THE BOOKSHELF

Book reviews in this article
Bruce J. Winick and David B. Wexler (Eds.), Judging in a Therapeutic Key: Therapeutic Jurisprudence and the Courts     

Swedish legal scholarship concerning protection of vulnerable groups: Therapeutic and proactive dimensions

This paper presents a brief overview of the legal theoretical problems that arise in connection with the societal ambition of protecting vulnerable groups. One of the central difficulties in legislation with proactive and therapeutic ambitions arises from the link between law and philosophy of science, i.e., the relationship between facts and norms. It is shown that Therapeutic Jurisprudence differs in several aspects from Swedish legal scholarship that follows Scandinavian Legal Realism. It is also demonstrated that Therapeutic Jurisprudence has several similarities with the so-called Proactive Approach. This paper suggests that Therapeutic Jurisprudence may serve as a useful legal theoretical perspective in Swedish legal scholarship, especially when studying complex and vague regulations with a future focus. Two examples from Swedish legislation are examined: (a) Laws regulating compulsory care of abused or neglected children, and (b) laws related to the mentally ill. This paper illustrates the complexity in these acts, and poses the question of whether the regulations serve their purpose of providing adequate care for and protection of those in need.     

The determination of ethylene glycol in biological objects in the presence of propylene glycol]

Therapeutic application of drugs containing propylene glycol 1.2 as a solvent may distort the results of forensic chemical detection of ethylene glycol from its oxidation products. Practical examples illustrate the possibility of ethylene glycol determination by gas chromatography in the presence of propylene glycol.     

The use of drugs in torture and human rights abuses

The forced administration of drugs, usually by injection, may accompany physical torture. In the extrajudicial environment in which torture occurs, documentation of the types of drugs used is difficult. In violation of all codes of professional ethics, physician participation appears to be ubiquitous. In the Soviet Union, human rights abuses have become institutionalized within the mental health care system. Therapeutic drugs are used, often at toxic levels, to punish political and/or religious dissidents.     

Putting mental health into mental health law

This article critiques the traditional doctrinal approach to mental health law and compares the traditional approach with a new, interdisciplinary approach known as therapeutic jurisprudence. Therapeutic jurisprudence views the law itself as a potential therapeutic agent. Examples are given of how legal rules, procedures, and the roles of legal actors may produce therapeutic or antitherapeutic results and of how the law may improve therapeutic outcomes without sacrificing the interests of justice.     

Cardiac injury during valve replacement surgery

The commonly referenced mortality of cardiac valve replacement surgery is 2 to 5%. Some of this mortality is due to therapeutic misadventure during the procedure. Therapeutic misadventure during cardiac valve replacement may result in patterned injury of the heart, so that postmortem examination can establish the nature of the surgical injury. A case of patterned myocardial injury during valve replacement surgery is presented, with a review of literature and associated cases.     

A testable theory of problem solving courts: Avoiding past empirical and legal failures

Recent years have seen a proliferation of problem solving courts designed to rehabilitate certain classes of offenders and thereby resolve the underlying problems that led to their court involvement in the first place. Some commentators have reacted positively to these courts, considering them an extension of the philosophy and logic of Therapeutic Jurisprudence, but others show concern that the discourse surrounding these specialty courts has not examined their process or outcomes critically enough. This paper examines that criticism from historical and social scientific perspectives. The analysis culminates in a model that describes how offenders are likely to respond to the process as they engage in problem solving court programs and the ways in which those courts might impact subsequent offender conduct. This Therapeutic Jurisprudence model of problem solving courts draws heavily on social cognitive psychology and more specifically on theories of procedural justice, motivation, and anticipated emotion to offer an explanation of how offenders respond to these programs. We offer this model as a lens through which social scientists can begin to address the concern that there is not enough critical analysis of the process and outcome of these courts. Applying this model to specialty courts constitutes an important step in critically examining the contribution of problem solving courts.     

Therapeutic jurisprudence and responsivity: Finding the will and the way in offender rehabilitation

Correctional systems worldwide are currently undergoing a shift towards rehabilitation. Underpinning rehabilitation are the principles of risk, need, and responsivity. Responsivity includes internal responsivity (offender characteristics) and external responsivity (staff and setting characteristics). The responsivity principle has been neglected in the literature. While contemporary psychological theories of offender rehabilitation address internal responsivity, they do not address external responsivity, particularly in relation to the impact of the law. Therapeutic jurisprudence as a legal theory provides the opportunity to complement psychological theory and to address responsivity in offender rehabilitation. Therapeutic jurisprudence utilizes psychological knowledge to determine ways in which the law can enhance individual well-being. The purpose of this article is to demonstrate a psycholegal approach to offender rehabilitation. Psychological approaches can be applied to motivate offenders and provide them with the opportunity to make informed decisions about participation in rehabilitation programmes. However, this approach will not succeed without harnessing correctional staff as legal actors and potential therapeutic agents. A cognitive--behavioural model of an organizational culture change towards rehabilitation is proposed. In this endeavour “the will and the way” in both offenders and staff can be harnessed to maximize the therapeutic effects of the law.     

