Download Forensic Psychiatry

Forensic Psychiatry
What is forensic psychiatry?
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Forensic psychiatry is a branch of medicine
which focuses on the interface of law and
mental health.
It may include psychiatric consultation in a wide
variety of legal matters
expert testimony
 clinical work with perpetrators and victims.
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What is a forensic psychiatrist?
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A psychiatrist is a medical doctor (M.D. or
D.O. in the U.S.) who has completed several
years of additional training in the understanding,
diagnosis, and treatment of mental disorders.
A forensic psychiatrist is a psychiatrist who
has additional training and/or experience related
to the various interfaces of mental health (or
mental illness) with the law.
Forensic psychiatrist vs Forensic
psychologist
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Psychiatrists are physicians with specialty training in the
understanding, diagnosis, and treatment of mental
disorders.
This includes:
 biological evaluations and treatments
 (such as laboratory tests and medications)
 psychotherapy, and family & social issues.
Doctoral-level psychologists do not go to medical
school,
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Have special expertise in topics not usually studied in detail
by psychiatrists (such as psychological testing).
How is forensic psychiatry useful to the
legal process?
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When legal matters involve issues outside lay (general public)
expertise, lawyers and judges regularly seek consultation from
professionals in a wide variety of fields, including medical
specialties.
Such professionals are often called "experts" or "expert
witnesses."
Forensic experts usually are truly knowledgeable, the criteria for
"expert" designation in such cases are legal ones, and not
necessarily scientific.
Sometimes the expertise is sought in an effort to provide the
best possible information to judges or juries, but there are many
other situations in which a prudent attorney, judge, or other
party may request consultation.
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Are forensic psychiatrists "advocates"
for one side or the other in legal
matters?
Usually not.
Ethical forensic psychiatrists try to avoid bias.
They focus on the data or evidence within their areas of
expertise, and comment objectively on the information as they
see it.
Are often consultants to advocates (lawyers) or courts, and at
other times may participate in advocacy strategy, but consider it
unethical to combine our expert opinions (testimony, reports, or
affidavits, for example) with advocacy per se.
Ethical forensic psychiatrists do not accept contingency fees or
otherwise conduct themselves in ways that may interfere with, or
imply, a lack of professional objectivity.
Doesn’t the expert have an incentive to agree with
the lawyer, so he or she can testify and make money?
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In most cases, no.
Ethical experts are paid for their time, not their
testimony.
Since the time spent forming the opinion usually far
exceeds time spent testifying, most payment is received
regardless of whether or not the expert testifies.
Forensic psychiatrists are similar to most other
professionals in their respect for their work and their
clients. The minority who "cheat" in some way risk
severe censure and loss of credibility.
What Does a Forensic Psychiatrist Do?
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Most forensic psychiatrists don't specialize in criminal
matters.
The word "forensic" refers to anything that has to do
with the law.
Forensic psychiatrists thus may be involved with:
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criminal matters
civil litigation (such as malpractice lawsuits)
competence to do things (like make a will, consent to medical
care, or take care of children)
child custody
treating and working with mentally ill people who get in
trouble with the law
helping victims of crimes
helping lawyers and judges understand the psychological
aspects of their cases.
Here are three things they are
not:
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(1) We're not lawyers. We may work with lawyers, or try to understand the
legal aspects of the matter we're working on, but our job is to be good
doctors who can translate what we know into something useful for the legal
system, not to be lawyers ourselves.
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(A few forensic psychiatrists and psychologists have law degrees as well as medical
ones. In my view, those folks usually do best when they pick one role or the
other.)
(2) We're not judges. We don't interpret the law or tell judges or juries how
they should rule. Most of the time, psychiatric issues are only a small part of
the entire legal matter being considered. Sometimes we're asked to give an
opinion about those psychiatric issues, but that's to help the judge or jury
decide, not to tell them what to do.
(3) We're not cops. We aren't the folks who protect the community, deal with
dangerous or criminal situations, or contain the bad guys. That's not our area
of expertise, and nobody gives us permission to do it anyway.
Stalking
"Even if I did do this,
it would have to have been because I loved her very
much, right?"
- OJ Simpson
Do Now:
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Is stalking socially acceptable?
