Forensic Psychiatry

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Forensic Psychiatry
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What is forensic psychiatry?

• Forensic psychiatry is a branch of medicine which
  focuses on the interface of law and mental
  health.
• It may include psychiatric consultation in a wide
  variety of legal matters
• expert testimony
• clinical work with perpetrators and victims.

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What is a forensic psychiatrist?

• A psychiatrist is a medical doctor (M.D. or D.O.
  in the U.S.) who has completed several years of
  additional training in the understanding,
  diagnosis, and treatment of mental disorders.
• A forensic psychiatrist is a psychiatrist who has
  additional training and/or experience related to
  the various interfaces of mental health (or
  mental illness) with the law.

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Forensic psychiatrist vs Forensic psychologist

• Psychiatrists are physicians with specialty
  training in the understanding, diagnosis, and
  treatment of mental disorders.
• This includes
• biological evaluations and treatments
• (such as laboratory tests and medications)
• psychotherapy, and family social issues.
• Doctoral-level psychologists do not go to medical
  school,
• Have special expertise in topics not usually
  studied in detail by psychiatrists (such as
  psychological testing).

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How is forensic psychiatry useful to the legal
process?

• When legal matters involve issues outside lay
  (general public) expertise, lawyers and judges
  regularly seek consultation from professionals in
  a wide variety of fields, including medical
  specialties.
• Such professionals are often called "experts" or
  "expert witnesses."
• Forensic experts usually are truly knowledgeable,
  the criteria for "expert" designation in such
  cases are legal ones, and not necessarily
  scientific.
• Sometimes the expertise is sought in an effort to
  provide the best possible information to judges
  or juries, but there are many other situations in
  which a prudent attorney, judge, or other party
  may request consultation.

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Are forensic psychiatrists "advocates" for one
side or the other in legal matters?

• Usually not.
• Ethical forensic psychiatrists try to avoid bias.
  
• They focus on the data or evidence within their
  areas of expertise, and comment objectively on
  the information as they see it.
• Are often consultants to advocates (lawyers) or
  courts, and at other times may participate in
  advocacy strategy, but consider it unethical to
  combine our expert opinions (testimony, reports,
  or affidavits, for example) with advocacy per se.
  
• Ethical forensic psychiatrists do not accept
  contingency fees or otherwise conduct themselves
  in ways that may interfere with, or imply, a lack
  of professional objectivity.

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Doesnt the expert have an incentive to agree
with the lawyer, so he or she can testify and
make money?

• In most cases, no.
• Ethical experts are paid for their time, not
  their testimony.
• Since the time spent forming the opinion usually
  far exceeds time spent testifying, most payment
  is received regardless of whether or not the
  expert testifies.
• Forensic psychiatrists are similar to most other
  professionals in their respect for their work and
  their clients. The minority who "cheat" in some
  way risk severe censure and loss of credibility.

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What Does a Forensic Psychiatrist Do?

• Most forensic psychiatrists don't specialize in
  criminal matters.
• The word "forensic" refers to anything that has
  to do with the law.
• Forensic psychiatrists thus may be involved with
• criminal matters
• civil litigation (such as malpractice lawsuits)
• competence to do things (like make a will,
  consent to medical care, or take care of
  children)
• child custody
• treating and working with mentally ill people who
  get in trouble with the law
• helping victims of crimes
• helping lawyers and judges understand the
  psychological aspects of their cases.

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Here are three things they are not

• (1) We're not lawyers. We may work with lawyers,
  or try to understand the legal aspects of the
  matter we're working on, but our job is to be
  good doctors who can translate what we know into
  something useful for the legal system, not to be
  lawyers ourselves.
• (A few forensic psychiatrists and psychologists
  have law degrees as well as medical ones. In my
  view, those folks usually do best when they pick
  one role or the other.)
• (2) We're not judges. We don't interpret the law
  or tell judges or juries how they should rule.
  Most of the time, psychiatric issues are only a
  small part of the entire legal matter being
  considered. Sometimes we're asked to give an
  opinion about those psychiatric issues, but
  that's to help the judge or jury decide, not to
  tell them what to do.
• (3) We're not cops. We aren't the folks who
  protect the community, deal with dangerous or
  criminal situations, or contain the bad guys.
  That's not our area of expertise, and nobody
  gives us permission to do it anyway.

