The forensic psychiatrist of the future

The rate of change in scientific knowledge and the growing psychiatric sophistication of attorneys and courts have made it increasingly difficult for forensic psychiatrists to retain proficiency in the full spectrum of potential professional activities. As the consumers of forensic services become more sophisticated, forensic psychiatrists have an increasing need to become scientifically informed and a decreasing need to become legally informed. Traditional training in forensic psychiatry, which emphasizes clinical, legal, and institutional knowledge and experience, gives short shift to behavioral science and other technical knowledge that can enhance the validity of forensic assessments and their value to the legal system and society. Forensic psychiatrists can best respond to these changes and maximize the value of their assessments by narrowing their focus to some subset of the four branches of the discipline: criminal behavior, mental disability, forensic child psychiatry, and legal aspects of psychiatric practice. Maximal proficiency in each of these four branches requires a greater depth of knowledge and experience than was once sufficient among those who practiced in all four areas. Fellowship training programs and professional organizations should lead forensic psychiatry into the twenty-first century by organizing their efforts along these four parallel tracks.     

Psychiatrists,criminals, and the law: Forensic psychiatry in Switzerland 1850–1950

Between 1880 and 1950, Swiss psychiatrists established themselves as experts in criminal courts. In this period, the judicial authorities required psychiatric testimonies in a rising number of cases. As a result, more offenders than ever before were declared mentally deficient and, eventually, sent to psychiatric asylums. Psychiatrists also enhanced their authority as experts at the political level. From the very beginning, they got involved in the preparatory works for a nationwide criminal code. In this article, I argue that these trends toward medicalization of crime were due to incremental processes, rather than spectacular institutional changes. In fact, Swiss psychiatrists gained recognition as experts due to their daily interactions with judges, public prosecutors, and legal counsels. At the same time, the spread of medical expertise had serious repercussions on psychiatric institutions. From 1942 onwards, asylums had to deal with a growing number of “criminal psychopaths,” which affected ward discipline and put psychiatry's therapeutic efficiency into question. The defensive way in which Swiss psychiatrists reacted to this predicament was crucial to the further development of forensic psychiatry. For the most part, it accounts for the subdiscipline's remarkable lack of specialization until the 1990s.     

Forensic mental health assessment in France: Recommendations for quality improvement

The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called “experts” in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods.     

Forensic psychiatry in private practice

This paper presents statistical and explanatory analyses of 637 forensic psychiatry cases in a private practice setting during the past 12 years, highlighting the remarkable variety of clinical and legal issues addressed by forensic psychiatrists. Emphasis is on how and why forensic psychiatrists need to be expert diagnosticians and clinicians, and ways in which they may respond to difficult clinical and legal opinions are recommended.     

Psychiatric aspects of sexual abuse

Sexual abuse of children and adolescents has become an increasingly publicized phenomenon. Psychiatrists and other mental health professionals are often called upon to evaluate and treat children and adolescents who may have been sexually abused, to provide counseling or treatment to the families of such children, and to provide reports and testimony for proceedings about such cases in the child protection system, the criminal justice system, and in custody disputes. Clarity regarding the medical, psychiatric, and legal aspects of sexual abuse is essential in carrying out such professional activities and in evaluating and formulating research on sexual abuse. In this paper current knowledge regarding these aspects of sexual abuse is summarized, and the role of psychiatrists in clinical and forensic work involving allegations of sexual abuse is discussed.     

Insanity, methamphetamine and psychiatric expertise in New Zealand courtrooms

The use of methamphetamine in New Zealand has increased significantly over the last decade. Due to the potential of methamphetamine to induce, exacerbate and precipitate psychotic symptoms, this drug has also taken centre stage in several criminal trials considering the sanity of defendants. Highly publicised and often involving contested expert evidence, these criminal trials have illustrated the limits of using psychiatric expertise to answer legal questions. This article considers the implications of such cases in light of material from a qualitative study that aimed to generate insights into the difficulties forensic psychiatrists and their instructing lawyers face when providing expert evidence on the relationship between methamphetamine, psychosis and insanity. It reports material from 31 in-depth interviews with lawyers and forensic psychiatrists and observation of one criminal trial that considered the relationship between methamphetamine and legal insanity. The findings are correlated with the clinical and medico-legal literature on the topic and subjected to scrutiny through the lens of "sanism". The article concludes that the continued use of forensic psychiatry to meet the legal objectives of insanity, where methamphetamine is involved, has the potential to reinforce sanist attitudes and practices.     

