How do you talk to dead people? This is a frequent response which people make when I tell them I am a forensic psychiatrist. These are people who relate to the old television show “Quincy” which was about a forensic pathologist who did autopsies on murder victims. Others relate to the recent spurt of CSI programs which are actually about criminal investigation and evidence gathering and examination.
On the other hand forensic psychiatric expertise usually focuses on the state of mind of the criminal or the plaintiff in civil matters. Here the psychiatrist initially acts as a consultant to attorneys and/or the courts and eventually may become an expert witness testifying in depositions and/or court.
Those defendants charged in criminal cases who plead insanity as an explanation for their behavior require evaluation to determine if they indeed suffer from a severe mental illness which prevented them from understanding the wrongfulness of their acts. Their competency to stand trial sometimes needs to be evaluated first.
If such an individual is judged to have been insane at the time of the crime (a very rare determination despite those highly publicized cases) he will be sent to a psychiatric facility until that mental state is resolved. Psychiatric evaluations are later done periodically outside of the institution to determine if there has been “a restoration of sanity”. Often such individuals remain incarcerated in a treatment facility longer than they would if required to serve a prison term.
Substance abuse and eyewitness identification are also matters which psychiatrists can be significantly helpful in evaluating. Substance abuse is never a sufficient reason to allow a claim of insanity but it might be considered as a mitigating factor in one’s defense.
In actuality, the issue of eyewitness identification should be referred to as “misidentification” because the defense attorney is usually hoping to prove that his client has mistakenly been identified as the perpetrator of a crime. This subject deals with the many factors important in memory especially perception, retention and retrieval of information. There are a myriad of other factors which must also be explained to a jury to balance out the inevitably great weight placed on an eyewitness’ testimony.
Civil cases frequently involve psychiatric evaluation and testimony when a plaintiff claims emotional injury secondary to a physical injury or a primary psychic injury such as in post-traumatic stress circumstance. Personal injury cases including auto or airplane accidents, tornado, hurricane, fire and mold damage to homes, medical and psychiatric malpractice, employment situations with sexual harassment, discrimination and wrongful termination are all areas where people sue for compensation for their pain, suffering and /or disabilities.
Other areas of civil concern necessitating psychiatric examination are child custody cases (where the entire family must be assessed) and “testamentary capacity” cases where the validity of wills and trust documents are challenged and the psychiatrist must conduct a “psychiatric autopsy”, i.e. examine hospital or other records to determine the former state of mind of a deceased person. The function of the forensic psychiatrist in these many different kinds of cases follows essentially the same steps. He/she must examine all the documents, legal and medical evidence, depositions photos, accident reports, etc. which pertains to the case. Most importantly he should conduct a psychiatric face to face examination of the plaintiff in civil cases and the defendant in criminal cases. In some instances additional persons will be evaluated.
The psychiatric examination of a plaintiff consists of questions and answers as well as observation of the individual’s behavior during the examination. In this way the psychiatrist is able to assess the validity of the claimed injury, the degree of injury and determine if there is a true connection to the underlying event. He must also evaluate the veracity of the plaintiff and the possibility or extent of confabulation.
Evaluations of those charged with crimes require the same kind of examination but with an eye toward determining the competency and/or sanity of that individual.
A written report to the attorney will recount the elements of the psychiatric examination, provide a diagnosis if one exists and formulate the psychodynamics of the case which prove or disprove the charges as determined by the psychiatrist. Rendering opinions on the ultimate issues and explaining the rational behind those opinions may become essential in settlement of the case at this stage.
In civil cases the psychiatrist will often then be faced with sitting for a deposition in which his work and opinions will be examined by the opposing counsel. This is done in a less formal manner than subsequent testimony at trial where the opposing counsel’s questions are usually much more challenging and aggressive.
The quality of work and the opinions rendered by the psychiatrist regarding emotional damages can be crucial in the settlement or compensation in civil cases. Some attorneys have said that a successful claim for emotional damages can double the size of the damages received.
Usually, the psychiatrist is involved in cases where many other types of forensic experts are consulting. Although many of the experts are unaware of each other the psychiatrist can be helpful to some of the other experts by explaining the behavior of other persons or their witness’ credibility. Thus, sometimes other forensic issues can be shown to have major weaknesses if the psychiatrist is given an opportunity to cross consult and perhaps recommend additional experts and case management steps for the attorney.
This article by Richard G. Rappaport, M.D. was published in The San Diego Daily Transcript on July 20, 2006 as part of the Forensic Consultants Association Spadia. Richard G. Rappaport, M.D. is an Associate Clinical Professor of Psychiatry at UCSD.
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