might cause us to revise some of our
moral concepts, such as evil. We cannot infer from the
fact that some reactive attitudes are attributed to
psychopaths that this attribution is warranted, given
evidence about their cognitive and affective
deficiencies.30
Another family of philosophical arguments for
the responsibility of psychopaths shares the
conclusion that they lack a form of moral
understanding.31 However, these authors question
why lacking this kind of understanding should
29
Greenspan 2003.
30
De Sousa and Heinrichs 2010.
31
Elliott 1996, Vargas and Nichols 2007.
332
undermine moral responsibility in every instance.

Thus, the general idea is that the notion of moral
understanding is wider than that considered by those
who would not ascribe moral responsibility to
psychopaths. Although they do not understand why
morality is important and they do not ‘seem to be
able to see why the interests of others matter’ they
understand that others value certain ways of
behaving. This kind of understanding warrants
holding them morally responsible for certain actions
that do not involve ‘the subtleties of moral reasoning
or emotional commitments’.
One way of replying to these authors is to
point out that they conflate moral understanding with
other forms of knowledge relevant in the ascription of
legal responsibility. In fact, while knowing the nature
of the action performed is sufficient, for example, for
the McNaughten rule, moral responsibility demands
more than this. Moral responsibility also requires that
agents understand the morality of actions as well as
being able to exert the right kind of control over
actions. In any case, we take these criticisms to point
to the fact that the interfacing of the conclusion that
psychopaths are not morally responsible with the
issue whether they are criminally responsible is not a
straightforward matter.
These criticisms suggest that the ascription of
moral responsibility has to be sensitive to the type of
context and actions that are under evaluation. Thus,
the claim that there is a complete lack of moral
responsibility in psychopaths for every action cannot
333
be justified easily. We think that this shows that in

certain contexts, especially in the case of the judiciary
and for crimes concerning certain moral violations,
psychopaths’ lack of sensitivity to, and engagement
with, certain types of moral consideration should be
taken into account.
Finally, there is another important view
advanced in a classic paper by Murphy that is worth
exploring.32 He assumes that psychopaths fail to be
motivated by the recognition of the rights of others.
Such a motivation is required for having rights of
reciprocity. Therefore, psychopaths cannot have
rights and we have no obligations to them, so they
should be treated as non-human animals. However,
Murphy maintains that the adoption of this practical
conclusion should be constrained by the following
considerations. First, there might be serious
difficulties in the clinical diagnosis of psychopathy.
Second, there are dangers deriving from political
abuse. Third, psychopathy might be the result of
collective choices. Fourth, psychopaths might be
potential or former persons. However, there appears
to be neither good reason for the type of treatment
that might derive from the exclusion of moral
community as envisaged by Murphy, nor that lack of
control and moral understanding implies such
32
Murphy 1972.
334
exclusion. Their capacity to suffer should ground our

concern about the proper treatment of psychopaths.
References
ADSHEAD, G. 2003. "Measuring Moral Identities:

Psychopaths and Responsibility." Philosophy, Psychiatry
& Psychology 10, 2: 185–187.
AHARONI, E., W. SINNOTT-ARMSTRONG, AND K. A.
KIEHL. 2012. "Can psychopathic offenders discern moral
wrongs? A new look at the moral/conventional
distinction." Journal of Abnormal Psychology 121, 2: 484-
497.
AYOB, G. AND T. THORNTON. 2014. "Psychopathy: what
apology making tell us about moral agency." Theoretical
Medicine and Bioethics 35, 1: 17-29.
BLAIR, J. 2013. "Psychopathy: cognitive and neural
dysfunction." Dialogues Clin. Neurosci. 15, 2: 181–190.
BLAIR, J., D. MITCHELL, AND K. BLAIR. 2005. The
Psychopath: Emotion and the Brain. Oxford: Blackwell.
BLAIR, R. J. R. 1995. "A Cognitive Developmental
Approach to Morality: Investigating the Psychopath."
Cognition 57: 1–29.
BLAIR, R. J. R., L. JONES, F. CLARK, AND M. SMITH. 1995.
"Is the psychopath morally insane?" Personality and
Individual Differences 19, 5: 741–752.
335
BOLTON, D. 2008. What is mental disorder? An essay in

philosophy, science, and values. Oxford: Oxford
University Press.
BOORSE, C. 1975. "On the distinction between disease and
illness." Philosophy and public affairs 5: 49–68.
CLECKLEY, H. M. 1976. The Mask of Sanity: an Attempt
to Clarify some Issues About the So-called Psychopathic
Personality. St. Louis (Mo): Mosby.
COOKE, D. J., MICHIE, C., AND HART, S. D. 2006. "Facets
of Clinical Psychopathy: Toward Clearer Measurement."
In PATRICK, CHRISTOPHER J. Handbook of Psychopathy.
New York/London: Guildford Press, 91–106.
COOPER, R. 2007. Psychiatry and philosophy of science.
Stocksfield: Acumen.
DE SOUSA, R. and HEINRICHS, D. 2010. "Will a stroke of
neuroscience ever eradicate evil?" In MALATESTI and
MCMILLAN 2010, 299-318.
DOLAN, M. and R. FULLAM. 2010. "Moral/conventional
transgression distinction and psychopathy in conduct
disordered adolescent offenders." Personality and
Individual Difference 49: 995-1000.
ELLIOTT, C. 1996. The Rules of Insanity: Moral
Responsibility and Mental Illness. New York: State
University of New York Press.
FEINBERG, J. 1986. Harm to Self: The Moral Limits of the
Criminal Law. New York: Oxford University Press.
FISCHER, J. M. and M. S. J. RAVIZZA. 1998. Responsibility
336
and Control. A Theory of Moral Responsibility.

Cambridge: Cambridge University Press.
FULFORD, K. W. M. 1989. Moral Theory and Medical
Practice. Cambridge: Cambridge University Press.
GREENSPAN, P. S. 2003. "Responsible Psychopaths."
Philosophical Psychology 16, 2: 417–419.
HARE, R. D. and NEUMANN, C. S. 2010. "Psychopathy:
assessment and forensic implication." In MALATESTI and
MCMILLAN 2010, 93–124.
KENNETT, J. 2010. "Reasons, emotion, and moral
judgment in the psychopath." In MALATESTI and
MCMILLAN 2010, 243-60.
KRUPP, D. B., L. A. SEWALL, M. L. LALUMIČRE, C.
SHERIFF, and G. T. HARRIS. 2012. "Nepotistic patterns of
violent psychopathy: evidence for adaptation?"Front.
Psychology 3, 305: 1-8.
LEVY, N. 2007. "The Responsibility of the Psychopath
Revisited." Philosophy, Psychiatry, & Psychology 14, 2:
129–138.
LEVY, N. 2013. "Psychopaths and blame: The argument
from content." Philosophical psychology.
MALATESTI, L. 2009. "Moral Understanding in the
Psychopath." Synthesis Philosophica 24, 2: 337-348.
MALATESTI, L. and BAXTER, J. 2010. "Psychopathy in
Psychiatry and Philosophy: An Annotated Bibliography."
Available at:
https://www.ffri.hr/phil/psychopathy/ (Accessed
337
10/03/2014).
MALATESTI, L. and J. MCMILLAN eds. 2010.
Responsibility and Psychopathy: Interfacing Law,
Psychiatry and Philosophy. Oxford: Oxford University
Press.
MALATESTI, L. and J. MCMILLAN. 2014. "Defending
psychopathy: an argument from values and moral
responsibility." Theoretical medicine and bioethics 35, 1: 7-
16.
MEALEY, L. 1995. "The Sociobiology of Sociopathy: An
Integrated Evolutionary Model." Behavioural and Brain
Sciences 18: 523-41.
MEGONE, C. 1998. "Aristotle's Function Argument and
the Concept of Mental Illness." Philosophy, Psychiatry, &
Psychology 5, 3: 187–201.
MURPHY, J. G. 1972. "Moral Death: A Kantian Essay on
Psychopathy." Ethics 82, 4: 284–298.
NICHOLS, S. 2002. "How Psychopaths Threaten Moral
Rationalism, or is it Irrational to be Amoral?" The Monist
85: 285–303.
RAINE, A. and YANG, Y. 2006. "The Neuroanatomical
Bases of Psychopathy: A Review of Brain Imaging
Findings." In PATRICK, CHRISTOPHER, ed. Handbook of
Psychopathy. New York, London: The Guildford Press,
278–295.
SZASZ, T. 1960. "The Myth of Mental illness." American
Psychologist 15: 113–118.
338
SZASZ, T. 2003. "Psychiatry and the Control of

Dangerousness: on the Apotropaic Function of the Term
"Mental illness"." Journal of Medical Ethics 29: 227–230.
VARGAS, M. and S. NICHOLS. 2007. "Psychopaths and
Moral Knowledge." Philosophy, Psychiatry and
Psychology 14, 2: 157–16
Isabella Merzagora B., Ambrogio Pennati, Guido V. Travaini
339
Personological Features Of White

Collar Crime: Theoretical
Backgrounds Of Assessment Projects
Isabella Merzagora Betsos1, Ambrogio Pennati2, Guido

Vittorio Travaini3
Keywords: Psychopathy, white collar crime.
1. White-Collar Crime: Psychology and

Psychopathology
One of the most common axiom of studies in

this field is that economic crime cannot be adequately
explained by psychology or psychopathology. As a
matter of fact, clinician criminologists seem to have
1
Professor of Criminology - Department of Biomedical Sciences for Health
- University of Milan - Via L. Mangiagalli 37, 20133 Milan, Italy.
2
Psychiatrist, Psychotherapist, Master in Forensic Psychopathology.
President of the Scientific Association Integrational Mind Labs, Milan.
3
PhD in Criminology, Professor Department of Biomedical Sciences for
Health - University of Milan - Via L. Mangiagalli 37, 20133 Milan, Italy
Personological Features Of White Collar Crime: Theoretical
340
left the issue to criminologists who deal with the fact,

not with who committed it.
Sutherland, the father of the term "white collar
crime", argues that social or individual pathology
does not explain such behaviors, and this idea has
accompanied all subsequent criminological
research. According to him the great entrepreneurs
are capable, emotionally balanced, and pathology, in
this case, does not play any role.
It’ s important to highlight that most of the
psycho(patho)logical research in white collar crime
was developed in an old fashioned psychoanalytical
frame: this allowed researchers to state some
questionable period, such as: “ One cannot think, he
says, that General Motors has an inferiority complex,
the Aluminum Company of America has an Oedipus
complex, the Armour Company has death instincts or
the DuPonts wants to return to the womb
(Sutherland, 1949)”. This approach misses the point
that only a single subject can be burdened by mental
disorder, not a company. In fact, in the papers of
criminologists after Sutherland, psychological traits
and psychopathology of white-collar criminals are
described.
For Baumhart (in Paradiso, 1983) the most
important psychological characteristics of white-collar
criminals are cynicism and aggressivity; for Clinard
egocentrism, emotional insecurity, a negative attitude
towards the others (in: Ceretti, 1987); also, according
to other authors, the others are viewed with cynicism
and contempt, according to the old saying that
341
everyone has a price (Alalehto, 2003); furthermore

other Authors refer about narcissism, self-
centeredness, selfishness, lack of empathy,
antagonism, and although we do note that narcissism
is a prerequisite for the social positions of success,
Blickle et al. (2006) found significantly higher scores
in narcissism of white-collar criminals than in those
managers who are not criminals.
According to many authors, competitiveness
is another key feature among such criminals: it is an
even desirable quality in an area such as business, but
the excess can lead too often to prefer competition to
cooperation, making a person unable to make to work
with others. Spencer (1965) identifies among the 30
inmates for economic crimes he studied the tendency
to an exaggerated social climbing which would be
compensatory for the lack of appreciation received in
childhood.
Moreover, Bromberg (1965) emphasizes the
characteristic of the self, the narcissistic structure, the
experience of omnipotence and invulnerability, the
hubris, which facilitate the illegal act and provide the
feeling of being right and unpunished, and also the
compulsion to accumulate money, as a compensatory
experience for early emotional deprivation.
For example, according to an approach in
terms of rationality of delinquent choice the subject
tends on the one hand to the maximization of utility
or profit, and on the other to reduce the risk intrinsic
to every behavior, and even stronger if it is an
342
offense. But what if the economic criminal was a

pathological risk-lover?
More empirically-grounded approaches to to
the study of psycho(patho)logy of white collar were
developed using some of state-of-the-art
personological models, which take into account
temperamental and characteriological traits.
For example, Alalehto (2003) studied the
white-collar criminals using the model of the five
fundamental dimensions of personality (Big Five), and
his conclusion is that there are three different types of
white-collar criminals: the positive extrovert, whose
illegal behavior is supported by his being
manipulative, egocentric, prone to control; the
disagreeable business man, suspicious, jealous,
competitive, ready to use dishonest tactics when
things do not go as he wished or his status is
threatened; the neurotic anxious, characterized by low
self-esteem, anger, hostility, proneness to self-blame.
In the latter case, criminal behavior would serve as a
balance of the feeling of not being sufficiently capable
in their work and not being able to achieve their
objectives. Extroversion is one of the traits found in
economic crime also by Collins and Schmidt (1993)
and Ben-David (1991), together with cunning
arrogance, assertiveness, intolerance, presumption
and aggressivity.
A key to explain economic crime is
"opportunity" or "chance." This is reflected in the
reconstruction formulated by Horoszowski (1980) of
the Special Economic Opportunity Conduct (ESOC-
343
crime), highlighting the other element which is of

central importance for the configuration of
occupational crime: the breach of trust. According to
Braithwaite (1984) the breach of trust is at the heart of
the definition of corruption.
In a study of crime in the medical field, Ceretti
and Merzagora (1993) suggested that opportunities
may also be the particular vulnerability of the victims.
Mutually, the characteristic of the
perpetrato"Opportunity", particularly its ability to
inspire confidence. An example of it is the conviction
of a Chief Medical Officer who, in the exercise of its
functions, directs patients to his private practice,
"relying on the exploitation of moods and
psychological conditions of desperate people, to
desperate requests for admission he gave the chilling
response that there was no chance, predicting long
and uncertain waiting time, but immediately he
rushed to say that M. visited at the Private Clinic VG,
and gave immediate appointment. Illuminating, also,
the negotiation of compensation depending on the
condition of the client or the reactions of the same
"(Court of Appeal of Rome, 19 November 1985).
From the point of view of evolutionary
psychology (Buss, 2012) another feature, which will
be taken into account also when dealing with
psychopathy, is being manipulative, having the
tendency to control and manipulate others to achieve
their goals, and even be "Machiavellian": the others
are seen as a means to achieve their ends without any
emotional resonance for potential victims of their
344
tricks (Jones, Kavanagh, 1996; Rayburn, Rayburn,

1996; Verbeke et al., 1996). This reminds that crime is
not synonymous with uncontrolled violence, but it
can also be fed by the conduct of controlled
opportunism.
Alalehto concludes his research of 128
businessmen in Sweden, at least 55 of whom had
violated the law, saying that the most important
result was that the personality is a relevant factor in
economic crime, although it is difficult to say how
much, and although it is not the only factor at play;
he added that to consider it may be useful to those
who have the task of conducting recruitment
interviews.
2. Psychopathies and Corporations
The pioneering research of Cleckley describes

the concept of psychopathy for the first time in a book
published in 1941 evocatively titled: "The Mask of
Sanity". A mask, in fact, because the psychopath
comes free from coarse psychiatric symptoms and
sometimes is even well adapted. Cleckley's
description does not focus on those aspects of
violence, explosion, cruelty that will make it later
known as synonymous with the term psychopath.
According to Skeem et al. (2012), it is possible
to distinguish between two different types of
psychopathy: the "a là Cleckley psychopathy"
345
(cleckleyan psychopathy), or "primary", and criminal

psychopathy, or "secondary", characterized by
impulsive and reactive aggression which easily ends
into a serious and persistent criminal career.
However, the traits distinguishing primary
psychopaths from secondary psychopaths are the
emotional coldness, the lack of empathy, and the
personological way of functioning based only on a
cost-benefit approach without any regard to the cost
for the others. However, this personological pattern
also gives some advantages: the "paradox of the
psychopath" (Skeem et al., 2012) is that he may
occupy prestigious positions in several social
environments.
This distinction is similar to the one between
"unsuccessful psychopaths" and "successful psychopaths",
where success is defined by the fact that they don’t
end up in jail (Lynam, 1997), because their coldness
allows them to have sufficient self-control to avoid
legal troubles.
In particular, successful psychopaths do not
undertake the classic criminal career marked by
physical aggression, but rather they are more
engaged in acts of "relational aggression," and in
white-collar crimes rather than conventional crimes
(Schmeelk et al., 2008).
Neuroimaging studies evidentiate in
Psychopaths peculiar abnormalities that suggest that
their amoral behavior can be related to specific
malformations of the brain structure. Gao and Raine
(2010) have looked for neurobiological differences
346
between successful and non-successful (including

some serial killers) psychopaths. The latter are
defined as "semi-successful" psychopaths; for the
Authors, in fact, the killing of several people over a
long period of time without being identified can be
considered as a success. Some of them have the same
features as the successful psychopaths, namely the
features that allow them to lure victims first, and then
to escape the arrest: superficial charm, intelligence,
and lack of remorse. A suggestive analogy between
the "corporate psychopaths", which will be discussed
later, and a psychopathic serial killer of success is
found in the figure of John Gacy, who sodomized and
killed 33 people, 27 of them were buried under his
house, but looked like a reliable and charming man,
and was elected "Man of the Year" by the local
Chamber of Commerce.
Successful psychopaths have the same
neurological abnormalities that can be found in
pathological liars (Yang et al., 2005), and in fact the
possibility to lie naturally is a great advantage for
both manipulating others and standing an
interrogation with ease.
Successful psychopaths, therefore, can be
white-collar criminals, but today there’s some more.
We owe the recent theory of Corporate
Psychopaths to Boddy (2005); this theory combines the
psychiatric observations about psychopaths with the
studies carried out within the companies. Boddy
partly attributes the current global financial crisis to
the presence of people with many psychopaths
347
features, or even true psychopaths, at the top of many

major corporations, especially the financial ones.
According to this author, some psychopaths
are violent and end up in prison, while others build
their careers in companies (Boddy, 2011 / b).
As well as other psychopaths, the Corporate
Psychopaths are charming, elegant, charismatic,
outgoing, ingratiating, self-confident, Machiavellian,
narcissistic, parasites, liars, arrogant, untrustworthy,
manipulative, incapable of remorse (Boddy, 2011 / a;
Clarke, 2005). They are predators (Boddy, 2011 / a),
but can control themselves ... and can control the
others, who are seen as mere objects, useful only to
achieve their goals.
Also in analogy with the "other" psychopaths,
among the characteristics of their behavior there are
promiscuous sexual behaviors, the propensity to
embark on short-term relationships, which in the
workplace can result in attempts to seduce relying on
their power, and therefore in sexual harassment
(Clarke, 2005). Boddy (2011 / a) points out that the
legal costs and compensations paid by companies in
case of documented sexual harassment can
intrinsically be a damage.
The damages of psychopathic behavior are,
however, more than this: even large companies fail,
thousands of employees are deprived of work and
livelihoods, investors lose their investments, and
capitalism loses credibility (Boddy, 2011 / a).
Many authors describe the real work of
erosion that the behavioral and relational style of
348
psychopathic leadership does on companies, starting

with the demoralization and demotivation of
employees. A person incapable of empathy is in fact
ready to humiliate subordinates or colleagues, to lie
to them and about them, to mistreat them, to blame
their mistakes and vice versa to take credit for the
successful tasks accomplished by others (parasitism),
and to subject them to various forms of
harassment. Another devastating effect is that, since
these individuals hold positions of prestige, the
example of their immorality ends up infecting the
ethics of the entire company (Clarke, 2005).
In spite of the confusion they caused,
corporate psychopaths are not at all shocked by the
destruction of the company, they are superficially
unaware of the chaos created around them, not at all
worried about the fate of those who have lost their
jobs and savings, and without any remorse. They lie
about their involvement, and they are very
convincing in externalizing the blame to others, the
self-perception of their value being not at all affected
(Boddy, 2011 / b).
Since, as we have said, they are charming,
elegant, charismatic, outgoing, ingratiating, self-
confident, Machiavellian (Blair, 1995), we can explain
their professional success in spite of the fact that their
work has a negative effect, even devastating, on the
Company in which they work.
Moreover, given their inclination to lie, they
show their best, even if fake, at job interviews. And
because they are skilled at manipulating others, they
349
say what the other person wants to hear. Babiak and

Hare (2006) add that they have a special talent for
"reading people" and quickly modelling the
interviewer; they are as chameleons.
Sometimes they rapidly reach the top of
organizations thanks to their open-mindedness and
ability to create the more convenient alliances, on the
one hand by moving the pieces right, and on the other
by using disreputable means, getting rid of those who
overshadow them (Boddy, 2011 / a). In the end, they
surround themselves with yes-men rather than people
who are capable but not obsequious, and this is not
an advantage for the company.
Furthermore, they prefer those companies in
which the climb is faster; such companies, to shine
further light on their role in the financial crisis, are
often the financial ones. In the choice of work
environments they favor the ones where they can
earn more, but also those in which it is easy to gain
power, for example public companies. However,
corporate psychopaths are found nearly everywhere
(Boddy, 2011 / a).
Moreover, again according to Boddy (2010),
the very spirit that lingered for several decades in the
business environment rewards them, because there is
a philosophy based on the speed of change rather
than respect for the experience, the success rather
than the accuracy. So, as already said by Merton to
explain a certain type of deviance, the important
thing is to win the game, not to win according to the
rules of the game.
350
Babiak et al. (2010) measured the psychopathic

traits of 203 employees from different companies: the
results suggest that, although the subjects on average
have quite low psychopathy rating scales scores, such
scores were higher than those found in the general
population. Among those who had obtained the
highest scores there were also those who were
considered "promises" of companies, or individuals in
higher management positions. The authors add that it
is easy to mistake some of the traits of psychopathy
for traits of their leadership; manipulative skills can
be seen as ability to persuade, a characteristic that
leaders must have, the lack of empathy can be
interpreted with the necessary know-how to make
someone unpopular if needed and by being cold-
blooded.
A prominently wide research was conducted
by Boddy (2011 / a), who has also developed a test
for psychopaths business, the Psychopathy Measure-
Management Research Version (PM-MRV). Depending
on the score obtained in this test among managers
one could find true psychopaths (119), such as
managers with psychopathic traits called
"dysfunctional Manager" (104), and 264 "Normal
Manager", who presented no psychopathic features.
Boddy found several areas in which the adverse
effects of psychopathic leaders were more evident: a
high level of conflict in the organization due to the
"DIVIDE ET IMPERA" rule style adopted by the
executive psychopath, in an unfair and aggressive
way. Another negative effect found was a diminished
351
sense of responsibility towards society of the entire

company: if the psychopath has no capacity for
empathy and ethics, then he sees no reason why the
company should act in an ethical and socially
responsible way. Moreover, since these people do not
feel responsible towards the fortunes of the company
itself, and since they are risk lovers, it is likely that
they take risky decisions for their company. Boddy
highlighted that corporate psychopaths’ employees
have to work harder and faster, which ends in a
higher turnover of employees, higher shares of
absenteeism, and more absences due to false
illnesses. Finally, Boddy (2011 / a) defines the
working environment of psychopaths as "toxic."
In 2005, Boddy, describing for the first time
the corporate psychopaths, predicted the risk that
they might lead to "social disaster"; today, he not only
finds that his dire predictions have come true, but
also pointed out that those same Corporate
Psychopaths who caused the global crisis are now
being asked by governments to give their expert
opinion about the way out of this crisis.
3. Research Perspectives
Understanding the problems that the lack of

ethics of some managers creates in civil society and
the firms they work for, since a long time companies
have developed codes of ethics; it is very important,
352
of course, but if you do not assess the personality of

the leaders, and in particular their greater or lesser
propensity to break the rules, they are not sufficient
to ensure respect for these.
One strategy could be to identify psychopaths,
and then to prevent them from occupying senior and
strategic positions in companies; however, some
companies seem to be not particularly collaborative
(Babiak, Neumann, Hare, 2010).
The research group of the Chair of
Criminology of the Department of Biomedical
Sciences for Health, headed by Full Professor Isabella
Merzagora, is aimed to identify psyhopathic features
by personological assessement tools. HEXACO
(Ashton, 2004) is a self-administerd questionaire
based on BIG 5 theory of personality, and it allows to
detect, among other personological facets, the
proneness to be fair and empathic to others.
We hope that our research experience, now in
progress, could help in such a complex, hard and
fascinating task.
References
ALALEHTO, T. (2003) Economic crime: Does personality

matter?, International Journal of Offender Therapy and
Comparative Criminology, 47(3): 335-355.
ASHTON, MICHAEL C.; LEE, KIBEOM; PERUGINI,
MARCO; SZAROTA, PIOTR; DE VRIES, REINOUT E.; DI
353
BLAS, LISA; BOIES, KATHLEEN; DE RAAD, BOELE (2004).

"A Six-Factor Structure of Personality-Descriptive
Adjectives: Solutions From Psycholexical Studies in Seven
Languages.". Journal of Personality and Social
Psychology 86 (2): 356–366
BABIAK, P. and HARE, R. D. (2006) Snakes in Suits:
When Psychopaths Go to Work. New York: Regan
Books.
BABIAK, P., NEUMANN, C. S. and HARE R. D. (2010)
Corporate Psychopathy: Talking the Walk, Behavioral
Sciences and the Law, 28: 174-193.
BEN-DAVID, S. (1991) Personality traits in white-collar
offenders, Medicine and Law, 10: 527-536.
BLAIR, R.J.R: A cognitive developmental approach to
morality: investigating the psychopath. Cognition 57
(1995) 1-29.
BLICKLE, G., SCHLEGEL, A., FASSBENDER, P. and KLEIN,
U. (2006) Some personality correlates of white collar crime,
Applied Psychology: An International Review, 55(2): 220-
233.
BODDY, C. R. (2005) The Implications of Corporate
Psychopaths for Business and Society: An Initial
Examination and a Call to Arms, Australasian Journal of
Business and Behavioural Sciences, 1(2): 30-40.
BODDY, C. R. (2010) Corporate Psychopaths and
Organisational Type, Journal of Public Affairs, 10(4): 300-
312.
354
BODDY, C. R. (2011 / a) Corporate Psychopaths -

Organizational Destroyers. London: Palgrave
Macmillan.
BODDY, C. R. (2011 / b) The Corporate Psychopaths
Theory of the Global Financial Crisis, Journal of Business
Ethics, 102: 255-259.
BRAITHWAITE, J. (1984) Corporate Crime in the
Pharmaceutical Industry. London: Routledge and
Kegan Paul.
BUSS, M.: (2012) The Evolutionary Psychology of Crime.
Journal of Theoretical and Philosophical criminology
Commentary Special edition, January, 2012, Vol. 1(1):90-
98
BROMBERG, W. (1965) Crime and the mind. New York:
McMillan.
CERETTI, A. (1987) Studies on the personality of the
criminal white-collar, Review of Criminology,
vol.XVIII(2): 290-374.
CERETTI, A. and MERZAGORA, I. (1993) White-collar
crime and medicine, The Italian Review of Criminology,
IV(1): 19-46.
CLARKE, J. (2005) Working with Monsters: How to
Identify and Protect Yourself from the Workplace
Psychopath. Sydney: Random House.
CLECKLEY, H. (1941) The mask of sanity: an attempt to
reinterpret the so-called psychopathic personality. Oxford:
Mosby.
355
COLLINS, J. M. and SCHMIDT, F. L. (1993) Personality,

integrity, and white collar crime: a construct validity
study, Personnel Psychology, 46(2): 295-31.
GAO, Y. and RAINE, A. (2010) Successful and
Unsuccessful Psychopaths: A Neurobiological Model,
Behavioral Sciences and the Law, 28: 194-210.
GURWIN, L. (1984) The Calvi Affair: Death of a Banker.
London: Macmillan.
HARE, R. D. (2003) The Hare Psychopathy Checklist-
Revised (PCL-R, 2nd ed.). Toronto: Multi-Health
Systems.
HOROSZOWSKI, P. (1980) Economic Opportunity Special-
Conduct and Crime. New York: Lexington Books.
JONES, G. E. and KAVANAGH, M. J. (1996) An
experimental examination of the effects of individual and
situational factors on unethical behavioral intentions in the
workplace, Journal of Business Ethics, 15(5): 511-523.
LYNAM, D. R. (1997) Pursuing the Psychopath; Capturing
the Fledgling Psychopath in a nomological net, Journal of
Abnormal Psychology, vol. 106(3): 425-438.
PARADISE, P. (1983) Crime in business - A criminological
approach. Padua: Cedam.
RAYBURN, J. M. and RAYBURN, L. G. (1996) Relationship
Between Machiavellianism and Type-A Personality and
Ethical Orientation, Journal of Business Ethics, 15(11):
1209-1219.
356
SCHMEELK, K. M., SYLVERS, P. and LILIENFELD, S. O.

