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The practice of forensic child psychiatry is a relatively new subspecialty. Just like every other specialized field of endeavor, there exists a certain base of knowledge that one must learn and integrate. This article has reviewed several of these principles in an attempt to assist practitioners in performing a forensic evaluation and testifying in a court of law.
Countertransference is a clinical term introduced by Freud in 1909. For years, despite mounting criticism, forensic psychiatrists borrowed this clinical concept to explain their emotional experiences and responses to examinees' emotions and behavior. The authors describe the impact of examinee and nonexaminee factors during evaluations and beyond, including during trial and while providing forensic testimony. The suggestion is made that using the term countertransference in forensic psychiatry can be problematic. The authors delineate the complexities of the term as related to forensic psychiatry and consider modified terms to provide a better explanation of these concepts in forensic contexts.
In Rock v. Arkansas (1987) the United States Supreme Court ruled in a 5 to 4 decision that the constitutional rights of defendants to testify on their own behalf take precedence over whatever state rules exist regarding exclusion of hypnotically refreshed testimony. The problem of denying defendants their constitutional rights was the reason we have argued that defendants' hypnotically refreshed testimony should generally be permitted, whereas the unreliability of hypnotically elicited memories and the manner in which hypnosis diminishes the effectiveness of cross-examination make the general exclusion of testimony from hypnotized witnesses essential (M. T. Orne, 1982). We discuss the Rock case, as well as the majority and minority opinions expressed by the United States Supreme Court, and offer reasons why a bifurcated standard--one that admits hypnotically refreshed testimony from defendants and excludes it from witnesses--is consistent both with the Court's ruling and with the scientific evidence regarding the use of hypnosis, as well as being an appropriately fair way in which to protect the constitutional rights of the defendant and the state.
The present study examined a selected group of potential jurors' opinions on the effects of hypnosis on eyewitness identification and testimony. A group of 78 undergraduate psychology and optometry students completed a 2-part multiple choice questionnaire. The first part assessed Ss' knowledge of several issues concerning eyewitness testimony. The second part of the questionnaire contained 11 items which assessed Ss' beliefs and expectations concerning the effects of hypnosis on eyewitness identification and testimony. It was found that Ss' opinions on the effects of hypnosis on eyewitness testimony and identification were at odds with current empirical findings. These results, in accord with the previous literature, suggest that it is imperative that the courts be informed of the use of hypnosis during police work and that adequate precautions be taken to avoid a potential source of miscarriage of justice.
OBJECTIVE: To determine the frequency of court appearance by pediatricians evaluating child abuse and neglect cases and to identify case characteristics associated with actual court appearance or case adjournment. DESIGN: Retrospective review of subpoenas received between 1995 and 1999 for child maltreatment cases personally evaluated by 2 pediatricians during the years 1995 to 1998. Information was collected regarding patient age, gender, race/ethnicity, type of suspected maltreatment, date of evaluation, date of subpoena, type of court hearing, whether the pediatrician actually testified in court, and legal outcomes. Case characteristics were compared between pediatricians and were used to predict physician appearance and case continuance or adjournment in logistic regression models. RESULTS: Four hundred forty-five subpoenas concerning 260 patients were received. Although significant differences were noted between the pediatricians in type of abuse, no differences were found in patient age, gender, ethnicity or legal outcomes. The pediatricians received subpoenas in <15% of child maltreatment cases, and <5% of children seen resulted in the physician being required to actually appear in court. No case characteristics significantly predicted court appearance or case continuance or adjournment. CONCLUSIONS: Although pediatricians are sometimes subpoenaed to appear in court to explain the medical evaluation and the needs of the child in cases of child abuse and neglect, most court cases were continued, adjourned, or settled before physician testimony. Most subpoenas did not result in the pediatrician going to court, and it is unclear which child factors may predict court involvement. Pediatricians can take steps to minimize (but not eliminate) the potential dissatisfaction and inconvenience associated with receiving and responding to subpoenas in child maltreatment cases.
When examining most traditional sciences a thorough review of the relevant primary literature is usually sufficient to provide the investigator with a sound insight into the discipline. Forensic science differs in this regard, as it is presented in two main arenas: the peer-reviewed forensic journals and the Courts of Law where testimony is proffered. Because of this duality of scientific assessment the following legal review is presented. The review analysed Appellate Court rulings from the United States and identified trends of objections to bitemark testimony. Nine major trends were identified within the cases assessed: bitemark evidence not sufficiently reliable or accepted, arguments regarding the uniqueness of the human dentition, constitutional arguments, inflammatory photographs, inaccuracy of techniques and errors in protocol, use of historical bitemarks and previous biting behavior, funds for defence witnesses and objections pertaining to witness credibility.
It appears that minimal regulation of milk banking may be prudent to protect recipient infants from the possibility of disease transmission through unscreened raw milk. However, these must be written in a manner, apart from those for organ and tissue banks, to address the unique properties of human milk. It is essential that this valuable resource be promoted and access improved so that all infants and children in need may benefit.
This article reviews legal concepts involved in challenges to wills and how wills are influenced by psychiatric testimony. The outcome of litigation in certain landmark cases and in cases from the extensive experience of the first author is discussed. Clarifications of legal terms of art such as "lucid interval," "testamentary capacity," "undue influence," and "insane delusion" are offered. Pre-death psychiatric evaluations are becoming increasingly important in an aging population more susceptible to mental impairment.
