December 4, 1998

It is retrogressive not to recognize violent paraphilias as mental illnesses worthy of treatment in hospitals rather than jail ("APA Opposes Civil Commitment of Sex Offenders After Prison," August 21).

We have no conflict in committing a paranoid patient who shoots authority figures or a depressed woman who kills her newborn acting upon her profound pessimism and fears. But we have a problem in viewing dangerous paraphiliacs as mental patients because of the sexual pleasure they get from acting out their irresistible urges or compulsions.

With political forces of the world weak and business interests on ascendancy, we have less to fear that psychiatry will get used for nonmedical societal needs. Today the problem is the other way around: criminalization of psychiatric symptoms to save on medical spending. It is less of a headache to incarcerate than to hospitalize.

By joining the rest of society in chasing paraphiliacs away from one's neighborhood and declaring them primarily criminals, APA is showing shortsightedness and shirking its responsibility in dealing with these unfortunate human beings, most of whom became sexual predators as a response to their past victimization. It is neither safe for society nor for these sexually sick individuals to be let loose on the streets after short criminal sentences. A joint medical and legal tethering followed by "teletethering" of these patients is the correct medical and legal response.

Surendra Kelwala, M.D.
Livonia, Mich.