(2008) Trait correlates of relational aggression in a
nonclinical sample: DSM-IV personality disorders and
psychopathy, Journal of Personality Disorders, 22: 269-
283.
SKEEM, J. L., POLASCHEK, D. L. L., PATRICK, C. J. and
LILIENFELD, S. O. (2012) Psychopathic Personality:
Bringing the Gap Between Scientific Evidence and Public
Policy, Psychological Science in the Public Interest, 12(3):
95-162.
SKEEM, J. L., POYTRESS, N., EDENS, J. F., LILIENFELD, S.
O. and CALE, E. M. (2003) Psychopathic personality or
personalities? Exploring potential variants of psychopathy
and their implications for risk assessment, Aggression and
Violent Behavior, 8: 513-546.
SPENCER, J. C. (1965) White-collar crime, in GRYGIER, T.,
JONES, H. and SPENCER, J. C. et al. (ed.), Criminology in
Transition. London: Tavistock.
SUTHERLAND, E. H. (1949) White Collar Crime. New
York: Dryden Press.
VERBEKE, W., OUWERKERK, C. and PEELEN, E. (1996)
Exploring the contextual and individual factors on ethical
decision making in salespeople, Journal of Business Ethics,
15(11): 1175-1185.
YANG, Y., RAINE, A., LENCZ, T., BIHRLE, S., LACASSE, L.
and COLLETTI, P. (2005) Prefrontal white matter in
pathological liars, British Journal of Psychiatry, 187: 320-
325.
Giovan Battista Ivan Polichetti
357
The “Sound” Dimension in Satanic

Crimes: an History of the Infamous
“Track”
Giovan Battista Ivan Polichetti1
Keywords: Satanism, heavy metal music, backward

masking, recruitment strategies, sects, occult persuasion,
culpability.
1. Objectives
Usually none thinks that music, or a particular

kind of music, could put someone to commit a sort of
crime. Anyway there is who works for it. Therefore
too many crimes were attributed to the effect of
words and/or sounds in the contest of a song, for
example.
1
M.D., Psychopathologist, ED Expert, Criminologist; Department of Mental
Health and Pathologic Addictions, Azienda-Unita' Sanitaria Locale di
Cesena.
The “Sound” Dimension in Satanic Crimes: an History
of the Infamous “Track”
358
The music interested in that phenomenon is in

fact a particular kind of music, so called “heavy
metal”; instead the particular field in which crime
science sees the nexus is the cult of the devil, better
Satanism: according to that hypothesis some people,
listening to heavy metal music, could commit crimes
without a real intention but pulled in by a sort of
hidden persuasion, maybe mediated by a process also
known as backward masking in a major contest of
recruitment strategies wanted from diabolical sects.
So the point is: are that ones responsible, culpable,
imputable?
This paper should demonstrate two different
aspects of the question: if is true that heavy metal
music contains occult messages and, in case of reality,
if those messages could influence anyone doing
something wrong.
In April 1982 Philip Wyman, participating to a
Committee in Sacramento (California), was successful
obtaining approval from U. S. Government for his
Law: every phonographic support resulting
containing that kind of insertion must take, for
vending, the following text. “Warning: this record
contains backward masking which may be
perceptible at a subliminal level when the record is
played forward!”.
Three years later Tipper Gore submitted, and
was successful too, her Law at Parents Music
Resource Center: every record containing strong texts
must take, for vending, the following words.
Giovan Battista Ivan Polichetti 359
“Parental Advisory / Explicit Lyrics” or “Parental

Advisory / Explicit Content”.
Many years later Joe Libermann, even with
Sam Nunn or John McCain, submitted “Senate
Commerce Committee”, plea for rights and “21st
Century Media Responsibility Act”.
Apart from every kind of chronology it is now
clear that Law has been involved in those problems,
so for “subliminal” subjects as in order to “explicit”
communication.
In that sense there are, more or less, sixty-five
“criminal” cases from 1952 to 2012.
Here there are major examples (obviously
according to best references):
in April 1991 Per Yngve Ohlin (also known as
“Dead”), singer front-man in “Mayhem” (Norwegian
black metal band), let literally “explode” his own
brain by a shotgun; his defaced body was found by
Øystein Aarseth, founder of the group also known as
“Desctructor” and later “Euronymous”: this one took
some pictures of Dead’s crushed brain, collected some
skull fragments and even cooked some pieces of the
same brain eating them so to say he “was a cannibal”;
skull fragments necklace was an homage to Morgan
Hakansson of Marduk (another “worthy” band) or
Jan Axel Blomberg (“Hellhammer”, Mayhem’s
drummer);
in August 10th 1993 Øystein Aarseth died too,
murdered by Varg Vikernes (founder of one man
project “Burzum”): he has expiated a maximal 21
years sentence;
360
in July 1995 three American teen-agers (Royce

Casey, Jacob Delashmutt and Joseph Fiorella of
Hatred) were accused of homicide and complicity for
death of the younger Elyse Pahler, and
simultaneously two friends of them were convicted
for a 75 years old woman homicide; it seems that
Royce Casey not only admitted crime but argued to
be driven by a Slayer’s song verse: “if you’re not with
us you may no longer exist”; anyway Italian daily
newspaper “il Corriere della Sera” wrote something
breaking: “Slayer and Sony risk now to pay
billionaire reparation to victim’s family and to see
limited group’s sells to no younger consumers area”
(December 4th 2000).
2. Method
The present scientific work means to illustrate

if the “instigation” phenomenon is real and, in case of
positive exit, demonstrate if it is possible to be
“conditioned” by that. Then questions were posed to
reach an answer: where does exist satanic bond
between music and words and where not, where is
this bond explicit and where is it “occult”, where is it
“conscious” and where less or not at all, where found
and recommended but even where not, where
wrongly recommended and where wrongly
disregarded, where demonstrable and where simply
striking in one sense or another, where confirmed and
361
where denied, where certainly neglected and where

stressed, where overlooked and where ignored,
where demonstrable and where not in both ways.
10067 bands were tested and analyzed: 2 talk
“against God”, 3 talk about “exorcism”, 4 “against
religion”, 5 about “black masses”, 8 “infernal”, 11
about “the Beast”, 12 about “Devil”, 14 of
“possession”, 15 “against Christ”, 19 “anti-God”, 24
about “sacrifice”, 49 about “Lucifer”, 166 about
“demoni(a)c”, 267 about “Hell”, 510 about
“blasphemy”, 520 “anti-religion”, 1132 about “evil”,
1154 of “pagan cults”, 1250 of “occult”, 1836 “anti-
Christ” and 2886 of “Satan”.
The conclusion is unmistakable: phenomenon
exists. It consists of two different modalities, despite
all “clear” referral: truly “subliminal” message and
“backward masking”. In the first situation 50% of
participants should “understand” the message and
50% shouldn’t (definition); in the second case
message is never “consciously” understood but it
“passes” into people’s unconscious.
A really articulated study was conducted: it
consists of 4 different phases.
Phase one (psycho-galvanic reflex) involving 40
voluntaries, 11 stimuli, 22 surveys.
Phase two (a non sense history) involving 30
voluntaries, 4 tests, 120 recordings.
Phase three (subliminal communication)
involving 50 voluntaries, 4 songs, 12 listening.
Phase four (reversed dimension) involving 100
voluntaries, 7 listening, 7 exams and confirmations.
362
During the first phase voluntaries were

exposed to bioelectrical impedance analysis while
listening to 11 different verbal experiences (including
“reverse” talking): Ohm variations were also token
before and after every stimulus to demonstrate entity
of intervals.
At the second phase a tall story, grossly
corresponding to a song moral, was first listened and
then read by every voluntary: later everyone was
invited to refer (freely) words reminded from the
story, note which of them pronounced he seems to
remind, what every word recalls in mind and finally
words reminding after reading the same tall story.
The whole story includes surprising insertions
according to almost every kind of “occult”
communication.
In the third phase voluntaries listened to 4
songs (each containing both a clear text and an
adjunctive communication, subliminal and/or
preconscious, in different typologies): everyone
listened to any song, one by one, 3 consecutive times;
then he listens to another track consisting uniquely of
that subliminal and/or preconscious content so to
relate with the real song; also listens to hidden
expression so to report if ever heard before; and so for
an intrusive lyric or an undefined sound.
During the last phase every voluntary listened
to 7 songs anyone including a different backward
masked message: they were then invited to report
something “strange”, freely and choosing through 21
possibilities including the real ones.
363
3. Results
From the first phase they are truly minimal,

not over than 1 Ohm plus or minus from basal
registration (apart from chronotopic decline).
In the second phase no significance emerged.
Third phase illustrated that only few subjects
were discovered and in an almost casual way or,
more, in case of expected evidence.
No one, concretely, outdid the last phase.
4. Discussion
Very often public opinion appears upset by

sui generis scoops, maybe about (pre)supposed links
between satanic crimes and heavy metal music.
Someone says, aprioristically, that this is not possible,
and that music is something other than criminality;
too many others say, instead, that this is possible and
that represents a real threat for millions of young
listeners. This paper have demonstrated two
elements, sufficiently certain: heavy metal related
satanic crimes exist, but this kind of relation is surely
not mediated by any form of “occult” instigation, nor
preconscious neither subliminal even though similar
elements surely exist too. The link must be
investigated in the area of “talking about”, especially
364
in journalistic and broadcasting or internet form. And

that because of a sure combination of advertising
appeal that soon became malignant through young
generations. Statistic dimension of the phenomenon,
for example, demonstrate how often the first
“proclaimed” crime draws other similar crimes in a
short term effect: that may be explained recurring to
Werther or copycat effect, to malignant fascination
and psychodynamic feature, but certainly appears so.
Unimportant experiences, anyhow observed in the
last two phases of the experiment, may be explained
recurring to only two conditions, since particularly
trained people could “understand” something
pronounced backward: both ones (speaker and
listener) must have made literate; inverse
communication must be pronounced directly from
“inducer” translator to receiving one, maybe in a
recorded form too but always directly pronounced in
that form: it is not possible to expect of being
“understood” if recording a message as usually
spoken to present it later by means of backward
masking.
Inter-humans communication is based on
speech, maybe all the human social life results based
on communication, and some says no less than finest
psychology is based on language. Anyway elective
communicating model is the spoken one (verbal), so
in psycho-physiological terms receptiveness to
spoken language is based on formation of precise
acoustic “images” related to phonemic recall
pertinent to every word, verse or phrase. When this
365
form of recall, usually according to our attention

level, results aligned with acoustic stimulus, the
comprehension results “automatic”; where “image”
instead doesn’t correspond, both specular and chyral
forms, whether retrograde or opposite, so reversed as
backward masked, there recall cannot happen, at least
not correctly. It may happen in the case of an acoustic
“image” phonetically recalled to a form of reading
directly reversed by virtue of a “natural” phonic and
syllabic concatenation.
Finally sorting legal cases we simply get a
very particular aspect: non casual concentration of
rock related violent crimes results in precise historic
moments but even in well delimited geographic
ambient; those circumstances suggest that a direct
fascination exists, but rather “conscious”, practiced by
special “atmospheres” toward certain “personalities”.
All explains how indiscriminate adhesions to
“spectacular” violence best thrive where diabolical
dimension appears explicit and clear, not where
“occult” manipulation is supposed.
Culpability is always individual.
Perhaps solution is still far, but Freudian
conception of “Unheimlich” really clarified evil
fascination: Devil’s not where you think him.
References
366
ARANZA, J. (1985) More rock, country and backward

masking unmasked. Huntington House Inc.,
Shreveport.
BALDUCCI, C. (1991) Adoratori del diavolo e rock satanico.
Casale Monferrato, Alessandria, Piemme.
BARONI, P. (1997) I Principi del Tramonto. Satanismo,
Essoterismo e messaggi subliminali nella musica rock.
Rimini, Il Cerchio Iniziative Editoriali.
BEGG, I. M., NEEDHAM, D. R., BOOKBINDER, M., (1993)
Do backward messages unconsciously affect listeners?
Canadian Journal of Experimental Psychology, Vol.
47 (1), Mar., 1-14.
CLIMATI, C. (1996) Inchiesta sul rock satanico. Casale
Monferrato, Alessandria, Piemme.
MASTRONARDI, V. M., DE LUCA, R., FIORI M. (2006)
Musica e satanismo, in: Sette sataniche. Dalla stregoneria
ai messaggi subliminali nella musica rock, dai misteri del
mostro di Firenze alle “Bestie di Satana”. Roma, Newton
& Compton.
PACKARD, V. (1957) The Hidden Persuaders. New York,
David McKay Company Inc. Trad. ital.: (1958), I
persuasori occulti. Torino, Einaudi.
367
Neurobiology and Psychodynamics in

Cannibalism: From Mythic
Anthropophagus to Infamous Serial
Killer.
Giovan Battista Ivan Polichetti1
Keywords: cannibalism, serial killer, evolutionism,

serotonin, niacin, sexual drive, oral/cannibalistic drive.
1. Objectives
Cannibalism, in spite of disturbing fallacies,

existed and still exists. It has a general dynamic but it
is possible a classification too: according to major
experts in that original field it may be “profane”,
“juridical”, “magic” or “ritual”. First type consists of
human flesh consumption for nutritional purpose
1
M.D., Psychopathologist, ED Expert, Criminologist; Department of Mental
Health and Pathologic Addictions, Azienda-Unita' Sanitaria Locale di
Cesena.
Neurobiology and Psychodynamics in Cannibalism: From
Mythic Anthropophagus to Infamous Serial Killer.
368
only: it represents therefore a source, available and

pleasing, just like any other food. So you can read, in
topics, of “dietary”, “gastronomic”, “culinary”,
“epicurean”, “anomic” or “nutritional” cannibalism.
Tupí-Guaraní, Aztec and Kuru populations
represent excellent examples of what we are talking
about, in general; but “profane” kind, despite of
historical and cultural aspects, may contain several
disquieting sub-types: “psychopathological” and
“criminal” forms.
This article intends to illustrate the possibility
of detaching those “modern” forms by separating
from the “profane” one.
2. Method
Total revision of available literature, general

re-classification of the problem, comparison of related
records and parallelism between data bases should
define the problem well and clearly; at the same time
illustration of actual neurobiological theories with
demonstration of their related inadequacy would be
completed, giving way to psychodynamic exposition
in order to evolutionistic dynamics, certainly more
impressive.
Dietary theory assume that a man having a
body weight of approximately 50 Kg has the use of
around 30 kg in musculature: every man being so
shows no more than 4-4.5 Kg in proteins; that protein
369
pool couldn’t be absorbed more than at 90%, so to

consent maximal absorption of 120 g in proteins (pure
flesh) but nevertheless about 72 g of proteins in every
Kg of the human total body. And that quantity is
more than normal requirement of an eater toward an
eaten: it results more than in speck, few less than in
eggs and about a half of pork chops; and maybe no
one should eat preferentially a Kg of eggs. Who
considers this reason the one responsible in the
extinction of the phenomenon is evidently in error.
In the opinion of scientists who claimed
serotonergic theory the selective tryptophan
deficiency in particular dietary habits would be the
reason why Aztec carnage was periodically made:
they assume that Mexican diet was based on
agricultural products only, but also restricted to the
almost exclusive use of corn, so to result
automatically poor in amino acidic amount of
tryptophan. They interrelate characteristic symptoms
deriving from this lack with Aztec customs in general
and in every period of a special calendar due to that
kind of massacre. But a corn base diet lacks in lysine
too, without a due attention from the scientist:
however they said that the problem is not exclusively
guided by the amino acidic deficiency in itself, but
derives from the presence (or absence) of many other
amino acids in relative concentrations capable of
competition during passage through
hematoencephalic barrier: all those amino acids are
neutral being tyrosine, phenylalanine, leucine,
isoleucine and valine, overall known as Large Neutral
370
Amino Acids (LNAAs); algebraic ratio between those

ones and tryptophan, or better between tryptophan
and those ones is in fact well known as Trp/LNAAs:
at lower ratio correspond lower tryptophan transport
to the brain. Well, hypothesizing the resulting
serotonin deficiency they pretended to explain Aztec
sacrifice.
But Aztec population isn’t far the only one to
base diet on agricultural products, and not on sole
corn too. In fact is already demonstrated how north
Italian populations were object of interesting studies
on so called toxico-maidic theory: those who longer
ate corn based diet were systematically found
impaired in nutritional requirement of niacin
(vitamin), and even experimental animals put in
similar diet restraint develop systematically that lack
amounting to Pellagra.
Yet no cannibal was first pellagrous and none
pellagrous developed a similar behaviour:
serotonergic theory for cannibalism does not work.
Then all (in)famous cannibals were classified
and analyzed in order to define their common usages
in relation to feeding behaviour and in the full respect
of correlated characteristics: the following is to be
considered a sort of resume (according to best
sources).
Jean Grenier (1590-1610) was imprisoned
thirteen, and twentieth died: he was involved in
many “incredible” stories but with serious
coincidences, so during an evasion he was reached
while “overwhelmingly” stopped for an heap of
371
entrails. “I killed some dogs and drunk their blood”,

he said, “but young girls have a better taste, their skin
is tender and sweet, their blood rich and warm”.
Leonarda Cianciulli had 17 pregnancies, 3
premature babies, 10 living births, 4 survivors; when
eighteen accepted a “good” marriage later revealed as
an error, by the alcoholism of her husband,
blundering herself into “comforting” extra-conjugal
relations: killed 3 women, cutting them in 9 parts to
make soap, biscuits and roasted steaks for her
unaware guests.
Richard Trenton Chase killed 6 persons in one
month (1980): cannibalism usually came after
sodomizing and necrophilia.
Daniel Rakowitz ate her girlfriend’s brain after
a sexual intercourse.
Marcelo Costa Andrade killed 14 boys in 3
months, even though he was accused for 45: violent,
necrophiliac and cannibal with his victims.
Ottis Elwood Toole was initiated to brutal sex
by his sister Drusilla and was abused by the step-
father: when adult and married used to attract men
by sex appeal in his house, killing at least 108 victims.
Henry Lee Lucas killed 157 victims,
participating to 108 with Ottis Elwood Toole: he also
violated several cadavers although expiated 16 years
of imprisonment.
Frieda Lorraine “Blacky” Powell, daughter of
Drusilla and niece of Ottis Elwood Toole, was
accomplice in Toole/Lucas/Powell trio.
372
Armin Meiwes was judged for an atrocious

crime: he received a young man who contacted him
for being eaten; they had a dinner with the guest’s
penis, then homicide was sought-after the same guest.
Kevin Ray Underwood raped a ten years old
little girl, then strangled her for eating; he was also
obsessed by carnal violence on cadavers.
Jeffrey Dahmer, particularly notorious,
collected 17 homicides with “orgasm”.
Issei Sagawa had sex several times with the
cadaver of a young woman who rejected his love
proposal, yet taking pictures of her violated body.
Friedrich Heinrich Karl “Fritz” Haarmann
butchered 27 young persons between 1918 and 1924:
raped, vampirized, mutilated, eaten, sold or threw
out.
Andreij Romanovič Chikatilo was a “case”
(antonomasia), having molested numerous teen-agers
in the school where he usually taught: seminal liquid
found on every victim seemed longer don’t
correspond to his own blood group for a sort of
genetic rare reason, anyway he was finally
recognized.
Albert Fish, the Westchester “ogre”, exceeded
400 victims: he was known, on the whole, for sadism,
masochism, pedophilia, homosexuality, coprophagia,
fetishism, partenophagia, necrochlesis and
cannibalism.
After all only Sandy Charles, also known as
“the fourteenth”, Kevin Loyd Artz, Mark Sappington
also known as “the vampire” and Rodzija Adzovič,
373
also known as “Rocco”, seemed to consider

cannibalistic features without a certain necrophiliac
part in it.
3. Results
Cannibalism has not, thus far, an impressive

neurobiological theory; it cannot be based on an
instinct, neither a drive nor a simplistic perversion:
certainly not an instinct, maybe sustained by a sort of
derived drive, finally encouraged by perversion.
Every instinct is, in fact, extremely complex,
hereditary, innate, invariable, independent from
experience and/or learning, free from external
situation or psychological status, obeying to
biological behavioural lines, imperatively controlled
by a regulatory action, characterized by purpose
ignorance and species-specific.
Fulfillment re-establish equilibrium finally
opposing itself to “need”: drive cannot be won by
recurring to escape actions.
Initially oral stadium appears characterized by
a “cannibalistic” organization when sexual activity is
not yet separated from devouring action: there oral
drive is well supported by digestive function; suction
itself appears as a vestige while support, in fact,
separation between sexual activity and eating
behaviour so to replace an external object with a part
of the body (subject) finally for pleasure and to the
374
limit auto-eroticism; oral-labial portion becomes

erogenous. The other moment, or second phase, is
characterized by the passage from suction to bite and
libido results joined to aggressive and destructive
drive.
Mathematically, furthermore, is easy to infer
how intra-specific cannibalism results so much as
advantageous; nevertheless anthropophagia results
practiced where “justified” by poverty and
malnutrition, on the contrary Total Fertility Rate by
Energy Consumption decreases according to Energy
Consumption per capita increasing.
4. Discussion
From the “oralized” sexuality to “eroticized”

orality demographic development extensively
overtake intention as far as unavailability of
nutritional resources; by the way demographic
contraction, there where we note it, appears
indubitably linked to reproductive refusal in spite of
food overabundance. Perhaps the persistence of
“primitive” linkage between cannibalistic
organization and erotic activity, without any
possibility in physiologic development, may support
the chance of mortal devouring instead of vital lust.
375
References
ARENS, W. (1979) The Man-Eating Myth, Anthropology

and Anthropophagy. Oxford University Press Inc., New
York. Trad. ital.: Il mito del cannibale, antropologia e
antropofagia. Bollati Boringhieri, Torino «Prove» (1980)
e «Gli Archi» (2001).
CAMERANI, C. (2010) Cannibali, le pratiche proibite
dell’antropofagia. Castelvecchi, Roma.
ERNANDES, M. (1991) Motivazioni ecologiche e
neurobiologiche del cannibalismo azteco. Comunicazione
all’Ottavo Congresso Nazionale dell’ANSIN, Genova
23-7 ottobre.
GIAMMANCO, S., ERNANDES, M. (1992) A serotonin
deficiency hypothesis explaining the Aztec human
sacrifice/cannibalism complex. Antropologia
Contemporanea, 15 Pagg. 65-73.
LUSETTI, V. (2008) Il cannibalismo e la nascita della
coscienza. Armando, Roma.
ORTIZ DE MONTELLANO, B. R. (1978) Aztec
Cannibalism, an Ecological Necessity? Science Vol. 200
No. 4342, Pp. 611-7 May 12.
POLICHETTI, G. B. I. (2009) A L’Ombroso Cesare, un po’
di luce nel centenario della morte. Le Voci - Associazione
Nazionale Operatori della Comunicazione -
Approfondimento Scientifico Pag. 12, Ottobre.
376
VOLHARD, E. (1949) Kannibalismus. Strecker und

Schröder, Stuttgart. Trad. ital.: Il cannibalismo.
Einaudi, Torino (1949).
Luisa Ravagnani, Nicoletta Policek
377
Women in Prison in Italy
Luisa Ravagnani1, Nicoletta Policek2
Keywords: women in prison, children, Bankog rules
1. Women in Prison in Italy: the Numbers
According to data compiled by the Italian

Ministry of Justice (30 April, 2013) in Italy there are
2,888 women held in custody over a total population
of 65,917 inmates. A small minority, compared to
their male counterpart, women in prison are
distributed in 7 women's only establishments and in
62 sections intended for women within male prisons.
This means that most of the time prison facilities are
predominantly not catering for women: a major
consequence of the small proportion of women
within the total prison population is indeed that
prisons and prison systems tend to be organised on
1
Researcher in Criminology at University of Brescia.
2
Senior Research Fellow, Centre for Conflict and Migration, RiSSC | Centro
Ricerche e Studi su Sicurezza e Criminalità.
378
the basis of the needs and requirements of male

prisoners. This applies to architecture, to security and
to all other facilities. In some instances, special
provision for women prisoners is added on to the
normal male provision rather than designed from
scratch from a women-centred perspective.
In Northern Italy, in the region of Lombardy,
over a population of 9,390 inmates, 577 are women.
Amongst them, there are 332 female inmates who
have able to take advantage of law 199/2010, dealing
with alternatives to imprisonment, because they have
been sentenced to spend no more than twelve months
in prison. In fact, often women carrying a low
sentence can, under the supervision of the relevant
Court, have their sentence suspended.
When women enter prison, they are dislocated
from their families and their social support networks.
Facilitating visits is a very important part of maintain
links with their families, although, because fewer
women are in prison than men, there are fewer
prisons for women. Consequently, women are often
imprisoned far away from their homes and families,
causing serious problems in the attempt to preserve
strong family ties as the distance and costs involved
in visiting women imprisoned far from home pose a
major obstacle to regular visits. Data from the study
presented here demonstrate, in accordance with
research findings in other countries that, in Italy, most
women in custody are mothers and usually the
primary or sole carer for their children. The
Luisa Ravagnani, Nicoletta Policek 379
relationship with their children is the most pressing

concern for the women interviewed.
With regards to gender specific sentencing it is
worth noticing the imprisonment of mothers with
young children. In Italy there are 17 kindergartens
with 2 operating in Lombardy. The total number of
children incarcerated with their mothers is 41 (40
mothers) with Lombardy accounting for 10 children
living in prison with their mothers (9 mothers). In
total, with reference to data collected by the Ministry
of Justice on 30 December, 2012, 5 pregnant women
were held in custody in Italy, none of them were
hosted in a penal institution in Lombardy.
2. The Italian Legislation
The Decree of the Minister of Justice 5

December 2012, provided for the contents of the
"Charter of Prisoners’ and Internees’ Rights and
Duties" as per art. 69 paragraph 2 Decree of the
President of the Republic 30 June 2000, n. 230
(Regulations containing provisions on the
Penitentiary Act and on the measures entailing
restrictions on, and deprivation of personal liberty) as
amended by Decree of the President of the Republic 5
June 2012, n. 136. The Charter of prisoners’ and
internees’ rights and duties is provided by the
Regulations containing provisions on the Penitentiary
380 Women in Prison in Italy
Act and on measures entailing restrictions on, and

deprivation of personal liberty.
The Charter is given to each prisoner upon
arrival to prison – during their first interview with the
prison governor or with prison staff in order to grant
prisoners better knowledge of all rules and
regulations relevant to daily life in prison
environment.
Together with the Charter, inmates are given
abstracts of Law 354, of 26 July 1975 (Penitentiary Act
and enforcement of liberty deprivation and restriction
measures), of the Presidential decree No. 230, of 30
June 2000 (Regulations containing provisions on the
Penitentiary Act and on measures entailing
restrictions on, and deprivation of personal liberty),
of the internal prison regulations and other acts, even
supranational, relevant to prisoner’s rights and
duties, to discipline and penitentiary treatment,
among which the Convention for the Protection of
Human Rights and Fundamental Freedoms.
The arrival in prison is managed by
Penitentiary Police staff working at the Reception and
Registration Unit. Prisoners have the right to call their
family, if they are entering prison from liberty or they
have been transferred from another facility. Inmates
have the right to appoint one or two legal advisers of
their own choice (if not, a defence counsel will be
appointed by the Court). Unless the judicial authority
is imposing prohibitions at the moment of the arrest
(which cannot exceed 5 days), inmates have the right
to have interviews with their legal adviser since their
381
admission and during the whole prison term,

according to scheduled times and fixed modalities,
after having made application through the prison’s
Reception and Registration Unit.
Inmates are full searched and their
fingerprints detected. They have to deposit their
valuables and properties, such as money, watches, for
example. They also have to undergo a medical and
psychological screening, during which they can refer
of any personal healthcare problems, addictions,
allergies and declare if in need of medicines.
Generally speaking, each prison establishment
should be provided with areas for personal life needs
and for association activities: those areas shall be
sufficiently roomy, well ventilated and heated, and
provided with private sanitary installations.
Prisoners’ contacts with their own family are
guaranteed and inmates’ relatives are to be informed
of transfers to other detention facility. Furthermore,
prisoners have the right to list all relatives, whom
they would like to timely inform in case of death or
serious infirmity, or whom he would like to know
about if in similar situations.
With specific reference to incarcerated women
the relevant legislation states that pre-trial custody
cannot be ordered, or continued, for pregnant
prisoners or mothers with children aged up to six
years, unless there are exceptionally relevant
precautionary exigencies. Law 21 April 2011 n. 62
states that women sentenced to prison terms with
minor children will no longer be held in jail until the
382
child will not have reached the sixth year of age (the
current limit is 3 years of age), except in
circumstances where there are "needs of exceptional
importance "(in this case, the detention will take place
in a penal institution providing attenuated
regulations for mothers in prison – the so called
ICAM. These new rules are operative since January
2014.
Also, the execution of sentence is postponed if
the offender is a pregnant woman or mother of
children aged up to one year and likewise for mothers
with children aged up to three years; the execution of
the sanction of exclusion from the prison association
activities is suspended if the offender is a pregnant
woman or if the woman has recently given birth (up
to six months after birth), or if she is breast-feeding
her child, up to one year.
Convicted female prisoners can request to
bring up their children aged up to ten years outside
prison. Finally, pregnant prisoners and mothers with
children in prison are granted adequate care by
specialized doctors, midwives and paediatricians and
those inmates are allocated in dedicated prison units.
3. United Nations Rules for the Treatment of

Women Prisoners and Non-custodial
Measures for Women Offenders - the
Bangkok Rules
383
Italy is signed up to the United Nations Rules

for the Treatment of Women Prisoners and Non-
Custodial Measures for Women Offenders (the
Bangkok Rules) which require that the distinctive
needs of women be recognised.
The Rules stress the importance of providing
physical and psychological safety for women, and
mandate the provision of diversionary measures and
sentencing alternatives “taking account of the history
of victimisation of many women offenders and their
caretaking responsibilities”. The Bangkok Rules,
adopted by the UN General Assembly in 2010,
provide standards to govern the treatment of the
more than 625,000 women and girls in prison around
the world.
The Standard Minimum Rules for the
Treatment of Prisoners apply to all prisoners without
discrimination; therefore, the specific needs and
realities of all prisoners, including of women
prisoners, should be taken into account in their
application. The Rules, adopted more than 50 years
ago, in October 1960, did not, however, draw
sufficient attention to women’s particular needs. With
the increase in the number of women prisoners
worldwide, the need to bring more clarity to
considerations that should apply to the treatment of
women prisoners has acquired importance and
urgency. Recognizing the need to provide global
standards with regard to the distinct considerations
that should apply to women prisoners and offenders
and taking into account a number of relevant
384
resolutions adopted by different Unite Nations

bodies, in which Member States were called on to
respond appropriately to the needs of women
offenders and prisoners, the present rules have been
developed to complement and supplement, as
appropriate, the Standard Minimum Rules for the
Treatment of Prisoners and the United Nations
Standard Minimum Rules for Non-custodial
Measures (the Tokyo Rules) in connection with the
treatment of women prisoners and alternatives to
imprisonment for women offenders. The most
relevant points from the Rules are listed below:
 Rule 64 Pregnant Women or Women
with Children: Non-custodial sentences for pregnant
women and women with dependent children shall be
preferred where possible and appropriate, with custodial
sentences being considered when the offence is serious or
violent or the woman represents a continuing danger, and
after taking into account the best interests of the child or
children, while ensuring that appropriate provision has
been made for the care of such children.
 Rule 67 Research, planning, evaluation
and public awareness-raising : Efforts shall be made to
organize and promote comprehensive, result-oriented
research on the offences committed by women, the reasons
that trigger women’s confrontation with the criminal
justice system, the impact of secondary criminalization and
imprisonment on women, the characteristics of women
offenders, as well as programmes designed to reduce
reoffending by women, as a basis for effective planning,
Luisa Ravagnani, Nicoletta Policek 385
programme development and policy formulation to respond

to the social reintegration needs of women offenders.
 Rule 68: Efforts shall be made to organize
and promote research on the number of children affected by
their mothers’ confrontation with the criminal justice
system, and imprisonment in particular, and the impact of
this on the children, in order to contribute to policy
formulation and programme development, taking into
account the best interests of the children.
 Rule 69: Efforts shall be made to review,
evaluate and make public periodically the trends, problems
and factors associated with offending behaviour in women
and the effectiveness in responding to the social
reintegration needs of women offenders, as well as their
children, in order to reduce the stigmatization and negative
impact of those women’s confrontation with the criminal
justice system on them..
Rule 70: Raising public awareness, sharing
information and training. 1. The media and the public
shall be informed about the reasons that lead to women’s
entrapment in the criminal justice system and the most
effective ways to respond to it, in order to enable women’s
social reintegration, taking into account the best interests
of their children. 2. Publication and dissemination of
research and good practice examples shall form
comprehensive elements of policies that aim to improve the
outcomes and the fairness to women and their children of
criminal justice responses to women offenders. 3. The
media, the public and those with professional responsibility
in matters concerning women prisoners and offenders shall
be provided regularly with factual information about the
386
matters covered in these rules and about their

implementation. 4. Training programmes on the present
rules and the results of research shall be developed and
implemented for relevant criminal justice officials to raise
their awareness and sensitize them to their provisions
contained therein.
4. Researching Women in Prison in Italy
The main purpose of this study has been to

examine the experience of women incarcerated in
Italy. The data highlighted in this research briefing
forms part of a much wider project carried out by the
University of Oklahoma comparing women’s
experience of their lives in custody worldwide.
The methodology adopted consisted in the
administration of anonymous questionnaires to a
sample of women held in custody in Italy. In order to
cover the entire Country, three geographical areas,
Lombardy, Lazio and Sicily, had been identified as to
offer a representative illustration of the experience of
women incarcerated in Italy, notwithstanding the
acknowledgment that, as researchers, we were able to
only glimpse the world of the women interviewed,
being no more than bystanders at its very margins.
Below is a list of the major areas of investigation
undertaken during this study divided according to
the number of questions asked to respondents for a
total of 68 questions:
387
 Personal Information (questions 1-6)