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Stalking
"Even if I did do this, it would have to have
been because I loved her very much, right?"
- OJ Simpson
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Do Now

• Is stalking socially acceptable?

Eight million American women -- or one in 12
will be a victim of stalking at some point in
their lives. -Kristin Ohlson
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Well Is It?
"The Lloyd Dobler Effect". Emily, like me, is a
crazy fan of John's, specifically of his Lloyd
Dobler role in Say Anything
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What is Stalking ?

• a set of "behaviors that last more than two weeks
  and involves repeated and persistent attempts to
  impose on another person unwanted contacts and/or
  communications which induce fear or distress."
• -Paul Mullen, M.D.

He always told me he would make me sorry, I
never dreamed he would do it by killing our
child.
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Who is doing the Stalking ?

• ____ of the stalkers were male
• ____ of the stalkers were ex partners of the
  victims
• ____ had some form of relationship with the
  victim
• Who is stalked the most??
• ex-partners professional relationship,
  fellow employees,
• customers casual acquaintances
• the stalkers who assaulted were most likely to be
  ____?
• -(Mullen, Pathe, Purcell, Stuart, 1999 1244)

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Who is doing the Stalking ?

• 79 of the stalkers were male
• 30 of the stalkers were ex partners of the
  victims
• 86 had some form of relationship with the
  victim,
• including ex-partners (36),
• professional relationship (23)
• fellow employees or customers (11)
• casual acquaintances (19)
• 36 (52) of the stalkers attacked their victims,
  14 involved sexual assault
• the stalkers who assaulted were most likely to be
  rejected ex partners.
• (Mullen, Pathe, Purcell, Stuart, 1999 1244)

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According to a 1998 study by the Department of
Justice.

• 8 of women will be stalked in their lifetime
• Women
• aged 18 to 35 (11)
• aged 36 to 55 (8 )
• 56 or older (4)
• -Paul Mullen, M.D., at APAs 2001

• 2 of men will be stalked in their lifetime
• Men
• ages of 18 and 35 (8)
• aged 36 to 55 (4)
• aged 56 and older (3),
• Professor of forensic psychiatry at Monash
  University in Victoria, Australia.

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Do Now

• In what ways can stalkers communicate with their
  victims?

I have to eliminate what I cannot obtain.
Bardo,in a letter to his sister Later he killed
Rebecca Schaeffer
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Do Now Answers

• In what ways can stalkers communicate with their
  victims?
• telephone, e-mail, fax, letters, notes, gifts
• Attempt to be physically close to the victim by
  approaching, following, surveilling, and
  loitering near that person

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Do Now 11/12What might concern you about this
letter?
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How might you describe the stalkers profile?
He always told me he would make me sorry, I
never dreamed he would do it by killing our
child.
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How might you describe the stalkers profile?

• Usually an isolated and shy person , May be
  unemployed
• Social Failure one who lives alone, lacks any
  type of important intimate relationship
• Narcissistic personality disorder and very low
  self-esteem.
• The stalker feels that they're the most important
  person in the world."
• Many people stalk someone they have only met
  briefly
• Someone they don't really know, or barely know.

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What are Mullens Five Categories of Stalkers
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Mullens Five Categories of Stalkers
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1. The Rejected Suitor

• Sometimes a partner rejected by their spouse or
  lover may vacillate between overtures of
  reconciliation and revenge. They have a
  narcissistic sense of entitlement and belief this
  is the only relationship they are going to have.
• More than 80 of rejected stalkers in Mullens
  study had personality disorders.
• Therapeutic treatment of the rejected stalker
  involves helping him or her come to terms with
  the end of the relationship.

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2. The Intimacy Seeker

• The intimacy-seeking stalker intends to establish
  a relationship with his "true love" regardless of
  her wishes.
• More than half of the intimacy seekers Mullen
  evaluated were delusional, believing that their
  love was reciprocated, and nearly a third had a
  personality disorder and a delusion that their
  quest would be ultimately successful.
• Legal actions do not work well with intimacy
  seekers, who may justify their behavior with the
  belief they must pay a price for true love.
• The court may order treatment, which should focus
  on treating their delusions or other mental
  disorders.

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3. The Incompetent Suitor

• This type is typically a man who had been
  rebuffed after asking a woman for a date.
• Hes often socially inept, and when rejected,
  begins to stalk with the hope that his persistent
  behavior will change the womans mind.
• The incompetent suitors can be responsive to
  judicial sanctions but are also likely to relapse.

