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PubMed1992

New perspectives in the legal psychiatry of cocaine-related crimes.

The legal criteria for the insanity defense as it applies to cocaine-related crimes remains elusive because of cocaine's unique spectrum of effects on human thought and action. This paper discusses the literature relevant to cocaine and forensic psychiatry/psychology, and summarizes the results of a survey of forensic psychiatrists on the topic of drug-induced psychosis. A conceptual framework is posited for the expert witness to distinguish the separable effects of cocaine on human behavior and to clarify their relationship to criminal responsibility.

Cocaine↗
PubMed2006

[Asylum for curing or securing? The confinement of forensic patients as a challenge of asylum psychiatry in Imperial Germany].

Asylum for curing or securing? The confinement of forensic patients as a challenge of asylum psychiatry in Imperial Germany. In Imperial Germany psychiatrists sought to give their asylums the character of modern medical hospitals. Due to the increase of insanity defence these efforts were obstructed by the high number of inmates with a criminal background. Special departments for mentally ill criminals were founded both in asylums and in prisons. But the clientele was not welcome in any of these institutions. Thus, there was a high fluctuation between prisons and asylums. A new definition of criminal responsibility was needed. In order to keep criminals out of their hospitals psychiatrists developed the medical concept of psychopathy referring to a mental defect without lack of responsibility. On the other hand penal law reformers plead to introduce preventive measures, such as security confinement, into the criminal law book. Since the resolution of the 'law against habitual criminals' in November 1933 judges are allowed to sentence mentally ill offenders to indefinite confinement in psychiatric institutions.

Forensic Psychiatry↗
PubMed2006

Clark v. Arizona: diminishing the right of mentally ill individuals to a full and fair defense.

In Clark v. Arizona, the U.S. Supreme Court was faced with two main questions: Does Arizona's insanity defense statute, with its abridged M'Naughten standard, violate the Fourteenth Amendment? And does Arizona case law, with its complete prohibition on the use of mental disease or defect evidence to combat required mens rea elements of a crime, violate due process? In a six-three decision, the Court answered both of these questions in the negative.

Adolescent↗
PubMed1991

[Vicissitudes of Geneva forensic psychiatry at the turn of the century].

In the second half of the 19th century two sensational criminal trials took place at Geneva. They lead to theoretical debates about insanity and responsibility on an international level, which reveal not only a contest for power between medicine and law; they also show us a science in making in search for reliable concepts. Later it will find them in Freud's theories.

Forensic Psychiatry↗
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

Dangerous mentally disordered criminals: unresolvable societal fear?

The average person fears dangerous criminals, especially those suffering from mental illness. Existing mental health and criminal justice systems provide social control for some of these dangerous individuals, but may be inadequate to deal with those mentally disordered offenders who were not found not guilty by reason of insanity (NGI). In California, innovative laws have attempted to address this problem. However, putative lack of efficacious treatment of mentally ill criminals, insufficient economic support, and individual liberty concerns loom as limiting factors in solving the criminal and psychiatric recidivism problem posed by non-NGI dangerous mentally disordered offenders.

California↗
PubMed1990

Who's afraid of forensic psychiatry?

Forensic psychiatry has come under mounting criticism from the press and other medical professionals, largely for its participation in the insanity defense. The author argues that the expertise available from the specialty is of increasing importance to psychiatry as a whole, as more and more legal issues become relevant to the practice of general psychiatry, and should be actively encouraged and legitimized rather than ostracized. All psychiatrists should be exposed to forensic principles and practices during their training, and the ability of forensic psychiatrists to serve as transducers between the clinical and the legal/judicial should be increasingly used to present the clinical viewpoint effectively in courts and legislatures.

Ethics, Medical↗
PubMed1989

Psychiatric evidence in extenuation: assessment and testimony in homicide defendants.

The role of psychiatric evaluation and testimony on 202 cases demonstrates the participation of mental health experts in the legal process. The majority of these cases fall outside the mental abnormal groupings of 'incompetent to stand trial' or 'criminal insane'. A finding of diminished responsibility on account of mental illness provides for a finding of extenuating circumstances on account of mental illness. The numerous factors and categories influencing the defendant's behaviour are specific to each, requiring presentation for the court's discretion as to significance of psychiatric factors in extenuation of sentence. The population studies as representative of psychiatric extenuation are a personal consecutive sample of court referrals for formal evaluation undertaken in a psychiatric hospital unit. Reasons for referral all include possible psychiatric disorder. One third of referrals were accused of killing a family member. Alcohol and drugs were contributory to the behaviour in 50 per cent of cases. The contributions of witchcraft and history of head injury to the sample are evident in subgroupings. The value of psychiatric contribution to the courts is discussed in relation to South African legal process and clinical experiences.

