Forensic psychiatry and malpractice

This paper concerning the last 87 malpractice cases referred to the Department of Psychiatry and Law, Menninger Clinic, includes 57 suits against mental health practitioners and/or institutions, and 30 nonpsychiatric suits against general hospitals, surgeons, obstetricians, etc. A patient was available for interview in only 12 percent of the psychiatric cases; in 88 percent we reviewed medical records and consulted with attorneys. In the psychiatric cases the crucial question was whether a generally accepted standard of care was breached. The inherent problems of applying appropriate criteria to standards of care by practitioners and institutions are discussed. In half the psychiatric cases we found no significant deviation from acceptable clinical performance; in half we concluded that negligent practice had occurred. We did see a litigant for evaluation in 90 percent of the nonpsychiatric cases. The main issue involving them concerned harm or disability related to presumed negligence by medical personnel. How we evaluate such cases and apply disability criteria is discussed.     

Wilton Marion Krogman, Ph.D. (1903-1987): the end of an era

Dr. Wilton Marion Krogman was one of the major founders of physical and forensic anthropology in the United States. His extraordinary career spanned nearly six decades, and he was universally admired and respected for his scholarship, teaching, research, wit, and humanity. While studies based on human skeletal remains have long been used to assist the medicolegal system, the late Dr. Krogman can be credited with uniting these areas into the discipline of forensic anthropology. His "Guide to the Identification of Human Skeletal Material" (1939) in the F.B.I. Law Enforcement Bulletin became the foundation of this discipline; his monumental book The Human Skeleton in Forensic Medicine (updated with the author in 1986) solidified its establishment. The purpose of this paper is to pay tribute to this great man and outline his influence on the development and advancement of forensic anthropology.     

Effects of positional restraint on oxygen saturation and heart rate following exercise

This report assesses the effects on peripheral oxygen saturation and heart rate that positional restraint induces when a person is prone, handcuffed, and "hog-tied." Peripheral oxygen saturation and heart rate were monitored at rest, during exercise, and during recovery from exercise for 10 adult subjects. The effects of positional restraint produced a mean recovery time that was significantly prolonged. Consequently, the physiological effects produced by positional restraint should be recognized in deaths where such measures are used.     

Garcia and the Political Safeguards of Federalism: Is There a Better Solution to the Conundrum of the Tenth Amendment?

In Garcia v. San Antonio Metropolitan Transit Authority (1985),Justice Harry Blackmun held that the Tenth Amendment does notprevent the Congress from subjecting state and local governmentsto the provisions of the Fair Labor Standards Act, concludingthat the "political safeguards offederalism" are generally adequateto protect state interests on the national scene. This articleexamines the intellectual foundations of the "political safeguardsof federalism" and finds them inadequate. It then surveys thepost-Garcia scholarship to ascertain whether an alternativetheory of the Tenth Amendment has emerged. Concluding that ithas not, the author suggests the need for afresh approach inview of the hints contained in Justice Sandra Day O'Connor'sopinion in Gregory v. Ashcroft (1991) that five justices maybe ready to reexamine the central thesis of Garcia.     

Impersonal influence: Effects of representations of public opinion on political attitudes

Many phenomena of interest to political scientists involve what may be termed impersonal influence; that is, influence that derives from individuals' perceptions of others' attitudes, beliefs, or experiences. Others in this case refers not to the close friends and acquaintances that concerned the authors of classics such asThe People's Choice andPersonal Influence, but rather to the anonymous others outside an individual's realm of personal contacts. Modern mass media facilitate the influence of anonymous others by devoting considerable time and attention to portraying trends in mass opinion. This study explores the rationale for theories of impersonal influence, synthesizing existing research findings falling under this general theoretical framework, and investigating its psychological underpinnings using experiments embedded in representative surveys.     

Situational variation in moral judgment: In a stage or on a stage?

Two issues were examined in this study—the consistency of moral judgment across different types of dilemma and different social contexts, and the relationship between the structure (stage) of moral judgment and the content of moral decisions. Forty subjects were given two hypothetical dilemmas about business decisions and two standard Kohlberg dilemmas. Half the subjects directed their responses to a business audience, half to a philosophical audience. Responses to the moral dilemmas were scored in accordance with the Colby and Kohlberg (1987) scoring manual. Stage of moral reasoning was found to be significantly higher on the Kohlberg dilemmas than on the business dilemmas. A significant interaction between type of dilemma and audience was attributed to the tendency of subjects directing their responses to a business audience to interpret one of the business dilemmas in terms of the moral order of business, but for subjects directing their responses to a philosophy audience to treat it as a philosophical dilemma. The other business dilemma evoked uniformly low-level moral judgments. The amount of selfishness intrinsic in subjects' moral choices on the business dilemmas was significantly negatively correlated with moral maturity on the business dilemmas, but not with their moral maturity on Kohlberg's test. These results are interpreted as more consistent with models of moral development such as those advanced by C. G. Levine ([1979] Stage Acquisition and Stage Use: An Appraisal of Stage Displacement Explanations of Variation in Moral Reasoning, Human Development, Vol. 22, pp. 145–164), J. Rest ([1983] Morality, in: P. H. Mussen [ed.], J. H. Flavell and E. Markman [Vol. eds.], Handbook of Child Psychology [Vol. 3, 4th ed.], John Wiley & Sons, New York), and R. Harré ([1984]) Personal Being: A Theory for Individual Psychology, Harvard University Press, Cambridge, Massachusetts), which posit a relatively wide range of within-person stage use and emphasize the determining power of social situations, than with the more constructivistic model of moral development of Colby and Kohlberg (1987).This research was supported by Grant No. 410-87-1115 from the Social Sciences and Humanities Research Council of Canada.Received B.A. and M.A from Simon Fraser University. Research interests include moral development, and the influence of social interaction and language on the development of reasoning.Received Ph.D. from Harvard University. Research interests include moral development, altruism, and self-deception.