Forensic psychiatry, its place and its promise.
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Biomedical subjects
Publications and source records attributed to W Bromberg.
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Dr. Diamond's courageous defense of the diminished capacity plea in People v. Gorshen (1959) emphasized mental disturbances negating malice aforethought. Diminished capacity as a defense in California remained effective from 1978 to 1982 until overturned by a modified American Law Institute rule. Diamond's advocacy of psychologic elements, including motivation, did much to enliven forensic thinking re: the death sentence and the fated diminished capacity defense.
Functionalism, as generally understood, is not included in DSM-III-R. It differs from somatization and hysteria. Analysis of cases of functional overlay indicates the presence of a fixed attitude--depending on body-image distortion, feelings of injustice toward the existing medicolegal methodology, social and economic impairment, anger against legal delays, and a conviction of the futility of treatment or of attempts at rehabilitation. It should be included in DSM-IV as a subset under posttraumatic stress disorder.
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Functional overlay is not a recognized psychiatric diagnosis. Evaluating functional overlay and differentiating between this concept and organic conditions is important in medicolegal areas in which financial values are placed on pain and disability. Functional overlay is not malingering: the former is based on preconscious or unconscious mechanisms, the latter is consciously induced. In considering psychologic reactions to pain and disability, a gradient of simulation, malingering, symptom exaggeration, overvaluation, functional overlay and hysteria is useful. The dynamics of overlay are a combination of anxiety from body-image distortion and depression from decreased efficiency of the body, as well as the resulting psychosocial disruption in a patient's life.
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