 Information about family and personal history
(questions 7-23)
 Information prior to current arrest (questions 24-
36)
 Information on health, mental health and
substance misuse (questions 37-48)
 Family situation prior detention (questions 49-68)
With regards to enquiries pertaining to
children who are minor in sections 3 and 5 are some
questions that relate to the presence of children (and
in particular minors) in the family context prior to the
arrest of their mother; the conditions of the life of the
children held in custody with their mother; problems
they might experience prior or as a consequence of
their mother’s arrest; likelihood of family re-
establishment at the end of their mother’s
incarceration.
5. Countries Involved in the Project
Several Countries were invited to take part in

the project to assure worldwide representation of the
issues hereby discussed. At the time of writing this
briefing the list goes as following: Nigeria (formally
accepted); Libya (preliminary step, waiting for formal
acceptance); Nepal (formally accepted for a sample of
questionnaires); Iraq (preliminary step, waiting for
formal acceptance); Mexico (preliminary step, waiting
388
for formal acceptance); Philippines (preliminary step,

waiting for formal acceptance); Taiwan (formally
accepted); Thailand (formally accepted).
6. Project’s Target
The main aim of the study in question had

been the monitoring of the condition of women in
prison in Italy; the evaluation of possible correlations
between the experience of victimisation and the
experience of being considered a deviant subject; the
evaluation of the experience of children whose
mother is incarcerated; the sharing of practices among
the countries involved in the study worldwide; and
finally the structuring of proposals able to tackle the
issue of women in custody at national and
international level.
7. Highlights of the Study
The highlights of the project can be

summarised in the following points:
 Possibility of ongoing update
 Possibility of extension of the Italian sample
incorporating in the study other penal institutions
 Possibility of extension of the study to other
countries worldwide.
389
Some of the tables below summarise the research key

findings.
Number of Children for Each Woman Detained
390
Number of children living with the mother at

the time of the arrest
50
37,5
35,2
34,1
32,9
31,3
28,1
21,6
21,6
16,5
8,2 12,5
12,5
12,5
10,8
6,3
5,4
6,2
5,9
3,1
0 2,7
2,7
1,2
1,2
0
0
0
0
0
0
0 1 2 3 4 5 6 7
Total Lombardy Lazio Sicily
Table 2
With regard to the number of children, table 1

makes it possible to attribute the higher percentage, at
national level, of women who state that they have
only one child (25.4%), followed by those with 3
(16.7%), then with 2 (13.2%) and finally with 4
391
children (10.5%). Definitely lower is the percentage

attributable to women stating that they have 5, 6, 7
and 8 children: 3.5% is instead the highest percentile
value referring to women with 5 children.
Some variations can be found at regional level:
the women incarcerated in Lazio represent the
highest percentage of inmates with only one child
(31.8%), those held in Lombardy reach the highest
percentage of inmates with two children (16%), and
the women detained in Sicily reach the highest quota,
with regard to being a mother of three (23.8%).
With regard to 4 to 5 children is again
Lombardy to achieve the most significant percentage,
although - as already mentioned - all women
incarcerated are settling at lower levels than those
women with 1to 3 children.
Finally, in percentage, inmates with 6 -7 and 8
children are to be found more often amongst women
held in custody in Sicily.
Narrowing the field to only respondents living
with minor children at the time of arrest (table 2), it
can be observed that women who report being in this
predicament account for 67.1% of the entire sample of
women with children.
The chart below shows how Lazio and
Lombardy are the regions in which women
incarcerated were mostly in the situation of having to
deal with minor children at the time of the arrest:
37.5% of women in Lazio and 35.2% of women
in the region of Lombardy had a minor child living
with them, 21.6% of the women incarcerated in
392
Lombardy and 12.5% of those incarcerated in the

region of Lazio and in Sicily had two children, 10.8%
of the women in Lombardy had 3, 12.5% of the
women in prison in Lazio had 4 and, albeit with a
much lower percentage, it is worth emphasizing that
2.7% of women incarcerated in Lazio had respectively
6 and 7 children to look after.
In the face of a greater number of children
declared, women inmates in Sicily appear to be part
of the sample less affected by the problem of
cohabiting children to care for at the time of arrest.
From what discussed thus far, it seems
therefore comprehensively rather significant the share
of women who deliberately keep out of prison two,
three, four or even more minor children, with
predictable and growing hardship for the children.
Other interesting data relating to the condition
of reclusive mothers and collected by means of the
anonymous questionnaire can be briefly summarized
as follows:
Situation of the children of women in prison
- Almost all of the women had all the children
by the same partner (83.8%);
- 80% of mothers are planning to return to live
with their children as soon as they leave prison;
- 3.8% of women have children who, in turn,
are in prison;
- 62.7% of the inmates at the time of arrest, had
minor children living with them (this figure is in line
with that of the national study: in fact, 58% of women
interviewed said they had minor children);
393
- There is a remarkable share of minor

children, even before their mother’s arrest, who were
not living with their mother: to be more precise 30
cases out of 80, 37.5% of mothers with minor children,
taking account that a percentage of 5.8% did not
answer this question.
Children’s Age
First child's age
46,7
35,3 37,2
29,6
19,7 23,7
7,8
0
1-6 anni 7-12 anni 13-18 anni 19-23 anni
age at the time of the arrest

age at the time of the interview
394
Second child's age
63
44,5
37
18,5 18,5
11,1 7,4
0
1-6 ANNI 7-12 ANNI 13-18 ANNI 19-23 ANNI

Third child's age
57,4
42,7 43,1
21,3
14,2 14,2
7,1
0
1-6 ANNI 7-12 ANNI 13-18 ANNI 19-23 ANNI

395
At the time of the mother’s arrest, the majority

of children were aged between 7 and 12 years, with a
peak around 10 years (12.9%), and at the time the
interview was conducted children were aged between
13 and 18 years. As for the gender, the first child is
female in 59.6% of cases, 40.4% is male whilst both
genders, in almost all cases (92.5%) needed her care at
the time of separation from the mother. 10.5% of
mothers did not however respond to questions about
age and gender of the first child.
Also, with regard to the second child we have
that, in most cases, upon their mother’s arrest, the
child was aged between 7 and 12 years, reaching a
peak between 9-10 (33.3%) and that at the time of the
interview still remained in the same age bracket. In
51.9% of cases, the second child is female, while is
male in 48.1% of the cases. 3.5% of the inmates did not
respond to questions about age and gender of the
second child. In this instance, 92.6% of women
interviewed said that children needed more care and
support at the time of separation.
The third child at the time of the arrest, was
mostly between the age of 3 and 8 years (50.3%), and
at the time of the interview remained in the same age
bracket. The third child is male in 64.3% of the cases,
and female in 35.7% of the cases, whilst both gender,
i.e. 85.7% of children, needed the support of the
mother.
The totality of women with three children
under age, answered all questions regarding age and
gender of their children.
396
Raised by (when the mother is/was in prison):
397
From the tables below, it appears that, in most

cases, the child, at the time of their mother’s arrest,
remains to live with the other parent (42.5%).
It is important to highlight, however, that, in
the remaining 57.5% of the cases, the situation of the
mother being detained coincides, for many children,
with a double loss, albeit probably temporary, i.e.
with the removal from both parents.
This results in a strong fragmentation of the
child's psychological wellbeing, but, also, in most
cases the outcome is the dissolution of the entire
family.
From such reasoning, it could be inferred that
in 79.5% of cases, the child is still living in the family
of origin (grandparents, uncles or other relatives)
although not with the father. It is also worth noticing
the percentage of custody cases (13%) either in the
care of foster families or in residential care settings.
The institutionalization instead affects only a small
minority of cases (1.6%).
No woman claims to have had or have chosen to keep
their children with them in prison.
398
Raised by (before mother's

incarceration)
28,6 28,5
14,3 14,3 14,3
FATHER SISTER G.PARENTS CHILD CARE CHILD

INSTITUTE
As it can be observed, however, is the father or

the family of origin to shoulder the burden of caring
for the children; yet, institutionalization or foster care,
covering a significant proportion (around 30%)
remains a reality.
This is, indeed, a rather disturbing matter,
especially when taking into account the fact that the
foreign parent, for whom the separation from their
children at any time prior to incarceration might be a
simply geographical datum, represents a minority of
the group.
399
With regard to the reasons for early

separation, in some instances, we should refer to
reasons related to employment, geographical distance
or economic reasons, in other instances it is a choice,
but most of the time, these are measures implemented
by a Juvenile Court. 34.6% of the inmates no longer
can claim legal custody of their children, and 9.6%
have custody of only a few, in the face of a high
percentage of non-respondents (38.8%).
This outlines a framework of family
relationships seriously compromised even before the
arrest, and often characterized by a personal
biography riddle with addiction or with previous
experience of detention.
If this is the result obtained with regard to
mothers, we need to ask those who had legal custody
of the child. The role of that 34.6% of women
deprived of custody is covered mainly by the other
parent (3.4%), by the care home (3.4%) or by
grandparents (5.2%).
Considering instead the group of mothers
who lived with their children at the time of the arrest,
we analysed several aspects of the child's life before,
during and after the incarceration of their mother.
400
Where the Children Live
Number of children living with the

mother at the time of her arrest
50
37,5
35,2
34,1
32,9
31,3
28,1
21,6
21,6
16,5
12,5
12,5
12,5
10,8
8,2
6,3
6,2
5,9
5,4
3,1
2,7
2,7
1,2
1,2
0
0
0
0
0
0
0
0 1 2 3 4 5 6 7
Total Lombardy Lazio Sicily

401
Contacts With the Incarcerated Mother
Contacts with children

67,2
46,6
43,8
36,8
25,9
15,8
8,6
6,9 6,9
1,8 1,8
0 0 0 0
MORE ONCE A LESS THEN ONCE A NEVER

THAN MONTH ONCE A YEAR
ONCE A MONTH
MONTH
meeting in prison mail telephone call
The emphasis on maintaining contacts with

incarcerated parents is enshrined in Article 9 of the
Convention on the Rights of the Child, since the
constant relationship between parents and children is
402
believed to be, on the one hand, based upon the best

interest principle of the child involved and, secondly,
such relationship is a good way to reduce the
reoffending rate of the parent involved thus
increasing their chances of rehabilitation after
incarceration.
From the graph, it appears that a fairly
significant amount of the sample from this study
(36.8%) sees "often" or talk to their children or often
receive mail from them (46.6%), with "often" meaning
more than once a month, but an even higher
percentage (43.9%) stated that they do not ever see or
talk to their children on the phone (67.2%).
To make understandable this sporadic
frequency of talks or correspondence with their
children we could offer a number of reasons: the
remoteness of the prison establishment from the place
of residence, family opposition, difficulties in
accompanying them, the suffering that the meeting is
capable of arousing or, ultimately, an expulsion
measure established by the courts or even financial
hardship.
In any case, even if the meeting takes place,
the talks do not represent per se a tool that can
alleviate the pain associated with the separation.
In fact, the limited time, the difficult
attainment of intimate moments, the contraction of
affectivity and the closed coldness of the environment
make it, perhaps, even more painful to meet the
children.
403
We conclude, therefore, that the talks are often

inadequate to alleviate the pain of physical and
emotional separation. It is also important to keep in
mind the variance between the perceived time and
the actual frequency of the meetings held, in other
words the implicit evaluation of the perception that
the inmates have held for that frequency. Even when
inmates held weekly talks, in terms of subjective
perception, they complain of experiencing inadequate
attendance of their children in the management of
what is in effect perceived by the mothers a recluse
affectivity.
8. Critical Situations: First Child
The scope of the survey questionnaire was

also to analyse how the inmates prior to incarceration,
were able to support their own children. This query
has led to the following results: in most cases (70.6%),
the inmates or the husband / partner supported their
children through their work; a small percentage
(5.3%) stated they have supported their children with
money unlawfully obtained (theft, prostitution, drug
dealing).
Many inmates have underlined their financial
hardship, often linked to situations of unemployment,
drugs misuse, alcohol dependency, physical or
mental health problems, and they have declared that,
in order to meet their children’s needs, they have
404
taken advantage of welfare benefits (in the format of

free school meals, special school programmes, boy
scout groups, summer camps or support from the
local church).
The last part of the questionnaire focuses, as
anticipated, on the existence of any deviant behaviour
patterns of children, in order to understand if these
were already known prior to their mother entering
prison, or whether such behaviours had arisen during
or after the period of custody of the mother.
Reference has been made to the children’s
relationship with their parents or with peers, school
performance, the use of drugs or alcohol,
incarceration and early inclusion in the community
care settings.
The tables presented below show,
respectively, data with regard to the first (49 women
respondents), the second (23 women respondents)
and the third child (12 women respondents).
It is clear that, in most cases, an alarming
situation had already been there before the
incarceration of their mother, and indeed only in few
cases, the outset of any problem began during their
mother’s incarceration.
This may be due, on the one hand, to the fact
that many of the detainees interviewed had very
young children, within the age group 1 to 6 years,
and, as such, their behaviours could not be
considered stereotypical linked to 'adolescence; on the
405
other hand, this could testify the inclusion of children

in the context of deviant life even before their
mother’s imprisonment.
80% of female prisoners were aware of where
the children live and had no concerns about the place
where their children are, however, most women
expressed a desire to return to live with them at the
end of the period of incarceration, thereby showing a
strong need for family reunification and a clear desire
to pursue and accomplish their parental role.
Only 5.8% did not answer this question.
However, although the data do not allow to
determine a two-way link between the detention of
the mother and the conduct at risk of delinquency of
the children, for the reasons given above, it is
important to remember that "the size of the family
and the reconsideration and the reclaiming of
parental roles, are of extraordinary importance in the
process of recovery of the prisoner irrespectively of
their gender. This perspective offers to those who
have committed a crime, a drive towards socially
acceptable changes, and helps them to be aware of the
fact that a child growing up healthy, free, and
emotionally satisfied, has all the potential to avoid
taking routes of personal distress and social
deviance".
406
Problemat
Problemat
Problematic ic before
ic before Non
since mother and after
First child mother problemat
entering mother
entering ic
prison entering
prison
prison
9 Expelled 36
Bad grades 1 instance
instances from school instances
Expelled 2 Withdrawn 44
none
from school instances from school instances
Relationshi
Withdrawn 2 44
ps with none
from school instances instances
friends
Relationshi Relationshi
4 43
ps with p with none
instances instances
friends parents
Relationshi
3 1 42
ps with Runaway
instances instance instances
parents
1 47
Runaway Arrested none
instance instances
48
Arrested none Incarcerated none
instances
48
Incarcerated none Alcohol none
instances
47
Alcohol none Drugs none
instances
46
Drugs none Depression 1 instance
instances
2 44
Depression Suicide none
instances instances
48
Suicide none Pregnancy none
instances
1 Expelled 47
Pregnancy none
instance from school instances
407
Critical Situations: Second Child
Problematic
Problematic Problematic
before and
before since
after Non
Second Child mother mother
mother problematic
entering entering
entering
prison prison
prison
17
Bad grades 2 instances 1 instance 1 instance
instances
Expelled 20
1 instance none
from school instances
Withdrawn 19
1 instance none 1 instance
Relationships 19
4 instances none none
with friends instances
Relationships
1 instance none 1 instance 21instances
with parents
22
Runaway None none none
instances
22
Arrested None none none
instances
22
Incarcerated None none none
instances
22
Alcohol None none none
instances
22
Drugs None none none
instances
21
Depression 1 instance none none
instances
22
Suicide None none none
instances
21
Pregnancy 1 instance none none
instances
408
Critical Situations: Third Child
Problemati
Problemati Problemati
c before
c before c since Non
and after
Third Child mother mother problemati
mother
entering entering c
entering
prison prison
prison
9
Bad grades 1 instance None none
instances
Expelled 9
1 instance 1 instance none
Withdrawn 9
1 instance none none
Relationship
2 9
s with none none
instances instances
friends
Relationship
10
s with 1 instance none none
instances
parents
11
Runaway None none none
instances
11
Arrested None none none
instances
11
Incarcerated None none none
instances
11
Alcohol None none none
instances
11
Drugs None none none
instances
10
Depression 1 instance none none
instances
11
Suicide None none none
instances
11
Pregnancy 1 instance 1 instance none
instances
409
References
AA.VV., Reforming Women’s Justice: Final Report of the

Women’s Justice Taskforce, Prison Reform Trust, 2011,
www.prisonreformtrust.org.uk
AYRE L., PHILBRICK K., REISS M. (eds.), Children of
Imprisoned Parents: European Perspectives on Good
Practice, EUROCHIPS, Paris, 2006.
BAUNACH P.J., Mothers in Prison, Transaction Books,
New Brunswick 1985
GIUFFRIDA M.P., Studio sulle donne ristrette negli istituti
penitenziari, DAP – Gruppo di lavoro ICAM, Roma, 3
aprile 2009.
GURANSKY, D., HARVEY, J., MCGRATH, B., O’BRIEN, B.,
Who’s minding the kids?... developing coordinated services
for children whose mothers are imprisoned, Social Policy
Research Group, University of South Australia,
Adelaide 1998.
HUMAN RIGHTS WATCH: Collateral Casualties: Children
of incarcerated drug offenders in New York, Vol. 14, No. 3
(G) (June 2002) pp. 9-11,
http://www.hrw.org/reports/2002/usany/USA0602
.pdf
HUMAN RIGHTS WATCH: Collateral Casualties: Children
of incarcerated drug offenders in New York, 4, 3 (G), June
2002, http://www.hrw.org/reports /2002/usany-
/USA0602.pdf.
410
NELLIS, M., Kids Are The Issue: Sentence deferral and the
use of custody for women offenders.Report by a member of
the Ecumenical Group on Women in Prison, submitted to
the Home Office (January 2001) pp. 3-4, 2001, pp. 2-3,
www.quno.or.
SEVENSSON R., “Shame as a Consequence of the Parent-
child Relationship. A Study of Gender Differences in
Juvenile Delinquency”, European Journal of Criminology,
1, 4, 2004, 498-499.
Michele Sanza
411

Personality Disorders
Michele Sanza1
Keywords: severe personality disorders, treatment

management.
In 2013 the Mental Health and Addiction

Disorders office of the Emilia Romagna Region has
approved the Guidance on treatment of Sever
Personality Disorders (1; 2), basically founded on the
“Borderline personality disorder: Treatment and
Management. The Nice Guideline” (3), which have been
updated and adapted to the national and local contest
of one of the larger and populated region in Italy. The
aim of the Guidance is to ameliorate treatment
standards for people with a Personality Disorder, as it
is well known that they often receive inappropriate
pharmacological therapies (4), are frequently met in
1
M.D. Psychiatrist, Director of the Pathological Addiction Programme –
Azienda USL della Romagna (Cesena)
Personality Disorders.
412
the emergency settings (5) and are often hospitalized

(6) for crisis and self damage behaviors. Despite the
lack of evidence for each of these solutions they are
driven as first line approach to Personality Disorders,
because of the negative prognosis commonly
associated to the Axis II area and, not secondarily,
because of the self defense intentions of the clinicians
for the so called unpredictable social undesirable
behaviors to which Borderline patients are so often
equalized.
Emilia Romagna has a 4.200.000 inhabitants
population and a widespread mental health service
network that includes addiction services and child
and adolescence psychiatric services gathered in 11
Departments. Emergency psychiatric hospital beds
are all in one with the departments themselves.
Mental health care, in EMR, as well all over the
Country, is founded on principles of advocacy, self
determination and assertive outreach to manage drop
outs, crisis interventions and risk taking behaviors.
Any way compulsory treatments, intended like
extreme treatment tools, are not rare.
The growing epidemiological wave of
Personality Disorders (PD) and their common
comorbilities in Axis I, Substance Abuse Disorders,
Eating Disorders, affective Disorders, are challenging
the well settled Mental Health Care in Italy (7), as it is
largely fitted on psychoses needs of care, for which
services provide long term rehabilitative programs
often offered as residential care in sheltered and
protective environments. But in the perspective of
Michele Sanza
413
recovery of the PD, the parens patriae orientation is

condemned to fail. For that reason the Mental Health
office of Emilia Romagna has landed to the guidance
on treatment of Sever Personality Disorders.
The first step has been the definition of target

population. It has been identified in a non specific
categorical way as Severe Personality Disorders
including all the cluster B area diagnosis with the
exception of the Antisocial Personality Disorder
(APD). This last one has been taken a part for the
reason that in Italy the legal system and the health
care system are basically separated. Criminal subjects
who are mentally disordered are not punished for
their crimes but are obliged to be treated in special
hospitals. A new reform is waited to change those
hospitals, at the moment managed and enforced by
the legal system, into residential care programs
carried on by Mental Health Community Services.
Than the scientific committee, composed by
clinical experts, belonging to the different
professional areas, has selected the principal
questions to whom the adaptation of the guidelines
had to be responsive. After that, the main
international guidelines had been processed and
selected. So they have been measured using the Agree
II (8), a semi structured method that helps experts to
analyze the quality of Guidelines. The NICE 2009 GL
on Borderline Personality Disorder has been chosen
as the best one compared to the American Psychiatric
Association Guideline (9) and to the Department of
414
Health of Cataluña Guideline on Borderline

Personality Disorder Treatment (10).
Then has been pointed out the extension to
which the NICE Guideline covered the questions
formulated by the committee. The literature on all the
topics related to the questions area has been updated
using the same research criteria, so to maintain the
maximal coherence to the original guideline.
The final step has been the adaptation of the
recommendations, through the experts consensus
structured conference dehly type. Points of reference
for this task were: the recent primary literature
findings, subsequent to 2009, the national and
regional legal frame and the plan of accessibility of
Emilia Romagna Mental Health Office (11). This plan
offered an extended current analysis of the
organizations of all the 11 mental health departments
of Emilia Romagna.
The Guidance offer a set of specific
recommendations for some of the topic questions
related to treatment of Personality Disorders into the
Public Health Care System.
The first issue is the therapeutic contract. To
improve coherence of actions and avoid the potential
pathological aftermath of patient’s attitude to split
professionals, a well settled and formalized contract
has been recommended as essential (12). It has to be a
paper where to put on goals, tools, people involved
(both professionals, patient and family group) and
not less important the crisis management plan (13).
The main criticism on this point has been the risk that
Michele Sanza
415
the contract could be such a formal and bureaucratic

manner to establish the relation with patients, so
mining the possibility of empathy. The reason why
the term contract has ben maintained are three. First,
this term is well recognized in the specialized
literature, since Kernberg (14) indications on how to
adapt psychoanalytic therapy, to the clinical
necessities of borderline patients. Second, the
concepts of “alliance” and “deal”, which both had
been proposed as alternative to contract, could be
part of the contract, but not the contrary. And third,
may be the main reason, is that Services need to learn
how to react with coherence and constancy to the
continuous instability of Severe Personality
disordered patients. To this claim, the formalization
of therapeutic contract seems to be a successful
potential instrument of communication, able to
sustain the therapy structure along the time.
Emergency service use and crisis
management are topics strictly linked to the
therapeutic contract. Patients should be helped to
identify the specific conditions that characterize their
stress related outbursts. At the same manner,
solutions have to be developed trying to use the
personal behavioral skills repertoire and patient’s
wisdom as starting points to cope with anger and
other emotional distress conditions. Not excluding
the possibility of hospitalization, especially to prevent
suicide events, patients should be trained to better
use other services resource to seek help and recovery
from crisis.
416
The third recommendations cluster regards

the Configuration of Services. Here as been
translated the stepped care model adapted to the
Italian Public health Care System. The basic principle
of stepped care (15) is to give the intervention at the
minimum level of complexity and cost. The E.R.
Guidance individuates three levels of care: the
intensive, the extensive (or simple) treatment
pathways, both supplied by specialized services, and
the self help level of care, that is linked to Primary
Care and Social Services. Patients are supposed to use
the more appropriate level of care at each phase of
long time experience of service use. Professionals, and
case managers should facilitate the correct
identification of the right track at any time.
Transition from Child and Adolescence to
Adult Mental Health Services is a key question as in
many cases Personality Disorder traits are well
defined since the age of adolescence. Not rarely those
traits are consequence of specific child disorders as
Attention - Deficit/Hyperactivity Disorder (ADHD).
Research have shown the utility of early intervention
to reduce risks of Axis I comorbidity and impact of
symptoms during the adulthood. Young persons, and
their families, who are under treatment in Child and
Adolescence Mental Health Services should receive
great attention and transitions to adult services must
be carried on a structured interface pathway. The
common belonging to the same Mental Health
Department, both of Child and Adolescence Services
Michele Sanza
417
and Adult Services is supposed to be a facilitating

factor.
Psychotherapy is considered the most
effective treatment for Borderline Personality
Disorder. Research has shown promising results of
evidence based psychotherapies in treating BPD, with
no superiority of one type over another. Recently,
authors have highlighted some common factors that
may drive the efficacy of these psychotherapies, such
as a predictable structure and methods specifically
designed (16). Moreover, Community Mental Health
Services have to develop a systematic attention to
improve motivational attitude to elective treatments.
Real patients have a different degrees of compliance
to treatment and often they aren’t ready for a
structured psychotherapy, but still they have to be
treated. Related to this, teams involved in treatment
of Borderline patients need a specific attention to
improve the ability to cope with the stressing
situations activated by the patients. Supervision is a
strategic tool to prevent splitting among teams and to
empower professionals on their own therapeutic
attitudes. While pharmacological approach must be
selectively chosen to treat transitory target symptoms
or comorbid Axis I conditions, like Major Depression
Episodes, Bipolar Disorders, a generalized and
indiscriminative use of multi pharmacotherapies,
often found in practice, should be avoided if even
banned for the multiple iatrogenic effects.
Emilia Romagna Guidance have been diffused
and implemented through a large educational
418
programs, to witch have taken part more than 50

mental health managers and 120 clinical
professionals. A research has been planned to
evaluate the effectiveness of the non paternalistic
empowering approach to Severe Personality
Disorders through the dissemination of contract
based well structured model identified by the Emilia
Romagna Guidance.
References
(1) REGIONE EMILIA ROMAGNA - Servizio Salute

Mentale, Dipendenze Patologiche e Salute nelle Carceri,
Linee di indirizzo per il Trattamento dei Disturbi Gravi di
di Personalità Versione con le strategie di Ricerca , 2013,
Bologna;
http://www.saluter.it/documentazione/leggi/regio
nali/linee-
guida/disturbi_gravi_personalita_linee_versione_rice
rca.pdf/view?searchterm=personalità
Linee di indirizzo per il Trattamento dei Disturbi Gravi di
di Personalità, 2013, Bologna;
http://www.saluter.it/documentazione/leggi/regio
nali/linee-
guida/disturbi_gravi_personalita_linee.pdf
(3) BORDERLINE PERSONALITY DISORDER: Treatment and
Management. The Nice Guideline. National collaborating
Michele Sanza
419
centre for mental health. 2009.

http://www.nice.org.uk/nicemedia/pdf/Borderline
%20personality%20disorder%20full%20guideline-
published.pdf
(4) BAKER-GLENN, E., STEELS, M., EVANS., C. (2010) Use
of psychotropic medication among psychiatric out-patients
with personality disorder. The Psychiatrist; 34: 83–86.
(5) BORSCHMANN R., HENDERSON C., HOGG JOANNA,
PHILIPS R., MORAN P. (2012) Crisis interventions for
peolple with borderline personality disorder. Cochrane
Database of Sistematic Reviews, Issues 6.
(6) BERRINO A., OHLENDORF P., DURIAUX S., BURNAND
Y., LORILLARD S., ANDREOLI A. (2011) Crisis
intervention at the general hospital: An appropriate
treatment choice for acutely suicidal borderline patients.
Psychiatry Res.; 186:287-92.
(7) M.SANZA “Pazienti senza Compliance o Servizi senza
Compliance?”, 2005 Psichiatria di Comunità, Vol. 4,
n°2.
(8) AGREE NEXT STEP CONSORTIUM. (2011) AGREE II.
Checklist per valutare la qualità delle linee guida.
Fondazione GIMBE: Bologna.
(9) AMERICAN PSYCHIATRIC ASSOCIATION. (2001)
Practice guideline for the treatment of patients with
borderline personality disorder. Washington DC: APA.
(10) GRUPO DE TRABAJO DE LA GUÍA DE PRÁCTICA
CLÍNICA SOBRE TRASTORNO LÍMITE DE LA
PERSONALIDAD (2011). Fórum de Salud Mental y
420
AIAQS, coordinadores. Guía de práctica clínica sobre

trastorno límite de la personalidad [Versión resumida].
Barcelona: Agència d’Informació, Avaluació i Qualitat
en Salut. Servei Català de la Salut. Pla Director de
Salut Mental i Addiccions. Departament de Salut.
Generalitat de Catalunya.
(2011) Piano dell’Acesso ai Dipartimenti di Salute
Mentale, Documento interno non pubblicato.
(12) BEN PORATH DD (2004) Strategies for securing
commitment to treatment from individuals diagnosed with
borderline personality disorder. J.Contemp. Psychother.;
34: 247-263.
(13) WONG M.T. (2005) Low hospital inpatient
readmission rate in patiens with borderline personality
disorder: a naturalistic study at Southern Health, Victoria,
Australia. Aust. N.Z.J. Psychiatry; 39: 607-611.
(14) KERNBERG O.F., (1987), Disturbi Gravi della
Personalità, Torino, Bollati Boringhieri.
(15) NATIONAL INSTITUTE FOR HEALTH AND CLINICAL
EXCELLENCE, (2011) Commissioning Stepped Care for
People with Common Mental Health Disorders,
http://www.nice.org.uk/guidance/cmg41.
(16) MCMAIN SF, LINKS PS, GNAM WH, GUIMOND T,
CARDISH RJ, KORMAN L, STREINER DL. (2009) A
randomized trial of dialectical behavior therapy versus
general psychiatric management for borderline personality
Michele Sanza
421
disorder. Am J Psychiatry.
422
Franco Scarpa, Benedetta Vittoria, Tommasa Agueci
423
Treatment of Mentally Ill Offenders

Not Guilty by Reason of Insanity
(NGRI)
Franco Scarpa1, Benedetta Vittoria2, Tommasa Agueci3
Keywords: forensic hospital, ri-organization, psychiatry
1. Closing procedure of National Forensic

Psychiatric Hospitals (Ospedali
Psichiatrici Giudiziari - OPG) in Italy
The “O.P.G.” (Forensic Psychiatric Hospital) is

a Penitentiary Institute managed by the Ministry of
Justice. The institute hosts offenders who have been
recognized “not guilty by reasons of insanity” but are
considered “socially dangerous”. Security measures
are applied to these subjects.
1
Director of the Unit “Health in Prison” USL 11 Toscany.
2
Psicologista t the Unit “Health in Prison” USL 11 Toscany.
3
Unit “Health in Prison” USL 11 Toscany.
Treatment of Mentally Ill Offenders Not Guilty by
Reason of Insanity (NGRI)
424
These measures were introduced in the Italian

Criminal Code in 1930 with “Rocco Code”; they can
be divided into:
1. Custodial: “psychiatric” (admission to
OPG or to Care Custody House4) and “not
psychiatric” (assignment to a workhouse or
agricultural colony, admission to a reformatory for
minors (under 18 years old).
2. Not custodial: probation, prohibiting
residence in one or more municipalities, prohibiting
access to certain places, expulsion of foreigners from
the Italian state (controlled freedom).
The type of security measure is related to the
legal concept of social dangerousness and
imputability, while the duration is strongly
influenced by the quality and the outcome of
treatment. The security measure can be revoked only
when social dangerousness has ceased. In a more
specific way the scenario of the consequences of the
combined assessment of imputability and
dangerousness can therefore be:
If high: acquittal and

Total insanity + social admission to OPG.
dangerousness If attenuated: probation
or controlled freedom.
4
Care Custody House is a section inside OPG.
425
Both measures remain

in force until social
dangerousness ceases
Total insanity + lack of Acquittal and dismissal
social dangerousness of the case
Penalty reduced
If high: admission to
Partial insanity + social
Care Custody House
dangerousness
(OPG)
If attenuated: probation
Penalty reduced and no
Partial insanity + lack of
application of security
social dangerousness
measure
Therefore the security measures (admission to

OPG or Care Custody House) may be applied to any
offender who is not imputable or partially imputable
by reasons of insanity. Article 222 of the Italian Penal
Code states that in case of “acquittal” due to mental
illness, the period of detainment in OPG is not
inferior to 2 years; 10 years for a life conviction and 5
years of OPG if sentenced to a minimum of 10 years.
Article 219 of the Italian Penal Code states that the
person convicted to a decreased penalty, by reason of
insanity, is admitted to OPG for a period not inferior
to 1 year when the sentence is not inferior to 5 years;
if the law establishes, for the crime committed, a life
sentence or a minimum of 10 years, the security
measure has a duration of a minimum of 3 years.
426
Finally, in the case of conviction for another crime,

the socially dangerous offender will be detained for a
period of at least 6 months in OPG (diagram 1).
Diagram 1
The admission to OPG therefore does not

depend on a physician’s decision, but is exclusively
ordered by the Court. The security measure applied is
based on the recognition that the offender is socially
dangerous.
427
However, in order to apply it the judge

assigns, to a technical consultant, the task of
providing a forensic psychiatric opinion (expertise)
regarding the mental competence of the offender and
his/her social dangerousness. There are essentially
three queries to which the expert must reply:
imputability, social dangerousness and capacity to
stand trial (Art. 70 c.p.c.). The presence of a mental
disorder does not invalidate (automatically) the
individual's ability to stand trial. If, as a result of
assessment, the defendant is found unable to stand
trial, the Judge orders its suspension. After a six
month period (Art 72 c.p.c.) the defendant undergoes
reassessment.
The judge may order that the defendant be
assigned to the care of Psychiatric Services but
admission in OPG is strictly linked to security
measures. On the other hand, discharge is strictly
dependent on attenuation of dangerousness and if
this is not achieved the duration of the security
measure is prolonged.
Others eligible for admission to OPG are:
 Art. 148: onset of mental disorder
during imprisonment which prevents the execution of
the sentence.
 Art. 232: probation converted into a
security measure.
 Art. 112: “psychiatric observation”,
mental state assessment of prisoners for a period of 30
days following notification by the Executive Board of
the Penitentiary Institute.
428
Discharge is usually granted by the

Surveillance Judge through “final experiment license”
(art 64 p.o.), after the formulation of a rehabilitation
program by the healthcare team in collaboration with
the patient’s Mental Health Services. The “final
license” allows continuity of treatment and
guarantees that any eventual failure will determine
revocation of the license and readmission to OPG.
The final license may be granted in the last 6 months
of the measure and it can be suspended if the patient
does not adhere to the program. If satisfactory results
are obtained (adherence to treatment and no
recidivism), the judge proceeds to definitely revoke
the security measure.
The OPG was opened in the late 1800s to
accommodate the increasing number of “insane”
prisoners or those declared incorrigible and therefore
not accepted by health care facilities and those
“acquitted” of the crime, not imputable and not
accepted by the mental hospitals of the time because
they were considered dangerous. The OPGs in Italy
are 6:
1) Aversa (Napoli), 1876;
2) Montelupo Fiorentino (Firenze), 1886;
3) Reggio Emilia, 1892;
4) Napoli, 1923;
5) Barcellona Pozzo di Gotto (Messina), 1925;
6) Castiglione delle Stiviere (Mantova), 1939.
The total number of patients hospitalized in
the 6 OPGs are distributed as follows (diagram 2):
429
Diagram 2
ACTUAL NUMBER OF PATIENTS (12-12-31)
OPG WOMEN MEN TOTAL
Castiglione
delle Stiviere 80 196 276
(Mantova)
Reggio Emilia 123 123
Montelupo
Fiorentino 89 89
(Firenze)
Aversa
128 138
(Napoli)
Napoli 90 90
Barcellona
Pozzo di Gotto 175 175
(Messina)
TOTAL 80 811 891
The OPG of Castiglione delle Stiviere is the

only institute under the management of the Ministry
of Health, entirely staffed by medical personnel
without penitentiary staff and it is the only one with a
women's section. The type of diagnosis encountered
430
in the total population of patients admitted to the