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4. The Resentful Stalker

• These offenders express anger in response to a
  perception that they have been humiliated or
  treated unfairly by the object of their
  obsession.
• They thrive on having a sense of power and
  control over the victim, and are hard to treat
  because they often see themselves as the victim.

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5. The Predatory Stalker

• Predator plans their attack, rehearses it, has
  lots of sexual fantasies about it.
• Derives pleasure from gathering information about
  the target and fantasizing about the assault.
• Doesn't necessarily know the victim.
• The victim may not know she is being stalked.
• They often have prior convictions as sexual
  deviants.

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Lets see whos a stalker..
I love you
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Do Now

• Why might a person stalk a celebrity?

From todays headlines http//abcnews.go.com/Ente
rtainment/wireStory?id6237229
Know this Commercial? Is Stalking acceptable??
http//www.youtube.com/watch?vmhehKgU5oBs
Burger King Stalker
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Do Now

• Why might a person stalk a celebrity?

From todays headlines http//abcnews.go.co
m/Entertainment/story?id6241069page1
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Do Now ANSWER

• Why might a person stalk a celebrity?
• may focus on a celebrity, especially if they've
  seen him or her in person at a public appearance
  like a concert.
• Develop a relationship through viewing
• Learn about their family and who they are from TV
  or Radio
• "They develop convoluted thoughts about this
  person.
• They feel this person is the answer to their
  dreams,"

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Looking inside the letters
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Two Questions1. Why did we leave off the
Predatory Stalkers?2. Predict which stalker is
the most to be concerned about causing harm?
From Jack Jordan
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Why did we leave off the Predatory Stalkers ?
Threats () Assaults ()
Rejected Suitor 71 54
Intimacy Seeking 50 23
Incompetent Suitor 32 27
Resentful Stalker 87 25
Predatory Stalker 33 50
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Predict which is the most to be concerned about?

• The rejected and predatory stalkers are most
  likely to assault their victims.

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When to Be Concerned

• The red flags
• You immediately start getting several phone calls
  or emails right after meeting this person.
• The person is clingy, controlling, or upset if
  you want to spend time with friends and family.

Marlon Pagtakhan stalked Jerry Ryan
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How to Take action

• Tell everyone you know that this is going on --
  your employer, friends, family.
• Gently but firmly tell the person you've decided
  to move on.
• Don't get drawn into discussions of why. Just
  say, "This situation isn't right for me" or "I'm
  not ready.." -- whatever you need to say, but say
  it gently.

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Treatments for Victims

• Mullen has found that cognitive-behavioral
  therapy works well in managing the anxiety
  stalking victims experience.
• Medications such as SSRIs for some patients.
• "It is important to inform and educate family
  members about the stalking and enlist their help
  in managing it," he stated.

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Treatments for Victims

• Stressed that victims of stalking, like victims
  of sexual or physical abuse, often blame
  themselves for the situation.
• Because they feel shame or misplaced guilt, they
  do not share their ordeal with others and become
  more isolated and afraid
• Counseling the victim to realize that he or she
  is not responsible for the stalking.
• Advises victims to file a complaint with the
  police if the stalking episodes continue for more
  than two weeks.
• "To prove that the perpetrator is guilty of a
  crime and have the court order treatment,
  evidence is critical. Do not destroy
  answering-machine tapes, notes, letters, e-mails,
  or gifts in a moment of distress," he advised

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Professionals at Risk, What about the victims?

• "Professionals who work with the lonely and
  unstable are at risk of being stalked," said
  Mullen.
• Estimated that about 15 percent have been stalked
  by a patient during their career.
• Victims are often forced to alter their lives to
  avoid the stalker.
• Mullens study found
• 53 of his subjects quit or changed jobs
• 40 moved to a different home
• 70 curtailed social activities.

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Professionals at Risk, What about the victims?

• In addition to the physical dangers, stalking
  takes a severe psychological toll on its victims.
  
• 83 Subjects were diagnosed with an anxiety
  disorder
• 37 with posttraumatic stress disorder (PTSD).
• Additional 18 had PTSD symptoms but did not meet
  formal diagnostic criteria.
• 24 had ideas of suicide
• 25 percent increased their alcohol consumption
  and/or cigarette smoking

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-END
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