Freedom of information applications as an "evergreening" tactic: Secretary, Department of Health and Ageing v iNOVA Pharmaceuticals (Australia) Pty Ltd (2010) 191 FCR 573; [2010] FCA 1442

A recent decision of the Federal Court of Australia illustrates how patent-holding pharmaceutical companies are attempting to use Australia's Freedom of Information Act 1982 (Cth) to force Australian safety, quality and efficacy regulators to disclose whether generic competitors are attempting to enter the market. In Secretary, Department of Health and Ageing v iNova Pharmaceuticals (Australia) Pty Ltd (2010) 191 FCR 573; [2010] FCA 1442 a single judge of the Federal Court overturned a decision of the Administrative Appeals Tribunal (AAT) that would have compelled the Australian Therapeutic Goods Administration (TGA) to reveal whether they were in possession of an application to register generic versions of two iNova products: imiquimod and phentermine. In its justification to the AAT for refusing to confirm or deny the existence of any application, the TGA argued that to reveal the existence of such a document would prejudice the proper administration of the National Health Act 1953 (Cth) as it could compromise the listing of a generic on the Pharmaceutical Benefits Scheme. The AAT failed to appreciate the extent to which this revelation to a competitor would have undercut 2004 amendments to the Therapeutic Goods Act 1989 (Cth) that provided penalties for evergreening tactics involving TGA notifications to drug patent-holders and 2006 amendments to the Patents Act 1990 (Cth) which protected the right of generic manufacturers to "springboard". The decision of the Federal Court is one of the first to explore the use of freedom of information legislation by patent-holders as a potential "evergreening" technique to prolong royalties by marginalising generic competition. Because of the significant amounts of money involved in ensuring rapid market entry of low-cost generic products, the issue has considerable public health significance.     

Tissue concentrations at autopsy in infants and children receiving therapeutic digoxin

Therapeutic tissue concentrations of digoxin have been reported for relatively small numbers of infants and children. In forensic medicine, knowledge of these concentration ranges is important for confirming or excluding digoxin overdosage in different age groups. In addition to age and weight, other factors such as dosage, duration of treatment, route of administration, sampling site, time of last dose, and death-autopsy interval may influence tissue concentrations. In this paper we report on tissue concentrations in 36 infants and children who received therapeutic digoxin before death.     

The application of tetracyclines in forensic dentistry

Therapeutic administration of tetracyclines, widely used antibiotic drugs, permanently labels layers of dentin that are calcifying at the same time. A method is described for detecting and photographing these stained layers of dentin. The presence of tetracycline-labeled dentin layers in the teeth of subjects of a forensic science investigation can be used for the individualization of specimens as well as to provide information about the age of the individual. When compared to medical records, the tetracycline-labeled dentin layers can also assist in establishing the identity of the subject. The interpretation of tetracycline-labeled dentin layers and its pitfalls are discussed.     

EXPANDING FORENSICALLY INFORMED EVALUATIONS AND THERAPEUTIC INTERVENTIONS IN FAMILY COURT

As the field of forensic family law has become more empirical and in need of novel behavioral health services, it has become necessary to broaden the duties of practitioners, to clarify forensic roles, and to develop more comprehensive court orders. This article introduces the application of Forensically Informed Evaluations and Therapeutic Interventions in family court; a constellation of evaluations and interventions developed to better meet the needs of children and families during and after dissolution or reconstitution. These family court appointments also meet the growing demands of the court and contribute to the trend toward discriminative application of empirically informed behavioral health services in forensic family law.     

Therapeutic community treatment programming in corrections

Abstract

This paper contrasts the American TC model with that of the United Kingdom, presents an overview and history from 1965 to the present of Therapeutic Community (TC) treatment as applied in the United States particularly to drug using offenders, and it details findings from five scientifically sound studies that this kind of treatment during custody for incarcerated drug using offenders is effective in reducing drug abuse and recidivism. A final section presents the therapeutic principles derived from North American TC research and practice conducive to altering addict-offender lifestyles and improving the likelihood of a positive outcome.     

