This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.


OBJECTIVE: To examine the comorbidity of severe mental illness with sexual offending in men.

METHOD: A case-control design was used to investigate psychiatric hospitalization and sexual offending. Data were obtained from Swedish national registers for crime, hospital discharge diagnoses (based on International Classification of Diseases revisions 9 and 10), demographic, and socioeconomic factors for the years 1988 through 2000. All male sexual offenders (N = 8495) in Sweden were included and compared with a random sample of male controls taken from the general population (N = 19,935). The population attributable risk fraction (the proportion of all sexual crimes throughout the study period that were committed by patients with a history of psychiatric hospitalization) was also estimated.

RESULTS: After adjustment for demographic and socioeconomic confounders, sexual offenders were 6 times more likely to have a history of psychiatric hospitalization compared with the general population (OR = 6.3, 95% CI = 5.7 to 6.9). Sexual offenders were significantly more likely to have a severe mental illness than the general population, whether this was schizophrenia (OR = 4.8, 95% CI = 3.4 to 6.7), other psychoses (OR = 5.2, 95% CI = 3.9 to 6.8), or bipolar affective disorder (OR = 3.4, 95% CI = 1.8 to 6.4). The proportion of all sexual crimes committed by hospitalized psychiatric patients (the population attributable risk fraction) was 20.1%.

CONCLUSION: The increased relative risk of psychiatric hospitalization and severe mental illness in sexual offenders is contrary to much expert opinion in the field. If these findings are replicated in other settings, policies in the criminal justice system regarding the assessment, management, and treatment of sexual offenders may need review.¹

Roy, Hunts Point. Courtesy of Chris Arnade.

Roy lives inside a vast cavern, formed where bridge meets expressway, strewn with garbage and women's clothing. The expanse's size could be compared to a car dealership lot, one with moguls and a harsh tilt. He lives with a Mexican man who cross-dresses, and he has a mental illness about which he does not speak or does not know. Others know after talking with him.

Buckets near his bed are partially filled with human waste. To loom over them is to hold in vomit.

There is a small mattress near the buckets and on the mattress, magazines flaunting pussy and ass from multiple decades.

On the other side, within yelling distance, another mattress. Two divided by dipped planes that form a river in heavy rain.

It is black inside, and the dirt is uneven. If such things could be seen, there would be dust clouds.

Cats roam, too. There are either many cats collected or none. Since recently there are less, the cavern's female occupants stole and collared a cat. It's a male tabby. Reliable company, a friend, a lightness, to be shown off.

Roy can be difficult. In the darkness, he speaks in circles about conspiracies and family inheritances. It can be wondered if he ever leaves the darkness. He isn't seen outside, over the bridge or in the neighborhood.

When women come to visit, he leers, with his voice and with his eyes when light is shined on him. When women stay, he tries to have sex with them. The acts, or forceful requests, the cost of a place to stay.

He invades space. One, two, three, four women say.

His place is the last place anyone goes. Women go there when there is nothing else. Go home to the dirty old man.

Alone, there, the bottom.


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