Criminal Law↗
PubMed1989

Spontaneous hypnosis in the forensic context.

"Hypnosis" denotes either specific phenomena (altered volition, perception, cognition, and recall) or interpersonal transactions that often elicit them. Basic research leads to paradox: hypnosis is validated, and shown to be dissociative in essence, at the same time that neither its phenomena nor transactions can be separated from those of everyday living without logical absurdity. This paradox can be resolved by assuming that consciousness and volition are complex, occurring simultaneously at many levels in the same waking individual. Hypnotic-like phenomena and transactions occur spontaneously, in either covert or overt forms. The former are pervasive, whereas the latter are often associated with psychological trauma. Forensic implications are twofold: for criminal responsibility, and the reliability of eyewitness testimony. Hypnotic-like states and transactions are rarely affirmed as an insanity defense because at some level these subjects are aware of what they are doing and why. Diminished capacity and mitigation of sentence are more appropriate defense strategies. Several conflicted traditions of case law have evolved to protect eyewitness testimony from hypnotic-like distortions in cognition, perception, and memory that can occur either during or outside of formal hypnotic procedures. These include the admissibility of posthypnotic testimony, due process safeguards at eyewitness identification procedures, and the admissibility of expert testimony on the findings of eyewitness research. These areas are inseparable from one another and demand a systematic coordinated approach.

Forensic Psychiatry↗
PubMed1986

Medication noncompliance in schizophrenia: codification and update.

Risk of relapse and recidivism makes the failure to take antipsychotic medication as prescribed a significant issue in forensic psychiatry. This question may arise in such contexts as the setting of bail, plea bargaining, the insanity defense, and sentencing. We have reviewed the literature on medication noncompliance in schizophrenia and present here the results, organized by topics relevant for the work of forensic mental health experts. Reported rates of noncompliance vary widely, reflecting major differences in the populations studied and the methods used as well as the complexities involved in defining noncompliant behavior. A noncompliance rate of 50 percent has been attributed globally to chronic patients, both medical and psychiatric. The tendency of significant factors to interact precludes a simple typology of noncompliance. However, environmental security and supportiveness correlate positively with adherence; whereas anxiety, paranoia, grandiosity, depression, and side effects correlate negatively. Clinicians' assessments of whether medication is being taken have proven to be unreliable. Although monitoring by chemical measurement, particularly a radioreceptor assay for urine samples, can be useful, depot injection ensures that prescribed medication is being taken. Less invasive means of promoting compliance are described; psychodynamic and ethical issues to be considered in the monitoring and promotion of compliance over extended time periods are presented. We also probe the link between medication noncompliance and behavioral relapse. The time between default and relapse is most often measured in weeks. Whether due to medication withdrawal or not, the relapse pattern of each individual tends to repeat, allowing its recognition before recidivism occurs. Restarting medication at this stage, especially with a dosage increase, is usually effective. In sum, the forensic mental health expert can now readily use a large and diverse literature to assist with a variety of significant issues.

Antipsychotic Agents↗
PubMed1988

Premenstrual syndrome: a view from the bench.

The author reviews the use of premenstrual syndrome (PMS) as a complete or partial legal defense in the United States. The basic arguments supporting and opposing the use of PMS in the insanity defense, in the diminished capacity defense, and as a mitigating factor in sentencing are briefly explained. The PMS defense has been unsuccessful in the United States, and its future success is unlikely. More likelihood exists that PMS will cease to be a continuing subject of law review articles and a basis for judicial determinations and instead will continue to be studied in the proper arena, the psychological/psychiatric community.

Female↗
PubMed1987

Military combat, posttraumatic stress disorder, and criminal behavior in Vietnam veterans.

