A Misleading Review?

To the Editor: Dr. Harold Carmel's review of my book Understanding Violence (1) in the December 1998 issue was a fair representation of the response I have generally received from medical psychiatry. In that sense, it was a very appropriate review for a psychiatric journal. However, I feel compelled to point out some shortcomings in the review that might mislead potential readers.

The purpose of the book is not to provide a comprehensive, in-depth review of the literature in the area of violent behavior. Rather, it is to provide a summary of that literature. One of the characteristics of the literature on violence is its enormous variety; many researchers are working in very different fields. To criticize the book because it does not spend a great deal of space on any one area is to misunderstand the book's mission. As the author, I am responsible for clarifying that mission, and Dr. Carmel's misunderstanding of it is at least partly due to my lack of clarification.

Specifically, Dr. Carmel criticizes the book for "trivializing" the diagnosis of antisocial personality disorder and for "dismissing" the link between serious mental illness and violence. The psychiatric community has traditionally seen these two areas as being of great importance as causes of violence. However, one of the major thrusts of the book is that when the literature is taken as a whole, antisocial personality disorder and mental illness are far from the most important causes of violence. In my opinion, this is an important fact. It may be that the mental illness model of violence is much less tenable than other, more modern theories. It was, and is, my purpose to educate my readers about this shift in the emphasis of most research. Of course, others will have different opinions. However, I stand by mine.