Fixing forensic patients: Psychiatric recommendations for treatment in pretrial settings

This article is concerned with psychiatric recommendations for treatment at the Metropolitan Toronto Forensic Service (METFORS), a clinical assessment agency providing both 1-day and 30-day evaluations of criminal defendants in Toronto, Canada. Analysis of both psychiatric reports and quantitative research instruments demonstrated the saliency of treatment as a central forensic issue at METFORS. Among a sample of 592 defendants, 134 were considered in need of outpatient care. Persons recommended for hospitalization were most likely to exhibit histories of mental health rather than criminal justice contacts; to be arrested for nonviolent offenses; to manifest psychotic behavior while at METFORS; to be found unfit for bail, incompetent to stand trial, in need of further assessment and dangerous to self; and to experience higher rates of hospitalization, but lower levels of criminalization during the two years following their initial forensic assessment. Psychiatric reports at METFORS tended to merge recommendations for treatment and assessment; to suggest prison or probation as means for securing clinical treatment; and to provide little written support for judgments about the need for intervention. Along with competency and dangerousness, treatment is a key issue in forensic practice, and warrants further attention in the psycholegal literature.     

Treatment recommendations for mentally disordered offenders: More than roulette?

Clinical judgments on the treatability and prognosis of mentally disordered offeenders (MDO) may strongly influence legal dispositions and the availability of treatment resources. This study examined 1,238 discharge summaries for MDOs referred for court assessments. Psychiatrists evidenced marked variability in how often they recommended treatment and how frequently they judged patients to have a poor prognosis. Two logit analyses suggested that diagnosis and consultation by other clinicians were associated with (a) treatment recommendations (i.e., Axis I diagnosis and social work consultations) and (b) prognosis (i.e., Axis II diagnosis and psychology consultations).     

Procedural Justice and Culture

The past fifteen years have seen the development of a considerable research literature on the social psychology of procedural justice (see Lind & Tyler, 1988, for a review). Procedural justice research reveals some serious shortcomings in the exchange theories that have traditionally dominated Western analyses of the social psychology of groups, and in so doing, the procedural justice literature has important ramifications for cross-cultural psychology. Results from a number of studies conducted in the United States and Western Europe show that individualistic, self-interest based models of human behaviour are insufficient to explain procedural justice phenomena. Instead, procedural justice effects frequently reveal strong group-oriented concerns and motivations even in cultural contexts generally thought to be characterized by individualistic orientations. The research literature also shows that if a group's procedures are judged to be fair, people are more likely to show group-oriented behaviour and to hold more favourable attitudes toward the group and its leaders. These findings have led to the development of a theory of justice judgments—the Lind and Tyler group-value theory—which is based on group norms and relations rather than on social exchange theory. We describe a general model of social behaviour that integrates group- and individually-oriented behaviour, and we discuss the implications of the model for social and cross-cultural psychology.     

Validity and clinical scale comparisons between the MMPI and MMPI-2 with psychiatric inpatients.

This study was designed to investigate the comparability of the original MMPI (1950) and the MMPI-2 (1989) with a psychiatric patient population. 34 male and 3 female patients, shortly after admission to one of two acute psychiatry units, completed the old and revised versions of the MMPI. Paired t tests indicated but scant differences for raw scores, while many more differences were found among T scores for validity, clinical, and supplemental scales. Analyses, however, showed all scales on the two forms to be highly correlated. Analysis of the high-point and two-point codes across the two administrations also showed relative stability, although the proportion of Scales 2 (Depression) and 8 (Schizophrenia) decreased, while those for Scales 6 (Paranoia) and 7 (Psychasthenia) increased markedly in the MMPI-2 protocols. Examination of each version's discriminability among mood- and thought-disordered subsamples suggested that the MMPI provides slightly better delineation between diagnostic classes. Discriminant function analyses showed that there were essentially no differences between the two forms in the accurate classification of clinical and nonclinical groups. The findings reported here provide support for the MMPI-2; despite modification, the newer form retains the advantages of the original MMPI. Differences found here may be unique to psychiatric patients and their patterns of MMPI/MMPI-2 equivalence and may not generalize to other special populations.     

Do recognizable figures enjoy an advantage in binocular rivalry?