Difficulties of cultural diversity. An exploratory study into forensic psychiatric reporting on serious juvenile offenders in the Netherlands

This paper discusses psychiatrists' assessments of the personalities of ethnic minority and ethnically Dutch juvenile offenders. Psychiatric reports and recommendations help courts determine the type and duration of sanctions. Psychiatrists are involved in almost all cases of serious juvenile crime, because under Dutch law, determining criminal responsibility is a matter for psychiatrists. The courts usually follow the recommendations of forensic psychiatrists when giving judgment and sentencing juvenile offenders.Far too little research has been conducted up to now on the difficulties encountered by forensic psychiatrists when making assessments. The present study discusses the nature and extent of these difficulties. It is based on an analysis of personality reports and sentence recommendations produced by psychiatrists attached to the juvenile courts in relation to youths subsequently sentenced to Placement in a Youth Custodial Institution (PIJ sanction) in the year 2000 (N = 164). A PIJ sanction is the most rigorous response available under the Dutch criminal law for juvenile offenders.The study shows, on the basis of the psychiatric reports, that arriving at a diagnosis is often more difficult when dealing with ethnic minority boys than in the case of their ethnically Dutch peers, since ethnic minority boys more frequently present themselves in a threatening and manipulative way, and tend to conceal their real selves. The reports indicate that the psychiatric assessment of personality is often difficult because forensic psychiatrists struggle with an inadequate knowledge and understanding of minority cultures, which seems to suggest that there is a need for a broader cross-cultural approach that would make it possible to conduct comprehensive personality assessments of serious juvenile offenders.This study was made possible by a grant from the Netherlands Organisation for Scientific Research (NWO), and was authorised by the Ministry of Justice.     

时代呼唤统一的刑事责任能力鉴定标准

阐述了我国制定《精神障碍者刑事责任能力评定大纲》必要性、可行性和历史意义,对如何统一精神疾病刑事责任能力鉴定的评定标准,如何有利于同行专家和司法机关对司法精神病学鉴定结论可采信性的审查提出见解。     

Emergent authority and expert knowledge: Psychiatry and criminal responsibility in the UK

In the UK context, the rise of the discipline and practice of forensic psychiatry is intimately connected with the concurrent development of principles and practices relating to criminal responsibility. In this article, we seek to chart the relationship between psychiatry and the principles and practices of criminal responsibility in the UK over the early modern, modern and late modern periods. With a focus on claims about authority and expert knowledge around criminal responsibility, we suggest that these claims have been in a state of perpetual negotiation and that, as a result, claims to authority over and knowledge about criminal non-responsibility on the part of psychiatrists and psychiatry are most accurately understood as emergent and contingent. The apparent formalism of legal discourse has tended to conceal the extent to which legal policy has been preoccupied with maintaining the primacy of lay judgments in criminal processes of evaluation and adjudication. While this policy has been somewhat successful in the context of the trial – particularly the murder trial – it has been undermined by administrative procedures surrounding the trial, including those that substitute treatment for punishment without, or in spite of, a formal determination of criminal responsibility.     

Treatment as punishment: Forensic psychiatry in The Netherlands (1870–2005)

This article provides an overview of the development of forensic psychiatry in the Netherlands from the late nineteenth to the early twenty-first century. The first part addresses the ways forensic psychiatry established itself in the period 1870–1925 and focuses on its interrelatedness with forensic practice, psychiatry's professionalization, the role of the government, the influence of the so-called New Direction in legal thinking and (Italian and French) anthropology of crime, and the debates among physicians as well as between psychiatrists and legal experts on the proper approach of mentally disturbed offenders. From the mid-1920s on the so-called ‘psychopaths laws’ anchored forensic psychiatry in the Dutch legal system. The second part zooms in on the enactment of these laws, which formalized special measures for mentally disturbed delinquents. These implied a combination of sentencing and forced admission to and treatment in a mental institution or some other form of psychiatric surveillance. The article deals with the meaning, reach and consequences of this legislation, its debate by psychiatrists and legal experts, the number of delinquents affected, the offenses for which they were sentenced and the (therapeutic) regime in forensic institutions. The goal of the Dutch legislation on psychopaths was ambiguous: if it was designed to protect society against assumed dangerous criminals, at the same time they were supposed to receive psychiatric treatment to enable their return to regular social life again. These legal and medical objectives were at odds with each other and as a result discussions about collective versus individual interests as well as about the usefulness and the effects of this legislation kept flaring up. To this day the history of this legislation is characterized by the intrinsic tension between punishment and security on the one hand and treatment and re-socialization on the other. Whether at some point one or the other prevailed was largely tied to the social climate with respect to law, order and authority.     

Russian and Soviet forensic psychiatry: Troubled and troubling

Russian forensic psychiatry is defined by its troubled and troubling relationship to an unstable state, a state that was not a continuous entity during the modern era. From the mid-nineteenth century, Russia as a nation-state struggled to reform, collapsed, re-constituted itself in a bloody civil war, metastasized into a violent “totalitarian” regime, reformed and stagnated under “mature socialism” and then embraced capitalism and “managed democracy” at the end of the twentieth century. These upheavals had indelible effects on policing and the administration of justice, and on psychiatry's relationship with them. In Russia, physicians specializing in medicine of the mind had to cope with rapid and radical changes of legal and institutional forms, and sometimes, of the state itself. Despite this challenging environment, psychiatrists showed themselves to be active professionals seeking to guide the transformations that inevitably touched their work. In the second half of the nineteenth century debates about the role of psychiatry in criminal justice took place against a backdrop of increasingly alarming terrorist activity, and call for revolution. While German influence, with its preference for hereditarianism, was strong, Russian psychiatry was inclined toward social and environmental explanations of crime. When revolution came in 1917, the new communist regime quickly institutionalized forensic psychiatry. In the aftermath of revolution, the institutionalization of forensic psychiatry “advanced” with each turn of the state's transformation, with profound consequences for practitioners' independence and ethical probity. The abuses of Soviet psychiatry under Stalin and more intensively after his death in the 1960s–80s remain under-researched and key archives are still classified. The return to democracy since the late 1980s has seen mixed results for fresh attempts to reform both the justice system and forensic psychiatric practice.     

