Abstract
Stalking is a disquieting phenomenon. It implies, in essence, a pattern of recurrent, unwanted attention and harassment of one person toward another. The harassment may at times become violent with grave and serious consequences, including death. It is a widespread phenomenon. For example, stalking in general is believed to have touched the lives of 1 in every 5 women and 1 in every 10 men in the United Kingdom alone (Home Office, 2011). Among the victims of such harassment are mental health professionals. A U.S. National Crime Victimization Survey for the period 1993 to 1999 placed the mental health professionals at the highest rate for violent victimization (Duhart, 2001). From 2005 through 2009, mental health groups were second only to law enforcement occupations for rates of workplace violence (Harrell, 2011). Also, the United States Bureau of Labor Statistics reported 69 homicides of health care personnel from 1996 through 2000 (Occupational Safety & Health Administration, 2011).
Stalking presupposes the existence of a relationship between the two people involved, be this present, past, or even, at times, imaginary. Stalking is a crime. It is a crime of control and power. The term may in fact derive from hunting. As in hunting, it involves tracking, following, and persistently pursuing. Hunting was originally necessary for survival and implied hunger. Only later it became, at least for the Western world, a form of recreation. The pursuit of prey however, regardless of the cause and regardless of the prey, may indeed be modulated by the same emotion-motivation brain systems that underlie other motivated behaviors, even if the appetite differs, such as sex, gambling, and perhaps genuine romantic lust, more commonly known as love (Fisher, Aron, Mashek, Li, & Brown, 2002; Meloy & Fisher, 2005). These behaviors may utilize or be governed by a wide array of neural circuits, as is, obviously, the case for all of the behaviors.
January 2013 was the 10th National Stalking Awareness Month in the United States, signifying a growing institutionalized concern over a complex and multifactorial crime. Interestingly in1996, the U.S. Congress, as part of the Violence Against Women Act, passed an antistalking law (Federal Domestic Violence Legislation, 1996). The same year, if one were to peruse the National Library of Medicine indexed references, no publications would be found regarding stalking. The United Kingdom, a year later passed a similar law, Protection From Harassment Act (1997), and that year the first scientific publications appear on the subject in the medical literature, numbering a mere 12.
Despite the growing concern and the increasing awareness of the problem, in 2002 PubMed citations when using the term stalking numbered a mere 28 climbing slightly to 34 in the year 2012. This is perplexing and may signify not just a relative lack of interest but rather the complexity of the behavior being studied. For example, in 2002 PubMed publications on pedophilia surprisingly numbered only 31; by 2012, there was a 10-fold increase to 314. While this notable difference may indeed be related to the abominable nature of the behavior, it is possible that it may be attributed to the relative ease with which the condition may be categorized and diagnosed. As so often happens in the imperfect language of psychiatry, or in the age-old problem of lumping and splitting in the arena of behavior problems, the stalking phenomenon is not as straightforward as is the case of a clearly abnormal paraphilic behavior. In fact, while lusting after a shoe may be bizarre, and having sexual fantasies or actual contact with a child is clearly abnormal and wrong, stalking, an unwanted attention, may be even culturally understood at times. An example is the case of stalking in the context of a romantic relationship which has ended where some may believe stalking to be an understandable, albeit temporary, response. This is clearly untrue, as stalking is always, by definition, in particular in the case of romantic relationships, a form of coercive control. Not infrequently, the interpersonal attitude was already present in the relationship and a reason for the termination of the same. Rarely, stalking may be part of a delusional system as in erotomania.
In this issue of the International Journal of Offender Therapy and Comparative Criminology, Mastronardi and colleagues report their study of the prevalence of the phenomenon of stalking of psychiatrists in a sample of Italian psychiatrists in Rome. The study seeks to shed some light on what is and perhaps has always been one of psychiatry’s most unpleasant occupational hazards (McIvor, Potter, & Davies, 2008).
What happens when it is a psychiatrist, a psychologist, or another mental health worker being stalked? Can this in truth be considered stalking? Or should it not be considered one possible outcome in the context of a profession which by nature involves caring for persons with disturbed behaviors and prone to misunderstanding situations on the basis of their own wishes or expectations of the therapeutic relationship, or, more specifically, the result of a negative transference or the misinterpretation of therapeutic empathy?
Stalking leaves those victimized emotionally scarred (Purcell, Pathé, & Mullen, 2005). It may persist for weeks, months, or even years. The impact on the victims may be highly destructive, with feelings of guilt, frustration, and embarrassment. Some professionals ask for police protection or even leave their profession entirely. However, most of them refrain from the former because of possible societal and professional misinterpretation connected with it. Posttraumatic stress disorder is not infrequent in stalking victims (Krammer, Stepan, Baranyi, Kapfhammer, & Rothenhäusler, 2007).
Not all stalkers, stalking or perhaps stalking-like behaviors, share the same characteristics. A stalker may be suffering from a dependent personality disorder with narcissism and paranoid features, or with underlying schizophrenia or other psychotic manifestation. The obsessional need for attention of a dependent person may be quite different from that of a narcissistically wounded individual and, depending on the person involved, each may require a different approach. As is the case at times in other mental health situations, the professional may need to decide whether to address the issue by thinking clinically or thinking legally (Dressing, Foerster, & Gass, 2011). If the usual psychological and practical approaches do not stop the behavior, it may, indeed, be necessary to take legal action against the victimizer, and involuntary commitment procedures may be necessary in the case of dangerous stalkers. This is one of the challenges for mental health practitioners.