Five experiments examined whether recognizable stimuli predominate in binocular rivalry. It was found that a face predominated more than did a pattern equated for spatial frequency, luminance, and contrast; an objective reaction time procedure confirmed predominance of the face. The face was still liable to fragmentation as stimulus size increased. Observers tracked exclusive dominance of a picture of a camouflaged figure (a Dalmatian dog) prior to and then following discovery of the figure's presence; control observers received the same protocol with a scrambled version of the dog stimulus. Compared with control results, predominance of the dog picture was higher even before observers knew of the camouflaged figure. Inversion of the dog figure reduced its predominance. Binocular rivalry is sensitive to object-related, configural properties of a stimulus.     

The gestural repertoire and its evolution over the second year

The entire repertoire of communicative gestures was documented in a longitudinal, observational study of 10 infants, whose combined ages covered the range from 9 to 22 months. Early in the second year, giving as a request to do something with the object increased, while emotive gestures decreased. Later in the second year, pointing gestures increased, while protest gestures tended to decrease. Combining gestures with vocalization tended to increase only for protest gestures later in the second year. Eye contact showed a small but continuous increase in coordination with gestures over the second year, particularly with comment, request, and emotive gestures. These findings indicate an increasing use of the parent as an agent and of the informative function in non-verbal communication during this period of transition to verbal communication.     

Journal Reviews

Astor , J. (London). ‘A conversation with Dr Michael Fordham.’Journal of Child Psychotherapy Astor , J. (London). ‘Adolescent states of mind found in patients of different ages seen in analysis.’Journal of Child Psychotherapy Blomeyer , R. (Berlin) ‘Der Umgang des Analytikers mit der Analyse’ (The interrelationship between the analyst and the analysis). Analytische Psychologie Blomeyer , Rudolf (Berlin). ‘Analytische Psychologie und Ich-Psychologie’. (Analytical Psychology and Ego-Psychology). Analytical Psychology Rudolf Blomeyer . ‘Anmerkungen zur Typologie’ (Comment on typology). Analytische Psychologie Corbett , L. Kugler , P. ‘The self in Jung and Kohut’ in Progress in self Psychology Dehing , J. ‘Jung aus der Sicht der anderen: anlässlich einiger Kritiken von Seiten der Freudianer.’ (Jung as others see him: some Freudian criticisms.) Analytische Psychologie Erlenmeyer , A. ‘Das kannabalische Phantasma—eine Annäherung’ (Cannibalistic fantasy—an appraisal). Analytische Psychologie Giera -Krapp , Margitta (Berlin). ‘Constellation of the good/bad mother archetype in the treatment of early disturbances.’Analytische Psychologie Lyard , D. (Paris). ‘Le corps et la “redonne” archetypique de l'adolescence.’ (The body and archetypal rebirth in adolescence) in Cahiers jungiens de psychanalyse Noschis , K. (Geneva). ‘La maison du jour et de la nuit’ (The house by day and by night). Le Journal des Psychologues “Le langage de notre intérieur” (The language of our interior). Les Cahiers Médicosociaux Erenest L. Rossi . ‘Mind Body Therapy: methods of ideodynamic healing in hypnosis.’ Norton Professional Books. New York. Samuels , A. (London). ‘Pluralism and the post-Jungians: A reply to Peter Bishop.’ Spring. Samuels , Andrew . (London). ‘A relation called father—Part I: The father in depth psychology.’British Journal of Psychotherapy Steinberg , Warren . (New York). ‘The Fear of Success’. Quadrant Thibaudier , Vivane (Paris). ‘La notion de Grande Mère dans l'optique Jungienne’Cahiers Jungiens de Psychanalyse     

A reappraisal of Teresa of Avila's supposed hysteria

This essay offers a reassessment of Teresa's severe seizures which were such a characteristic feature of her mysticism. The diagnosis of hysteria is no longer viable, at the very least given its abandonment by clinicians. An alternative analysis is developed by phenomenologically comparing Teresa's seizures to parallel experiences of subjects in LSD-assisted psychotherapy. Using Stanislav Grof's categories, it is argued that Teresa's seizures are perinatal symptoms. As such, they represent the emergence and reintegration of extremely primitive psychological systems and might be described as the growing pains of transpersonal consciousness. They reflect not degenerative psychopathology but progressive movement toward higher states of consciousness.He has published articles in the fields of metaphor and the psychology of mysticism. An earlier version of this paper was presented at the national meeting of the American Academy of Religion in New York in 1982.