迈向“过程导向信任”的刑事死因鉴定争议解决机制

中国当今刑事鉴定争议频发。其中当事人与办案机关鉴定冲突最剧烈、不满手段最多样,且其社会影响最大者,目前主要聚集在部分死因鉴定领域。该类鉴定争议既滋生过度重复鉴定,更促使部分当事人上访、闹事,一度还以此衍生出暴力性群体事件。死因鉴定争议的发生,主要源于影响鉴定意见可信性的一系列因素,而非仅因为、甚或主要基于鉴定意见的客观可靠性。因此,为重塑中国刑事死因鉴定的公信力,必须走向从实践出发的法律研究与制度建构立场,以回应办案部门创建、并亟须理论提炼与立法改良的“过程导向信任”的鉴定争议解决机制。其关键措施,是通过死因鉴定程序的开放性与当事人双方（包括其聘请的法医专家）的充分参与性,从而实现鉴定意见的可信性或当事人可接受性;并以此领域的鉴定争议解决为突破口,进行鉴定制度改革,以提升中国整个刑事司法鉴定的公信力与可信性。     

The role of the defense psychiatrist in workmen's compensation cases

Tomorrow's psychiatrist should be more cognizant, competent, and comfortable in forensic science matters. Psychiatric cases are increasingly the subjects of litigation, but justice in the court depends on able advocacy by all parties. Advocacy for patient-plaintiffs is more similar to customary clinical roles than is advocacy for defendant insurance companies, which nevertheless are as needful of competent psychiatric experts as patient-plaintiffs if justice is to be done. Ironically, defense psychiatrist can do much to help patient-plaintiffs if they understand their roles correctly. Since legal systems are designed to produce justice, not therapy, the forensic competence of future psychiatrists will help to make litigation more therapeutic and just for patients. This paper describes the peculiarities of psychiatric work in litigated workmen's compensation cases, focusing on the role of the defense psychiatrist. We will highlight the constructive and therapeutically gratifying potentials of this work. Greater familiarity with the process will help to enlist the interest and participation of psychiatrist in workmen's compensation cases for the ultimate benefit of the patients and improvement of the legal system.     

Forensic psychiatric expert witnessing within the criminal justice system in Germany

In recent years, the number of occupied beds in German forensic–psychiatric hospitals has continued to rise. Diversion refers to the removal of offenders from the criminal justice system at any stage of the procedure and court proceedings. There are no specific diversion programs in Germany but diversion does in fact happen via legal regulations that are based on the construct of legal responsibility. The assessments of responsibility as well as risk are the core tasks of forensic–psychiatric expert witnessing in Germany. Recommendations of an interdisciplinary working group serve as a guide to operationalize this forensic–psychiatric task. These recommendations list formal minimum requirements for expert reports on the question of criminal responsibility and risk assessment as well as minimum standards regarding content and in writing the report.     

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.     

刑事裁判中类推思维的作用及其运用——一种基于方法论意义的思考

我国刑法在确立罪刑法定原则的同时废除了类推制度,填补刑法漏洞意义上的类推适用被严格禁止。然而,作为一种司法判断的方法,类推思维依然在刑事裁判中发挥着重要作用,它是法官解明刑法规范含义、进行犯罪构成要件符合性判断、践行"相同案件相同处理"法治理念的有效方法。当然,在罪刑法定原则之下,刑事裁判中的类推思维应当受制于刑法规范目的和可能文义范围,确保类推结论没有超越刑法规定而违背罪刑法定。     

刑事诉讼视野下的法医物证应用研究

法医物证在刑事诉讼中发挥着多种功能,但目前实践中对法医物证的有效发现、提取、保管、检验鉴定及应用的技术规范和证据规则尚不完善。本文从技术规范、诉讼程序以及证据应用的角度发掘法医物证应用的规律性内容,用以指导实践部门提高法医物证的发现、提取、检出的比率以及法医物证在刑事审判中的采用率及证明力,从而较好地解决定案证据的来源和案件事实的认定问题,并避免因法医物证错用而导致的错案。     

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.     

英国专家证据可采性问题研究

现代科学技术的突飞猛进,使社会分工越来越细,专业化要求越来越高,在刑事诉讼中专家证据的作用也越来越明显.英美法系国家的专家证人制度起源于英国,经过几个世纪无数判例的积累和发展,有关专家证据的可采性问题已形成一整套相当具体、完备的规则,如专家资格规则、有用性规则,专业技术领域规则、普通知识规则以及终局性问题规则等.在现代刑事诉讼中,专家证据的重要性越来越明现,其在改革中的发展趋势,可以为我国亟待完善的司法鉴定制度提供一些有价值的借鉴作用.     

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.