Review of: Forensic and Medico‐legal Aspects of Sexual Crimes and Unusual Sexual Practices

This is a quite remarkable book. For the first time an authoritative text for medical, psychiatric, psychological, forensic, and legal professionals has been written which addresses both the clinical and legal dimensions of the paraphilias. Dr. Aggrawal, who teaches forensic medicine at the Maulana Azad Medical College in New Delhi, deftly brings to bear his 25 years of interest and knowledge of sexual deviancy and sex crimes in an authoritative and comprehensive textbook. The book generally follows the organization of the DSM paraphilias, and elucidates in separate chapters their respective definitions, etiology, history, epidemiology, medical characteristics, management, and legal understanding in various U.S. jurisdictions and other selective countries. One of the most enjoyable aspects of this book is Dr. Aggrawal’s grasp of ancient references concerning the paraphilias in both religious and historical texts, and his illustrations through the selective use of contemporary clinical and legal cases. The book also contains well-written chapters on rape and sexual harassment, and a comprehensive appendix of paraphilias, no less than 547 cited in the scientific and lay literature. The book, however, is not without its shortcomings, and I offer these in the spirit of improving the second edition, which Dr. Aggrawal invites in his preface. My criticisms fall into two categories; first, there are some striking omissions of authors’ research which clearly belong in the text. Most apparent is the complete absence of any mention of psychopathy, which turns out to be the best predictor—along with sexually deviant fantasy—of sexual offending (1). A discussion of psychopathy is essential, especially when sexual offenders and their crimes are addressed. Another example is the absence of reference to Roy Hazelwood et al.’s text (2) on autoerotic asphyxia when discussing this particular paraphilia: a diminutive book which has become a classic. And lastly, the discussion of false memories in relationship to child sexual abuse omits any mention of the work of Elizabeth Loftus, the principal researcher in this area for many years (3). The second category of criticism concerns assertions, or lack thereof, which tend to mislead the reader. The brief discussion of child satanic ritual abuse (p. 52) leaves the impression that such abuse is an actual reality, when, in fact, multiple criminal investigations, many of them originally done by FBI Special Agent Ken Lanning 30 years ago, have failed to reveal any credible evidence that would confirm even one case of child satanic ritual abuse, at least in the United States. Another assertion that is incorrect is Dr. Aggrawal’s definition of piquerism which only includes selfinflicted penetration of the body with sharp objects (p. 364). Forensic psychologists and psychiatrists are quite familiar with piquerism as a rare sexual deviancy that is usually perpetrated against another, although admittedly, any systematic research on this paraphilia has yet to be done. Finally, many of the reviews of psychoanalytic formulations concerning etiology in this book are quite dated and some are inaccurate. For example, the assertion that ‘‘according to psychoanalysts, all children have a desire to have sexual relations with family members’’ (p. 364) is incorrect, although developmentally children will find pleasure in their genitals during the first year of life even though parents tend to resist any acknowledgment of such observed activity (4). Contemporary writings of psychoanalysts concerning sexuality, and the evolution of psychoanalytic thought, need to be acknowledged and referenced in this book. Despite my criticisms, this book will likely become a fixture in most forensic libraries, and offers a vivid and highly informative guide to realms of human behavior which often pique the curiosity, sometimes disgust, and occasional horror of most people.