What we’ve said about Forensic psychiatry

“forensic psychiatry is not correctional psychiatry. Forensic psychiatry is the application of psychiatric expertise and knowledge to legal questions”

“your job is to give advice and to lend expertise to in a pretty much neutral fashion rather than putting weight on the scales in one direction or another”

“you should not equate or confuse your moral reasoning and your moral ideas and wishes with legal conclusions. And I do think a responsible forensic expert working in a case, they are giving an opinion based on the legal conclusion”

“the question isn't does she have a mental illness? The question isn't was she psychotic? The question is could she control her behavior? And that's what's being answered”

“in almost every country and probably in most developed countries, Psychiatry is a branch of the executive state. Sorry, it's part of the executive branch of the state. Similarly to prosecutors, police officers, et cetera, in a small way or sometimes in a bigger way, we are part of social control and protection of the people”

“I'm not so sure the function of a judicial system is to get to the truth. I think the function of a judicial system is to resolve disputes first and foremost”

“If you're a neutral and ethical expert, you will come to conclusions that do not help the side that appoints you. But then those conclusions never see the light of day”

“far more common than not guilty by reason insanity is incompetency to stand trial. What should happen to someone who is incompetent to stand trial because of a mental illness and that they can never be restored to competency”

“just like in a forensic psychiatry analysis of a moment of any person's behavior, we need to consider all the different possibilities, not just the possibilities that are medical diagnoses like autism or neurodiversity, right? We want to consider rational behaviors”

“one moment like that alone, again, only tells us about traits, right? It doesn't tell us anything about disorder, and it particularly does not allow us to come to much in terms of conclusions about why someone did what they did in terms of a criminal charge”

“evidence that is from that time of the incident is worth more than any recollection by a person after the fact because memory is fallible”

“Don't look at the internal logic. And say, that's not logical. Of course, it's not logical. It's psychosis. Compare the reported or recorded internal logic to the surrounding circumstances in the history”

“It actually doesn't matter if it was a voice or not, because people with psychotic disorders can experience foreign thoughts or they can even experience their own thinking, but in a manner that is quite intrusive and different than their normal selves”

“people think of malingering as some binary where you're either fully genuine or fully malingering. And that's the splitting aspect again, right? That's all or nothing type thinking. There are so many varieties”

“In clinic, our outcome is simply getting the patient better. So we don't have to worry about this stuff as much. But when it comes to the law, we need to strike a balance”

“Have the patient describe the events step-by-step, moment-to-moment in a hallucinatory level of detail. Obviously, you're not going to have time for this in med management, but in the therapy, in the forensic interview”

“what kind of problems were you having at that time in the period leading up to the offense? And so I had her talk about her day and she talked about how she didn't put it in these words, but she basically gave a narrative description of intermittently freezing and not being able to respond throughout the day”

“The more sudden religious insight, basically, you have into a strange idea or a very valued idea, the more likely it is to be from a psychotic disorder”

“it was a high level of achievement and persistence in achievement that did not match the kind of apparently psychopathic assaultive behavior that is usually the product of a personality disorder or a personality problem. So that was a mismatch there”

“you need to make connection between your conclusion and what you're seeing. And again, the best way to do that is to actually consider the context”

“because psychiatry is so fuzzy, it's especially important that forensic and general psychiatrists know exactly what is based in science, what is based in clinical experience, and what is not”

“any good forensic psychiatric determination requires you to be a good psychiatrist. You need experience as a psychiatrist. You need to have actually attempted to evaluate and differentiate all these things in many, many people and seen How successful you've been”

“there aren't really so many people who are just outright hired guns. People who detect knowingly what the attorney wants in terms of opinion and gives it. I think that there are just more and less talented evaluators”

“your opinions are only accepted if you can lay out the database that you used and your reasoning to connect the evidence that you reviewed to get to your conclusion. And in the same way, you can't expect patients to simply believe you because you've got a diploma on the wall”

“when you give an opinion, when you have a conclusion, a clinical conclusion for a patient, you better have that on a good basis that you can explain to a neutral audience”

“in a clinical setting, we don't diagnose to decide if something is purposeful or whether the patient is responsible, right? We're diagnosing to inform our treatment plan and to inform the patient of, What are your treatment targets”

“There is this whole section of humanity that is just mentally ill enough to exist in society most of the time without having to go to a clinic or hospital. Yet also that may land them in some trouble with the law”

“there's one more weird one that you only see in forensics. People can develop PTSD from being essentially the assailant, the murderer. Interesting, isn't it”

“If you encounter it because of a delusion, right? A hallucination. It's technically not objectively threatening. But I would say that that's a situation where most people encountering that and unable to tell it apart from reality would be objectively threatened”