The Dangers of Posthumous Diagnoses and the Unintended Consequences of Facile Associations

• Date: 01 December 2015
• Author: Mark T. Palermo,Stefan Bogaerts
• DOI: 10.1177/0306624X14550642
• Published date: 01 December 2015
• Subject Matter: Articles

International Journal of

Offender Therapy and

Comparative Criminology

2015, Vol. 59(14) 1564 –1579

© The Author(s) 2014

Reprints and permissions:

sagepub.com/journalsPermissions.nav

DOI: 10.1177/0306624X14550642

ijo.sagepub.com

Article

The Dangers of Posthumous

Diagnoses and the

Unintended Consequences

of Facile Associations:

Jeffrey Dahmer and Autism

Spectrum Disorders

Mark T. Palermo1,2 and Stefan Bogaerts3,4

Abstract

Posthumous diagnoses are not uncommonly given to notorious public and historical

figures by applying retrospectively, and typically in the absence of the individual being

diagnosed, contemporary diagnostic criteria. Although this may be relatively easy

and free of consequences when it concerns clear-cut medical conditions, it may have

unintended repercussions in the case of psychiatric disorders by creating myths and

perpetuating stigma. The case of serial killer Jeffrey Dahmer is a typical example

where a somewhat facile and almost syllogistic application of perhaps over-inclusive

criteria may have contributed to the legend of solitary murderers as possibly suffering

from an autism spectrum condition. Although there may be an understandable human

need to explain abominable and heinous behaviors, the lack of the possibility to verify

a diagnostic theory and the ill-advised attempt to make a diagnosis fit may de facto be

the basis of prejudice and profiling that do not correspond to clinical reality. Although

there is no doubt that the brain is the organ of behavior, the authors caution against

a budding neo-Lombrosian approach to crime and criminality and against the all

too common use of widely differing terms in the study of deviance, such as crime,

delinquency, and aggression, the operational use of which, often used interchangeably

even in association studies, often erroneously leads to further confusion.

1Medical College of Wisconsin, Milwaukee, USA

2The Law and Behavior Foundation, Amsterdam, The Netherlands

3Tilburg University, The Netherlands

4Forensic Psychiatric Centre de Kijvelanden, Rotterdam, The Netherlands

Corresponding Author:

Mark T. Palermo, Via Capo le Case 3, 00187 Rome, Italy.

Email: mt.palermo@lawandbehavior.org

550642IJOXXX10.1177/0306624X14550642International Journal of Offender Therapy and Comparative CriminologyPalermo and Bogaerts

research-article2014

Palermo and Bogaerts 1565

Keywords

Asperger syndrome, serial killers, autism spectrum disorders

Introduction

Posthumous diagnoses, although controversial (Karenberg, 2009; Muramoto, 2014),

are not uncommon in medicine and a posteriori clinical explanations of complex

behaviors are often given in an attempt to shed light on famous or infamous individu-

als, events, or historical periods that might otherwise bewilder witnesses or survivors

because of their monstrosity. In addition, psychological or psychiatric explanations of

heinous behaviors may be one way to circumscribe a socially or morally unacceptable

action and, in relegating it to a medical and psychological realm, attempt to control it

(Fromm, 1973). This has been attempted most notoriously with prominent historical

villains, such as Adolf Hitler (Rosenbaum, 1999), but psychological investigations of

the minds of more or less well-known deviant individuals abound and seem to be very

attractive to the general public.

Although contemporary psychiatric nosology claims to rely on rigorous definitions

resulting from the objective application of scientifically based standards, the apparent

ease in applying diagnostic criteria to observable behaviors not uncommonly can

result in over-diagnosis (Bolton, 2013). This has most certainly been the case in the

field of developmental psychiatry where, following the introduction of Diagnostic and

Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric

Association [APA], 1994), only recently replaced with the new fifth edition of the

DSM (DSM-5; APA, 2013), we have witnessed not just a sudden rise in the prevalence

of a number of disorders but also, for some, an actual apparent epidemic, such as in the

case of Asperger syndrome (AS), attention deficit and hyperactivity disorder (ADHD),

and childhood bipolar disorder (Frances & Batstra, 2013). Unfortunately, in fact, in the

mental health arena, it is not uncommon that complex behaviors are simplistically and

erroneously labeled by using a checklist approach, which appears, at a superficial

glance, to be connected to the way contemporary psychiatric diagnoses are thought to

be made (McHugh & Slavney, 2012), or, possibly, actually are made.

Common sense, sound clinical judgment, and experience and expertise should eas-

ily circumvent the alarming medicalization at all costs of behavior (which does not

actually seem to be the case, hence the aforementioned epidemic). However, in situa-

tions of a more public nature, commonly magnified and dramatized by the media,

psychiatric illness leaves the clinic and enters the courtroom and the news, and

becomes a matter of curiosity, often morbid, and of public debate. As an example of

this, the authors present the case of serial killer Jeffrey Dahmer and of the develop-

ment of a myth regarding his unproven diagnosis of AS, a form of autism (M. T.

Palermo, Palermo, & Federico, 2003).

The relevance of this case is in relation to a number of facts. First, the diagnosis of

AS made on the serial killer in question may have led to an increase in clinical stereo-

typing of “lone murderers.” Although “lone” and potentially dangerous individuals

suffering from AS have been described (M. T. Palermo, 2013), this is hardly the case