Eight million American women -- or one in 12 –
will be a victim of stalking at some point in their lives.
-Kristin Ohlson
"The Lloyd Dobler Effect".
Emily, like me, is an a crazy fan of
John's, specifically of his Lloyd Dobler
role in Say Anything
Well Is It?
What is Stalking ?
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a set of "behaviors that last more than two
weeks and involves repeated and persistent
attempts to impose on another person unwanted
contacts and/or communications which induce
fear or distress."
-Paul Mullen, M.D.
“He always told me he would make me sorry,”
“I never dreamed he would do it by killing our child.”
Who is doing the Stalking ?
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____% of the stalkers were male
____% of the stalkers were ex partners of the victims
____% had some form of relationship with the victim
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Who is stalked the most??
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ex-partners professional relationship, fellow employees,
customers casual acquaintances
the stalkers who assaulted were most likely to be ____?
-(Mullen, Pathe, Purcell, Stuart, 1999: 1244)
Who is doing the Stalking ?
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79% of the stalkers were male
30% of the stalkers were ex partners of the victims
86% had some form of relationship with the victim,
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including ex-partners (36%),
professional relationship (23%)
fellow employees or customers (11%)
casual acquaintances (19%)
36% (52) of the stalkers attacked their victims, 14 involved
sexual assault
the stalkers who assaulted were most likely to be rejected ex
partners.
’ (Mullen, Pathe, Purcell, Stuart, 1999: 1244)
According to a 1998 study by the
Department of Justice.
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8% of women will be stalked
in their lifetime
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2% of men will be stalked in
their lifetime
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Women
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Men
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aged 18 to 35 (11%)
aged 36 to 55 (8 %)
56 or older (4%)
-Paul Mullen, M.D., at APA’s
2001
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ages of 18 and 35 (8%)
aged 36 to 55 (4%)
aged 56 and older (3%),
Professor of forensic psychiatry
at Monash University in
Victoria, Australia.
Do Now:
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In what ways can stalkers communicate with
their victims?
“I have to eliminate what I cannot obtain.”
Bardo,in a letter to his sister
Later he killed Rebecca Schaeffer
Do Now: Answers
In what ways can stalkers communicate with
their victims?
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telephone, e-mail, fax, letters, notes, gifts
Attempt to be physically close to the victim by
approaching, following, surveilling, and loitering
near that person
Do Now 11/12:
What might concern you about this
letter?
How might you describe the stalker’s
profile?
“He always told me he would make me sorry,”
“I never dreamed he would do it by killing our child.”
How might you describe the stalker’s
profile?
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Usually an isolated and shy person , May be unemployed
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Social Failure: one who lives alone, lacks any type of important
intimate relationship
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Narcissistic personality disorder and very low self-esteem.
 The stalker feels that they're the most important person in the world."
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Many people stalk someone they have only met briefly
 Someone they don't really know, or barely know.
What are Mullen’s Five Categories of
Stalkers
Types
of
Stalkers
Mullen’s Five Categories of Stalkers
Rejected
Suitor
The
Predatory
Stalker
The
Resentful
Stalker
Types
of
Stalkers
Intimacy
Seeker
The
Incompetent
Suitor
1. The Rejected Suitor
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Sometimes a partner rejected by their spouse or lover
may vacillate between overtures of reconciliation and
revenge. They have a narcissistic sense of entitlement
and belief this is the only relationship they are going to
have.
More than 80% of rejected stalkers in Mullen’s study
had personality disorders.
Therapeutic treatment of the rejected stalker involves
helping him or her come to terms with the end of the
relationship.
2. The Intimacy Seeker
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The intimacy-seeking stalker intends to establish a
relationship with his "true love" regardless of her
wishes.
More than half of the intimacy seekers Mullen
evaluated were delusional, believing that their love was
reciprocated, and nearly a third had a personality
disorder and a delusion that their quest would be
ultimately successful.
Legal actions do not work well with intimacy seekers,
who may justify their behavior with the belief they
must pay a price for true love.
The court may order treatment, which should focus on
treating their delusions or other mental disorders.
3. The Incompetent Suitor
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This type is typically a man who had been
rebuffed after asking a woman for a date.
He’s often socially inept, and when rejected,
begins to stalk with the hope that his persistent
behavior will change the woman’s mind.
