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Biomedical subjects

I N Perr

Publications and source records attributed to I N Perr.

At least 19 recordsLinked to original sources
PubMed1992

Asbestos exposure and psychic injury--a review of 48 claims.

Asbestos exposure has been a common occupational risk resulting in much litigation. Where pulmonary dysfunction has been minimal or even absent, psychic injury has been made an element in claimed damages. Analysis of psychiatric and psychologic claims in 48 cases reveals that diagnoses often do not conform to professional standards, are based on insufficient data sampling, lack adequate overall history as well as medical history, and do not comport with the standard of probability usually required for litigation. The group studied was elderly (mean age--62.6), mostly retired (71%), with some significant medical illnesses (18% on medical retirement). None were retired for pulmonary reasons. As expected, conflict in opinion between the opposing professional medical participants was frequent. Commonly the patients did not substantiate the complaints reported in the medico-legal reports; some ridiculed statements made on their behalf. Many psychological reports reflected simplistic or erroneous concepts of medicine or ignored relevant medical data. This study indicates that in this group claims of psychic injury due to asbestos exposure have little justification and supports the view that the current system of utilization of expert opinions is not reliable or in conformity with reasonable professional standards. Correspondingly, these claims did not result in augmented awards.

Adult↗
PubMed1992

Misidentification of self and the Riel Phenomenon.

Misidentification syndromes or phenomena are found in a number of psychiatric situations that may become the subject of forensic science review. One of the most curious is misidentification of self in which the individual perceives himself or herself as another being while able to explain the loss of the original identity. Recognizing these phenomena may be helpful in accurate diagnosis, in considering such conditions as psychosis of whatever type, multiple personality disorder, and other amnesia and fugue states, and in understanding the person's psychopathology. Two cases are presented to illustrate a process that the authors have named the Riel Phenomenon, after the person who was a party to what is often recognized as the most famous case in Canadian history.

Adult↗
PubMed1992

The trial of Louis Riel: a study in Canadian psychiatry.

The Riel case in 1885 is one of the most striking cases in the history of forensic psychiatry. On the one hand, Riel was the hero of the underprivileged, French Canadian-Indian halfbreeds whose futile revolt in the Canadian Northwest captured the imaginations of French Canadians in Quebec, for whom he became a hero and a martyr. Prior review in this journal has detailed the clinical data referrable to his mental condition. This paper reviews the actual trial, the questionable management by the defense, and the inadequate preparations by the defense psychiatrists. Subsequent to the sentence of death, the Canadian prime minister, Macdonald, ordered a medical review, more or less dictating the result. For whatever reason, the medical reports when made public did not fully reflect the actuality of what occurred. The result was a questionable execution, the creation of a martyr, and a spark for the cultural conflict that continues to bedevil Canada.

Canada↗
PubMed1991

Alleged brain damage, diminished capacity, mens rea, and misuse of medical concepts.

As focus on the insanity defense diminishes, defendants may place emphasis on a lack of knowing or purposeful behavior in order to negate a criminal charge. This use of a mens rea defense in accord with Model Penal Code principles is exemplified by the current New Jersey statute. Such a defense may result in a lesser charge or a finding of not guilty. In addition to reviewing applicable law, this report presents a sex offense case in which remote brain damage was invoked as a purported basis for incapacity to formulate the required intent; the study also raises the issue of the inappropriate or questionable use of medical principles, a practice that diminishes professional credibility in the courts and in the community.

Adult↗
PubMed1991

Crime and multiple personality disorder: a case history and discussion.

The application of the concept of multiple personality disorder (MPD) is one of the most complex and controversial issues facing forensic psychiatrists. The case presented is one in which a diagnosis of multiple personality disorder is not only well documented, but was so diagnosed at least 10 years before the ultimate homicide. Nonetheless, consideration of the legal issues was difficult. Other cases, particularly the Bianchi case, reflect the clinical difficulties in diagnosis. Subsequent cases have reflected a judicial review of the issues and a trend to disallow the concept of MPD as a defense; the author suggests that forensic psychiatrists incorporate these opinions in their future judgments.

Dissociative Identity Disorder↗
PubMed1990

"False confessions" and identification with the aggressor: another forensic misuse of a psychiatric concept.

