Training and credentialing in forensic psychiatry

The increase in legal regulation of psychiatric practice, malpractice litigation, number of mentally ill in correctional settings and concerns about the sometimes embarrassing quality of expert witness testimony has led to an heightened focus on training and credentialing of psychiatrists who work in these areas. The past 20 years has witnessed a growth of professional organizations, journals, accredited training programs and board certification. The paper outlines the nature of these programs and some of the dilemmas for the profession in establishing formal subspecialties.     

The lawyer and the forensic expert: Boundaries of ethical practice

The role of attorneys in relationship to mental health experts is examined. Issues which are discussed include the necessity of expert testimony, selection of the expert, and the data underlying the expert opinion. In addition, the attorneys' responsibilities in presenting the mental health expert in court is discussed with reference to different elements of the trial process.     

The ethical confrontation of the unethical forensic colleague

In the course of clinical and forensic work, psychologists sometimes discover serious weaknesses in knowledge, performance, or ethics in other psychologists' work. The ethical code of the American Psychological Association mandates confronting such a psychologist prior to making a professional complaint. This mandatory confrontation typically is omitted because of a sense of awkwardness or a fear of insulting the other psychologist. Education and training in psychology does not cover this sensitive and important area. In this article, sample templates of letters are provided to meet that ethical requirement and to begin to resolve problem behaviors by colleagues.     

Human dignity and vulnerable agency: An ethical framework for forensic practice

In this paper, we present an integrated ethical framework that covers the different levels of ethical tasks inherent in forensic and correctional work. First, we briefly give an overview of the ethical framework and its component notion of human dignity. Second we analyze in depth the concept of dignity and its relationship to normative theories and ethical concepts that are particularly relevant for forensic practitioners. Third, we explore the capacity of the conceptions of human dignity and vulnerable agency to integrate principles typically contained in ethical codes and practice, such as beneficence, autonomy, and justice. Fourth, we discuss how conflict between ethical codes or duties of station adhered to by practitioners can be effectively addressed in light of the model of dignity and agency outlined earlier. Fifth, we explain how individuals' specific ethical judgments and actions should proceed in light of our framework model.     

Confidentiality and the rape victim: ethical intent versus political reality

...The clinician who works with the victim of rape, either in hospital emergency departments, community mental health settings, college environments, or private practice, should consider ways that would effect the many overdue reforms for which this specialty cries out. The need for sensitivity in the area of record keeping, particularly as to how such records might be used, can hardly be debated. Beyond this, there is the role of patient advocate, calling upon the clinician to serve an educative function with reference to the members of his profession and of the larger society. Confidentiality of patient records can be preserved only to the extent that the cultural context in which they exist values such privacy.     

The contribution of forensic psychiatry in the determination of punishable guilt]

As part of the consultative discussions between members of the Supreme Court and workers at the Department of Forensic Psychiatry, G.D.R. Institute of Psychiatrists and Neurologists, problems are being dealt here with, which have been discussed by the present authors as early as in 1972. These are questions arising in connection with expert opinions on responsibility and guilt and concerning the offender's personality, the motives, the kind and extent of guilt, the possible exclusion of guilt, as well as urges of passion beyond the limits of paragraphs 15 and 16 in addition to exceptional objective and subjective circumstances.     

Cassandra in the Classroom: Teaching and Moral Madness

Moral madness is a symptom of the moral violence experienced by teachers who are expected to exercise responsibility for their students and their work, but whose moral voice is misrecognized as self-interest and whose moral agency is suppressed. I conduct a feminist ethical analysis of the figure of Cassandra to examine the ways in which teachers may be driven to moral madness.     

The establishment of the department of psychiatry in the Mount Sinai Hospital: a conflict between neurology and psychiatry

A conflict between neurology and psychiatry and controversies about psychoanalysis played an important role in the establishment of psychiatry in the general hospital. This article reviews the impact of this conflict on the establishment of an independent Department of Psychiatry in the Mount Sinai Hospital in New York during the first half of the twentieth century. A unique opportunity is provided to consider the relationships and personalities of the individuals involved, as well as economic, social, and scientific factors, including the introduction of psychoanalysis as a major psychiatric treatment.     

A review on eye movement studies in childhood and adolescent psychiatry

The neural substrates of eye movement measures are largely known. Therefore, measurement of eye movements in psychiatric disorders may provide insight into the underlying neuropathology of these disorders. Visually guided saccades, antisaccades, memory guided saccades, and smooth pursuit eye movements will be reviewed in various childhood psychiatric disorders. The four aims of this review are (1) to give a thorough overview of eye movement studies in a wide array of psychiatric disorders occurring during childhood and adolescence (attention-deficit/hyperactivity disorder, oppositional deviant disorder and conduct disorder, autism spectrum disorders, reading disorder, childhood-onset schizophrenia, Tourette’s syndrome, obsessive compulsive disorder, and anxiety and depression), (2) to discuss the specificity and overlap of eye movement findings across disorders and paradigms, (3) to discuss the developmental aspects of eye movement abnormalities in childhood and adolescence psychiatric disorders, and (4) to present suggestions for future research. In order to make this review of interest to a broad audience, attention will be given to the clinical manifestation of the disorders and the theoretical background of the eye movement paradigms.     

Literature and Madness: Fiction for Students and Professionals

Psychiatry studies the human mind within a medical paradigm, exploring experience, response and reaction, emotion and affect. Similarly, writers of fiction explore within a non-clinical dimension the phenomena of the human mind. The synergism between literature and psychiatry seems clear, yet literature—and in particular, fiction—remain the poor relation of the medical textbook. How can literature be of particular relevance in psychiatry? This paper examines these issues and suggests a selection of useful texts.     

Motion versus position in the perception of head-centred movement

Abstract. Observers can recover motion with respect to the head during an eye movement by comparing signals encoding retinal motion and the velocity of pursuit. Evidently there is a mismatch between these signals because perceived head-centred motion is not always veridical. One example is the Filehne illusion, in which a stationary object appears to move in the opposite direction to pursuit. Like the motion aftereffect, the phenomenal experience of the Filehne illusion is one in which the stimulus moves but does not seem to go anywhere. This raises problems when measuring the illusion by motion nulling because the more traditional technique confounds perceived motion with changes in perceived position. We devised a new nulling technique using global-motion stimuli that degraded familiar position cues but preserved cues to motion. Stimuli consisted of random-dot patterns comprising signal and noise dots that moved at the same retinal 'base' speed. Noise moved in random directions. In an eye-stationary speed-matching experiment we found noise slowed perceived retinal speed as 'coherence strength' (ie percentage of signal) was reduced. The effect occurred over the two-octave range of base speeds studied and well above direction threshold. When the same stimuli were combined with pursuit, observers were able to null the Filehne illusion by adjusting coherence. A power law relating coherence to retinal base speed fit the data well with a negative exponent. Eye-movement recordings showed that pursuit was quite accurate. We then tested the hypothesis that the stimuli found at the null-points appeared to move at the same retinal speed. Two observers supported the hypothesis, a third partially, and a fourth showed a small linear trend. In addition, the retinal speed found by the traditional Filehne technique was similar to the matches obtained with the global-motion stimuli. The results provide support for the idea that speed is the critical cue in head-centred motion perception.