OPG are summarized in diagram 3:
The process of reforming the existing OPGs
began in 1999 (D. Lgs. 230/99) but only recently,
according to a Government Decree dating 1-04-2008,
was the decision taken to transfer the competencies of
health care, for the entire prison population including
OPG patients, from the Ministry of Justice to the
Ministry of Health.
The Decree, and subsequent art. 3 ter of Law
09/2012, defined a program for the complete
shutdown of OPGs and substituting the existing
penitentiary institutes with residential health
communities.
The new Residential health Community will
be composed of two single units, each of which will
have a 20 bed capacity, forming a complex with a
total of 40 beds. The “roadmap” regarding the closure
of the existing 6 OPG’s provides for regional
residential health units so that offenders declared
NGRI and subject to security measures will do so in
their own Regions.
The New Residential Mental Health
Communities will be provided of surrounding and
tools systems in order to guarantee that people
submitted to measure should stay inside them cause
of their declared social dangerousness.
431
2. Analysis of patients’ discharge from an

OPG.
With the aim of reducing the present number

of patients in Montelupo Fiorentino OPG, the
Tuscany Region supported and funded 22 therapeutic
programs for the discharge of patients. Diagnosis of
those patients is described in diagram 3.
Diagram 3
Main Psychiatric Comorbidity for

Diagosis substance abuse
Schizophrenic 7 2
Disorders
Bipolar Disorders 5 2
Personality 8 4
Disorders
Mental Retardation 2
At the end of the program the discharged patients

destination varied as described in the diagram 4.
432
Diagram 4
Community Service of
discharge
Therapeutic
7
Communities for NGRI
Therapeutic
9
Communities
Home and Assistance

4
programm
Nursing homes 1
Negative effect 1
Discharge programs were specifically aimed at

those patients whose security measure had been
extended measure.
They are cause of their greater burden for
ordinary services of Community, as showed in the
following diagram about time spent in OPG for
security measure.
433
Diagram 5
Time spent under 39,6

security measure
(months)
Prolongation of measure 16,5

(months)
Every project has an annual cost which

regards a monthly rate in the Residential Community
Facilities (Therapeutic Communities, Home or Group
Apartment, Job support and other economical
support).
More than the half of the 22 projects (12
projects) had a cost superior to € 60.000, 5 cost
between € 30.000 and € 60.000 and only 5 projects cost
less than € 30.00,00. The average cost of the 22 projects
was € 49.650.
This means that the cost of treatment for the
entire population of 1.000 patients actually still
confined in the 6 OPG’s will be about € 50 million per
year.
Very important and useful is monitoring the
“revolving door patient” that occurs when the
program is unsuccessful and the patient returns to
OPG because the security measure has been restored
by Surveillance Judge. At the moment this
phenomena regards less than 15% of the patients still
remaining in the OPG.
434
Testing another patient population (52

patients discharged) with HCR-20 scheme, we
discovered that those who failed in their program and
have returned in OPG had higher scores.
HCR- SCALA SCALA SCALA

20 H C R
Returning
Patients 26,81 14,63 6,18 6,00
(N. 11)
Other
patients 17,19 11,34 3,56 2,29
(N. 41)
Test T <
<0,0001 0,0004 0,0001
Student 0,0001
More than 90% of these patients were

diagnosed with a Mental Disorder in Axis I of DSM-
IV-R such as Schizophrenia, Paranoia, Psychotic
Disorders and Drug Abuse .
435
References
ALIBRANDI A., CORSO P., a cura di, Codice Penale e di

Procedura Penale e leggi complementari, La Tribuna,
Piacenza, 2014.
BORZACCHIELLO, A., Alle origini del Manicomio
Criminale in “Mi firmo per tutti: dai manicomi criminali
agli Ospedali Psichiatrici Giudiziari, Datanews, Roma,
1997.
Sitography
Altalex, http://www.altalex.com
Ristretti Orizzonti: http://www.ristretti.it
436
Alessandra Stringi
437
Vulnerability Factor and Infant

Traumas in Drug Addiction. A
Psychotherapeutic Group Model
Inside a Penitentiary.
Alessandra Stringi1
Key words: Vulnerability, trauma, addiction, group,

penitentiary.
1. Introduction
In the present work evolutionary perspective

an explanatory model is assumed by which early
growth and socialization processes have an
immediate effect on the personality development.
Literature shows that traumas in primary
relationships have a negative effect on the capacity of
self/hetero affective regulation, causing a psychic
1
Psychologist, Group Psychoanalist at the Italian Institute of Group
Psychoanalysis of Palermo (I.I.P.G.).
Vulnerability Factor and Infant Traumas in Drug Addiction.
A Psychotherapeutic Group Model Inside a Penitentiary.
438
vulnerability predisposing to drug addiction

although not a real psychopathology.
In this regard in literature different
psychotherapeutic approaches take into account such
findings across the reference models.
2. Assumptions and Reference

Paradigms
The present article takes into account group

psychoanalysis studies (W.R. Bion, 1961, 1972, 1977;
S.H. Foulkes, 1964; R. Kaës; 2007), on the assumption
that any psychic process is to take place inside group
relationships (A. Stringi, 2013). At the same time it
considers the paradigms of relational and
intersubjective psychoanalysis (J.R. Greenberg e S.A.
Mitchell, 1986; V. Lingiardi, A. Amadei, G. Caviglia,
F. De Bei, 2011), the Infant Research findings and the
attachment theory (J. Bowlby, 1951, 1958, 1979), with
some references to the consequent psychotherapy
model (J.D. Wallin, 2007).
Particularly, as regards the psychotherapeutic
intervention for drug addiction, the present work
takes as a reference the psychopathologic models of
addiction from drugs (S. Freud,1905; V. Caretti & D.
La Barbera, 2005; 2010; 2012) and the American
studies on the etiology of drug addiction as a result of
affective disregulation in terms of a predisposition to
Alessandra Stringi
439
‘addictive’ behaviors (E.J. Khantzian, 1985; G.J.

Taylor, et al., 1977; P. Fonagy e M. Target, 2001).
3. Definition of Pathologic Addiction and

Vulnerability Factor
As a previous work already shows (A. Stringi,

2013) at an oral stage the pathologic addiction is
considered a ‘sort of illness <<characterized by the
misuse of a substance, an object or a behaviour- and more-
addictive behaviours are meant as a dysfunctional attempt
to counteract the uncontrolled coming out of infant
traumas>> (V. Caretti et al., 2012, p. 18).
According to such approach the object-drug
provides real shelters to the mind, creating ‘mental
states dissociated from conscience’ (P.M. Bromberg, 2001;
E.R.S. Nijenhuis, 2004; G. Liotti, 2009; V. Caretti e S.
Ciulla, 2012). Moreover V. Caretti et al., (2005) bring
back the pathologic substance addiction to a
narcissistic vulnerability due to the lack of the breast-
mother object representation in the early phases of
mother-child interaction. According to Kohut (1971)
in pathological Narcissism can be seen the
consequences of an attempt to replace the lack of
narcissistic defect (Caretti et al, 2010).
For other authors (M.S. Mahler, F. Pine, A.
Bergman, 1975) personalities using addictive
behaviours are marked by a lack of resolution in the
‘phase of separation- identification in early mother-
440
child relationship’. In this respect the process of

identification, i.e. perceiving oneself as a person with
specific characteristics, occurs through the separation
process. The differentiation from the primary
caregiver demands recognizing oneself and the other
from oneself, even through painful and contrasting
emotions. This process recurs in every new
experience of relationship and for each person the
swinging in the fusion-separation polarity ensures
independence, healthy growth and adventure
throughout the world (L. Ambrosiano, E. Gaburri,
2013), which in an addictive personality seem to be
compromised
In the Infant Research studies E.Z. Tronik
(1989) deals with the implementation of defensive
infant mechanisms of self- stimulations or ‘self directed
regulating behaviours’. In this scientific frame it has
been highlighted how the vulnerability factor can be
related to the caregiver emotional incompetence in
providing the first cares to the child.
As it has already been reported (A. Stringi,
2013), the caregiver emotional incompetence may
bring to: emotional neglect, denial of affections, lack
of tuning with the affective state of the child, (D.
Stern, 1985; A. Amadei, 2005), weak repair of affective
breaks, traumatic or traumatizing reflections of
emotions (G. Gergely & G. Csibra, 2005; G. Gergely &
Z. Unoka, 2008).
According to various authors the experience
with a ‘not sufficient’ caregiver (1971, D.W. Winnicott)
is in relation with an inadequate recognition of the
Alessandra Stringi
441
child affective experience in his body and in relation

to the other, in terms of physiological activation not to
be related to processes of the adult mirroring and
tuning (G.J. Taylor, R.M. Bagby, J.D.A. Parker, 1997;
A.N. Shore, 2002c; P. Fonagy, G. Gergely, E. Jurist, M.
Target, 2002; M.M. Linehan, 1993; A. Schimmenti, A.
Bifulco, 2008; A. Schimmenti, V. Caretti, 2010; V.
Caretti, G. Craparo, A. Schimmenti, 2013).
The above described vulnerability factor, or
‘basic defect’ (M. Balint, 1968) is not to be meant as an
illness, but may have pervasive cumulative
consequences, on short or long term development
(M. Khan, 1963). The child develops a consequent fear
of a mental life, suffering <<a lack of the basic
representation of the Self, a deficit in metacognitive and
mentalizing processes>>. (A. Schimmenti, 2013, p. 25),
an incapacity to support suffering or to represent
painful past events, a lack in co-regulating affective
states (B. Beebe & F. Lachman, 2002) and to build
reflexive meanings (P. Fonagy, M. Target, 2001). The
consequent difficulties consist in the inability to
recognize and describe internal emotions, desires and
needs and to communicate them to others (A.
Schimmenti, 2013).
Therefore the disregulation of affective states
arises in a ‘primary intersubjective system’ where
mental processes of attention, perception and
memory, but also selection of affections and
behaviour responses are organized . In that area the
subject since the preverbal age develops
442
progressively mental representations in relation to

himself and to others.
As regards the ontogeny of affections E.Z.
Tronick (2008) uses the terms ‘prolonged affective states’
that is the background tone in the interaction
between two persons that produces a bodily state, a
shared experience of life and behaviour. When the
interaction with the caregiver is altered the
experimentation of prolonged affections as well as
the adequate development of hetero and self
regulation is not possible.
4. Trauma, Disfunctional Attachment and

Lack of Self-Regulation in Drug
Addiction
A serious alteration or the failure of primary

relations cause cognitive-affective representations
that J. Bowlby (1973) defines as ‘insecure’, ‘confused’
and/or ‘disorganised’. A deep fear in relation to
attachment figures (M. Main, 1981; M. Main & K.
Weston, 1982); the relationship with scared or
traumatized attachment figures (Main & Hesse, 1990)
may produce a deconstruction in personality
development.
Disfunctional attachment states (Internal
Operative Models, IOM) in connection with a lack of
emotional and affective self-regulation strategies in
the subject (E.Z. Tronik, 1989; E. Hesse et al. 2003, G.
Alessandra Stringi
443
Liotti 2005; G. Liotti, 2012; M. West et al. 2001; A.

Schimmenti, A. Bifulco, 2008b; K. Lyons-Ruth e D.
Block, 1996; M. Schuder e K. Lyons-Ruth 2004)
arrange to drug addiction behaviours in adult age V.
Caretti et al., 2012; V. Caretti et al., 2013; A. Stringi,
2013).
To understand better the development of
deviant personalities where a drug addiction is
present it may be helpful the construct of complex
trauma (B.A. van der Kolk, 2005), according to which
interpersonal experiences of chronic exposure to
abandonment, neglect, violence, physical and sexual
aggressiveness, menace to life, emotional abuse and
coertion, are the causes of disregulated response
patterns bringing consequences at various levels
(affective, somatic, behavioural, cognitive and
relational). This is followed by a pervasive alteration
of the Self and the others’representation so as to bring
to personality disorders, anti-social personality
disorders, and post traumatic stress disorder (PTSD)
(A. Schimmenti, 2013). In the personality of a subject
developing addiction, often in a morbid connection
with DSM-IV TR Axis II , the stabilization of missing
relationship modes with emotions and the structuring
af alexythymia and lack of impulse control may occur
(V. Caretti & G. Craparo, 2005; V. Caretti et al. 2010,
A. Schimmenti, 2013; A. Stringi, 2013).
444
5. The Psychotherapeutic Homogenous

Group Intervention in the Institutional
Context
In the psychoanalytic mind theory the

‘relationship’ and the ‘field of relationships’ acquire
an important role as concerns the birth and
development of human mind and this is a favourite
element in an analytic group intervention especially
in the context of total institutions. In fact the
therapeutic group device throws in transpersonal
aspects of the subject (F. Corrao, 1984a), recreating a
context of multiple and complex relations. The
analytic group may activate one of its thought
functions (gamma function), based on the mithpoietic
capacity (F. Corrao, 1994). The mirroring, rêverie and
multiple identification processes allow in the group
the assimilation of regulation models of affectivity
and new ways of thought riorganization (A. Stringi,
2013).
On the other hand the specific institutional
context has a sort of ‘resistance’ as for the aspects of
persecutoriety, which make the field and ‘local culture’
understanding more difficult. For the psychoterapist
it is of great importance and emotionally involving
and challenging to get awareness of the various
conscious and inconscious levels, as well as of the
personal, relationship, and role aspects. Thus in
Alessandra Stringi
445
institutions like a penitentiary it may be useful the

reference to Baranger’s field model to activate
analytic experiences (C. Neri, 2006). The penitentiary
strong regulation system facilitates the group
therapy with drug addict subjects, only if the
relationship between institution and micro group
makes it possible (A. Accursio, 2012).
Moreover the psychtherapist has to pay
attention to the presence/absence of the participants,
taking into account not only the group dynamics, but
also institutional events, even if only for exclusion.
The homogeneous group device based on the
participation of nine people besides the leader must
be preferably weekly to activate the participants
emotionally and avoid a surplus of recircuiting of
painful and distressing emotions in a closed
institutional context with convicted subjects. It is also
important to select the participants, taking into
consideration not only difficulties and uneasiness
symptoms like adjustment problems, impulse lack of
control, selfinjuring attempts, relationship and family
issues, but also above all a personal motivation to
group psychotherapy, an availability to be open to
relations.
6. First Interventions of the Group

Psychotherapist in the Penitentiary
Context
446
As concerns the distorsions of early

interactions with primary attachment figures in drug
addicted subjects as well as the characteristics of
controls in a prison it is of paramount importance that
the group psychotherapist works to promote
intersubjective processes. To this aim it is necessary
to work on reciprocal confidence at the beginning.
The psychotherapist interventions have to foster the
acceptance of uncertainties and of dubious self
percepion, even of a group dependance from the
conductor.
A further aim of the first interventions is to
foster the multiple relation of the Self (P.M.
Bromberg, 2001), to facilitate the experiences of
mirroring and support the capability of tolerance
towards what is difficult to express because of voids
and lack of affection generating primary
vulnerability. The therapist must facilitate the
expression of the Self in the participants so as to let
negative and positive feelings come out (from fault to
hate, from envy to anger, and especially shame and
solitude, loss, bereavement, but also joy, love and
sympathy). J.A. Allen (2013) underlines the
importance for the patients bringing infant traumas to
mentalize the feelings of solitude suffered in infancy
in order to reintegrate self dissociated aspects.
Thus the therapist has to take charge of violent
aspects of the Self of the group members, stimulated
by the violence of prison regulations. Dissociated
elements, unprocessed, not yet mentalized, ‘traumatic
emotions’ (V. Caretti et al., 2010) of the participants
Alessandra Stringi
447
may be present in the group “area” involving also the

therapist’s mind and body (A. Stringi, 2013). Such
elements activate in the participants anger, frustration
and pain creating short circuits and paralysis in the
thought function and in the apparatus for thinking
thoughts (W.R. Bion, 1972). Therefore the therapeutic
process demands a constant commitment in order to
stimulate mentalization and symbolization processes.
7. Psychotherapist Interventions, Group

Therapy Process and Dynamics
The psychotherapist interventions cannot be

based mainly on interpretations, but in some cases
the use of self-disclosure or the recovery of physical
perceptions and sensations or enactment of the
therapist (P.M. Bromberg, 2011) are particularly
useful to promote the process of symbolization.
Therefore the therapist has to recover what the body
‘feels’ roughly in the intersubjective interaction and
offer something to ‘the others’curiosity’ (J.R.
Greemberg, 2012; S.A. Mitchell, 1993). In some cases
in communicating physical perceptions in a group
the therapist will foster the sharing inside the group
of a sensation or emotion. This paves the way to what
in psychoanalitic terms Corrao calls ‘koinodinia’
(1986a, p.121), the common experience of a pain in the
448
group , which facilitates and encourages the

intersubjective contact (J.D. Wallin, 2007).
Such interventions from the psychotherapist
are in relation to the possible reaction of the
participants in the group, who leave the primitive
attempts of self regulation and overcome the
perception of psychic void, through the narration in
the group of traumatic infant memories and the
experience of interpersonal contact. This introduces
elements of vitality (D. Stern, 2010) and promotes the
decrease of the narcissistic closure.
The lack of mirroring and/or tuning from
parental figures (V. Caretti et al, 2010) and the
participants’ traumatic experiences may produce in
the participants a clustrophobic fear of the mind
perceived as potentially persecutory and threatening,
a group that suffocates and confuses. (A. Stringi, 2002;
A. Stringi, 2008; A. Stringi, 2013).
Therefore the therapist’s interventions have to
keep the atmosphere of confidence and trust anyway
and underline the importance to keep the group
boundaries closed, so that the participants may feel it
as a safe and delimited even though not punitive and
judging place where life events and individual stories
may acquire a new significance. Thus the analytical
group therapy might stir the capacity of the single
participants to be part in a complex system of
relations and mirroring, by making experience of
being a member without the disruptive trend to
Alessandra Stringi
449
pathologic fusion but keeping their individuality

enhanced and intact.
8. Conclusion
Thanks to a more rigorous and stable setting,

which the institution itself must ensure, through the
intersubjective sharing of affective, emotional,
traumatic, dissociated and complex elements, the
homogeneous, analytic group for drug addict subjects
may offer inside the penitentiary an opportunity of
emotional regulation and addiction processing of the
subjectivity recovery in a new dimension of greater
unity and respect of the Self.
References
A. ACCURSIO, Costanti ed evoluzioni del setting in

psicoterapia psicoanalitica: eventi traumatici attuali, 2°
Giornata di Studi della Sezione Italiana della EFPP,
Roma 25 gennaio 2003.
A. ACCURSIO, Le dipendenze patologiche attraverso
l’ottica del gruppo, in Koinos. Gruppo e Funzione
Analitica. Psicoanalisi di gruppo e masse, (2010) Anno
XXXI, 2, 51-61.
J.G. ALLEN, Il mentalizzare nello sviluppo e nel
trattamento psicoterapeutico dell’attaccamento traumatico,
450
in (Memorie traumatiche e mentalizzazione. Teoria,

ricerca e clinica) (a cura di) V. CARETTI, G. CRAPARO,
A. SCHIMMENTI, Casa Editrice Astrolabio, Roma 2013.
A. AMADEI, Come si ammala la mente, Il Mulino,
Bologna 2005.
L. AMBROSIANO E E. GABURRI (2013). Pensare con
Freud. Raffaello Cortina Editore, Milano.
M. BALINT, “Il difetto fondamentale”. In M BALINT E E
BALINT, La regressione, (1968), Raffello Cortina, Milano
1983.
W. & M. BARANGER, La situazione psicoanalitica come
campo bipersonale, (1990), Raffaello Cortina Editore,
Milano.
A.W. BATEMAN E P. FONAGY, (Psychotherapy for
Borderline Personality Disorder: Mentalization Based
Treatment. Oxford: Oxford University Press, 2004).
traduzione italiana, Trattamento basato sulla
mentalizzazione, Raffaello Cortina, Milano 2006.
B. BEEBE E F. LACHMAN, (Infant Research and Adult
Treatment: Co-constructing Interactions. Published
London: Analytic Press, 2002), traduzione italiana
Infant research e trattamento degli adulti. Un modello
sistemico-diadico delle interazioni, Raffello Cortina,
Milano 2005.
W.R. BION, (Experiences in Groups and other Papers.,
London, Tavistock Publication Ltd, 1961), traduzione
italiana Esperienze nei gruppi. Armando Editore, Roma
1971.
Alessandra Stringi
451
W.R. BION, (Learning from experience. William

Heinemann – Medical Books – Ltd., London, 1972),
traduzione italiana Apprendere dall’esperienza,
Armando Editore, Roma 1994.
W.R. BION, (Bion in Rome, The Estate of W.R. Bion,
1977-1983, London), traduzione italiana. Seminari
italiani. Borla, Roma 1985.
J. BOWLBY, (Separation: anxiety and anger, in Attachment
and loss, vol. II, Basic Books, New York, 1973),
traduzione italiana Attaccamento e perdita, vol. II.
Boringhieri, Torino 1978.
P.M. BROMBERG, (Standing in the spaces. Essay on
Clinical Process, Trauma, and Dissociation. The Analytic
Press, Inc. 2001), traduzione italiana Clinica del trauma
e della dissociazione. Standing in the spaces, Cortina,
Milano 2007.
P.M. BROMBERG, (The shadow of the Tsunami and the
Growth of the Relational Mind, 2011), traduzione
italiana, L’ombra dello tsunami. La crescita della mente
relazionale, Raffaello Cortina Editore, Milano 2012.
V. CARETTI, S. CIULLA, Trauma, dissociazione,
disregolazione, dipendenza, in Psichiatria e Psicoterapia,
31, 2012, 2, pp.101-119.
V. CARETTI, G. CRAPARO, A. SCHIMMENTI, Fattori
evolutivo-relazionali dell’addiction, in (Addiction.
Aspetti biologici e di ricerca) (a cura di) V. CARETTI. &
D. LA BARBERA, Raffaello Cortina Editore, Milano
2010, pp. 99-134.
452
V. CARETTI, G. CRAPARO, A. SCHIMMENTI,

Psicodinamica delle dipendenze patologiche, in (Le nuove
dipendenze: diagnosi e clinica), (a cura di)V. CARETTI
E D. LA BARBERA, Carocci editore, Roma 2012, pp. 18-
24.
V. CARETTI, G. CRAPARO, A. SCHIMMENTI (a cura di),
Memorie traumatiche e mentalizzazione. Teoria, ricerca e
clinica, Casa Editrice Astrolabio, Roma 2013.
V. CARETTI, G. CRAPARO, A. SCHIMMENTI, Emozioni,
corpo, mentalizzazione: il trattamento delle sindromi
traumatiche. In (Memorie traumatiche e
mentalizzazione. Teoria, ricerca e clinica) (a cura di)
V. CARETTI, G. CRAPARO, A. SCHIMMENTI, Casa
Editrice Astrolabio, Roma 2013 pp. 169-182.
V. CARETTI E D. LA BARBERA (a cura di), Addiction.
Aspetti biologici e di ricerca. Raffaello Cortina Editore,
Milano 2010.
V. CARETTI E D. LA BARBERA (a cura di), Le dipendenze
patologiche. Clinica e Psicopatologia, Raffello Cortina
Editore, Milano 2005.
V. CARETTI & D. LA BARBERA (a cura di), Le nuove
dipendenze: diagnosi e clinica, Carocci editore, Roma
2012.
F. CORRAO, Pathema/Mathema, in Orme, Vol. II,
(1984a), Cortina, Milano 1998.
F. CORRAO, Il concetto di campo come modello teorico, in
Orme, Vol. II, (1986a), Cortina, Milano 1998.
Alessandra Stringi
453
F. CORRAO, Duale-Gruppale, in Orme, Vol. II, (1993),

Cortina, Milano 1998, pp.
F. CORRAO, Sul Sé Gruppale, in Orme, Vol. II, (1995),
Cortina, Milano 1998, pp.
A. CORREALE E L. RINALDI, Quale psicoanalisi per le
psicosi? Borla, Roma, 1997.
A. COOK, J. SPINAZZOLA, J. FORD, C. LANKTREE, M.
BLAUSTEIN, M. CLOITRE, R. DE ROSA, R. HUBBARD, R.
KAGAN, J. LIAUTAUD, K. MALLAH, E. OLAFSON E B.
VAN DER KOLK “Traumi complessi nei bambini e negli
adolescenti” (2005b), in (Trauma e relazioni ) (a cura di)
R. WILLIAMS, Raffaello Cortina, Milano 2009, pp. 115-
127.
N. DAZZI, V. LINGIARDI, A. COLLI (a cura di), La ricerca
in psicoterapia. Modelli e strumenti, Raffaello Cortina
N. DAZZI, V. LINGIARDI, Il movimento relazionale:
ascendenze teoriche e fecondazioni culturali pp. 3-31, in
(La svolta relazionale. Itinerari italiani), (a cura di) V.
Lingiardi, G. Amadei, G. Caviglia, F. De Bei, Raffaello
Cortina Editore, Milano 2011, pp. 3-21.
P. FONAGY E M. TARGET, Attaccamento e funzione
riflessiva, traduzione italiana, Raffaello Cortina Milano
2001.
P. FONAGY, G. GERGELY, E. JURIST, M. TARGET,
Regolazione affettiva, mentalizzazione e sviluppo del Sè,
(2002), Raffello Cortina, Milano 2005.
454
S.H. FOULKES, (Introduction to Group Analytic

Psychotherapy, 1948, Heinemann, London) traduzione
italiana, Analisi terapeutica di gruppo, Boringhieri,
Torino 1967.
S. FREUD, Psicologia delle masse ed analisi dell’Io, (1921),
in Opere Vol 9, Bollati Boringhieri editore, Torino
1989.
C.M. GENTILE, I contesti del gruppo e il vertice
psicoanalitico. In Koinos. Gruppo e Funzione Analitica.
Contesti di Gruppo, 2011, Anno XXXII – Numero 2,
pp. 105-115.
G. GERGELY E G. CSIBRA, “The social construction of the
cultural mind: Imitative learning as a mechanism of
human pedagogy” in Interaction Studies, 6, 2005, pp.
463-81.
G. GERGELY E Z. UNOKA, “Attaccamento e
mentalizzazione negli esseri umani: lo sviluppo del Sè
affettivo” (2008), in (Da mente a mente. Infant
research, neuroscienze e psicoanalisi), (a cura di) E.L.
Jurist, A. Slade, S. Bergner, Raffello Cortina, Milano
2010, pp. 171-193.
J.R. GREENBERG E S.A. MITCHELL, (Object Relations in
Psychoanalitic Theory, 1983, Cambridge, Harvard
University Press), traduzione italiana, Le relazioni
oggettuali. Il mulino Milano 1986.
J.R. GREENBERG Quale demone ti condusse a queste
azioni? Riflessioni sul desiderio nella stanza d’analisi,
(2012), Seminario aprile 2012 all’I.I.P.G. - Palermo.
Alessandra Stringi
455
E. HESSE, M. MAIN, K.Y. ABRAMS, A. RIFKIN,

Unresolved states regarding loss or abuse can have ‘second
generation’ effects. Disorganized, role-inversion and
frightening ideation in the offspring of traumatized non-
maltreating parents” (2003), in (Healing trauma:
Attachment, mind, body and brain) (a cura di) D.J.
SIEGEL, MF. SOLOMON, Norton, New York, pp. 101-
120.
I. HIRSC, Observing-partecipation, mutual enactment, and
the new classical model in Contemporary Psychoanlysis, n.
3, (1996), pp. 441-459, traduzione italiana di A. Fasce,
Enactment: modello classico e modello interpersonale a
confronto, www.sipreonline.it.
R. KAËS, La trasmissione delle alleanze inconsce,
organizzatori metapsichici e meta sociali, Relazione al
Convegno generi e generazioni. Ordine e disordine nelle
identificazioni, Centro Psicoanalitico di Roma, 1-2
dicembre 2007.
M.M.R. KHAN, “Il concetto di trauma cumulativo”,
(1963), in Lo spazio privato del Sé, Bollati Boringhieri,
Torino 1979.
E.J. KHANTZIAN, The self-medication hypothesis of
addictive disorders. Focus on heroin and cocaine
dependence. In American Journal of Psychiatry, 34 (1985),
pp. 1-5.
D.M. KIVLIGAN, J.M. TARRANT, “Does group climate
mediate the group leadership-group member outcome
relationship? A test of Yalom’s hypotheses about leadership
456
priorities”, in Group Dinamics: Theory, Research, and

Practice, 5 (2001) pp. 220-234.
H. KOHUT, The analysis of the self. International
University Press, New York. Tr. it. Narcisismo ed
analisi del Sé, (1971), traduzione italiana, Boringhieri,
Torino 1976.
V. LINGIARDI, G. AMADEI, G. CAVIGLIA, F. DE BEI (a
cura di), La svolta relazionale. Itinerari italiani, Raffaello
Cortina Editore, Milano 2011.
V. LINGIARDI, F. DE BEI, La svolta relazionale nella ricerca
in psicoterapia, in (La svolta relazionale. Itinerari
italiani), (a cura di) V. LINGIARDI, G. AMADEI, G.
CAVIGLIA, F. DE BEI, Raffaello Cortina Editore, Milano
2011, pp. 99-122.
M.M. LINEHAN, “Trattamento cognitivo-comportamentale
del disturbo borderline. (1993), traduzione italiana,
Raffaello Cortina, Milano 2001.
G. LIOTTI, La natura interpersonale della coscienza,
seconda ed. Carocci, Roma, 2005.
G. LIOTTI, “Attachment and dissociation”, (2009), in
(Dissociation and the dissociative disorders: DSM – V
and beyond), (a cura di) P. DELL, J.O.’NEILL,
Routledge, New York, pp. 88-120.
G. LIOTTI, “Attachment disorganization and the clinical
dialogue: Theme and variations”, (2012), in
(Disorganization of Attachment and Caregiving), (a
cura di) J. SOLOMON, C. GEORE, Guilford Press, New
York, pp. 90-115.
Alessandra Stringi
457
K. LYONS-RUTH, D. BLOCK, “The disturbed caregiving

system: Relations among childhood trauma, maternal
caregiving and infant affect and attachment” (1996),
Infant Mental Health Journal, 17, pp. 257-75.
M.A. LUPINACCI, Stare con la sofferenza, (2013),
Seminario I.I.P.G. (Istituto Italiano di psicoanalisi di
Gruppo) del 23.03.2013 - Palermo.
K.R. MACKENZIE, “Measurement of group climate”,
(1981), in International Journal of Group Psychoterapy,
31, pp. 287-296.
M.S. MAHLER, F. PINE, A. BERGMAN, La nascita
psicologica del bambino, traduzione italiana,
Boringhieri, Torino 1978, (The psychological birth of the
human infant: symbiosis and individuation, (1975), Basic
Brooks, New York).
M. MAIN, Avoidance in the service of attachment: a
working paper, (1981), in (a cura di) K. Immelman, G.
BARLOW, L. PETRINOVICH, M. MAIN, Behavioral
development: the Bielefeld interdisciplinary project,
Cambridge University Press, New York, pp. 57-80.
M. MAIN, K. WESTON, Avoidance of the attachment figure
in infancy: Descriptions and interpretations, (1982), in
(The place of attachment in human behaviour), (a
cura di) C.M. PARKERS, J. STEVENSON-HINDE,
Tavistock, London, pp. 130-151.
M. MAIN, E. HESSE, Parents’ unresolved traumatic
experiences are related to infant disorganised attachment
status: Is frightened and/or frightening parental behaviour
458
the linking mechanism? (1990), in (Attachment in

preschool years. Theory, research and intervention),
(a cura di) M.T. GREENBERG, D. CICCHETTI, E. M.
CUMMINGS, University of Chicago Press, Chicago, pp.
77-95.
S.A. MITCHELL Speranza e timore in psicoanalisi (1993)
traduzione italiana Bollati Boringhieri, Torino 1995.
C. Neri, Pensieri senza pensatore. Gruppo e funzione
Analitica, (2006) XVII, 1, pp. 17-32.
E.R.S. NIJENHUIS, La dissociazione somatoforme. Elementi
teorico-clinici e strumenti di misurazione, (2004), Casa
Editrice Astrolabio, Roma 2007.
A. ROCCHI, P. CRUCIANI, Crescere e vivere nei legami e
nella mente del gruppo. In Koinos. Gruppo e Funzione
Analitica. Contesti di Gruppo, (2011), Anno XXXII –
Numero 2, pp. 57-73.
A. SCHIMMENTI, A. BIFULCO, “Quando i genitori
maltrattano i figli: le radici psicopatologiche dello sviluppo
affettivo”, (2008b), in (Trauma e psicopatologia. Un
approccio evolutivo-relazionale), (a cura di) V.
CARETTI, G. CRAPARO, Astrolabio, Roma, pp. 94-131.
A. SCHIMMENTI, V. CARETTI “Psychic retreas or psichic
pits? Unbereable states of mind and technological
addiction”, Psychoanalitic Psychology, 27, (2010), pp.
115-32.
A. SCHIMMENTI Trauma evolutivo: origini e conseguenze
dell’abuso e della trascuratezza nell’infanzia, (2013), in
(Memorie traumatiche e mentalizzazione. Teoria, ricerca e
Alessandra Stringi
459
clinica), (a cura di) V. CARETTI, G. CRAPARO, A.

