Forensic Psychiatry

1. Forensic Psychiatry

2. 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.

3. 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.

4. 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).

5. 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.

6. 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.

7. Doesn’t 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.

8. 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.

9. 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.

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

11. 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

12. "The Lloyd Dobler Effect". Emily, like me, is a crazy fan of John's, specifically of his Lloyd Dobler role in Say Anything Well Is It?

13. 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.”

14. 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)

15. 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)

16. 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 APA’s 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. According to a 1998 study by the Department of Justice.

17. 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

18. 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

19. Do Now 11/12:What might concern you about this letter?

20. How might you describe the stalker’s profile? “He always told me he would make me sorry,” “I never dreamed he would do it by killing our child.”

21. How might you describe the stalker’s 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.

22. What are Mullen’s Five Categories of Stalkers

23. Mullen’s Five Categories of Stalkers

24. 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 Mullen’s study had personality disorders. • Therapeutic treatment of the rejected stalker involves helping him or her come to terms with the end of the relationship.

25. 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.

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

27. 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.

28. 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.

29. Lets see who’s a stalker.. I love you

30. Do Now: Why might a person stalk a celebrity? From today’s headlines: http://abcnews.go.com/Entertainment/wireStory?id=6237229 Know this Commercial? Is Stalking acceptable?? http://www.youtube.com/watch?v=mhehKgU5oBs Burger King Stalker

31. Do Now: Why might a person stalk a celebrity? From today’s headlines: http://abcnews.go.com/Entertainment/story?id=6241069&page=1

32. 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,"

33. Looking inside the letters

34. Two Questions:1. Why did we leave off the Predatory Stalkers?2. Predict which stalker is the most to be concerned about causing harm? From Jack Jordan

35. Why did we leave off the Predatory Stalkers ?

36. Predict which is the most to be concerned about? • The rejected and predatory stalkers are most likely to assault their victims.

37. 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

38. 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.

39. 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.

40. 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

41. 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. • Mullen’s study found: • 53% of his subjects quit or changed jobs • 40% moved to a different home • 70% curtailed social activities.

42. 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

43. -END

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