Giving Voice to ‘Age at the Edge’ – A Challenge for Social Workers Intervening with Elder Abuse and Neglect

The purpose of this qualitative study was to learn about social workers’ experience of the therapeutic encounter with victims and perpetrators of elder abuse and neglect and its implications for their personal and professional lives. Participants were 17 experienced women social workers, who worked with abused and neglected older adults in Israel. Data were collected by in-depth semi-structured interviews, which were later transcribed and content analyzed. Four main themes were revealed: (1) The Complexity of the Experience of the Therapeutic Encounter; (2) Circles Echoing Between the Professional and the Personal; (3) Between Growth and Attrition; and (4) Experiencing the Mission and its Meaning. As time is running out for older adults, the “now or never” perspective shapes social workers’ encounter with elder abuse opening a unique kind of dialogue. Implications for practice and further research are discussed.     

Paths toward reclamation: therapeutic jurisprudence and the regulation of medical practitioners

Much about what used to be termed "disciplinary" investigations and hearings is being revisited in the modern era. Therapeutic jurisprudence enables informed and sensitive awareness to potentially therapeutic and counter-therapeutic effects of both investigations and hearings conducted by medical regulatory authorities. This article analyses key aspects of authorities' processes from the perspective of notifiers/complainants and practitioners. Using developments at the Victorian Medical Practitioners Board as a base, it addresses issues of both investigative procedures and decision-making at formal and informal hearings, as well as the ramifications of re-hearings for the integrity of peer review informed regulation. It argues that where reclamation of practitioners is possible (namely where impropriety is not of the most serious order), there is much that is constructive about a focus upon enhancement of performance and competence levels, rather than the traditional preoccupation with whether registered status needs to be affected as a result of practitioner conduct.     

The function of aggression in personality disordered patients

It has been suggested that psychological interventions for personality disorders should focus on improving adaptive expression of the functional needs expressed through problematic behaviors such as aggression. The measurement of function is a necessary condition for devising a function-based treatment approach. Two studies that employ a method for assessing the functions of aggressive behavior in personality disordered patients are described by: (a) a retrospective analysis, through file review of inpatient aggressive behaviors and of the index offenses of patients admitted for treatment, and (b) an analysis of inpatient aggressive incidents where staff and patients were interviewed to elicit functions. Results showed that most aggression had the function of expressing anger, although other functions were also evident. The profile of functions observed in the inpatient studies was somewhat dissimilar to that observed in the studies of predominantly psychotic patients. Therapeutic implications of these findings are discussed.     

Misconceived bioethics?: The misconception of the "therapeutic misconception"

Bioethics needs to include study of the social and historical context in which ethical meanings in medical encounters make sense. It needs to do this in order to remain relevant, vibrant, and aware of how it might unwittingly facilitate the agendas of others. As an illustration, this paper critiques some of the accepted meanings and purposes of the idea of the Therapeutic Misconception (TM) which has been an increasingly attractive concept with which to organize thinking about experimentation ethics. By considering the history of alternative viewpoints against which TM was offered as a replacement, this paper suggests that TM, and bioethics more generally, may contribute to increasingly technocratic and standardized practices in medicine.     

Incarcerated clients' perceptions of therapeutic change in substance abuse treatment: a 4-year case study

Therapeutic communities (TCs) are a primary approach for treating substance abusers in the criminal justice system. The transformation from residential treatment to a TC marked a significant change in the service delivery and organizational culture for one in-prison substance abuse treatment program. This longitudinal case study examines how clients perceived their treatment as a result of treatment and organizational changes. This is important because the scientific literature shows that client perceptions of their treatment impacts treatment retention and the benefit they gain from treatment. Data that were collected over 5 years are presented. Implications, including how the program's interim therapeutic milieu eased the transition to a therapeutic community, are discussed.     

Postmortem concentrations of citalopram

The postmortem concentrations of citalopram in blood, bile, liver, and vitreous humour were investigated in 14 cases using a specially developed high performance liquid chromatography assay. Concentrations from drug and non-drug related deaths were categorized to determine a postmortem therapeutic and toxic range. Therapeutic citalopram concentrations for blood, bile, liver, and vitreous humour ranged to 0.4 mg/L, 2.1 mg/l, 6.6 mg/kg, and 0.2 mg/L, respectively. In one potentially fatal response to citalopram, concentrations were 0.8 mg/L, 6.0 mg/L, 0.3 mg/L for blood, bile and vitreous humour, respectively.