During a violent conflict, a young man was shot dead in front of a bar. The offender stated that he had acted in self defence after having been attacked with a knife. Taking into account the testimonies, the medical findings (f. ex. sonotomogram of the left femur) as well as the crime scene regarding the position of the body, it could not be excluded from the forensic point of view that a knife attack of the later victim had taken place. Nevertheless, the court convicted the man who had shot for murder and gave a life prison sentence.
Facing the inevitable, psychiatry formally acquired PTSD as a diagnostic entity in 1980. It then discovered that PTSD had a bevy of nasty laylegal relatives (e.g., disability and personal injury claims). In response, psychiatrists have been continuously trying to refine PTSD criteria. There have even been cogent arguments that psychiatrists should take their own forensic medicine and formally address legally relevant behavior in the DSM. In the meantime, prosecutors, defense attorneys, and adjudicators sometimes stretch and pull the DSM-III-R PTSD diagnosis beyond justifiable limits to try to fit square pegs of psychiatric testimony into round holes of legal rules. Ultimately, however, lawyers cannot be blamed for misusing the PTSD diagnosis because only clinicians can make it. Causal diagnosticians may fail to apply the requisite symptomatic criteria or do so only superficially. In their haste to eliminate bogus stress claims, clinicians should not throw out the baby (authentic PTSD) with the bathwater (idiosyncratic "stress" disorders and careless PTSD diagnoses).
In the criminal-justice system psychiatric evidence may be relevant both before and after conviction. The scope of psychiatric testimony in the criminal courts has been more restricted in Britain than it has been elsewhere. It is generally confined to questions of fitness to plead, responsibility and disposal after conviction. A distinction must be made between matters of clinical psychiatry and those of moral culpability or legal competence. When psychiatric evidence strays from purely clinical questions there is an increased likelihood of misuse and abuse. Even when considering clinical issues there are factors of a non-clinical nature which may distort the type of evidence given. The implications of these matters for psychiatric witnesses are discussed. It is suggested that forensic psychiatrists are refining their role as expert witnesses.
"Recovered memory therapy" for eating disorders and other psychiatric conditions seeks to help the patient recover repressed memories of childhood sexual abuse and other traumatic experiences. Through this technique, it is hoped that the patient can work through these experiences to achieve relief from shame, body dissatisfaction, and symptoms of depression and eating disorders. However, this method was questioned in the recent Ramona case, where a father successfully sued two therapists and a hospital for allegedly implanting false memories of childhood sexual abuse in his bulimic daughter. The testimony and verdict in this case recall the principle of primum non nocere: Although it is clearly reasonable to consider an unproven therapeutic technique in an attempt to relieve human suffering, the potential risk of the technique--in this case the possible induction of false incest memories--must be weighed carefully against the technique's expected benefits.
The hematologist-historian author became interested in the nature 'medical miracles', following a request to write a report on a set of bone marrows that was sent to the Vatican as a possible miracle cure in a cause for canonization. She questioned the prevalence of medical miracles, their structure, and relationship to other 'official' miracles that are recognized by the Church. Evidence was drawn from a variety of sources: oral testimony of pilgrims at feast day celebrations, ex voto paintings, and 160 miracle files in 67 canonization records of the Vatican Archives. Some changes can be detected through time, but the results also testify to remarkable longue durée in the healing experience: the patterns of suffering and despair, the gestures of pleading, the presence of beds and dreams, the astonishment of the caregivers, and above all the simultaneous recourse to medicine and religion both.
Testimony in court by child victims of sexual abuse results in further trauma, frequently inconsistent or retracted accusations, and, in incest cases, exacerbation of family difficulties. A number of states have liberalized rules of evidence in such instances to spare the child; some states have enacted legislation simplifying introduction of the child's out-of-court statements, although the constitutionality of these statutes has yet to be tested.
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.
Test results from the MCMI have been ruled admissible in court for a variety of clinical and forensic issues. This article addresses MCMI issues such as the test's applicability and admissibility of test results in forensic evaluations, test administration, test scoring, malingering and deception, prediction and diagnosis of behavior, reliability, validity, operating characteristics and diagnostic efficiency statistics, and use of computer-assisted interpretation of test results for forensic presentation. Recommendations are suggested for dealing with each of these issues in a forensic context.
Realizing the competitive environment of medicine, the gold standard for credentials must remain training, experience, ability, and/or competence. These two doctors have met this standard. Family physicians have cesarean privileges in Memphis, Tenn.; Wichita, Kan.; Kansas City, Mo.; Rochester, Minn.; and numerous other cities across our state and nation. With access to perinatal care of critical importance, all physicians must practice medicine to their fullest capabilities. This hospital will greatly benefit from its support of fair privileging for family physicians. And the AAFP will vigorously defend each family physician's right to practice obstetrics on both a state and national level.
The arguments for and against mental health professionals' participation in death penalty proceedings are presented against the background of U.S. Supreme Court decisions which have had a bearing on this issue. It is concluded that the possibility of presenting mitigating psychologic testimony in such proceedings necessitates the possibility of exacerbating psychiatric testimony and that hence, mental health professionals who testify for the prosecution in such cases do not, on a wider view, violate their hippocratic oaths or other ethical codes. A number of safeguards, however, should be instituted with respect to such testimony. Psychiatrists, psychologists or other qualified mental health professionals should (1) testify with medical "possibility" or "probability," (2) not be permitted to address ultimate legal issues and (3) be permitted, in fact encouraged, to present alternative interpretations of forensic psychiatric findings. It is further argued that in addition to being justified in testifying for the prosecution on death penalty cases, mental health professionals may have a moral rationale for treating death row prisoners and restoring them to competency.