Book Review
Violence 
Release Decision Making. Christopher D Webster, Stephen J Hucker. Hamilton (ON): St Joseph Healthcare; 2003. 200 p. CDN$25.00.
Reviewer
rating*: Fair
Review by Julio E Arboleda-Flórez, MD, FRCPC, FAPA, DABFP, PhD
Kingston, Ontario
Prior violence foretells future violence, severe conduct problems in childhood influence later criminality, and people who lack conscience are more apt to be violent than those who do not (p iv).
These short phrases from the book’s prologue summarize the entire book, and to some extent, they summarize our total knowledge on predictor factors of violence: a myriad of scales and violence-risk assessment tools are all built on these assumptions. This small book attempts to explain to clinicians the nuances of the interrelation between diagnostic entities and the potential for behavioural manifestations of violence. Chapters are arranged by diagnostic categories, each introduced by a short vignette presented in a poem-like structure. This is followed by a discussion of the case’s merits as a predictor of violence and a series of relevant notes and bibliographical materials. The vignettes are based on the type of patient most likely to become violent following release.
The book concludes with a series of chapters on such technical matters as predictor factors, base rates, and the debates on the use of risk-assessment instruments, as well as a description of some of these instruments. Although the authors warn that diagnoses “by themselves tend not to have much statistical power when it comes to violence prediction” (p 33), the whole book seems an exercise in providing clinicians with the certainty that a good diagnosis can lead to good prediction. Further, the book is organized as a little “do-it-yourself” treatise for harried clinicians in an area that has been claimed by the superspecialists in forensic psychology and psychiatry: it attempts to popularize concepts and techniques for risk assessment based on sound clinical practices and the use of some specific scales. It is not a treatise on risk assessment or risk management but an easy clinical “how-to” for approaching a person in whom violence is considered a possibility.
Unfortunately, the book offers no disclaimers about the state of the science of risk assessment or risk prediction or about the scientific quality (or lack thereof) of the many actuarial scales and guides devised “to diagnose” violence potential. The chapter titled “Debates” focuses on whether clinical methods of risk assessment are better than actuarial methods (or vice versa) and says nothing about the sociopolitical, legal, and ethical debates surrounding these assessment methods—as if the science of risk assessment and risk prediction were already a fait accompli unencumbered by challenges and misgivings about its validity and usefulness.
The book, however, does serve a purpose for clinicians who want to have a general introduction to the issues and to learn some of the language of violence-risk assessment and prediction. If bought only for that purpose, the book would be a good buy.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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