The incompetent suitors can be responsive to
judicial sanctions but are also likely to relapse.
4. The Resentful Stalker
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These offenders express anger in response to a
perception that they have been humiliated or
treated unfairly by the object of their obsession.
They thrive on having a sense of power and
control over the victim, and are hard to treat
because they often see themselves as the victim.
5. The Predatory Stalker
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Predator plans their attack, rehearses it, has lots of
sexual fantasies about it.
Derives pleasure from gathering information about the
target and fantasizing about the assault.
Doesn't necessarily know the victim.
The victim may not know she is being stalked.
They often have prior convictions as sexual deviants.
Lets see who’s a stalker..
I love
you
Do Now 11/13:
Why might a person stalk a celebrity?
From today’s headlines: http://abcnews.go.com/Entertainment/wireStory?id=6237229
Know this
Commercial?
Is Stalking
acceptable??
Burger King Stalker http://www.youtube.com/watch?v=mhehKgU5oBs
Do Now 11/13:
Why might a person stalk a celebrity?
From today’s headlines:
http://abcnews.go.com/Entertainment/story?id=6241069&page=1
Do Now 11/13:
ANSWER
Why might a person stalk a celebrity?
 may focus on a celebrity, especially if they've seen him or
her in person at a public appearance like a concert.
 Develop a relationship through viewing
 Learn about their family and who they are from TV or Radi
 "They develop convoluted thoughts about this person.
 They feel this person is the answer to their dreams,"
Looking inside the letters
Two Questions:
1. Why did we leave off the Predatory Stalkers?
2. Predict which stalker is the most to be
concerned about causing harm?
From Jack Jordan
Why did we leave off the Predatory
Stalkers ?
Threats (%)
71%
Assaults (%)
54%
Intimacy Seeking
50%
23%
Incompetent
Suitor
Resentful Stalker
32%
27%
87%
25%
Predatory Stalker
33%
50%
Rejected Suitor
Predict which is the most to be
concerned about?
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The rejected and predatory stalkers are most
likely to assault their victims.
When to Be Concerned
The red flags:
 You immediately start getting several phone
calls or emails right after meeting this
person.
 The person is clingy, controlling, or upset if
you want to spend time with friends and
family.
Marlon Pagtakhan stalked Jerry Ryan
How to Take action:
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Tell everyone you know that this is going on
-- your employer, friends, family.
Gently but firmly tell the person you've
decided to move on.
Don't get drawn into discussions of why.
Just say, "This situation isn't right for me"
or "I'm not ready.." -- whatever you need to
say, but say it gently.
Treatments for Victims
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Mullen has found that cognitive-behavioral therapy
works well in managing the anxiety stalking victims
experience.
Medications such as SSRIs for some patients.
"It is important to inform and educate family
members about the stalking and enlist their
help in managing it," he stated.
Treatments for Victims
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Stressed that victims of stalking, like victims of sexual or
physical abuse, often blame themselves for the situation.
 Because they feel shame or misplaced guilt, they
do not share their ordeal with others and become
more isolated and afraid
Counseling the victim to realize that he or she is not
responsible for the stalking.
Advises victims to file a complaint with the police if the
stalking episodes continue for more than two weeks.
 "To prove that the perpetrator is guilty of a crime and
have the court order treatment, evidence is critical. Do
not destroy answering-machine tapes, notes,
letters, e-mails, or gifts in a moment of distress,"
he advised
Professionals at Risk,
What about the victims?
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"Professionals who work with the lonely and
unstable are at risk of being stalked," said Mullen.
Estimated that about 15 percent have been
stalked by a patient during their career.
Victims are often forced to alter their lives to
avoid the stalker.
Mullen’s study found:
53% of his subjects quit or changed jobs
 40% moved to a different home
 70% curtailed social activities.
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Professionals at Risk,
What about the victims?
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In addition to the physical dangers, stalking takes
a severe psychological toll on its victims.
83% Subjects were diagnosed with an anxiety disorder
 37% with posttraumatic stress disorder (PTSD).
 Additional 18% had PTSD symptoms but did not
meet formal diagnostic criteria.
 24% had ideas of suicide
 25% percent increased their alcohol consumption
and/or cigarette smoking
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Pics