Although data are inconclusive, popular perception has linked military combat, posttraumatic stress disorder (PTSD), and criminal behavior. This paper discusses the multifactorial elements of this association that include both conscious and unconscious parameters of psychologic functioning. Testimony on combat-related PTSD has been presented in the courtroom to support veterans' claims of not guilty by reason of insanity (NGRI) and diminished capacity and for consideration during judicial sentencing. Because there is a known connection between the degree of combat involvement and PTSD, verification through collateral sources of the veteran's report of combat experiences is an important component of forensic assessment. The DSM-III-defined diagnosis of PTSD and the presence of a dissociative state have particular relevance in NGRI determinations. In other aspects of the judicial process demonstration of the absolute presence or absence of PTSD is often irrelevant and should be replaced by efforts to establish plausible links between provable combat experiences and the circumstances of the crime.

Combat Disorders↗
PubMed1988

Current issues in state mental health forensic programs.

The major current issues facing state and local forensic mental health programs are presented in this paper. Debates over forensic patients' rights and the insanity defense are discussed, together with many administrative problems such as the pros and cons of correctional versus mental health system program control and payment incentives for treatment. The authors cite the differing goals of correctional and mental health systems, i.e., security and treatment, as reasons for difficulties in developing needed collaboration. Guidelines are suggested to address such important issues as mixing civil with criminal patients, developing units for special populations, defining patients who can respond to treatment, and follow-up after discharge.

Adolescent↗
PubMed1988

A judge's three worlds: proof, philosophy, and the prison.

Tensions between the world of science and the world of law may arise because of their differing viewpoints and philosophies. Disagreements may center around such questions as what constitutes proof, around human behavior, and around the use of the insanity defense in criminal cases. The just deserts model is examined and is criticized as being harsh and possibly unrealistic in today's society.

Capital Punishment↗
PubMed1987

Young patients detained under the Lieutenant Governor Warrant in Ontario.

Few studies have focused on mentally ill juvenile offenders who end up on warrants of the lieutenant governor (LGW). The present study arose out of a larger study (1982) of all patients (N = 332) being held on lieutenant governor warrants in Ontario, Canada. Of this group, 24 were placed on warrants as juveniles (18 years and younger). The characteristics of this group, who are predominantly males with histories of psychiatric illnesses, diagnosed mainly as antisocial personality, and who have been found not guilty by reason of insanity on charges primarily of murder, or attempted murder, are described. In light of the proposed Young Offenders Act, a further study of all juveniles held on warrants of the lieutenant governor in Canada is proposed.

Adolescent↗
PubMed1987

Medical jurisprudence in the local context.

Medical jurisprudence in the local context would require the examination of a wide area. This paper focuses on liability producing conduct arising from the providing of medical services, other than liability for criminal negligent conduct. It examines the circumstances in which the physician-patient relationship emerges, in medical jurisprudence as against practice by medical practitioners. Tort law is the dominant legal theory, and reference is made to some intentional and miscellaneous torts. Implied contracts creating the relationship are touched upon, besides the reference to vicarious liability. Insanity and diminished responsibility in the criminal law, particularly the issue of whether the status quo is satisfactory and reliance on medical reports for purposes of treatment under drug laws are examined. Where abortion is performed, the question whether the husband has any right to prevent his wife from having a lawful abortion is discussed in the local context. Some thoughts on the medical (therapy, education and research) Act 1972 are expressed in relation to the living body, the corpse and the parts of the human body. The patient's right to determination and information in the light of the above legislation is also discussed.

Abortion, Illegal↗
PubMed1983

Dissection of the prongs of ALI. A retrospective assessment of criminal responsibility by the psychiatric staff of the Clifton T. Perkins Hospital Center.

The staff of the Clifton T. Perkins Hospital Center has systematically reassessed the impact of the proposed modification of the ALI test removing the second prong. Findings of this retrospective survey reveal few changes in the composite staff opinions reported by the hospital but many variations in the opinions of individual psychiatrists when rating the prongs independently. The effect of these changes in Maryland (while difficult to anticipate) might be an increase in litigation. The resulting fiscal impact, therefore, not only could affect the Division of Corrections but also could increase court costs. The data suggest that rather than limiting psychiatric testimony and ensuring that only the sickest patients are exculpated, the proposed truncation of ALI may have paradoxical consequences. There may be more frequent battles of the experts based on less rigorous science and potential exclusion of affective psychosis from appropriate access to the defense of insanity. While the study methods and sample size prohibit reliable conclusions concerning the likelihood of these consequences in vivo, the issues raised strongly support a need for further investigation before a relatively well-functioning legal framework is changed in favor of the untested rubric of the proposed modifications of ALI.

Commitment of Persons with Psychiatric Disorders↗