Some psychiatrists misuse theoretical concepts beyond their generally accepted dimensions in an attempt to support a conclusion favorable to a litigant or defendant. In the case presented, the concept of identification with the aggressor was used in an attempt to eliminate or minimize the effect of a confession and to buttress the claim that the confession itself was false. Quotations from the actual reports and testimony are used to reflect both this tactic and the context in which these issues were pursued, including a rather startling admission by the psychiatrist dealing with the thoroughness of his professional effort. A brief history of "identification with the aggressor" is presented, a history which contrasts with its application to rather routine police questioning. Similarly, skepticism is clearly merited when a psychitrist testifies as to truthfulness or falsity of a statement.

Child↗
PubMed1988

Claims of psychiatric injury after alleged false arrest.

Litigation has increased rapidly in the United States; those who feel aggrieved sue readily for damages. Police officers and security people may be sued after arrests or detention followed by unsuccessful prosecution or dropping of criminal charges. Claims of psychiatric injury may be made where there are no discernible damages otherwise. Examiners must keep in mind that physical abuse or grossly inappropriate police behavior may be factors in the ultimate results. This paper reviews 13 cases of claimed psychiatric injury after arrest. Almost all were settled, some for significant amounts. Appropriateness of evaluation, the value of nuisance suits in this type of litigation, the role of attorneys' fees, and the effect of Federal suits as opposed to state suits are discussed.

Adult↗
PubMed1986

Legal problems in inpatient psychiatry.

This paper has discussed broadly a panorama of legal issues which may arise in the practice of inpatient psychiatry. Such a discussion can only be general and may not apply in a specific jurisdiction. Psychiatrists in inpatient settings should be familiar with all the issues raised and with local practices. Psychiatry is a field of medicine with a multitude of legal problems, more so than other medical specialties. Psychiatrists therefore have the obligation to themselves, their hospitals, and their patients to be cognizant of the legal issues in psychiatric practice. Hopefully, the more that they know, the less likely they are to be confronted with claims that they did not pay attention to this essential aspect of inpatient psychiatric practice.

Commitment of Persons with Psychiatric Disorders↗
PubMed1986

Pathological intoxication and alcohol idiosyncratic intoxication--Part I: Diagnostic and clinical aspects.

The concept of pathological intoxication and its successor term, alcohol idiosyncratic reaction, has been one of ambiguity and professional disagreement. The history of such an entity reveals contradictions and varying usage--particularly in regard to the amount of alcohol required. Some feel that the current classification system is broad enough to include such reactions without the use of such terms. Laboratory and electroencephalographic findings are not diagnostic. The author suggests that if the concept is to be retained, psychiatrists utilize where possible the term "alcohol idiosyncratic reaction" in accord with Diagnostic and Statistical Manual of Mental Disorders (DSM) III guidelines, particularly in view of the medicolegal implications discussed in Part II, which follows as a separate paper.

Alcoholic Intoxication↗
PubMed1986

Pathological intoxication and alcohol idiosyncratic intoxication--Part II: Legal aspects.

The law does not generally allow alcohol intoxication as a defense in a criminal matter. Among the exceptions may be pathological intoxication, or PI, or its current psychiatric correlate, alcohol idiosyncratic intoxication (AII). Because of the lack of specificity in the medical concept and the varying approaches by different authors, careful analysis and adherence to current standards are necessary. Relevant laws, particularly that of the model penal code, are reviewed, as are three cases which demonstrate the issues involved. Actual testimony is presented to illustrate possible misuse or inappropriate use of the concept.

Adult↗
PubMed1985

Liability of the mentally ill and their insurers in negligence and other civil actions.

Although familiar with the insanity defense, psychiatrists know little about the liability of mentally ill persons in civil actions or the secondary liability of their insurers. Generally the mentally ill are responsible civilly for their actions regardless of mental state except where the law requires specific intent and the illness negates such intent. Psychiatrists and other mental health workers may thus have grounds for suit against patients who injure them. While insurance coverage may exclude intentional acts, insurers may be civilly liable, even for blatant criminal acts. The author reviews the relevant laws and presents illustrative case examples.

Criminal Law↗
PubMed1985

The insanity defense: the case for abolition.

The author discusses psychiatrists' objections to the insanity defense, including the negative publicity generated by murder trials in which psychiatrists provide expert testimony. He also examines the legal profession's attitudes toward the defense and the pressure applied to expert witnesses through our adversarial system of justice. The abolition of the insanity defense might expedite the legal process, the author concludes, but it would not greatly affect the courtroom role of psychiatrists. Psychiatric evaluation would still be required in certain cases, such as those involving diminished responsibility and competency to stand trial.

Commitment of Persons with Psychiatric Disorders↗