SCHIMMENTI, Casa Editrice Astrolabio, Roma, pp. 15-
36.
A.N. SCHORE, “The effects of early relational trauma on
right brain development, affect regulation, and infant
mental health”, Infant mental Health Journal, (2001), 22,
pp. 201-69.
A.N. SCHORE, “Dysregulation of the right brain: a
fundamental mechanism of traumatic attachment and the
psychopathogenesis of posttraumatic stress disorder”,
Australian & New Zeland Journal of Psychiatry, (2002c),
36, pp. 9-30.
M. SCHUDER, K. LYONS-RUTH, “Hidden trauma” in
infancy: attachment, fearful arousal and early dysfunction
on the stress response system, in (Trauma in infancy and
early childhood) (a cura di) J. Osofsky, Guilford Press,
New York 2004, pp. 69-104.
D.N. STERN Il momento presente. In psicoterapia e nella
vita quotidiana (2004), traduzione italiana, Raffello
Cortina Editore, Milano 2005.
D.N. STERN. Forms of Vitality: Exploring Dynamic
Experience in Psychology, the arts, Psychotherapy, and
Development, (2010), traduzione italiana Le forme
vitali. L’esperienza dinamica in psicologia, nell’arte,
in psicoterapia e nello sviluppo. Raffaello Cortina
460
R.D. STOLOROW E G.E. ATWOOD. I contesti dell’essere. Le

basi intersoggettive della vita psichica, (1992)traduzione
italiana Boringhieri, Torino 1995.
A. STRINGI, Le funzioni dello spazio. Memoria e silenzio
in un gruppo a funzione analitica, in Koinos, gruppo e
funzione analitica, (2002) - Anno XXIII - Numeri 1-2,
Borla, pp. 57-79.
A. STRINGI, L’invidia e il gruppo analitico: tra teoria,
fenomenologia e clinica, , in Koinos. Gruppo e Funzione
Analitica. Second Thoughts: Funzione Alfa e
Cambiamento Catastrofico (2008) Volume II. Luglio –
Anno XXIX – Numero 2, Borla, pp. 105-130.
A. STRINGI, Traumi infantili, tossicodipendenza e
regolazione affettiva in un gruppo analitico in ambito
penitenziario in Psichiatria e Psicoterapia, Trimestrale
di Psichiatria. n.1 marzo (2013), pp. 1-22, Fioriti
Editore, Roma.
G.J. TAYLOR, R.M. BAGBY & J.D.A. PARKER, I disturbi
della regolazione affettiva (1997), Fioriti, Roma 2000.
E.Z. TRONICK, Le emozioni e la comunicazione affettiva
nei bambini (1989) in (La comunicazione affettiva tra il
bambino e i suoi partner) a cura di C.R. CRUGNOLA,
Raffaello Cortina, Milano 1999, pp. 203-235.
B.A. VAN DER KOLK, Il disturbo traumatico dello
sviluppo: verso una diagnosi razionale per bambini
cronicamente traumatizzati in (Trauma e
psicopatologia. Un approccio evolutivo-relazionale) a
Alessandra Stringi
461
cura di V. CARETTI, G. CRAPARO, Roma 2005,

(Astrolabio) pp. 176-210.
J.D. WALLIN Attachment in Psychoterapy, New York
(2007), The Guilford Press (traduzione italiana
Psicoterapia e teoria dell’attaccamento, Il Mulino,
Bologna 2009).
M. WEST, K. ADAM, S. SPRENG, S. ROSE, “Attachment
disorganization and dissociative symptoms in clynically
treated adolescents”. In Canadian Journal of psychiatry,
46 (2001), pp. 627-631.
D.W. WINNICOTT, (Playing and reality, Londra, 1971)
traduzione italiana Gioco e realtà, Editore Amando,
1974 Roma.
I.D. YALOM, Teoria e pratica della psicoterapia di gruppo,
(1995), traduzione italiana, quarta ed. Bollati
Boringhieri, Torino 1997.
462
Marzia Tosi
463
Imprisoned Motherhood. From Law

to Good Practices
Marzia Tosi1
Keywords: Detained mothers, imprisoned parenthood,

underage, protected family homes, ICAM, kindergarten,
female detention.
1. Mothers in Prison: Italian Background
It is well-known that female detention is a

numerically marginal phenomenon: during the last
decades, data made available by the Italian Ministry
of Justice show that women imprisoned are about 4
and 5% of the entire prison population.
Issues related to women’s detention are not at
all marginal: one of the main problems is linked to the
motherhood, considering that in Italy the 73% of
1
Jurist and Criminologist, Researcher at FDE Institute of Criminology of
Mantua. Responsible for Restorative Justice Area at Libra Onlus
Association of Mantua.
Imprisoned Motherhood. From Law to Good Practices
464
imprisoned women are mothers and the 42% of them

have minor children2.
Women with children outside the prison meet
the major problems at the moment of separation due
to their entry in prison, the difficulties in maintaining
relationships with family and with the offspring, as
well as discrimination and stigma that easily affect
children because of their association with the
detained mother, often considered as an unfit
caregiver.
The awareness of the risk that the son of the
inmate woman may be stigmatized, led the
Committee on the Right of the Child to clarify that
States should conform their legislative frameworks in
order to avoid undue external interferences3.
Furthermore, the Committee, during the General
Discussion Day held in September 2011, focused on
the moment of the arrest, providing the procedures to
be adopted in order to reduce as much as possible the
negative impact of the stressful event4.
This is the situation numerically more
represented, but certainly is more peculiar the
circumstance regarding mothers who, accordingly
2
M. P. Giuffrida, Studio sulle donne ristrette negli istituti penitenziari, DAP
- Gruppo di lavoro ICAM, Roma, 3 Aprile 2009, cit. in L. Ravagnani, C.A.
Romano, Women in prison, Pensa MultiMedia editore, Lecce - Brescia,
2013, p. 188.
3
L. Ravagnani, C.A. Romano, cit., p. 185.
4
Ibidem.
Marzia Tosi
465
with the actual legislative framework, are allowed to

keep the minor sons at themselves. In the last ten
years, the trend has been slightly fluctuating; its
highest point occurred in June 2001, when there were
twenty pregnant women and sixty-eight mothers in
prison with eighty-three underage children inside.
Excluding the survey conducted in June 1994, the
Ministerial data updated at 31th December 2013,
detect the absolutely lowest numbers within the
considered timeframe (seventeen pregnant women
and forty mothers imprisoned with as many minor
children inside the institute). Most cases refer to
women coming from situations of marginality and
social degradation; most of them are foreign with a
low degree of education, often these women had
become mothers when they were really young. The
offenses they have committed are mainly linked to
the area of property crimes, prostitution and violation
of the drug law.
Several studies have reported the prison’s
negative effects on minors: many of them develop an
insecure attachment due to the symbiotic bond
created with the mother and show difficulties in
separating from her also for a short period. Often the
lack of stimuli causes self-inflicted injuries and delays
in cognitive and linguistic development. With regard
to this last topic, is well-known how much prison
slang differs from the common language used in the
466
outside world: often the underage interiorizes the

first one as origin language and so he uses words
such as «open», «keys», «air»5. Other problems are
restlessness, tearfulness, loss of appetite, lethargy and
difficulty in sleeping.
2. Legislative Framework
Although mother detention is numerically

marginal, this fact cannot motivate a little attention at
this phenomenon: the presence of minors in prison
contrasts with the individual nature of penalties ex
art. 27 of the Italian Constitution and with European
and International normative background, considering
the minor as the subject at the center of each interest6.
Furthermore, the importance of the family is
also recognized intra moenia: Italian penitentiary law
354/1975 states that familiar relationships have to be
considered as an essential element of the prison
treatment and that particular efforts have to be done
in order to create, strength and rebuild these bonds.
5
F. Motta, S. Sagliaschi, Il bambino in regime di codetenzione con la
madre, 9 giugno 2013, in Psicopatologia cognitiva, 2, in
http://psicopatologiacognitiva.wordpress.com/2013/06/09/il-bambino-in-
regime-di-codentezione-con-la-madre-f-motta-s-sagliaschi/
6
In particular we refer to the Best interest principle ex art. 3.1 of the
Convention on the Rights of the Child. Please note, Ravagnani L., Romano
C.A., Women in prison, cit., p. 185.
Marzia Tosi
467
This is particularly important in the relation mother-

son, not only for the future development of the child
but also for the rehabilitation of the woman who has
been deprived of her liberty: several research show
that familiar support is the main incentive for stop re-
offending.
Italian legislative framework has been
emended by Gozzini law, which has modified Italian
penitentiary law inserting art. 47-ter: in case of
exclusion of penitentiary probation, this article states
the possibility of the home-detention for pregnant
women or for mothers with children under the age of
three, when they have to execute a penalty up to two
years (even if it represents the residual part of a
longer sentence).
The same article has later been redesigned by
Simeone-Saraceni law: from one hand the limit of
penalty to be expired in home-detention has been
increased up to four years; from the other one the
opportunity to serve the sentence in alternative
measure has been extended to the father, if the
mother is death or absolute unable to provide
assistance to the offspring.
In 2001 Finocchiaro law has modified Italian
Criminal Code and also Italian penitentiary law, in
which art. 47-quinquies about home-detention in
particular cases has been insert. In order to restore
cohabitation with the children, the opportunity to be
admitted to such alternative measure was enshrined,
also in case of long sentences, for mothers of children
under the age of ten, after they have served one-third
468
of the penalty (or fifteen years, in the case of life

imprisonment). The introduction of art. 21-bis, tracing
the mechanism of art. 21 on outside work stated the
possibility for the mother (or father, in case of death
or inability of the first) to be allowed to nursing and
care outside of the children under the age of ten.
However, the changes to the Criminal Code have
increased the terms of the optional and mandatory
referral of the penalty: now it is possible to benefit of
the first up to the age of three year of the child and of
the second up to his/her first year (instead of the
previous six months).
Finally, law 62/2011 has made several changes
to the Criminal Procedure Code and to the Italian
Penitentiary law, basically introducing provisions in
order to protect the relation between imprisoned
mothers and minor sons, in the pre-trial phase and
also in the post-sentence one. It is important to note
that the provisions contained in the first article of this
law, dedicated to the preventive custody, have been
subject to a particular and much discussed
transitional regime, which provided for their entry
into force at the moment of the special penitentiary
plan and anyhow from 1st January 2014. However,
this first article has affected art. 275 of the Criminal
Procedure Code providing for the incompatibility of
the pre-trial detention with particular vulnerable
situation, including the one of the mother of children
under the age of six living with her. It has to be noted
that, accordingly to parliamentary works, the
reference was increased from three to six years
Marzia Tosi
469
because this age coincides with the first obligations of

schooling by the child. Concerning pre-trial house
arrest, it is stated that it could be implemented, as
well as in the classic places of habitation, private
dwellings and those of public care and assistance,
even in a so-called protected family home. An
implementing decree of the Ministry of Justice, to be
taken in consultation with the State, Cities and Local
Autonomies Conference, would have to dictate the
characteristics of these family homes within one
hundred eighty days from the promulgation of the
law. However only on 26th July 2012 a Ministerial
Decree was issued, but - lacking the aforementioned
agreement - it was then lifted with the Ministerial
Decree of 11th January 2013. Later, reached the
condition laid down by the law, the Ministerial
Decree of 8th March 2013, entered into force, stating
the features that must characterize the said family
homes: having been designed to protect the child and
the parental relationship, they have to be placed in
contexts where it is possible to access to local, social
and health services. Furthermore, daily activities
must comply with those of daily life inspired by
family models; play activities for children must take
place and talks dedicated areas must be present, in
order to promote the maintenance and the creation of
parental and emotional bonds. To avoid the
overcrowding in such structures is necessary in order
to protect the parenthood relationship: in fact they
can accommodate up to six families each one.
Furthermore, it has to be kept into account the need
470
of confidentiality and differentiation that arise if there

are male users. Finally, we have to remember that the
Judge - no new or increased burdens on public
finances - may enter into agreements with local
authorities in order to identify structures to be used
as protected family homes. It has to be noted that,
during the parliamentary proceedings, several doubts
emerged regarding agreements at no cost, that seems
to be the consequence of the lack of financial
resources, which risk to affect the effective
implementation of the said rules7.
Now let’s move on to art. 275-bis of the
Procedure Criminal Code on pre-trial detention in
Custody Attenuated Institute for Mothers (ICAM is
the Italian acronym), which the same Penitentiary
Administration has defined as ‘jewel in the crown’.
The importance of the ICAM is due to the fact that
such structures are able to reduce the negative impact
affecting the minors living inside penitentiary
environment. In fact, in these institutions there are no
bars on the windows, the police staff does not work in
uniform but in civilian clothing and there is the
important presence of practitioners of the juvenile
area.
7
S. Marcolini, Legge 21 aprile 2011, n. 62 (Disposizioni in tema di
detenute madri), 5 maggio 2011, in
http://www.penalecontemporaneo.it/area/3-/26-/-/520-
legge_21_aprile_2011__n__62__disposizioni_in_tema_di_detenute_madri/
Marzia Tosi
471
3. Good practices
The pilot experience is the ICAM of Milan,

depending of the San Vittore Prison’s direction: it has
been created in 2006 and up to now it has been able to
accommodate about four hundred detained women.
The implementation of the initiative has been made
possible thanks to an agreement between the Ministry
of Justice, the Lombardy Region, City and Province of
Milan, which has become available to dedicate to this
scope a large stable of the twentieth century, then
properly restored. The structure, arranged on one
level, has talks rooms, a multipurpose room equipped
as library, with televisions and computers and a
games room, a kitchen, infirmary, six bedrooms and
an outdoor garden.
Antigone Association visited the ICAM of
Milan in January 2014 and drafted a report in which
notes that the inside population is almost exclusively
made up of women of Roma ethnicity, while the
Italian ones are a distinct minority (one or two per
year)8. In the past offences committed by ICAM users
was almost petty crimes, but today we have to face
8
Associazione Antigone, Rapporto Online sulle condizioni di detenzione
nelle carceri italiane – Istituto a custodia attenuata per detenute madri,
2014, in http://www.associazioneantigone.it/Index3.htm
472
more serious crimes, so that the average stay at the

institution has increased from three months to two
years, reducing the turn-over and allowing an
intervention characterized by greater integration with
outside services9. Retracing some ways the Milan
model, in the Lorusso e Cutugno of Turin, a special
pavilion has been renovated to be destined for
mothers with minor children living intra moenia;
however, we have to point out that - although
appreciable - the initiatives regard a pavilion inside
prison and not an ad hoc building10.
Also in Giudecca prison of Venice, a particular
section has recently been reorganized respecting
criterions of the ICAM of Milan: it is about three
hundred square meters, distributed on two floors11.
A recent experience similar to the Milan one
has been done in Senorbì, near Cagliari. The new
structure, which has been inaugurated in July 2014,
consists of four rooms with bathroom and television,
9
Idem.
10
AA.VV., Carcere / Un nido tra le sbarre: a Torino le mamme detenute
avranno una “nuova” casa, 9 agosto 2010, in
http://www.affaritaliani.it/sociale/mamme_detenute_carcere_torino290710.
html.
11
V. Tonon, Il patriarca alle detenute: “La storia di molte di voi inizia dalla
violenza subita”, 12 gennaio 2014, in Gente Veneta, 1, 2014, in
http://www.genteveneta.it/public/articolo.php?id=7720.
Marzia Tosi
473
a kitchen with lunchroom, a visiting room, a toy

library and an outdoor garden12.
Going back to the legislation, we have to
notice that the 2011 law has engraved on the
penitentiary law, introducing article 21-ter, which has
provided that the mother accused, sentenced or
institutionalized (or the father, in case of death or
inability of the first) can get out of prison to visit
underage children in imminent danger of death, prior
permission by the Supervising Judge or - in case of
particular urgency - by the prison’s Director. The
same article states that the competent Judge may
authorize parents to assist the son under ten years
during specialist visits.
Other changes provided by the law 62/2011
have expanded the possibility of domiciliary
detention for the mother of children under ten years:
now she can serve this penalty in the protected family
homes.
Finally, the law has also affected art. 47-
quinquies introducing paragraph 1-bis, which points
out in what places the mother can expiate the period
of punishment needed to be admitted to the special
house detention: the article refers to the ICAM, or - if
12
L. Onnis, Una casa di reclusione modello per le detenuti madri, 17 luglio
201, in
http://lanuovasardegna.gelocal.it/cagliari/cronaca/2014/07/17/news/una-
casa-di-reclusione-modello-per-le-detenute-madri-1.9612112
474
danger of escape or reoffending does not subsist, to

the places of habitation, private dwellings, care,
assistance or reception centers. If the woman is
unable to access such places, she can - once more -
rely on protected family homes.
4. Concluding remarks
Such a legislative framework certainly

represents a new challenge for our Country: in
particular the reference to the child’s age of six as an
element of incompatibility of the pre-trial detention of
the mother, it is a rare example also for among the
European Member States. In fact, in most of them, the
limit consists in eighteen months, two or three years
of the child; above that age the minors cannot be kept
at the mother and must be released. Finally, it is
important to note the less protection that, in Europe,
characterizes the relationship between father and son.
The male parental figure, in Italian penitentiary field,
acquires importance only in case of absence of the
mother: in fact, if the last one is present, the father is
not allowed to hold the offspring at himself.
Only a few experiences keep into
account the whole family. Among them, we have to
remember the so-called family units in some Danish
prisons: here mother, father and son can stay up to
the third birthday of the minor. Furthermore, in
Marzia Tosi
475
Spanish Aranjuez prison, there are special cells for

families13.
Returning back to Italian framework,
we notice that the seventeen penitentiary
kindergartens are necessary but not sufficient to
ensure an adequate mental and physical development
of the child. Furthermore, the small number of these
structures often means that mother and son are
moved in prisons far from their original family,
negatively affecting the principle of the territoriality
of the sentence.
Finally, it is clear the complexity of the
issue of the development of the motherhood (rectius:
of the parenthood) intra moenia: different interests
have to be kept into account and, among them, the
most important is the one of the underage.
So, we hope that Italy can faces the
relevant and delicate challenges that practitioners and
regulations seem to have wanted to gather
experimenting good practices and emending the
legislative framework, which aims to keep extra
moenia the minor and his caregiver, so as to return the
deserved dignity to the irreplaceable parental
relationship.
References
13
L. Ravagnani, C.A. Romano, Women in prison, cit. pp. 196-197.
476
ASSOCIAZIONE ANTIGONE, Rapporto Online sulle

condizioni di detenzione nelle carceri italiane – Istituto a
custodia attenuata per detenute madri, 2014, in
http://www.associazioneantigone.it/Index3.htm.
AA.VV., Carcere / Un nido tra le sbarre: a Torino le
mamme detenute avranno una “nuova” casa, 9 agosto
2010, in
http://www.affaritaliani.it/sociale/mamme_detenut
e_carcere_torino290710.html.
GIUFFRIDA M. P., Studio sulle donne ristrette negli istituti
penitenziari, DAP - Gruppo di lavoro ICAM, Roma, 3
Aprile 2009, cit. in RAVAGNANI L., ROMANO C.A.,
Women in prison, Pensa MultiMedia editore, Lecce -
Brescia, 2013.
MOTTA F., SAGLIASCHI S., Il bambino in regime di
codetenzione con la madre, 9 giugno 2013, in
Psicopatologia cognitiva, 2, in
http://psicopatologiacognitiva.wordpress.com/2013
/06/09/il-bambino-in-regime-di-codentezione-con-
la-madre-f-motta-s-sagliaschi/.
MARCOLINI S., Legge 21 aprile 2011, n. 62 (Disposizioni
in tema di detenute madri), 5 maggio 2011, in
http://www.penalecontemporaneo.it/area/3-/26-/-
/520-
legge_21_aprile_2011__n__62__disposizioni_in_tema_
di_detenute_madri/.
Marzia Tosi
477
RAVAGNANI L., ROMANO C.A., Women in prison, Pensa

MultiMedia editore, Lecce - Brescia, 2013.
Onnis L., Una casa di reclusione modello per le detenuti
madri, 17 luglio 201, in
http://lanuovasardegna.gelocal.it/cagliari/cronaca/
2014/07/17/news/una-casa-di-reclusione-modello-
per-le-detenute-madri-1.9612112.
TONON V., Il patriarca alle detenute: “La storia di molte di
voi inizia dalla violenza subita”, 12 gennaio 2014, in
Gente Veneta, 1, 2014, in
http://www.genteveneta.it/public/articolo.php?id=
7720.
478
Turchi Gian Piero, Pinto Eleonora, Girardi Anna, Orrù Luisa
479
Efficacy Measurement in Penitentiary

Treatment: a Methodology to Meet
the Requirements of Current
Legislation
Turchi Gian Piero, Pinto Eleonora, Girardi Anna, Orrù

Luisa1
Keywords: penitentiary treatment, efficacy measurement,

methodology, textual data, discursive productions.
1. Foreword
This contribution owes its inspiration to a

study carried out in 2010 by the Staff of the
Department of Penitentiary Administration in the
High Security women's section in an Italian
penitentiary where there are women emprisoned for
various types of crime such as organised crime –
Article 41 bis of the Prison Administration Act –
political crimes, and international offences. The
1
Department of Applied Psichology, University of Padova.
Efficacy Measurement in Penitentiary Treatment: a
Methodology to Meet the Requirements of Current
480 Legislation
initiative arose from what was set out in the

Legislation (guarantee of the respect for human
dignity, revealing the ‘particular needs’ of offenders
and prisoners by means of scientific observation art.1
e art.13, L.26.7.1975, no.354) and, above all, in the
Italian Constitution: ‹‹Punishment must not involve
treatment that goes against the sense of humanity and
must tend towards re-education›› (Art. 27, comma 3). As
a consequence of these assumptions upon which
penal intervention must be based, the Legislator
defines the end goals, stating that ‹‹the re-education of
offenders and prisoners is directed moreover towards
promoting a process of modification of personal conditions
and attitudes as well as social and family relationships
which obstruct constructive social participation›› - art.1,
para2 D.P.R. 30.6.2000, no.230.
This leads to the possibility that intervention
in the penitentiary system could coincide with the
institutional mandate in order to configure a plan of
interaction among regulatory standards, cultural
changes and professional responsabilities.
In order for the intervention to serve as an
operational scientific tool, some epistemological
groundwork is required which also considers the
level of realism of the context of the subject of inquiry
(M. FOUCAULT, 1975; L. WITTGENSTEIN, 1953).
Therefore, while on the one hand it becomes
necessary to apply the criterion of epistemological
adequacy, on the other, the epistemological
481
foundation must satisfy the criterion of rigorous

argumentation, which allows it to be shifted from a
level of common sense. The project which was
presented is the fruit of a precise scientific approach
which originates in the assumption that the parties
that come into play in the field of execution of the
punishment (prisoner, operators, for example) resort
to an ordinary language, that is they use the common
sense reference of logos to declare the indentification
of a ‘prisoner’, sharing the way of knowing that
pertains to ‘common sense’. What has been stated
thus far therefore makes it necessary to shift from an
ontological perspective which gives central
importance to questions such as ‹‹why was the crime
committed? ›› or ‹‹what determines the permanent
labelling of the individual as prisoner?›› to one that
produces knowledge. Starting from the guidelines in
the Constitution and legislation, it must become
possible to proceed with the identification of those
aspects of the configuation of the ‘prisoner’ that are
most critical and to be able to intervene. As opposed
to a focus on the study of the ‘prisoner’, the
gnoseological framework concerns language as a tool
to be utilised in the penitentiary system for
configuring the reality of the ‘prisoner’, by asking
‹‹how can we – discursively – construct the role of
prisoner?›› and ‹‹what can be generated from this?››. In
this way we set out language as the departure point
for the definition of the type of statute (and thus
482 Legislation
science) of the subject of the penitentiary treatment

process.
2. The Cognitive Framework
Taking language as the point of departure for

the definition of the epistemological statute of the
subject of inquiry, the science we propose here as an
adequate reference for this statute is Dialogical
Science. The field of application for this is ‘discursive
configurations’, that is, the use of those symbolic
units that make up ordinary speech. In the
environment in question, the ‘prisoner’ is the user of
the penitentiary insitution, the one who takes
advantage of the institutional mandate the institution
, and is described in ordinary language and defined
on the basis of the cognitive categories utilised. This
dimension of process – otherwise known as
gnoseological dimension – assumes relevance in the
act of observation of the researcher and consequently
in the intervention by the operator. In keeping with
these epistemological presuppositions, the
‘prisoner/user’ can therefore be defined as the person
sentenced or awaiting a sentence against whom a request
for restriction of freedom has been requested. Then the
term ‘treatment’ can be defined as ‘a set of strategies
planned and shared with a view to generating ‘other’
biographical careers from that of ‘user-prisoner’ (G.P.
TURCHI, L. ORRÙ, 2008). Consequently, the objective
483
of the penitentiary treatment can be defined as

contributing to the generation of different biographies from
the biograpical career ‘prisoner’, which make it possible to
anticipate the configuration that can be generated at the
end of the incarceration period and promote a biography
that does not regard the incarceration as a stigma. In other
words, intervention must aim to change the
‘discursive productions’ promoted by the voices
speaking within a specific context, where by’change’
what we mean is a transformation of the discursive
matrix that generates a certain discursive
configuration of reality.
The underlying epistemic assumption thus
translated into the recourse to a science which brings
the use of symbolic units (words) to the centre of the
inquiry and intervention. Dialogical Science is that
science which deals with transforming logos into a
‘reliable’ and measurable object, a formal language
(conventional, in the sense that the value of its
assertions does not change according to the use made
of them).
The gnoseological epistemic plane within
which Dialogical Science is situated makes it possible
to reconfigure the’subject’ about which we are
‘speaking’ by means of ordinary language, into a
‘way of knowing’ and thus into an object of
knowledge formalised by means of formal language.
Within the domain of Dialogical Science it is therefore
possible to state the ‘dialogical weight’ of
configurations of reality generated in the interaction
of the components in the penitentiary environment
484 Legislation
and measure them at a set time. In this way it

becomes possible both to monitor the progress of the
intervention as well as the transformative efficacy of
the elements which make up the treatment offered to
the ‘prisoner’ user of the penitentiary service.
Having outlined the gnoseological framework
created for the environment of penitentiary treatment,
this study aims to evalute the efficacy of treatment2
carried out, to offer a measurement of how much of
the overall objective was actually transformed into a
result at the conclusion of the projects and/or
activities that comprised the treatment process.
In this study, the particular focus is on the
‘female prisoner’ undergoing treatment. Starting from
this focus, in view of the epistemological analysis
carried out, ‘treatment’ and ‘prisoner’ emerge as
constructs which can be defined with reference to the
congnitive, theoretical and methodological
assumptions adopted.
In particular, a fundamental aspect of the
efficacy evaluation project becomes the identification
of the’discursive productions’ brought into play by
the ‘chorus’, with which the reality itself is generated.
Specifically, the theory of Dialogic Identity (G.P.
2
By efficacy we mean the quantum of achievement of objectives,
therefore the quantum of transformation generated by the treatment,
ensuring that the objective of efficacy measuremeny as well as the
objectives set out have actually been reached.
485
TURCHI, 2002; see Fig. 1 below) outlines the

construction of reality as generated by the confluence
and the ‘intersections’ of the ‘voices’ which define the
context (in this case, the penitentiary institution). In
this sense, ‘prisoner’ user of the penitentiary service is
defined as a role, that is a construct based on
the’discursive productions’ used to define it and
constructed on the basis of specific competences
which are both technical and interactive-relational
competences. Therefore, the principal configuration,
the dialogic identity of ‘female prisoner’ undergoing
treatment, is generated by three discursive polarities
since it does not refer to ‘someone’ but is generated
by specific argumentative modalities: the polarity of
‘Storytelling’, that is all the’discursive productions’
generated in the first person singular or plural by
those who are in the condition of prisoner (that is, ‘I
am a prisoner’); the polarity of ‘Narrative’, that is the
‘discursive productions’ in the second person
singular or plural used by penitentiary operators in
the penitentiary institute (so, ‘you are a prisoner’).
Finally, the polarity of ‘Collective Matrix’, or all
the’discursive productions’ available and usable with
reference to the prison environment. To these
polarities we must add the dimensions of narrative
coherence, defined as the coherence of the processes of
construction of the reality, and of time kairòs, non-
chronological time or the moment itself of the
production of ordinary language (G.P. TURCHI, 2002).
486 Legislation
Narrative coherence
Collective Matrix
ID
Storytelling
Narration
Kairòs
Figure 1. The Theory of Dialogic Identity – iconographic

representation.
3. The study
In light of the above, the aim of treatment can

be understood as: ‹‹to contribute to generating
‘other’biographical careers3 than the ‘user’ biographical
3
In the light of the theory of Dialogic Identity, ‘biographical career’ is used
to describe the fabric of discursive productions expressed in present terms
and in anticipation (future projection) to be found both at the level of the
personal Storytelling as well as the Narration by third parties (including
487
carrer, which make it possible to anticipate the

configuration that can be generated at the end of the
incarceration period and promote a biography that does not
regard the incarceration as a stigma››. With reference to
this objective, the project adopts M.A.D.I.T
methodology (methodology based on analysis of
computerised textual data, G.P. TURCHI, 2009), in both
the set up and implementation of treatment directed at
female prisoners, and makes it possible to define
operative practices coherent with the level of inquiry
chosen and the plan of efficacy measurement for the
project itself. M.A.D.I.T and thus the methodological
steps (also called reference criteria, see next chapter)
required in order to conform with certain a level of
scientificity, is utilisedin this contribution on two
levels of analysis.
The first level of analysis involves efficacy
measurement, the objective being to measure how the
treatment contributes to modifying the dialogic
identity construct ‘female prisoner’ towards an
‘other’4 identity; to this end, a comparison is made of
institutions) and which take on the nature of predictions and / or

explanations as far as present and / or past behaviour is concerned. On
the contrary, ‘biography’ is used to describe all of those discursive
productions that contribute to constructing the configuration of ‘identity’
reality regardless of the storytelling and narratives which necessarily hinge
on an exclusively identity definition.
4
In virtue of the definition of efficacy (note 2), how far the objective of the
treatment has been transformed into a result at the end of the treatment.
488 Legislation
the’discursive productions’ noted before the start (t0)

and at the end (t1) of the treatment.
The second concerns the evaluation of the
process, with the aim of monitoring the way in which
the treatment activities (the strategies put into play by
the Institution) contribute to the attainment of the
treatment objective; in methodological terms, this
level of analysis involves recording the’discursive
productions’ over a time span that stretches from the
start to the end of the treatment, which we will call
‘intermediate time (tX)’.
In this contribution, we therefore intend to
deal with an analysis of the’discursive productions’
recorded for the evaluation of the orocess and will
present the efficacy measurements obtained.
4. Methodology
4.1. Description of the Text Corpora
The project for evaluating the efficacy and

process of treatment directed at female prisoners
therefore concerns a subject constructed on the basis
of the’discursive productions’ used to know it and
define it by the narrating voices found in the
penitentiary environment (prisoner-users and
operators). At the application level, the data we are
working with is therefore textual data, data collected
by means of a method dictated by the epistemological
489
foundation of the subject itself5. As regards evaluation

of efficacy, the data is obtained by administering a
specially designed protocol or questionnaire; the
protocol consists of 8 open questions directed at 21 of
the prisoners and 7 open questions directed at the
penitentiary operators. The corpus obtained from this
administraton comes to 7,234 occurrences. As far as
the evaluation of the process is concerned, the data
was obtained by considering 52 stories written by
female prisoners in the context of a publication and
two theatre plays written by a playwright based on
the stories of prisoners and then performed by the
prisoners themselves in the course of drama and
writing workshops for the user-prisoners in the High
Security women's section as strategies used in the
treatment process. In particular, these texts formed
the basis for two distinct corpora using the theoretical
basis of the research as a reference, and thus the
stories written by the prisoners are defined first
person storytelling and the drama productions as third
person narratives. The two corpora obtained consist of
25,535 and 10,180 occurrences respectively, which
comes to a total of 35,645 occurrences.
5
Where in the theoretical-epistemological framework ‘discursive
productions’ are defined, on the operative level (for example, in research),
these are collected as ‘textual data’ which, coherently with the former, can
be said to comprise a process dimension (the argumentative structure
which underpins the discursive production in the text) and a content
dimension (the linguistic elements which make up the text itself).
490 Legislation
4.2. Data analysis methodology
The following is the methodological

production line used for data analysis: M.A.D.I.T.
Methodology made it possible to describe
the’discursive productions’ by means of which reality
is generated. It is based on specific methodological
criteria; the first requires the object of the study to be
defined: coherently with the framework adopted and
the object of study6, the objective7 becomes to describe
the configuration ‘female prisoner undergoing treatment’.
The second criterion refers to the question
understood as a strategy directed at pursuing the
objective: it is possible to identify the question which
makes it possible to examine the text in keeping with
the object defined, by virtue of the fact that the
prisoner is placed in the first person (Storytelling) and
the second person singular or plural to tell about the
‘prisoner’ (Narration). For the ‘Storytelling’ polarity
we considered the stories of the prisoners collected in
6
Described in chapters 1 and 2
7
From a theoretical and methodological viewpoint, the aim of the study
must clarify what is to be pursued within the epistemological framework.
In this sense, the objective must allow the researcher to pursue it in the
terms in which it is defined according to the criteria of abstraction,
shareability, measurability and trigger processes that lead to the
achievement of same.
491
a publication which was the fruit of one of the

penitentiary treatment activities which answered the
question ‹‹Imagine you are writing a story in which you
appear as the main character: how would you describe
yourself?››. For the ‘Narration’ polarity, the texts were
the outcome of the theatre performances based on the
stories of the prisoners, being the answers to the
question ‹‹A director wants to produce a play about your
story, what would he write in the screenplay?››.
Finally, the third criterion defined by
M.A.D.I.T. comprises the mathematical-statistical
indices provided by the various procedures made
possible using the tools; in the case of this
contribution Taltac28 software was used.
These criteria were used as guidelines in the
application of the methodology used for data analysis
which made it possible to arrive at a description in
the text of the ways in which ordinary language is
used which give shape to the reality which is the
object of the study, operationalized in the naming of
‘discursive repertories’9.
Discursive repertories are the formalised rule
of the interaction among the symbolic units (words)
8
S. BOLASCO, 2010; S. BOLASCO, 2005.
9
That is, ‹‹finite means of construction of reality, linguistically speaking,
with a pragmatic valency, that also group several utterances
(called’archipelagos of meaning’), organised into connected sentences and
diffused with a valency of statement of truth, that aim to generate
(construct) / maintain narrative coherence›› (G.P. TURCHI, 2002).
492 Legislation
and generate a finite reality, since this construction

‘responds’ to a particular way of configuring reality.
Each discursive repertory has its own coherence and
the different coherences interact together, therefore
the particular discursive repertories that interact
among one another generate the specific
configuration of reality ‘female prisoner undergoing
treatment’.
By virtue of the properties of the rules for
constructing reality of discursive repertories, they can
be subdivided as follows:10: maintenance repertories
(which formalise the rule of use of ordinary language
and do not make it possible to produce a shift
towards ‘other’ discursive configurations from those
already provided and make the discursive
configuration stay ‘the same as itself’; generative
repertoires (which formalise those rules of use of
ordinary language bringing variability to the
configuration of reality under construction) and
10
The table of discursive repertories is periodic in that all the rules
represent the same property (i.e. Configure reality) regardless of the
language. The elements on the table are finite, but by means of their
interaction, they generate infinite and uncertain (not predictable, albeit
foreseeable) discursive configurations; by virtue of the particular
aggregation of the forms of use, an aggregation which sets the structure
of the discursive configuration generated. By virtue of the periodicity of
the table (which gives finiteness to the repertoires and the periodicity with
which these aggregate), different contents of discursive production can be
channelled from the same discursive repertory, in the same way that the
same content can be channelled from different discursive repertories.
493
hybrid repertoires (which formalise those rules of use

of ordinary language that can be either maintenance
or generative). Furthermore, discursive repertoires
are organised and distributed in the Periodic Table of
Repertoires.11
Therefore, the specification of the
identification of the ways of using ordinary laguage
that configures the reality under investigation here is
managed in the methodological analisys, as described
below, by considering the interaction among the
symbolic units, shifting from the lexical level to that
of the utilisation of rules of use of language.
To be precise, the corpora were processed
using Taltac2, obtaining a Vocabulary calculation and
carrying out the Normalisation procedure. We then
proceeded with a study of the graphic forms that
constitute the Vocabulary; considering that, in the
light of the reference theory adopted, these contribute
to configuring the reality which is the object of
inquiry. We therefore further investigated the ways in
which they are used in the light of the three criteria
discussed above. In particular, in the light of the
objective to describe the configuration ‘female prisoner
11
What is meant by ‘periodic table of discursive repertories’, as discussed
above, is the schematic diagram representing the finite universe of the
possible ways of use which can be applied in the utilisation of ordinary
language, formalised and defined as rules for use of ordinary language
and operationalized as discursive repertories.
494 Legislation
undergoing treatment’, we identify those graphic forms

which are possible indicators of a discursive turn12,
which trigger and characterise discursive processes13
that combine to construct the discursive configuration
which is the focus of inquiry. Based on this definition,
by means of Normalisation and segment analysis, it
was possible to identify the symbolic units14 that
account for the architecture of the text. These
procedures were used to identify and maintain the
symbolic units which combine to describe the reality
which is the object of inquiry, in particular, satisfying
the 1st and 2nd M.A.D.I.T. criteria concerning the aim
and question and so outlining the form that accounts
for how the text takes shape. The application of the
first two methodological criteria is substantiated by
the choice of forms of use by virtue of the three
12
What is meant by discursive turn is that element in the narrative plot
where it is possible to identify a separation vs a connection between one
part and the other of the period. The identification of the discursive turn
makes it possible to focus on the triggering of a primary discursive
modality through the discursive elements used. The content therefore
becomes a vehicle for generation of the process of construction of reality
in question. Using M.A.D.I.T. we therefore focus on the manner in which
these turns are applied in the text (G.P. TURCHI, 2009).
13
Discursive process is used here to mean the set of modalities of
knowledge (which are generated in the use of ordinary language) and
generate, construct or maintain a configuration of reality (what is known)
which imposes itself as real in its pragmatic effects (Turchi, 2009).
14
In fact, language is all of that which is characterised in terms of symbolic
units and rules of application (Wittgenstein, (1921) ed. it. 1998).
495
criteria and therefore also of the mathematical-

statistical indicators (3rd criterion), in this case the
total occurrances of the polyforms.
The analysis of repeated segments
subsequently allowed us to identify the strings of
forms peculiar to the use of languge in the text in
question. Based on these polyrhematics, we
considered those which in terms of the 1st and 2nd
criteria might turn out to be predominant forms
potentially describing the text. By means of the 3rd
criterion, the relative IS index15, we identified those
polyforms which ought to be treated as a single
graphic form. In relation to the 1st criterion (research
objective), calculating the index then makes it
possible to identify within the text which graphic
forms, independent of linguistic use as single forms in
the vocabulary, are used as polymorphous discursive
turns in the construction of reality. For example, the
sequences ‘I'm not interested’, ‘you're forced to’, were
kept in consideration of their meaninfulness in
relation to the object of analysis and/or associated
statistical data. Furthermore, sequences were
15
That is from a calculation of the level of absorption of the words that
make up the segment that allows us to obtain an index of the relevance of
the segments repeated in the corpus (relative IS index). The contributions
to text sequence absorption are on a scale from 0 to 1 (Morrone, A. (1993),
Some evaulation criteria for the significance of repeated sequences, in
Anastex (1994, pp. 445-53)).
496 Legislation
considered which could be seen in terms of content to

corroborate the use of the discursive process; ‘in this
country’, ‘my mother’ for example, are found in the
use of discursive processes as discursive nuclei round
which these discursive modalities are anchored. The
set phrases/polyrhematics obtained in this way
through use of Lexicalisation were maintained in the
light of their property of triggering possible ways of
constructing the realty in question, acting as
discursive turns in the text. Subsequnt to the
application of Grammatical Tagging and Semantic
Tagging, we proceeded with the association of a tag
to all those forms of the Vocabulary lined with
‘female prisoner’, which can be grouped together in
the sense that they account for the process of
construction of this reality. Table 1 shows some
discursive turns connotating the discursive processes
utilised in the texts analysed (first column), the
semantic tag in the methodology to such forms of use
(second column), a brief description of the factual
generative character of reality for each turn (third
column). In the light of the theory adopted in relation
to the object of inquiry the use of these procedures in
accordance with M.A.D.I.T. Methodology allowed us
to study the text collected, tracking the graphic forms
in relation to the generative valency with which they
497
are used16. On the other hand, Grammatical Tagging

was used as a precursor and aid in the definition of
the rhetorical turn used which feeds the discursive
process with reference to the epistemological
framework which is not exhausted in the language
and its grammar. This passage made it possible in fact
to proceed in the Semantic Tagging with
categorisation according to the use of the symbolic
units rather than their belonging to particular
grammatical or semantic categories. Some of these are
included in the following table, applied to the
Vocabulary, reconstructed in line with the application
of segment analysis and lexicalisation carried out in
accordance with the 3 methodological criteria.
SEMANTIC POSSIBILE
GRAPHIC
CATEGORY PROCESS
FORMS
NAME PROPERTIES
Delegitimisati
although – on of the
although
nonetheless statute of
reality of
16
Furthermore, the definition of discursive process, that all of the
modalities of knowledge that configure the ‘female prisoner undergoing
treatment’, considers the rhetorical-discursive architecture of the text
constructed on the basis of how the graphic forms are used together: the
syntactic-grammatical structure in itself doesn not account for the process
dimension which generates the configuration in question.
498 Legislation
another text
portion
we’ll run – vazionefutIpp Statement of a
we’ll go – (verbs action reality in terms
we’ll be future first of future
together person plural) perspective
Table 1. Examples of categories applied using the Semantic

Tagging procedure.
Taking a closer look at the table, just by way of

example we might note that the categorisations have
been formulated in the light of generativity
of’discursive productions’ in terms of configuration of
reality. Therefore ‘we’ll run’ and ‘we’ll go’ are lumped
together since they might be considered synonyms
and share – together with ‘we’ll be together’ – the
property of the type of reality that they generate (1st
criterion), that is, the contemplation of reality in terms
of a future perspective. In that sense they are
categorised as ‘vazionefutIpp’ (i.e.: verbs actions future
first person plural).
By virtue of the construction of ordinary
language in the interaction between symbolic units17,
we proceeded with the Extraction of information
from rules, that is the search for graphic forms or
17
Refer to chapter 2.
499
phrases through regular expressions which correspond

to the rules for use of the language. In this way it is
possible to identify all of the fragments that contain
one or more elements that satisfy the regularity
required by the description of the repertory18. The
criterion according to which the researchers stated
the queries to express the rules of use relates to the
possibility of use of the valency of use of that
symbolic unit in the language. The formalisation of
discursive processes is made possible by their
operationalization under the name of ‘discursive
repertories’ which the Periodic Table19 offers. For each
definition therefore, queries have been formulated
which mirror the discursive structure of the text
which generates the discursive reality described in the
definition of the repertory. First and foremost a
formalised operative formula was used for each
repertory. Thus, for example, starting from the
repertory definition of ‘Sanction reality’, a query was
formulated: ‘CATSEM(quando) LAG10 LEMMA(il
fatto che)’. This made it possible to collect 104 text
excerpts containing further process triggers which
rendered the text collected not compliant with the
operationalized name ‘repertory of sanction reality’.
18
That is, each definition of ‘discursive repertory’ is formalised in the
formulas that contain the elements of text (symbolic units) which combine
to generate precisely that repertory.
19
See note 10.
500 Legislation
Accounting, in the formula, for the set of possible

elements which combine in the use of a specific
discursive process, we then proceeded to formulate a
more specific query which gathered rules of use
belonging to a primary modality for constructing the
configuration ‘female prisoner undergoing treatment’. In
that sense, by anticipating the discursive turns, more
detailed queries were created with respect to the
forms of use in the process and the dimensions of
content.
Table 2 below gives some examples of queries
used in the interaction of the symbolic units which
made it possible in the text to identify the repertory of
sanction reality and the repertory of description.
Query for the Repertory Query for the Repertory

Santion reality Description
‘CATSEM(senso di) LAG5 CATSEM(vazionepass)
CATSEM(quando) LAG7 LAG15
LEMMA(il fatto che)’ OR CATSEM(quando)
‘CATSEM(vstato) LAG5 LAG15
CATSEM(causa) LAG5 CATSEM(vazionepass)’
CATSEM(possIIps)’
‘CATSEM(indicimperf) CATSEM(verbaz) LAG10

LAG5 CATSEM(elemcert) CATSEM(verbaz) LAG10
LAG5 CATSEM(verbaz)’
CATSEM(elemconnot)’
501
Table 2. Queries developed for the repertories of sanction

reality and description.
It can be seen from Table 2 that if polyforms and

lemmas found in the grammar are considered in the
formalisation of the discursive repertories by means
of the queries, then there is a consideration of the
conjugation and declination of these elements by
virtue of the valency based on which common
language is shared (for example, the use of the
imperfect indicative -indicimperf- to describe a past
action that is being repeated).
The gap between the two queries, however, becomes
clear in the use of symbolic units which for the use
they have in language define the female prisoner
furnishing a photograph without adding any
personal interpretations (Repertory of Description)
versus those that use connotative elements which
connotate what has been said as real (consider the
symbolic units elemenconnot; elemencert), which
proceed to identify, without being able to comment
on what has been stated, a reality as static and
immobile (Repertory of Sanction reality).
Here below is a list of the discursive repertories
created and the numbers of queries developed:
Number of
Discursive repertory
queries
Repertory of Sanction reality 17
502 Legislation
Repertory of Prediction 17
Repertory of Justification 31
Repertory of Contraposition 13
Repertory of Confrontation 11
Repertory of Evaluation 10
Repertory of Description 9
Repertory of Generalisation 8
Repertory of Prescription 8
Repertory of Possibility 7
Repertory of Judgment 6
Repertory of Cause 3
Repertory of Declaration of Intentions 3
Repertory of Comment 2
Repertory of Opinion 2
Repertory of Controversy 1
Table 3. Queries developed in relation to the various

repertories
Since the calculation involved queries which

were drawn up about different repertories, dealing
with these and extracting text excerpts from these, the
research project design included a calculation for an
indicator to ensure the precision of the analysis
carried out.
503
On an experimental level, we proceeded to

compare the results obtained from the test
methodology used with the results of the analysis of
the same text using the pencil and paper method. This
comparison led to two indices: the Index of Coverage
(of the query) and the Index of Error (of the query).
The first offers a measurement of how the extraction
of text excerpts which is achieved using a certain rule
expression detects the text excerpts to be extracted. In
actual fact, the numerical value of the index is the
percentage ratio between the number of repertories,
considered individually, extracted by means of the
queries and the total number of such repertories
named in the text20. On the other hand, the Index of
Error offers a measurement of to what extent the
extraction of text excerpts that is obtained by means
of a certain rule expression does not detect the text
excerpts to be extracted. In actual fact, the numerical
value of the index is the percentage ratio between the
number of different Repertories from each individual
repertory, extracted by means of the query in the left
hand column, and the total number of same named in
20
When the ratio equals 100%, the number of repertories extracted –
considered individually – coincides with the total number of repertories
named in the text being analysed. This index constitutes such an important
result indicator that the increase of the percentage ratio above
corresponds to an increase in efficacy of the rule expression.
504 Legislation
the text21. The use of such indices, regardless of the

dimensions of the corpus it is possible to collect, has
made it possible to note a shift between the first and
second application of each rule of use: analysis of the
interaction among a number of discursive symbolic
units showed that although the first formula allowed
for a maximum coverage of 60% for each repertory,
this value reached 93% (coverage index) following the
increase in precision – discussed above – with the
formalisation of the rules of use queries.
The above explains the methodological
procedures used in the project by means of which the
process evaluation data were analysed.
4.3. Efficacy Measurement Methodology
In the light of the objectives of pentientiary

treatment22 the research project came up with a
21
When the ratio equals 0%, the number of repertories extracted –
considered individually – equals 0. In this sense, the Index of Error (of the
queries) constitutes a result indicator such that the decrease in the above
percentage ratio corresponds to an increase in the efficacy of the rule
expression.
22
That is, ‘contributes to generating ‘other’ biographical careers from the
biographical career of the ‘user’, which can make it possible to anticipate
the configuration that can be generated at the end of incarceration and
promote a biography that does not stigmatise the incarceration’, see
chapter 2.
505
measurement methodology in order to evaluate the

efficacy of penitentiary treatment.
The methodology for evaluating the efficacy of
intervention is based on a protocol drawn up in order
to measure the configuration ‘female prisoner’ at t0
and at t123, by means of the following operations:
defining the formulas for calculating the dialogical
weight of the discursive configuration for each
individual question; calculating the discursive
configuration of the polarities of Alter and Personalis
to measure both T0 and T1; calculating the polarity of
Collective Matrix for each specific time (before and
after treatment); calculating the dialogical identity;
calculating the efficacy measurement.
As regards defining the formulas for calculating

the dialogic weight of the discursive configuration for each
individual question (first operation), indicated by the
symbolic unit’X’ the reference is to the formalisation
of the’discursive productions’ in terms of rules of use
of ordinary language in the Periodic Table of
discursive Repertories, where each repertory is
assigned a weight, called ‘dialogical weight’’24. The
calculation formula is:
23
In this regard see paragraph 2.1
24
In the light of the relations/interactions between the process properties
which generate them.
506 Legislation
‘X = [ [ S ( c * dw2 ) / S dw ] + 10 ] / 2’
The calculation deals with the ‘group’25 of
discursive repertory in the Periodic Table of repertories
(‘c’), to which is assigned a value of +1 (generative
repertory) o -1 (maintenance repertory) and the
dialogic weight of each of the discursive repertories,
called’Dw’ (being an acronym of ‘dialogical weight’).
Apart from these operationalizations of the founding-
theoretical elements, we also considered how the
contribution of formula provides a value which
accounts for the generative rather than maintenance
nature of the discursive processes, providing us with
a numerical result can is comparable within a scale of
reference.
In the light of the definition of the formula for
calculating the dialogical weight of the discursive
configuration, this is applied to the individual
questions in the protocol (second operation,
calculation of the discursive configuration relative to the
polarity Alter and Personalis to measure t0 and t1), thus
with reference to the repertories named in the text
produced by the female prisoners (Storytelling
polarity ) and the penitentiary operators (Narration
polarity), obtaining the dialogical weight of the
discursive configuration for both times T0 and T1.
Once the dialogical weight has been calculated
for the configurations of the Storytelling and
25
Regarding which compare with note 12.
507
Narration polarities (previous step), we proceeded

with the third operation, calculating the reference
value for the Collective Matrix (calculation of the
Collective Marix polarity for each specific time, before and
after intervention), another element26 which contributes
to the configuration of dialogical identity27. This, in
the light of the reference theory adopted, is defined as
‘the sum of all the’discursive productions’ that can be
practiced’ with reference to the penitentiary
environment.28
The operationalization of the Collective Matrix
as representation of the finite universe of modalities
of use of language consists of calculating the
dialogical weight of configuration comprising all the
elements in the Periodic Table. Thus the formula for
calculating the dialogical weight constructed, for each
specific measurement time, before and after
treatment, considers the interaction between three
units: the value for the dialogical weight of the
Storytelling, the Narrations and the constant value of
the Periodic Table.
With the fourth operation (calculation of the
dialogical identity) we proceeded with the
implementation of a formula which allows us to make
26
In the light of the Theory of Dialogical Identity, see paragraph 1.
27
Generated by the intersection of three theoretical polarities :
Storytelling, Narration, Collective Matrix.
28
In this regards, see foreword.
508 Legislation
the values for the Storytelling, Narration and

Collective Matrix interact, giving us a value for T0
and one for T1 and the value for the weight of the
configuration of the dialogical identity.
Below in Figure 2 we have an example, the
formula used at T1 which remained the same at T0
with two values as the result of this index (X (I.D.) ):
X (I.D.) at T1 = cubed root of (X (Storytelling at

T1) * X (Narration at T1) * X (Collective Matrix at T1) )
Figure 2. Calculation of Dialogical Identity
509
As regards evaluation of the process, the

values obtained for the theoretical configuration at t0
and t1, are positioned on a theoretical scale of
reference29, which has a minimum value of 0 and a
maximum of 10, allowing us to produce some
considerations on how the treatments have
contributed to achieving the objectives of the
treatment.
Finally, by means of the fifth
operationalisation (calculation of the value of efficacy), it
becomes possible to calculate the efficacy gap
between t0 and t1 both for the valuesi X (I.D.)
obtained, as well as for the individual polarities of
Storytelling and Narration, expressing the values
with the same unit of measurement, i.e. that of
dialogical weight, by means of the following
formulas:
Efficacy relative to I.D.T: = X (I.D.T. t1) –
X(I.D.T. t0)
Efficacy relative to Storytelling = X (Resoconto
t1) – X(Resoconto t0)
Efficacy relative to Narration = X (Narrazione
t1) – X(Narrazione t0)
29
The values for dialogical identity obtained in the two measurement
processes (t0 and t1) are projected on the continuum ‘biographical career
of the prisoner’ (numerical value 0) vs ‘biography’ (numerical value 10),
which represents the discursive configuration of dialogical identity in
relation to being a ‘prisoner’ (theoretical configuration at t0) or the ’
‘treatment objective’ (theoretical configuration at t1).
510 Legislation
These formulas allow us to calculate the shift

between t0 and t1 taking as a reference the
measurement values of the configuration in the two
treatment times, where the relative shift represents
the measure of change that the treatment has
produced in relation to the initial objective.
5. Comment on the Results of the Efficacy

Measurement
As regards the discursive configuration of the

Dialogical Identity of ‘female prisoner’, the efficacy
measurement shows the following values calculated
by means of the test operations presented and named
in Table 5:
Discursive polarity Values
DIALOGICAL IDENTITY T0 2,56
DIALOGICAL IDENTITY T1 5,20
Shift T1 - T0 (Dialogical Identity) 2,63

511
Shift T1 - T0 (Storytelling ) 4,54
Shift T1 - T0 (Narration) 1,56
Table 4. Values obtained from measurement of efficacy of

penitentiary treatment.
In particular, in relation to the discursive

polarities Storytelling and Narration at times t0 an t1,
the formulas discussed above make it possible to
produce numerical data (the values of dw) expressed
on the same scale. Moreover, these figures being
operationalisations of methodological criteria are
obtained on the shift of the text corpus analysed in
relation to compliance to the three M.A.D.I.T. Criteria.
Thus the size of the corpus available (whether small
or large) has no impact on the efficacy measurement.
As can be observed from the table above, the
shift is calculated between t0 e t1. In general, a
positive shift means that the intervention produced a
change in the direction of the preset objective; in
particular, there is a shift of 2.63, 4.54 in Storytelling
and 1.54 in Narration. There is therefore a clear
change in the direction of the objective, also taking
into consideration the fact that the change obtained is
more marked in relation to the polarity of Storytelling
512 Legislation
(a shift of 4.54) compared with Narration (shift of

1.56).
Taking a closer look, Table 5 below gives an
overview of the discursive repertories named in the
texts produced by respondents which account for the
shift described by the numerical data in Table 5:
Narration
Storytelling
(penitentiar
(prisoners)
y operators)
REPERTORIES
t0 t1 t0 t1
NAMED
21 118,8 59,4 158,4
DESCRIPTION
dw30 dw dw dw
ANTICIPATION - - - 7 dw
POSSIBILITY - - 7 dw -
REFERENCE TO 9,9
- - -
OBJECTIVE dw
15 20
CONSEQUENCE - -
dw dw
COMPARISON - - 4 dw -
FUTURE
- - - 4 dw
PROJECTION
30
The value here refers to the DW or dialogical weight index; see
paragraph 3.
513
METAPHOR 2 dw 2 dw 2 dw 7 dw
PRESCRIPTION - 2 dw - -
CONTRAPOSITIO 20
7 dw - 5 dw
N dw
198 24 72 96
ATTRIBUTION
dw dw dw dw
RIDIMENSIONING 6 dw - - -
63 63 21 28
CAUSE
dw dw dw dw
DERESPONSABILIS 18 35 14
-
ATION dw dw dw
16 49 70 63
JUDGMENT
dw dw dw dw
10
OPINION - 7 dw -
dw
48 56 48 56
COMMENT
dw dw dw dw
36 80
JUSTIFICATION 8 dw 8 dw
dw dw
18 32 64
PREDICTION 8 dw
dw dw dw
SANCTION 29,7 128,7 118,8
-
REALITY dw dw dw
Shift in discursive
4,54 1,56
configuration t0-t1
Table 5. Repertories named in relation to efficacy

measurement.
These results reveal: a reduction in dialogical

weight in the repertory of Justification between the
two measurement times t0-t1; an increase in
514 Legislation
dialogical weight in the repertory of Comment in the

two measurement times (48 dw at t0 and 56 dw at t1);
and an increase in dialogical weight in the repertory
of Judgment: from 16 dw to 49 dw. Furthermore, the
dialogical weight remains unaltered in the repertory
Sanction Reality in both times for Narration, while for
Storytelling, it goes down to zero at t1. While there is
an increase in dialogical weight for the repertory of
Attribution for the polarity of Narration (72 dw at t0
and 96 dw at t1), use falls for Storytelling at t1 (from
198 dw to 24 dw). The results described substantiates
the shift in weight of the discursive configuration
between t1 and t0, which varies between Storytelling
(4.54 units) and Narration (1.56 units), as well as the
efficacy measurement for penitentiary treatment
which is 2.63 units, using a measurement scale where
10 is the maximum quantum of efficacy of
pentitentiary treatment, thus the maximum level of
generation of biographical careers ‘other’ than that of
‘prisoner’ (target of the ‘treatment’). It is therefore
possible to highlight the critical contribution
of’discursive productions’ utilised by the penitentiary
operators (Narration) compared with those of the
prisoners (Storytelling ), since their contribution
maintains the construction of the identity of the
prisoner in relation to the configuration of reality that
generated the request for restriction of freedom.
515
6. Concluding Remarks
In the research project, the results obtained

from the process evaluation have show how, with
reference tothe construct ‘female prisoner’
undergoing treatment, the polarities of Storytelling
and Narration at tX remain largely compliant with the
role of ‘prisoner’. In this way, the opportunity to do
drama workshops come to represent ‘merely’ an
activity that consolidates the biographical career
instead of offering discursive spaces which move
towards an opportunity independent of the reason
that made it possible. In fact, discursive configuration
is characterised by the use of 11 maintenance
repertories out of the 16 repertories measured,
repertories that is, which generate a process of
‘definitiun of a state of affairs’31. The dialogical
identity that is generated therefore in the intersection
between the two polarities defines a value close to the
‘biographical career’. As regards efficacy
measurement, carried out using M.A.D.I.T.
methodology, this makes it possible to show how the
treatment objective is transformed into result with a
shift between t0 and t1 of 2.63 units. This value
31
See paragraph 2.2.
516 Legislation
highlights the use of maintenance repertories such as

the repertories of Sanction Reality, Judgment, and
Cause, which casue the reality ‘prisoner under
treatment’ to remain unaltered: for example, the
repertory Sanction reality, Judgment, Comment and
Cause. On the other hand, the repertories of
Description, Reference to the Objective, and
Anticipation contribute to the construction of a
possible reality of change independent of those
elements that construct the biographical career of
prisoner.
Based on what was measured in the research
study, we can highlight on the one hand how
prisoners maintain the use of’discursive productions’
which do not allow for the prospect of transformation
scenarios; on the other hand, the penitentiary
operators, using the same’discursive productions’ of
he prisoners, offer a contribution in line – that is, not
dyscrasic, which can therefore generate ‘other’
identities – than that of the configuration of reality
‘user-prisoner’. It is also possible to observe that
generative discursive repertories (repertories of
Reference to the objective and to Possibility), used at
t0 to configure the prisoner as polarity of Narration,
are not used at t1; in that sense the configuration of
the ‘prisoner undergoing treatment’ comes to lose the
potential for change, and thus compliance with the
treatment objective. Therefore a comparison of the
polarities of ‘Storytelling’ and ‘Narration’ also show
that the efficacy shift is greater in the case of texts
produced in the ‘voice’ of the prisoner. This shows
517
how the treatment has had greater efficacy in

transforming the’discursive productions’ of the
prisoners rather than those of the penitentiary
operators.
In the light of the above, in terms of
improvement of the penitentiary treatment, efficacy
measurement makes it possible to show the
possibility of constructing interventions to generate
‘other’ identities than that of ‘prisoner’. This can be
done by promoting the use of’discursive productions’
on the part of all the ‘voices’ that make up the context
in which the treatment is being carried out which,
making reference to a ‘third’ level as opposed to the
personal one, make it possible to describe and plan
scenarios for changing the identity ‘prisoner’.
Only in this way is it possible to carry out an
operation in the scientific sense, contributing to
constructing the potential for empowering the
various ‘voices’ that participate in the treatment and
thus to propose alternatives to these, putting them in
a position to trigger a differential in the discursive
configuration that is sufficient to generate an impetus
in the direction of achieving the goal of the treatment.
References
S.J. ANASTEX, JADT 1993, Actes des secondes journées

internationales d'analyse statistique de données textuelles,
Montpellier, October 1993
518 Legislation
S.J. ANASTEX,Actes des Secondes Journées Internationales

d'Analyse Statistique de Données Textuelles, Paris, 1994
(p. 445-53)
E. AURELI CUTILLO, S. BOLASCO, Applicazioni di analisi
statistica dei dati testuali, Roma, 2004
P.L. BERGER, T. LUCKMANN, La realtà come costruzione
sociale, Bologna, 1997
S. BOLASCO Taltac 2.10. Sviluppi, esperienze ed elementi
essenziali di analisi automatica dei testi, Milano, 2010
S. BOLASCO, S. CANZONETTI, M. F. CARO, Text mining.
Uno strumento strategico per imprese e istituzioni, Roma,
2005
G. DE LEO, A. QUADRIO, Manuale di Psicologia
Giuridica, Milano, 1995
F. FIORENTIN, G.G. SANDRELLI, L’esecuzione dei
provvedimenti giurisdizionali, Padova, 2007
M. FOUCAULT, Sorvegliare e punire: nascita della
prigione, Torino 1976
A. MORRONE, (1993), Alcuni criteri di valutazione della
significatività dei segmenti ripetuti, in “Jadt 1993”,
Montpellier 21-22 October, Paris, pp. 445-453.
A. MUSSONI, A.DI MASO, A. SALVINI, G.P. TURCHI,
Identity as social and self narration: an approach to clinical
psychology in International Journal of Psychology, p. 255,
abstracts presented at XXVII Stockholm International
Psychology Congress organized by International
Union of Psychological Science, 2000.
519
A. MUSSONI, A. DI MASO, A. GIRELLI, A. SALVINI, G.P.

TURCHI, A critical appraisal of state- and traits personality
labels theory: an empirical study, in International Journal
of Psychology, p. 285, abstracts presented al XXVII
Stockholm International Psychology Congress
organized by International Union of Psychological
Science, 2000
M. RONCO, S. ARDIZZONE, Codice Penale Ipertestuale.
Leggi Complementari, Torino, 2007
G.P. TURCHI, Tossicodipendenza. Generare il cambiamento
tra mutamento di paradigma ed effetti pragmatici, Padova,
2002
G. P. TURCHI, Immigrazione e consumo di sostanze a
Bergamo. Una proposta di Architettura dei Servizi per la
promozione della salute nel territorio, Roma, 2008
G.P. TURCHI, Dati senza numeri, Bologna, 2009
G.P. TURCHI, E. CELLEGHIN, Psicologia delle differenze
culturali e clinica della devianza. Occasione peripatetica
per un'agorà delle politiche sociali, Padova, 2010
G.P. TURCHI, R. FUMAGALLI, M. PAITA, (edited by), La
promozione della cittadinanza come responsabilità
condivisa. L'esperienza pilota di mediazione civica sul
territorio della Valle del Chiampo, Padova, 2010
G.P. TURCHI, L. ORRÙ, Lo psicologo, la giurisprudenza e
l'attività peritale: analisi del testo di consulenze tecniche di
parte e di ufficio in ambito penale e civile", in A. SALVINI,
A. RAVASIO, T. DA ROS, Psicologia giuridica. Firenze,
2008
520 Legislation
G.P. TURCHI, V. GHERARDINI, M. ROMANELLI, La

mediación como instrumento de promoción de la salud: del
estado del arte al trazado de líneas de dirección, contribute
presented at EMARC 2011, 2011
G.P. TURCHI, M. ROMANELLI, Flussi migratori, comunità
e coesione sociale. Nuove sfide per la mediazione, Milano,
2013
G.P. TURCHI, M. ROMANELLI, L. COLAIANNI, La filiera
della conoscenza emanazione della scienza dialogica: una
proprosta teorica ed operativa per l’intervento sociale, in
COLAIANNI e CIARDIELLO (edited by), Cambiamo
discorso, Milano, 2012
L. WITTGENSTEIN, Tractatus Logicus-Philosophicus,
Torino, 1953
L. WITTGENSTEIN, Ricerche filosofiche, Torino, 2009
L. MARIOTTI CULLA, G. P. TURCHI, Stranieri e droghe -
Dalla cura del corpo alle pratiche discorsive nel sistema
carcerario, Roma, 2007.
Sitography
http://www.governo.it/Governo/Costituzione/prin
cipi.html: Italian Costitution
Stefano Zago, Manuela Fumagalli, Silvia Inglese Irene Rossetti,
Giuseppe Sartori, Alberto Priori, Andrea Lavazza
521
Remembering and Lying in Relation

to Crime: Clinical and Research
Implications
Stefano Zago1, Manuela Fumagalli2, Silvia Inglese3 Irene

Rossetti4, Giuseppe Sartori5, Alberto Priori6, Andrea
Lavazza7
Key-words: memory, amnesia, deception, neuroimaging,

neurostimulation.
1
U.O.C. Neurologia, Dipartimento di Neuroscienze e di Salute Mentale,
IRCCS Ca’ Granda, Fondazione Ospedale Maggiore Policlinico, Milan, Italy.
2
Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i
Disordini del Movimento, Fondazione IRCCS Ca’ Granda, Ospedale
Maggiore Policlinico, Milan, Italy.
3
U.O.C. Neurologia, Dipartimento di Neuroscienze e di Salute Mentale,
IRCCS Ca’ Granda, Fondazione Ospedale Maggiore Policlinico, Milan, Italy.
4
Fondazione Guglielmo Gulotta, Milan, Italy.
5
Dipartimento di Psicologia Generale, Università degli Studi di Padova,
Italy.
6
Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i
Disordini del Movimento, Fondazione IRCCS Ca’ Granda, Ospedale
Maggiore Policlinico, Milan, Italy. Dipartimento di Fisiopatologia medico-
chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
7
Centro Universitario Internazionale, Arezzo, Italy.
Remembering and Lying in Relation to Crime: Clinical and
Research Implications
522
1. Introduction
Research is currently being carried out into the

use and development of psychological, neuroimaging
and neurostimulation techniques to evaluate amnesia
and lying. Courts increasingly avail of neuroscientific
experts to assist in resolving legal question regarding
crime related amnesia. We illustrate some new
possible applications which concern memory in the
law courts. The first paragraph looks at the offender’s
claimed amnesia following the crime, discusses the
role of neuropsychological tests and presents a new
memory detection tool, the autobiographical Implicit
Association Test (a-IAT) validated both in forensic and
in clinical settings. The second paragraph discusses
neuroimaging in distinguishing real or malingering
amnesia and its growing relevant role in the forensic
field. The third paragraph discusses drugs that have
shown to be able to dampen or erase memories,
generally used for treatment purposes but that open
relevant ethical issues when used for other aims.
Finally, the fourth paragraph discusses
neurostimulation techniques, both invasive and non-
invasive, and their ability to modify complex
cognitive and behavioural processes, such as moral
judgement and lying.
523
2. Characteristics of Crime-Related
Amnesia and the Application of the
Autobiographical Implicit Association
Test (a-IAT)
Amnesia in the context of crime is a puzzling

and fascinating phenomenon and the subject of
prolonged debate (Hopwood and Snell, 1933;
Schacter, 1986; Kopelman, 1987; Herman, 1995;
Bourget and Whitehurst, 2007). It is not uncommon
that after committing a violent crime the offender
does not have any memory at all of the events, or
recalls some of the details but with gaps.
Circumscribed amnesias in the context of crime have
been variously reported, ranging from 10 to 70%
(Porter et al., 2001; Cima et al., 2004; Bourget and
Whitehurst, 2007).
Judges, despite skepticism regarding claims of
amnesia, have started to refer to experts
(psychiatrists, neuropsychologists, neurologists, etc)
to understand its characteristics. Post-crime amnesia
has important implications for legal trials and
defendants who present with presumed memory loss
for the alleged crime are not uncommon (Denney,
2005; Bourget and Whitehurst, 2007). The accused,
who can’t remember the criminal event, may be
unable to defend himself adequately and therefore
could be considered unfit to stand trial. On the other
hand, the evidence of post-crime amnesia could
524
reduce the criminal responsibilities of the accused

once the amnesia is proved to be due to a dissociative
state or secondary to cerebral dysfunction.
Most clinicians and forensic experts are also
skeptical about the possibility that murderers can
develop authentic post-crime amnesia. The hiding of
information, which the offender knows to be true, can
create advantages during the trial and the offender
has no motive for collaboration, putting the supply of
further clues for the prosecution at risk. However,
widening research has shown that other than in
malingering (Bylin and Christianson, 2002), crime-
related amnesia could be connected to acute alcohol
and drug intoxication (van Oorsouw et al., 2012;
Stout, Farooque, 2008; van Oorsouw and
Merckelback, 2012), sleep disorders (Podolsky, 1959;
Broughton et al., 1994), psychotic episodes (e.g.
Eronen et al., 1996; Wessely, 1997), dissociative states
in traumatic and/or stressful events (Bradford and
Smith, 1979; Porter et al., 2001).
During violent crime, dissociative states have
been hypothesized to produce neurotransmission and
neuroendocrine dysregulation, which could
determine an acute effect on the attention process and
on the codification/consolidation of autobiographical
memory (Bourget and Whitehurst, 2007). Findings
flowing from empirical research indicate that
individuals often try to exclude the unwanted
memory from awareness. An autobiographical fact,
which threatens the internal world and preserves the
sense of the self, is removed from consciousness.
525
From a neurobiological perspective, a metabolic

increase in the prefrontal cortex, along with an
inhibiting effect in the hippocampus, has been
hypothesized in relation to impairing memory
retention (Kikuchi et al., 2009; Anderson and Lewy,
2009).
The increasing relevance of memory
impairment to criminal matters will undoubtedly
require forensic experts to possess a basic
understanding of the phenomenology and
neurobiology of memory in relation to organic and
psychogenic alterations. In addition, there are clinical
markers and tools to distinguish between genuine
and simulated amnesia in crime and it is also
important that forensic experts familiarize themselves
with these applications. This aspect is well evidenced
in some recent papers, in which the use of several
neuropsychological tests to evaluate memory loss
claims in crime is encouraged, highlighting
inadequacies in results when these tools are not used
for forensic evaluation (van Oorsouw and
Merckelbach, 2010; Peters et al., 2013). For example,
Jelicic et al., (2004) reported that Symptom Validity
Testing might be helpful in identifying feigned crime-
related amnesia. Recently, Sartori and colleagues, at
the University of Padua, introduced and developed
the autobiographical Implicit Association Test (a-IAT) a
technique that has been applied in various murder
cases in Italy in order to distinguish between genuine
and simulated amnesia (Sartori et al., 2008; Agosta
526
and Sartori, 2013). We can provide some guidance on

this technique.
Evaluating claims of crime-related amnesia with
autobiographical Implicit Association Test (a-IAT).
Autobiographical Implicit Association Test (a-IAT)

allows to evaluate which of two contrasting
autobiographical events is true for a given individual
in a forensic setting (Sartori et al., 2008). a-IAT is a
variant of the Implicit Association Test proposed by
Greenwald et al., (1998) used in social psychology to
detect and measure implicit attitude and, in
particular, the strength of a person’s automatic
associations for memorized concepts. The IAT
proposed by Greenwald et al, (1998) is a
computerized task in which participants are required
to classify stimuli into two sets of two contrasted
categories (e.g., two target categories: flower and
insect; two attribute categories: positive and
negative). The IAT measure is computed by
comparing the relative response times between the
two versions of the combined tasks in which stimuli
from all categories are randomly displayed in the
middle of a computer screen. The assumption
underlying the test is that the categorization task will
be easier when two highly associated concepts (e.g.,
flower and positive) share the same response key,
rather than when they require two different response
keys. IAT is widely used in studies of social cognition
and in order to analyse prejudice, stereotypes, self-
esteem, and personality traits. Gray et al., (2003)
527
extended its use and adapted the IAT also for forensic
purposes. In their studies, they discovered that
psychopathic murderers show abnormal cognitive
responses for concepts related to violence. In a further
study, based on IAT techniques, they found that
pedophiles show an association between children and
sex, whereas non-pedophilic offenders have an
association between adults and sex, highlighting a
cognitive abnormality that might underpin some
pedophilic deviant sexual behaviour (Gray et al.,
2005).
In the new forensic a-IAT, introduced by
Sartori et al., (2008), the computerized task consists of
five separate blocks of categorization trials, with
stimuli belonging to four categories: two represented
by alternative versions of an autobiographical event,
only one of the which is true (e.g. ‘I am climbing a
mountain’ and ‘I am sitting in front of a computer
screen’); the other represented by sentences that are
always true and sentences that are always false for
the respondent (e.g. ‘I stabbed my mum’ and ‘I was at
work at the time of death’).
The true autobiographical event is identified
by the response times during the categorization task
of two critical blocks. Since it is supposed to be highly
associated with the sentences that are always true,
when the categorizations share the same response key
the task will be easier as opposed to when two
different response keys are required.
Sartori’s technique has been validated both in
forensic and in clinical settings. In a series of six
528
experiments, including cases of simulated crimes,

Sartori et al., (2008) found that the a-IAT has a notably
high accuracy in determining which of the two
autobiographical events is true (overall, 91%). The
high accuracy reached in experimental settings has
induced the same team of researchers to systematize
and solidify the evidence collected thus far about the
methodology by putting forward a series of
guidelines for building an effective a-IAT (Agosta and
Sartori, 2013). Additional independent studies on a-
IAT proved that attempts to fake it can be detected
and corrected (Agosta et al., 2011). These findings
contrast with previous studies which had shown that
properly trained participants might strategically alter
the test outcome (Agosta, 2005; Verschuere et al.,
2009).
Other advantages of the a-IAT have been
demonstrated in respect to other methods applied in
the forensic field in evaluating autobiographical
memories, such as the Guilty Knowledge Test
(Lykken, 1959; Ben-Shakhar and Elaad, 2003). First,
the a-IAT is not a “lie detection” technique but rather a
“memory detection” technique. It measures reaction
times to evaluate whether a specific memory trace
connected to a crime is coded in the memory or has
been acquired from the outside. Secondly, it is easier
to administer and requires less time to be completed.
Finally, it meets the Daubert criteria for admissibility
of expert testimony in U.S. federal courts and has also
been adopted in Italian courts.
529
The potential of this new technique of memory

detection in distinguishing between cases of false and
actual crime-related amnesia is evident in an
illustrative and recent court case held in Northern
Italy. The defendant, prosecuted for the murder of her
sister and the attempted murder of her parents, was
diagnosed with Dissociative Identity Disorder (DID) by
the defence psychiatrist. She claimed crime-related
amnesia. The judge acknowledged the disorder, and
thus partial mental infirmity, also in reference to the
results of the a-IATs administered by the defence
neuropsychologists. The a-IATs showed that the
defendant did not have autobiographical memories of
the crimes (Sentence, 20.11.2011, Tribunale di Como,
pp. 49-50).
This trial shows that the application of
traditional psychiatric investigation methods (i.e.
interview and psychopathological tests) can be
successfully integrated with new tools. The a-IAT is
one of these, as it is able to identify malingering of
crime-related amnesia and can therefore be utilized to
corroborate the reliability of forensic psychiatric
evaluations of mental insanity based on clinical
interviews and related standard methodologies.
3. Neuroimaging in the Courtroom:

Perspectives and Risks
530
In a recent article, Schacter and Loftus (2013)

underlined the interesting and new possibility that
brain imaging techniques, such as functional
magnetic resonance imaging (fMRI) or event related
potentials, used by neuroscientist, could provide
answers about true or a false memory in crime.
Over the last few decades, neuroimages has
revolutionized research and ushered in modern
cognitive neuroscience. Neuroimaging makes it
possible to see cerebral activity as it happens: the
anatomical-clinical method that had typified
neuropsychology since its earliest days has made a
huge leap forward, as it can now see in real time the
neurological correspondents of our superior faculties,
which prior to this scientists could only study the
links between cognitive deficits and cerebral lesions
during post mortem autopsies. In a way – and there in
lies the seductive appeal (and risk) of these
instruments, particularly in the legal realm – our
thoughts have become visible (cf. Gazzaniga et al.,
2005).
In fact, neuroimages are based on secondary
indicators to reconstruct an image of the brain and/or
its activity. In particular, in functional magnetic
resonance imaging (fMRI) magnetic fields make it
possible to identify the areas of the brain with the
highest flow of oxygen-rich blood. We know that the
activation of neurons, as with all other cells, requires
energy, and that this energy is provided by the flow
of arterial blood. We can thus deduce that the areas of
the brain that drawn in the most blood are also the
531
most active ones. On the basis of this, we can then use

software to conduct mathematical and statistical
analyses to remove ‘background noise’ (even when
one is concentrating on a single specific task, the
nervous system is engaged in broader overall
activities) to identify the areas most directly involved
in that specific task (Logothetis, 2008).
Among the various neuroimaging techniques,
one can distinguish between those that are able to
view the brain’s anatomical structures – structural
neuroimaging, which can show lesions or anomalous
developments caused by disease – and those that can
view brain activity in the presence of certain cognitive
tasks – functional neuroimaging. Structural
neuroimaging techniques include computed axial
tomography (CAT scans), magnetic resonance
imaging (MRI) and diffusion tensor imaging (DTI,
specifically for white matter). Functional
neuroimaging techniques include positron emission
tomography (PET), single-photon emission computed
tomography (SPECT), fMRI and recent multivariate
analysis techniques concerning the functional
connectivity between brain regions.
As stated above, seeing the brain in real time
through an fMRI is not akin to having a direct
photograph, but is instead like having a
reconstruction “mounted onto” a standard brain and
coloured specifically in order to quickly visualize
which areas of the brain are the most active, and to
what extent. This does not mean that one should be
suspicious on principle, but it is advisable to have a
532
thorough knowledge of the methods and complexities

of neuroimaging if it is to be used in a court of law.
The reliability of neuroimaging is attested by its
clinical use, which has seen extraordinary progress in
the precision and efficacy of diagnoses and
treatments.
One of the main cautionary factors is the fact
that neuroimaging is much more precise when one is
analyzing averages across a population (even a small
population, such as a cohort for laboratory studies)
than when looking at a single individual, as would be
the case in a court trial. In any event, their use in the
courtroom can be justified as an attempt to confer
more objectivity to traditional psychiatric analyses.
The latter are often based on subjective
interpretations of symptoms, while being able to
“see” the defendant’s brain can help reduce the
margins of interpretation for disorders that affect the
subject’s fitness to stand trial.
Nevertheless, neuroimaging as scientific
evidence, and “new” evidence at that, must pass the
test of admissibility, for which task under Italian law
the judge is designated as “peritus peritorum”, or the
gatekeeper for all the elements that the parts want to
enter into the trial.
With the caveat that different judicial systems
have different standards for assessing and admitting
scientific evidence, a set of criteria that is increasingly
gaining traction is known as the Daubert standard:
falsifiability; error-rate; publication in peer-reviewed
journals; and acceptance among the relevant scientific
533
community. These standards arise out of a ruling of

the U.S. Supreme Court and have recently been
introduced in Italy as well.
Caution regarding the introduction of
neuroimaging as scientific evidence in the courtroom,
especially in evaluating fitness to stand trial, arises
both from a certain diffidence regarding a new factor
that marks a significant shift from traditional
methods, and from the fear of distortion effects
reported by studies carried out towards the end of the
first decade of the 21st century (Weisberg et al., 2008;
McCabe and Castel, 2008). These studies had pointed
to an alleged “seductive allure” of neuroimages.
According to these studies, the presence of
neuroimages seems to bolster neuroscientific
explanations and, more generally, any other
explanation which makes use of them. The
underlying assumption is that we tend to be
“neuromaniacs” who believe that neuroscientific
explanations are always better than any other
explanations. This seems to rest on our conviction
that we have reached a basic level of understanding
of human behaviour going beyond traditional
psychology. This assumption has not yet been fully
borne out by experimental results, although progress
in this direction is rapid and substantial.
Nevertheless, it remains to be proven that we
truly are “neuromaniacs”, and that jurors tend to be
swayed by neuroscientific explanations. A new and
very recent series of experiments seems to question
previous results (Gruber and Dickerson, 2012;
534
Michael et al., 2013; Farah and Hook, 2013). They

suggest that, unlike what had previously been
argued, neuroimages have almost no influence on
evaluations of proposed explanations.
According to those who play up the risk
associated with the use of neuroimages, the idea is
that any presentation thereof may steer judges and
jurors towards a “mechanistic” explanation of the
behaviour of the defendant, thus excusing him as
someone not responsible for his actions. In fact, when
simulation trials were conducted in which
neuroscientific data was introduced that could lessen
the defendant’s responsibility, the sample of
American test subjects involved did not seem to be
influenced. On the contrary, it was driven by an
implicit dualistic assumption, in which the mind
(which houses intentions) is kept separate from the
brain (which can show impairments without
influencing assessments of culpability) (Schweitzer et
al., 2011).
On the other hand, another simulation carried
out in the United States, this time using judges, had
the opposite result. A cohort of judges was sent a
judiciary case with various files on an individual
charged with assault, for which crime the average
sentence was of 9 years. If the files included a
diagnosis of psychopathy, the average sentence
increased to 14 years. If this diagnosis was
accompanied by the evidence for the neurobiological
basis of the psycopathy, the sentence decreased to 13
years (Aspinwall et al., 2012). This indicates that a
535
diagnosis that makes references to altered brain

structures or functions, especially as highlighted by
neuroimaging, encourages judges to think that a
biological cause somehow reduces the defendant’s
responsibility.
A position that recaps the above arguments –
given currently available evidence, which remains
insufficient for anything but a provisional assessment
– holds that neuroimages are one of the elements that
experts can use to assess a defendant’s fitness to stand
trial. Their effect on juries is less strong than generally
imagined. Neuroimaging can certainly provide
indications that are more precise than those in a
“classic” psychiatric evaluation (for example, they
make it a lot harder to a defendant to fake a disorder).
What seems to emerge is that perhaps judges
themselves are less sensitive to the suggestions of
contemporary science. Jurors and the public tend to
maintain a retributive perspective which is less
welcoming towards a neurobiological, reductionist
explanation of behaviours.
We can thus state that neuroimaging is a tool
that strengthens the use of the anatomical-clinical
paradigm, and as a consequence the applicability of
that epistemological paradigm to the judicial system.
Neuroimaging techniques are used in the courtroom
to say something about a legally relevant state of mind.
The Italian penal code allows a reduced punitive
response on the part of the state for subjects with
mental disorders, or the mentally ill. Paradoxically,
whether this mental illness is framed and explained
536
through neurobiological mechanisms is of little

importance. This can strengthen evidence for the
presence of mental illness, but this is strictly an issue
related to procedure, and not to substance. In
summary, what we aim to reiterate is the continued
validity of the principle according to which
extenuating circumstances apply only when fitness to
stand trial is reduced or absent due to mental
disorder, whose applicability is always linked to the
phenomenological presence of a state of mental illness,
to which neuroimaging can contribute very little, if at
all (cf. Lavazza and Sammicheli, 2012).
4. Criminal Memory Erasing: Perspectives

and Ethical Concerns
The desire to forget, to free oneself from

unpleasant and painful memories is as old as man
itself. One can find it in the Odyssey and again in
many other works of literature that shaped our
imagination. One of the most pertinent and beautiful
quotes, which strikes close to the heart of
contemporary issues related to memory erasing,
comes from Shakespeare’s Macbeth, whose
protagonist asks his doctor for a drug that will
unburden his wife from the oppression of remorse:
« Cure her of that. Canst thou not minister to a
mind diseased, Pluck from the memory a rooted
sorrow, Raze out the written troubles of the
537
brain And with some sweet oblivious

antidote Cleanse the stuff'd bosom of that perilous
stuff Which weighs upon the heart? » (Macbeth, 5, 3).
Such a drug, though, has never been available.
A way to selectively modify memory, a magic potion
from the goddess Circe, has never existed. For
centuries, however, we have been aware of the power
alcohol has on the human mind (or the brain, as we
would say today). With drunkenness comes
forgetting, or at least the temporary weakening of
memory. For this reason, in wartime like in peace
time, those for whom reality or their own experiences
are too heavy to bear turn to wine and spirits to dull
their conscience: it is the only way to go through with
certain actions, commit certain crimes, or resist in the
face of violence. But alcohol is a substance with very
strong collateral effects, and it is impossible to recur
to it systematically without putting one’s own life at
risk.
Recently, on the basis of newly acquired
psychological knowledge, attempts have been made
to develop techniques that make it possible to forget
things selectively through methods that exploit our
mnemonic mechanisms, such as the so-called
interference elements, which act on the same semantic
categories of the memories one wants to erase, and
may disrupt the process through which these specific
memories are recalled (Anderson 2005; Storm, 2011).
538
However, these laboratory experiments have enjoyed

very limited success.
In order to fight negative memories, which are
discomforting and may lead to the onset of post-
traumatic stress disorder (PTSD), various
psychotherapy techniques have been used so far, with
the support of drugs that are not specifically aimed at
mnemonic processes. In light of the pathological
persistence of painful memories tied to traumatic
events, the (casual) discovery of substances that seem
to be able to favour the partial removal of memories
has been hailed as a turning point.
The first and most important substance
currently being tested in many laboratories is
propranolol, a beta-blocker already in use in several
hypertension drugs already in commerce. By
inhibiting the action of norepinephrine, it slows down
the series of biochemical events that contribute to
memory consolidation. In particular, memories of fear
are tied to the activation of the amygdala, a region of
the brain that processes danger signals and triggers
avoidance reactions. By acting on processes that
involve the amygdala, propranolol seems help
dampen the emotional resonance of memories (Cahill
et al., 1994; McGaugh and Roozendaal, 2002),
although it does not remove them at the semantic
level. In other words, in the tests carried out so far,
the administration of propranolol within a narrow
window of time after a traumatic event (for example,
539
a car accident) allowed a certain percentage of test

subjects to not develop post-traumatic stress disorder
(whose onset, it should be pointed out, cannot be
predicted and is highly subject to individual
variability; only a subset of trauma victims
subsequently develop PTSD). The results obtained so
far remain controversial (Muravieva and Alberini,
2010). Nevertheless, it can be said that for the first
time, it appears to be possible to selectively intervene
on a painful memory, not by erasing it but by
rendering it “neutral” through preventing it from
acting on the typical psychological and physiological
triggers of stress.
Another brand-new field of inquiry concerns
memory reconsolidation, a physiological
phenomenon which has yet to be studied in depth. In
simple terms, every time a memory is recalled, its
retrieval implies that it enters into a transient state
and must be “reconsolidated” through a specific
molecular process which can apparently be
interrupted. The production of the appropriate
proteins has been successfully interfered with in
animal models, making it possible for the memory to
disappear completely. The substance used is zeta
inhibitory peptide, or ZIP (Shema et al., 2007). These
preliminary results have been achieved with lab mice:
after being injected with the substance, they
completely forget the aversive association between a
certain part of the cage and the electric shocks they
540
are administered there, and so they return to this

dangerous area, unlike the control subjects. Other
types of pharmacological interventions are currently
in the preliminary study phase as well (Li et al., 2011).
Obviously, the main goals of such studies are
to alleviate PTSD in humans. But in humans,
memories are a holistic network: completely
expunging a memories such as an assault of which
one is the victim (or perpetrator) seems to be an
impossible task in both medical and conceptual
terms. What will probably prove possible will be to
make these memories weaker and less oppressive.
This raises important legal questions. The
neuroscience of memory has already relevant
implications for the courtroom (Lacy and Stark, 2013),
as even minor memory distortions can have severe
consequences (cf. also Schacter and Loftus, 2013).
Indeed, someone who does not remember (or does
not have an emotionally salient and motivating
memory) cannot (or is not motivated to) accuse his or
her own offender. Someone who does not remember
cannot testify for or against anyone. Someone who
does not remember will always deny his or her guilt.
And there is also a general ethical aspect to consider.
Are there not certain occasions in which one is
morally bound to remember? Had all the Holocaust
survivors taken a pill to forget their ordeal, who
would have transmitted the memory of that horror to
ensure that the perpetrators would be punished and
541
that the crime would not repeat itself? (cf. Margalit,

2004). Certainly, survivors cannot be forced to hold
on to painful memories, but the dilemma is very
strong.
A more pressing need for society is whether or
not there is a legal obligation to remember. Victims
are not legally bound to accuse their offenders, but it
is in the interest of society as a whole that the latter be
captured and prosecuted. Additionally, if witnesses
are called to testify, they have a duty to tell the truth.
(It is in the interest of justice that they remember as
much as possible). If an eyewitness to a crime remains
deeply scarred, could they not take propranolol to
dampen the memory that threatens to ruin their
existence? On the other hand, if that person were the
only witness to the crime, one could argue that they
have a moral obligation to preserve a lucid memory
of the event to make sure that the offender is
prosecuted and sentenced and therefore prevented
from committing other crimes. Rights and duties thus
come into conflict, and a potential “oblivion pill”
could create dilemmas similar to the one detailed
above.
And what would happen if criminals
themselves tried to remove the memory of their own
guilt? Someone who committed a crime might want
to forget in order not to have to grapple with their
conscience (and commit more crimes without
remorse). Someone who sincerely does not remember
542
anything about their crime might not be considered

prosecutable for that particular offense. Indeed,
conscious will is necessary in order to be considered
fit for trial and sentencing (Kolber, 2006, 2011).
To conclude, a drug that could dampen or
erase memories would be used primarily for
treatment purposes (it would greatly benefit those
who suffer from PTSD). But other subjects could use
it, which major legal repercussions.
What should be done in that case? Rather than
banning “oblivion pills”, it would probably be better
to introduce sanctions for anyone using them in
situations that may be altered by voluntary oblivion
(for example, eyewitnesses or criminals).
Nevertheless, the use of such pills would remain
difficult to detect. As a result, it would be difficult to
create new felonies tied to the manipulation of one’s
own memories, since this would potentially clash
with the right to privacy, freedom of conscience, and
the right of citizens to be free from state intrusion in
their personal lives (cf. Lavazza and Inglese, 2013).
5. Neurostimulation Techniques and

Modulation of Deception and Morality:
Possible Forensic Applications
Neurostimulation techniques include invasive

and non invasive methodologies able to induce a
543
modulation in brain activity. In this paragraph,

studies with transcranial direct current stimulation
(tDCS) and with deep brain stimulation (DBS) and
their ability to modulate complex cognitive processes,
such as morality and deception, and behaviour will
be presented with the aim to discuss the possibility of
forensic application.
Can tDCS modulate complex cognitive processes

and behaviour?
tDCS is a non invasive brain stimulation

technique that can manipulate neuroplasticity and
modulate cortical function with weak direct currents
(Nitsche et al., 2008; Priori, 2003). It results in long-
term potentiation (LTP)-like synaptic changes that
accompany facilitatory effects on cortical excitability,
neuroplasticity, and learning (Nitsche et al., 2008;
Nitsche and Paulus, 2000). Previous studies showed
that tDCS can enhance cognitive functions, such as
memory, attention, learning, language, and motor
functions in healthy and in the clinical population
(Kuo and Nitsche, 2012; Monti et al., 2012; Schulz et
al., 2013).
In the last decade a new interest is growing
about the possibility to use tDCS to reduce
behavioural and psychiatric symptoms by
investigating complex cognitive processes such as
deception, moral decisions, and impulsivity. These
new fields of application open possibilities to use
544
tDCS for forensic aims, although important ethical

questions.
tDCS was demonstrated to be able to interfere
with cognitive processes underlying deception by
modulating activity in the dorsolateral prefrontal
cortex (DLPFC) (Priori et al., 2008; Mameli et al., 2010;
Fecteau et al., 2013) or the anterior prefrontal cortex
(Karim et al., 2010). Although these studies present
methodological differences in the task used and in the
stimulation montages and parameters, they showed
that tDCS is able to modulate deception, specifically
by altering response times and physiological
correlates such as the skin conductance response
(Priori et al., 2008; Mameli et al., 2010; Karim et al.,
2010; Fecteau et al., 2013; Luber et al., 2009). tDCS was
demonstrated to interfere also with risky and
impulsive behaviour: anodal stimulation of the right
DLPFC significantly decreased risky choices, by
suppressing seductive but unproductive options
(Fecteau et al., 2007, 2007), and anodal tDCS over the
right inferior frontal gyrus significantly improved
response inhibition (Jacobson et al., 2011). Finally, a
study on social decision-making found that cathodal
tDCS over DLPFC reduced the negative emotions that
emerge from disadvantageous offers and decrease the
punition of non cooperative behaviour (Knoch et al.,
2008). In the last decade, moral reasoning is one of the
most investigated issue in neuroscience. Only one
study explored the capacity of tDCS to modulate
moral decisions by stimulating the ventromedial
prefrontal cortex bilaterally. tDCS interfered with
545
moral reasoning: in a group of healthy subjects

solvuing moral dilemmas cathodal tDCS significantly
reduced altruistic responses in the female subjects,
and had no effects on males (Fumagalli et al., 2010).
All these studies showed that tDCS is able to
modulate aspects of cognition and behaviour related
to psychopathy and criminality, and open the
possibility to use tDCS as a treatment for criminal
population. Possible future application of tDCS in this
field opens legal, ethical and social challenges.
Can DBS modulate complex cognitive processes
and behaviour?
DBS is an invasive brain stimulation technique
that is realized with a surgical procedure that consists
in the implantation of macroelectrodes in specific
brain subcortical structures. DBS treatment is
presently indicated for complicated Parkinson’s
disease, dystonia, tremor, Tourette syndrome, and
recently for drug-resistant obsessive-compulsive
disorder and depression (Limousin and Martinez-
Torres, 2008; Johnson et al., 2008).
Several studies demonstrated that DBS in
some target brain nuclei is able to modify and
interfere with complex cognitive processes and
behaviours.
Subthalamic DBS in patients with Parkinson’s
disease has been demonstrated to be able to influence
behavioural and neuropsychiatric symptoms,
however with contradictory results: DBS increases
apathy (Drapier et al., 2006; Porat et al., 2009) and
hypomania (Romito et al., 2002), causes minimal
546
transient and treatable behavioural complications

(Houeto et al., 2006; Voon et al., 2006) or induces
improvement in emotional status (Altug et al., 2011).
Impulsive behaviours are also variably reduced
(Ardouin et al., 2006; Bandini et al., 2007; Lim et al.,
2009), induced (Lim et al., 2009) or worsened (Lim et
al., 2009; Halbig et al., 2009; Smeding et al., 2007) by
STN DBS. These conflicting results probably depend
on methodological limitations. For example,
behavioural and psychiatric adverse effects could be
misrecognized and thus under-reported (Rodriguez-
Oroz et al., 2005), or could arise when the stimulating
electrodes are misplaced (Bejjani et al., 1999),
stimulation settings are suboptimal (Krack et al.,
2001) or dopamine replacement therapy is rapidly
replaced or withdrawn (Volkmann et al., 2001;
Thobois et al., 2010).
STN DBS was demonstrated to be able to
interfere with decisional processes (Frank et al., 2007),
however its effect on moral decisions are yet
unknown. Local field potentials (LFPs) reflect the
synchronous presynaptic and postsynaptic activity in
large neuronal populations and can be recorded a few
days after the electrodes are surgically positioned
when they are still externalized before being
connected to a subcutaneous electrical stimulator. In a
study, LFPs were recorded from STN in parkinsonian
patients during a moral decision task. STN showed a
specific activity in the low frequency band during
moral reasoning for conflictual, or difficult, moral
547
issues (Fumagalli et al., 2011). Further studies should

clarify whether STN DBS could alter moral decisions.
Hypothalamus is a deep brain structure
involved in aggressive behaviour. DBS applied to
postero-medial hypothalamus is able to induce
aggressive behaviour in patients with Parkinson’s
disease (Bejjani et al., 2002; Sensi et al., 2004), whereas
DBS of the posterior hypothalamus improved
aggressivity in patients with disruptive behaviour
and mental retardation (Franzini et al., 2005;
Hernando et al., 2008; Kuhn et al., 2008). In a
neurophysiological study, LFPs were recorded from
the posterior hypothalamus in an aggressive patient
and in a control patient with cluster headache, both of
them implanted for DBS, and showed an
aggressivity-specific increase in low frequencies and
decrease in alpha, an electrophysiological pattern that
could reflect a dysfunction within the hypothalamic
neural network (Rosa et al., 2012).
Although studies on the effect of DBS on
behaviour and cognition are few, DBS to specific
brain areas is demonstrated to be involved in
regulating some aspects of behaviour, such as
impulsiveness and aggressivity, that are important
variables in criminal behaviour. Future DBS clinical
applications could be used in the treatment of
pathological antisocial behaviour, sexual violence and
pedophilia. At present, these applications are
hypothetical. Because DBS requires strict guidelines
to select patients, we retain that it is a technique
applicable only in serious cases, when education and
548
rehabilitation programmes or other treatments fail

(Fumagalli et al., 2012).
The hypothetical use of brain stimulation
techniques in this field could be of great interest for
clinical and for forensic aims, however, ethical issues
such as the possibility of shaping individual morality
and the lack of impeccable treatment guidelines leave
this field an intriguing possibility.
References
S. AGOSTA, A new lie-detector based on the IAT. Thesis

for Master's Degree. University of Padova, (2005).
S. AGOSTA, G. SARTORI, The autobiographical IAT: a
review, in Frontiers in Psychology, 4 (2013), 519.
F. ALTUG, F. ACAR, G. ACAR, U. CAVLAK, The influence
of subthalamic nucleus deep brain stimulation on physical,
emotional, cognitive functions and daily living activities in
patients with Parkinson's disease, in Turkish
Neurosurgery, 21(2) (2011), pp. 140-6.
M.C. ANDERSON, The role of inhibitory control in
forgetting unwanted memories: A consideration of three
methods, in Dynamic Cognitive Processes, a cura di C.
MACLEOD and B. UTTL, Tokyo, Springer-Verlag, 2005,
pp. 159-90.
M.C. ANDERSON, B.J. LEWY, Suppressing unwanted
memories, in Current Directions in Psychological Sciences,
18 (2009), pp. 189-94.
549
C. ARDOUIN, V. VOON, Y. WORBE, N. ABOUAZAR, V.

CZERNECKI, H. HOSSEINI, A. PELISSOLO, E. MORO, E.
LHOMMÉE, A.E. LANG, Y. AGID, A.L. BENABID, P.
POLLAK, L. MALLET, P. KRACK, Pathological gambling in
Parkinson's disease improves on chronic subthalamic
nucleus stimulation, in Movement Disorders, 21(11)
(2006), pp. 1941-6.
L. ASPINWALL, T.R. BROWN, J. TABERY, The double-
edged sword: Does biomechanism increase or decrease
judges’ sentencing of psychopaths?, in Science, 337 (2012),
pp. 846-9.
F. BANDINI, A. PRIMAVERA, M. PIZZORNO, L. COCITO,
Using STN DBS and medication reduction as a strategy to
treat pathological gambling in Parkinson's disease, in
Parkinsonism and Related Disorders, 13(6) (2007), pp.
369-71.
B.P. BEJJANI, P. DAMIER, I. ARNULF, L. THIVARD, A.M.
BONNET, D. DORMONT, P. CORNU, B. PIDOUX, Y.
SAMSON, Y. AGID, Transient acute depression induced by
high-frequency deep-brain stimulation, in New England
Journal of Medicine, 340(19) (1999), pp. 1476-80.
B.P. BEJJANI, J.L. HOUETO, M. HARIZ, J. YELNIK, V.
MESNAGE, A.M. BONNET, B. PIDOUX, D. DORMONT, P.
CORNU, Y. AGID, Aggressive behavior induced by
intraoperative stimulation in the triangle of Sano, in
Neurology, 59(9) (2002), pp. 1425-7.
G. BEN-SHAKHAR, E. ELAAD, The validity of
psychopatological detection of information with the Guilty
550
Knowledge Test: a meta-analytic review in Journal of

Applied Psychology, 88 (2003), pp. 131-35.
J.W. BRADFORD, S.M. SMITH, Amnesia and
homicide: the Padola case and a study of thirty cases,
in Bulletin of the American Academy of Psychiatry
and Law, 7 (1979), pp. 219-31.
S. BYLIN, S-Å. CHRISTIANSON, Characteristics of
malingered amnesia: consequences of withholding vs.
distorting information on later memory of a crime event, in
Legal and Criminological Psychology, 7 (2002), pp. 45-61.
D. BOURGET, L. WHITEHURST, Amnesia and crime, in
Journal of American Academy of Psychiatry, 35 (2007),
pp. 469-80.
R. BROUGHTON, R. BILLINGS, R. CARTWRIGHT, D.
DOUCETTE, J. EDMEADS, M. EDWARDH, F. ERVIN, B.
ORCHARD, R. HILL, G. TURRELL, Homicidial
somnambulism: a case report, in Sleep, 17 (1994), pp. 253-
64.
L. CAHILL, B. PRINS, M. WEBER, J.L. MCGAUGH, βeta-
Adrenergic activation and memory for emotional events, in
Nature, 371 (1994), pp. 702-70.
M. CIMA, H. NIJMAN, H. MERCKELBACH, K. KREMER, S.
HOLLNACK, Claims of crime-related amnesia in forensic
patients, in International Journal of Law Psychiatry, 27 (3)
(2004), pp. 215-21.
R.L. DENNEY, Criminal forensic and assessment of
competence, in Forensic neuropsychology: a scientific
551
approach, a cura di G.L. LARRABEE, New York: Oxford

University Press 2005.
D. DRAPIER, S. DRAPIER, P. SAULEAU, C. HAEGELEN, S.
RAOUL, I. BISEUL, J. PERON, F. LALLEMENT, I. RIVIER,
J.M. REYMANN, G. EDAN, M. VERIN, B. MILLET, Does
subthalamic nucleus stimulation induce apathy in
Parkinson's disease?, in Journal of Neurology, 253(8)
(2006), pp. 1083-91.
M. ERONEN, J. TIIHONEN, P. HAKOLA, Schizophrenia and
homicidal behavior, in Schizophrenia Bulletin, 22 (1996),
pp. 83-9.
M.J. FARAH, C.J. HOOK, The seductive allure of
“seductive allure”, in Perspectives on Psychological
Science, 8 (2013), pp. 88-90
S. FECTEAU, D. KNOCH, F. FREGNI, N. SULTANI, P.
BOGGIO, A. PASCUAL-LEONE, Diminishing risk-taking
behavior by modulating activity in the prefrontal cortex: a
direct current stimulation study, in Journal of
Neuroscience, 27(46) (2007), pp. 12500-5.
S. FECTEAU, A. PASCUAL-LEONE, D.H. ZALD, P.
LIGUORI, H. THÉORET, P.S. BOGGIO, F. FREGNI,
Activation of prefrontal cortex by transcranial direct
current stimulation reduces appetite for risk during
ambiguous decision making in Journal of Neuroscience,
27(23) (2007), pp. 6212-8.
S. FECTEAU, P. BOGGIO, F. FREGNI, A. PASCUAL-LEONE,
Modulation of untruthful responses with non-invasive
552
brain stimulation, in Frontiers in Psychiatry, 3, (2013),

pp. 97.
M.J. FRANK, J. SAMANTA, A.A. MOUSTAFA, S.J.
SHERMAN, Hold your horses: impulsivity, deep brain
stimulation, and medication in parkinsonism, in Science,
318(5854) (2007), pp. 1309-12.
A. FRANZINI, C. MARRAS, P. FERROLI, O. BUGIANI, G.
BROGGI, Stimulation of the posterior hypothalamus for
medically intractable impulsive and violent behavior, in
Stereotactic and Functional Neurosurgery, 83 (2005), pp.
63-6.
M. FUMAGALLI, M. VERGARI, P. PASQUALETTI, S.
MARCEGLIA, F. MAMELI, R. FERRUCCI, S. MRAKIC-
SPOSTA, S. ZAGO, G. SARTORI, G. PRAVETTONI, S.
BARBIERI, S. CAPPA, A. PRIORI, Brain switches utilitarian
behavior: does gender make the difference?, in PLoS One,
5(1) (2010), pp. e8865.
M. FUMAGALLI, G. GIANNICOLA, M. ROSA, S.
MARCEGLIA, C. LUCCHIARI, S. MRAKIC-SPOSTA, D.
SERVELLO, C. PACCHETTI, M. PORTA, M. SASSI, R.
ZANGAGLIA, A. FRANZINI, A. ALBANESE, L. ROMITO, S.
PIACENTINI, S. ZAGO, G. PRAVETTONI, S. BARBIERI, A.
PRIORI, Conflict-dependent dynamic of subthalamic
nucleus oscillations during moral decisions, in Social
Neuroscience, 6(3) (2011), pp. 243-56.
M. FUMAGALLI, A. PRIORI, Functional and clinical
neuroanatomy of morality, in Brain, 135(Pt 7) (2012), pp.
2006-21.
553
M.S. GAZZANIGA, R.B. IVRY E G.R. MANGUN, Cognitive

Neuroscience: The Biology of the Mind, New York,
Norton and Company 2008.
N.S. GRAY, A.S. BROWN, M.J. MACCULLOCH, J. SMITH,
R.J. SNOWDEN, An Implicit Test of the Associations
Between Children and Sex in Pedophiles, in Journal of
Abnormal Psychology, 114 (2) (2005), pp. 304-8.
A.G. GREENWALD, D.E. GHEE, J.K.L. SCHWARZ,
Measuring Individual Differences in Implicit Cognition:
The Implicit Association Test, in Journal of Personality
and Social Psychology, 74 (6) (1998), pp. 1464-80.
N.S. GREY, M.J. MACCULLOCH, J. SMITH, M. MORRIS,
R.J. SNOWDEN, Violence viewed by psychopathic
murderers. Adapting a revealing test may expose those
psychopaths who are most likely to kill, in Nature, 423
(2003), pp. 497-8.
D. GRUBER, J.A. DICKERSON, Persuasive images in
popular science: Testing judgments of scientific reasoning
and credibility, in Public Understanding of Science, 21
(2012), pp. 938-48.
T.D. HÄLBIG, W. TSE, P.G. FRISINA, B.R. BAKER, E.
HOLLANDER, H. SHAPIRO, M. TAGLIATI, W.C. KOLLER,
C.W. OLANOW, Subthalamic deep brain stimulation and
impulse control in Parkinson's disease, in European
Journal of Neurology, 16(4) (2009), pp. 493-7.
J.J. HERMAN, Crime and memory, in Bulletin of American
Academy Psychiatric Law, 23 (1995), pp. 6-17.
554
V. HERNANDO, J. PASTOR, M. PEDROSA, E. PENA, R.G.

SOLA, Low-frequency bilateral hypothalamic stimulation
for treatment of drug-resistant aggressiveness in a young
man with mental retardation, in Stereotactic and
Functional Neurosurgery, 86 (2008) pp. 219-23.
J.S. HOPWOOD, H.K. SNELL, Amnesia in relation to crime,
in Journal of Mental Science, 79 (1933), pp. 27-41.
J.L. HOUETO, L. MALLET, V. MESNAGE, S. TEZENAS DU
MONTCEL, C. BÉHAR, M. GARGIULO, F. TORNY, A.
PELISSOLO, M.L. WELTER, Y. AGID, Subthalamic
stimulation in Parkinson disease: behavior and social
adaptation, in Archives of Neurology, 63 (2006), pp. 1090-
5.
L. JACOBSON, D.C. JAVITT, M. LAVIDOR, Activation of
inhibition: diminishing impulsive behavior by direct
current stimulation over the inferior frontal gyrus, in
Journal of Cognitive Neuroscience, 23 (2011), pp. 3380-7.
M. JELICIC, L. MERCKELBACH, S. van BERGEN,
Symptom validity testing of feigned amnesia for a mock
crime, in Archives of Clinical Neuropsychology, 19 (2004),
pp. 525-31.
M.D. JOHNSON, S. MIOCINOVIC, C.C. MCINTYRE, J.K.
VITEK, Mechanisms and targets of deep brain stimulation
in movement disorders, in Neurotherapeutics, 5(2) (2008),
pp. 294-308.
A.A. KARIM, M. SCHNEIDER, M. LOTZE, R. VEIT, P.
SAUSENG, C. BRAUN, N. BIRBAUMER, The truth about
lying: inhibition of the anterior prefrontal cortex improves
555
deceptive behavior, in Cerebral Cortex, 20(1) (2010), pp.

205-13
H. KIKUCHI, T. FUJII, N. ABE, M. SUZUKI, M. TAKAGI, S.
MUGIKURA, S. TAKAHASHI, E. MORI, Memory
repression: brain mechanisms underlying dissociative
amnesia, in Journal of Cognitive Neurosciences, 22 (2009),
pp. 602-13.
D. KNOCH, M.A. NITSCHE, U. FISCHBACHER, C.
EISENEGGER, A. PASCUAL-LEONE, E. FEHR, Studying the
neurobiology of social interaction with transcranial direct
current stimulation--the example of punishing unfairness,
in Cerebral Cortex, 18(9) (2008), pp. 1987-90.
KOLBER, Therapeutic forgetting: The legal and ethical
implications of memory dampening, in Vanderbilt Law
Review, 59 (2006), pp. 1561-626.
KOLBER, Give memory-altering drugs a chance, in Nature,
476 (2011), pp. 275-6.
M.D. KOPELMAN, Crime and amnesia: a review, in
Behavioral Sciences & the Law, 5 (1987), pp. 323-42.
P. KRACK, R. KUMAR, C. ARDOUIN, P.L. DOWSEY, J.M.
MCVICKER , A.L. BENABID, P. POLLAK, Mirthful
laughter induced by subthalamic nucleus stimulation, in
Movement Disorders, 16(5) (2001), pp. 867-75.
J. KUHN, D. LENARTZ, J.K. MAI, W. HUFF, J.
KLOSTERKOETTER, V. STURM, Disappearance of self-
aggressive behavior in a brain-injured patient after deep
brain stimulation of the hypothalamus: technical case
report, in Neurosurgery, 62 (2008), pp. E1182.
556
M.F. KUO, M.A. NITSCHE, Effects of transcranial

electrical stimulation on cognition, in Clinical EEG, 43(3)
(2012), pp. 192-9.
J.W. LACY, C.E.L. STARK, The neuroscience of memory:
implications for the courtroom, in Nature Reviews
Neuroscience, 14 (2013), pp. 649-58.
LAVAZZA, L. SAMMICHELI, Il delitto del cervello. La
mente tra scienza e diritto, Torino, Codice Edizione
2012.
LAVAZZA, S. INGLESE, Manipolare la memoria. Scienza ed
etica della rimozione dei ricordi, Milano, Mondadori
Università 2013.
Y.Q. LI, Y.X. XUE, Y.Y. HE, F.Q. LI, L.F. XUE, C.M. XU,
T.C. SACKTOR, Y. SHAHAM, L. LU, Inhibition of PKMzeta
in nucleus accumbens core abolishes long-term drug
reward memory, in The Journal of Neuroscience, 31
(2011), pp. 5436-46.
S.Y. LIM, S.S. O'SULLIVAN, K. KOTSCHET, D.A.
GALLAGHER, C. LACEY, A.D. LAWRENCE, A.J. LEES, D.J.
O'SULLIVAN, R.F. PEPPARD, J.P. RODRIGUES, A.
SCHRAG, P. SILBERSTEIN, S. TISCH, A.H. EVANS,
Dopamine dysregulation syndrome, impulse control
disorders and punding after deep brain stimulation surgery
for Parkinson's disease, in Journal of Clinical
Neuroscience, 16(9) (2009), pp. 1148-52.
P. LIMOUSIN, I. MARTINEZ-TORRES, Deep brain
stimulation for Parkinson's disease, in Neurotherapeutics,
5(2) (2008), pp. 309-19.
557
D.T. LYKKEN, The Gsr in the Detection of Guilt, in

Journal of Applied Psychology, 58 (1959), pp. 864-73.
N.K. Logothetis, What we can do and what we cannot do
with fmri, in nature, 453 (2008), PP. 869-78.
B. LUBER, C. FISHER, P.S. APPELBAUM, M. PLOESSER,
S.H. LISANBY, Non-invasive brain stimulation in the
detection of deception: scientific challenges and ethical
consequences, in Behavioral Science Law, 27(2) (2009),
pp. 191-208
F. MAMELI, S. MRAKIC-SPOSTA, M. VERGARI, M.
FUMAGALLI, M. MACIS, R. FERRUCCI, F. NORDIO, D.
CONSONNI, G. SARTORI, A. PRIORI, Dorsolateral
prefrontal cortex specifically processes general - but not
personal - knowledge deception: Multiple brain networks
for lying, in Behavioural and Brain Resources, 211(2)
(2010), pp. 164-8.
A. MARGALIT, The Ethics of Memory, Cambridge (MA),
Harvard University Press 2004.
D.P. MCCABE, A.D. CASTEL, Seeing is believing: The
eﬀect of brain images on judgments of scientiﬁc reasoning,
in Cognition, 107 (2008), pp. 343-52.
J.L. MCGAUGH, B. ROOZENDAAL, Role of adrenal stress
hormones in forming lasting memories in the brain, in
Current Opinion in Neurobiology, 12 (2002), pp. 205-10.
R.B. MICHAEL, E.J. NEWMAN, M. VUORRE, G.
CUMMING, M. GARRY, On the (non) persuasive power of
a brain image, in Psychonomic Bullettin Review, 20 (4)
(2013), pp. 720-5.
558
A. MONTI, R. FERRUCCI, M. FUMAGALLI, F. MAMELI, F.

COGIAMANIAN, G. ARDOLINO, A. PRIORI, Transcranial
direct current stimulation (tDCS) and language, in
Journal of Neurology, Neurosurgery and Psychiatry 84(8)
(2012), pp. 832-42.
E.V. MURAVIEVA, C.M. ALBERINI, Limited efficacy of
propranolol on the reconsolidation of fear memories, in
Learning & Memory, 17 (2010), pp. 306-13.
M.A. NITSCHE, W. PAULUS, Excitability changes induced
in the human motor cortex by weak transcranial direct
current stimulation, in Journal of Physiology, 527 Pt 3,
(2000), pp. 633-9.
M.A. NITSCHE, L.G. COHEN, E.M. WASSERMANN, A.
PRIORI, N. LANG, A. ANTAL, Transcranial direct current
stimulation: State of the art 2008, in Brain Stimulation,
1(3) (2008), pp. 206-23.
M.J.V. PETERS, K. VAN OORSOUW, M. JELICIC, H.
MERCKELBACH, Let’s use those test! Evaluations of crime-
related amnesia claims, in Memory, 21(2013), pp. 599-
607.
E. PODOLSKY, Somnambulistic homicide, in Disease of
Nervous System, 20 (1959), pp. 534-6.
O. PORAT, O.S. COHEN, R. SCHWARTZ, S. HASSIN-BAER,
Association of preoperative symptom profile with
psychiatric symptoms following subthalamic nucleus
stimulation in patients with Parkinson's disease, in
Journal of Neuropsychiatry and Clinical Neuroscience
21(4) (2009), pp. 398-405.
559
S. PORTER, A.R. BIRT, J.C. YUILLE, H.F. HERVÈ, Memory

for murder. A psychological perspective on dissociative
amnesia in legal context, in International Journal of Law
and Psychiatry, 24 (2001), pp. 23-42.
A. PRIORI, Brain polarization in humans: a reappraisal of
an old tool for prolonged non-invasive modulation of brain
excitability, in Clinical Neurophysiology, 114 (4) (2003),
pp. 589-95.
A. PRIORI, F. MAMELI, F. COGIAMANIAN, S.
MARCEGLIA. M. TIRITICCO, S. MRAKIC-SPOSTA, R.
FERRUCCI, S. ZAGO, D. POLEZZI, G. SARTORI, Lie-specific
involvement of dorsolateral prefrontal cortex in deception,
in Cerebral Cortex, 18(2) (2008), pp. 451-5.
M.C. RODRIGUEZ-OROZ, J.A. OBESO, A.E. LANG, J.L.
HOUETO, P. POLLAK, S. REHNCRONA, J. KULISEVSKY, A.
ALBANESE, J. VOLKMANN, M.I. HARIZ, N.P. QUINN,
J.D. SPEELMAN, J. GURIDI, I. ZAMARBIDE, A. GIRONELL,
J. MOLET, B. PASCUAL-SEDANO, B. PIDOUX, A.M.
BONNET, Y. AGID, J. XIE, A.L. BENABID, A.M. LOZANO,
J. SAINT-CYR, L. ROMITO, M.F. CONTARINO, M.
SCERRATI, V. FRAIX, N. VAN BLERCOM, Bilateral deep
brain stimulation in Parkinson's disease: a multicentre
study with 4 years follow-up, in Brain, 128(Pt 10) (2005),
pp. 2240-9.
L.M. ROMITO, M. RAJA, A. DANIELE, M.F. CONTARINO,
A.R. BENTIVOGLIO, A. BARBIER, M. SCERRATI, A.
ALBANESE. Transient mania with hypersexuality after
surgery for high frequency stimulation of the subthalamic
560
nucleus in Parkinson's disease, in Movement Disorders,

17(6) (2002), pp. 1371-4.
M. ROSA, A. FRANZINI, G. GIANNICOLA, G. MESSINA,
A.C. ALTAMURA, A. PRIORI, Hypothalamic oscillations in
human pathological aggressiveness, in Biological
Psychiatry, 72(12) (2012), pp. e33-5.
G. SARTORI, S. AGOSTA, C. ZOGMAISTER, S.D. FERRARA,
U. CASTIELLO, How to accurately detect autobiographical
events, in Psychological Science, 19 (8) (2008), pp. 772-
80.
D.L. SCHACTER, Amnesia and crime. How much do really
know?, in American Psychologist, 41 (1986), pp. 286-95.
D.L. SCHACTER, E.F. LOFTUS, Memory and law: what can
cognitive neuroscience contribute?, in Nature
Neuroscience, 16 (2013), pp. 119-23.
R. SCHULZ, C. GERLOFF, F.C. HUMMEL, Non-invasive
brain stimulation in neurological diseases, in
Neuropharmacology, 64, (2013), pp. 579-87.
N.J. SCHWEITZER, M.J. SAKS, E.R. MURPHY, A.L.
ROSKIES, W. SINNOTT-ARMSTRONG E L.M. GAUDET,
Neuroimages as evidence in a mens rea defense: No impact,
in Psychology, Public Policy, and Law, 17 (2011), pp.
357-93.
M. SENSI, R. ELEOPRA, M.A. CAVALLO, E. SETTE, P.
MILANI, R. QUATRALE, J.G. CAPONE, V. TUGNOLI, M.R.
TOLA, E. GRANIERI, P.G. DATA, Explosive-aggressive
behavior related to bilateral subthalamic stimulation, in
561
Parkinsonism and Related Disorders, 10(4) (2004), pp.

247-51.
R. SHEMA, T.C. SACKTOR, Y. DUDAI, Rapid erasure of
long-term memory associations in the cortex by an
inhibitor of PKMz, in Science, 317 (2007), pp. 951-53.
H.M. SMEDING, P. VAN DEN MUNCKHOF, R.A.
ESSELINK, B. SCHMAND, P.R. SCHUURMAN, J.D.
SPEELMAN, Reversible cognitive decline after DBS STN in
PD and displacement of electrodes, in Neurology, 68(15)
(2007), pp. 1235-6.
B.C. STORM, The benefit of forgetting in thinking and
remembering, in Current Directions in Psychological
Science, 20 (2011), pp. 291-95.
R.G. STOUT, R.S. FAROOQUE, Claims of amnesia for
criminal offenses: psychopathology, substance abuse, and
malingering, in Journal of Forensic Sciences, 53 (2008),
pp. 1218-22.
S. THOBOIS, C. ARDOUIN, E. LHOMMÉE, H. KLINGER, C.
LAGRANGE, J. XIE, V. FRAIX, M.C. COELHO BRAGA, R.
HASSANI, A. KISTNER, A. JUPHARD, E. SEIGNEURET, S.
CHABARDES, P. MERTENS, G. POLO, A. REILHAC, N.
COSTES, D. LEBARS, M. SAVASTA, L. TREMBLAY, J.L.
QUESADA, J.L. BOSSON, A.L. BENABID, E. BROUSSOLLE,
P. POLLAK, P. KRACK, Non-motor dopamine withdrawal
syndrome after surgery for Parkinson's disease: predictors
and underlying mesolimbic denervation, in Brain, 133(Pt
4) (2010), pp. 1111-27.
562
J. TIIHONEN, P. HAKOLA, Psychiatric disorders and

homicide recidivism, in American Journal of Psychiatry,
151 (1994), pp. 436-8.
K.VAN OORSOUW, H. MERCKELBACH, Detecting
malingered memory problems in the civil and criminal
arena, in Legal and Criminological Psychology, 15 (2010),
pp. 97-114.
K.VAN OORSOUW, H. MERCKELBACH, The effect of
alcohol on crime-related memories: a field study, in Applied
Cognitive Psychology, 26 (2012), pp. 82-90.
K. VAN OORSOUW, H. MERCKELBACH, D. RAVELLI, H.
NIJMAN, I. MEKKING-POMPEN, Alcoholic blackout for
criminally. Relevant behavior, in The Journal of the
American Academy of Psychiatry and the Law, 32 (2012),
pp. 364-70.
B. VERSCHEURE, V. PRATI, J. DE HOUWER, Cheating the
Lie detector: faking the Autobiographical IAT, in
Psychological Science, 20 (2009), pp. 410-13.
J. VOLKMANN, N. ALLERT, J. VOGES, P.H. WEISS, H.J.
FREUND, V. STURM, Safety and efficacy of pallidal or
subthalamic nucleus stimulation in advanced PD, in
Neurology, 56(4) (2001), pp. 548-51.
V. VOON, C. KUBU, P. KRACK, J.L. HOUETO, A.I.
TRÖSTER, Deep brain stimulation: neuropsychological and
neuropsychiatric issues, in Movement Disorders, 14
(Suppl) (2006), pp. S305-27.
563
S. WESSELY, The epidemiology of crime, violence and

schizophrenia, in British Journal of Psychiatry:
Supplement, 32 (1997), pp. 8-11.
D.S. WEISBERG, F.C. KEIL, J. GOODSTEIN, E. RAWSON,
J.R. GRAY, The seductive allure of neuroscience
explanations, in Journal of Cognitive Neuroscience, 20
(2008), pp. 470-7.
564
565
FDE Institute of Criminology Mantua
An High and Innovative Research Institute.
FDE Institute of Criminology of Mantua is a

reasearch, traning and forensic consultation centre. It
is recognised by the Region Lombardy as body for
professional training (id.860151/2010). FDE Institute
principal aims are promotion of the culture and
scientific debate, increasing of the general level of
knowledge in the population and finally, to stimulate
the connection between the scientific knoledge and
the world of professionals. To this aim we promote
and develop training and research projects in
collaboration with several body of profit and not for
profit field.
The FDE Institute is expression of an high
level project that intend to work in order to train
specialists and experts in the field of criminology,
victimology in a restorative justice perspective. FDE is
supported by an intensive research activity financed
by the European Commission, by the National Peer
Opportunity Department, by the Region Lombardy
and several local Foundation. It proposes to Phd,
Master students and practitioners stages, internships
and workshops, in addiction to the annual training
path that lasting more than 400 hours.
566
Our Vision
Promote the development of criminological

sciences throught research projects and high level
trainings.
To consider simultaneously sensitive
existences of the offender, victim and observant
community is the philosophy we use to approach and
to study the criminological issues.
Our Mission
- To develop knoledges and skills necessary to

work in the criminology field;
- To study deviance e criminality in order to
propose best practice in criminal policy;
- To develop skills to fight and prevent crimes,
especially against child, women and elderly;
- To develop a multifactorial research
methodology in criminology;
- To develop a forensic consultation and
investigative methodology in order to cooperate
as expert within tribunals cases;
- To deep more inside the connection to crimes and
pesonality diseases;
- To study and promote human rights and fight
intollerance and violations;
- To disseminate findings and results of our
studies within the international scientific
community.
567
Advisory Board & Coordination
Mr. Angelo Puccia

Head of Unit
Mrs. Savazzi Francesca

Financial Manager
Dr. Giuseppe Sandri

Senior Researcher in Criminology
Dr. Stefano Barlati, M.D. Psyc.

Senior Lecturer in Forensic Psychiatry
Dr. Luigi Caracciolo

Senior Lecturer in Investigation and Organized Crime
Dr. Corrado Benatti, Ph.d.

Researcher in Research Methodology
Dr. Marzia Tosi

Researcher in Restorative Justice
Dr. Elisa Corbari

Researcher in Victimology
Dr. Mauro Bardi, Ph.d.

Senior Researcher in Criminology and Cultural Crimes
568
Prof. Stefan Bogaerts, Ph.D.

Senior Supervisor (The Netherlands)
Prof. Anthony Pinizzotto, Ph.D.

Senior Supervisor (United States)
Prof. Julia Davidson, Ph.D.

Senior Supervisor (United Kingdom)
Prof. Antonia Bifulco, Ph.D.

Senior Supervisor (United Kingdom)
Info on: www.istitutofde.it

and more on: www.newcriminology.com
569

Criminal Behaviors. Impacts Tools and So

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Criminal Behaviors. Impacts Tools and So

Uploaded by

Copyright:

Available Formats

CRIMINAL

2013 | MILAN | ITALY

Puccia, Puccia, Tosi (eds.)

FDE INSTITUTE PRESS®

People interested in FDE Institute Press® can consult

All rights reserved. No part of this publication may be

© FDE Institute Press 2014

Foreword, by Angelo Puccia………………………………………….11

Welcome from the Honorary of the Congress

Neuroscience and Penal Trial, by Lorenzo Algeri…..17

Aggressive Behaviour in Psychopathy: a

The Evaluation of Personality Disorders in the

The Cosmologies of Violence. A Radical

Observations on Criminal Versatility Start From

Treatment Unit for Authors of Sexual Crime (at

Offender Mental Health Developments in

Treatment for Sex Offenders in Prison. The

Two Philosophical Questions About

Personological Features Of White Collar Crime:

The “Sound” Dimension in Satanic Crimes: an

Neurobiology and Psychodynamics in

Women in Prison in Italy, by Luisa Ravagnani,

Emilia Romagna Guidance on Severe

Treatment of Mentally Ill Offenders Not Guilty

Vulnerability Factor and Infant Traumas in Drug

Imprisoned Motherhood. From Law to Good

Efficacy Measurement in Penitentiary

Requirements of Current Legislation, by Gian

Remembering and Lying in Relation to Crime:

FDE Institute of Criminology Mantua……………….565

After the first edition in Mantua (2010), FDE

Barcelona) just to list the European ones. From Italy

time to be ready. For me it meant to work closely with

Mantova, 19th December 2014

Welcome from the Honorary of the

I had the good fortune of being named

That is, it will address recent advances in

Neuroscience and Penal Trial

1. Neuroscience: Introductory Considerations

Issues concerning the use of scientific evidence

recent years we have witnessed a remarkable

2. The Concept of Insanity According to the

The verification of a state of insanity, in order

In the past, in regards to the concept of

classification is not enough. It is necessary to

code, the concept of disability also includes severe

3. The Use of Neuroscience in Criminal

In criminal proceedings these studies have

In this regard, studying the functional

Before the accident he was considered a

technique13. The methodologies of neuroimaging

contrary, human behavior is determined by the

Very recent studies have shown that the

disease16. In the case of susceptibility genes, instead, a

It is, in fact, found that there are four allelic

on the basis of psychiatric examinations, in which

5. Psychopathy and Neuroscience

The case of a psychopathic subject offers the

The main characteristic of psychopathy is

characterization has strong similarities with the classic descriptions of

sphere (lack of remorse and callousness, lack of

features of brain structure have been highlighted in

recognizing emotions in facial expressions26;

6. Conclusions: Neuroscientific Evidence in