Forensic Psychiatry

Whenever a suicide happens in the New Asylums, a palpable, muted dread descends over the institution...it is added as another sedimentary layer to the strata and culture of the particular institution. Before things get too deeply buried, it is important to excavate...

Depression, PTSD, panic disorder, and abuse of alcohol and drugs are more insidious, quieter forms of illness that can cause the same desperation and disability as psychotic disorders.

What role do you play in managing stalking behaviors? How can you read between the lines and determine which stalker type behavior a patient's communication suggests?

Here, Debra Pinals, MD, looks at the development of anti-stalking legislation, the epidemiology of stalking, and various stalking classification schemes from a clinical perspective.

Here, John Femia, a former police officer and senior investigator, describes his experience as a first responder to scenes of violence and stalking. He offers a profile of those who stalk others; describes different types of stalkers; and focuses in on cyberstalking-all with the mental health clinician in mind.

Randi K. Bregman, LMSW, is the Executive Director of Vera House, Inc. (http://www.verahouse.org/). In this video, she talks about the impact of trauma and violence as defining forces in the lives of those who have been abused.

At the 3rd Annual Forensic Psychiatry Conference in Syracuse on August 11, retired FBI agent Robert (Roy) Hazelwood, MS, discussed how ritualistic serial rapists are distinguished from other rapist populations.

In 2009, Maj Matthew P. Houseal, a psychiatrist, was in Iraq attempting to help suicidal soldiers when a fellow soldier killed him, a clinical social worker and 3 others at a combat stress center near Bagdad. Paradoxically, Houseal’s accused killer, US Army Sgt John Russell, had earlier threatened to take his own life, according to witnesses’ testimony during a recent investigative Article 32 hearing.

Here’s why it is painful to see a man cry: he's not supposed to. Emotions are arresting when society tells us they should not be expressed. In the case of a grown man crying, there are some thousands of years of cultural training laying down the prohibitive regulations.

The proposal to include "coercive paraphilia" as an official diagnosis in the main body of DSM-5 has been rejected. This sends an important message to everyone involved in approving psychiatric commitment under Sexually Violent Predator (SVP) statutes.

What should clinicians do if they realize that they don’t like a particular patient who has come to them for help

When my clinic manager told me that prison may be the best place to practice psychiatry nowadays, I didn’t believe him. After all, prisons often seem like a world apart, often in isolated rural areas or in windowless, nondescript urban buildings.

II would have to wait until the next day, when K’s internal flames of resistance had died down, to learn why he had burned so fiercely. When we finally sat across from one another, his embers still glowed, and I learned that the source of his combustion had been the classic lose-lose scenario.

In previous blogs and papers, I have done my level best to skewer the misuse of the misdiagnosis "Paraphilia NOS." I regard it as no more than a flimsy justification, concocted to allow the psychiatric incarceration of rapists who would otherwise have to be released from prison to the street.

Here is a “pocket guide” for clinicians drawn from actual cases. With some modification, the list could become a patient information sheet or office policy.

Pascal’s “Wager” uses “reason” to conclude that even though the existence of God cannot be determined, one should nevertheless “wager” as though God exists, because one has everything to gain, and nothing to lose.

There have been four ringing rejections of the concept of paraphilic rape--in DSM-III, in DSM-IIIR, in DSM-IV, and in a 1999 APA Task Force report. The circumstances surrounding the latter three decisions are fairly well known, the first less so.

The movie Bronson loosely follows the true story of the infamous "most violent prisoner" in the UK -- a man named Michael Peterson who later changed his name to Charles "Charlie" Bronson on the advice of his bare knuckle boxing promoter.

What goes on in the minds of those who attempt suicide? Here: a psychologist who explores the myths that surround suicide notes "We need to get it in our heads that suicide is not easy, painless, cowardly, selfish, vengeful, self-masterful, nor rash."

Violence by patients towards staff members is an inherently complex matter for the physically and/or psychologically injured person. An expert in the field of forensic psychiatry answers a reader's question about what clinicians can do in the aftermath of an assault.

Psychiatrists helping nonpsychiatrists refer their patients has a long but not always illustrious history.

Although acute pain typically resolves on its own with little need for intervention, for some persons pain persists past the point where it is considered an adaptive reaction to injury.

A funny thing happened to me on the way back from the New Hampshire Governor’s Statewide Conference on Domestic & Sexual Violence. I don’t mean funny in a comedic sense, but rather in an unexpected, shocking sense.

In a question-and-answer discussion with Dr Phillip Resnick, clinicians gained valuable insights into the legalities of psychiatry and how best to treat patients and protect the public (and themselves).

DEBATE When you get facts wrong, as Dr Halpern does, it is hard to end up with the right conclusions. He suggests incorrectly that my approach to forensic ethics leads to the conclusion that participation in interrogation is permissible, when exactly the opposite is true.

DEBATE In 2005, the Board of Trustees of the American Psychiatric Association (APA) prepared a Position Statement entitled Psychiatric Participation in Interrogation of Detainees

Dr Allen Frances pleads for the United States Supreme Court to “step up to the plate” and halt the “disturbing misuse” of the “makeshift” psychiatric diagnosis of Paraphilia NOS (nonconsent).

Every year, more than 1 million children are exposed to sexual or physical abuse or neglect in the US. The research summarized here clearly demonstrates that exposure to stress before adulthood can result in persistent effects on both mental and physical health.

Would you be surprised to find out that Freud is gaining a foothold in China? As psychoanalysis and related therapies are slipping in the USA, psychoanalysts from the US are beginning to train a cadre of interested clinicians in China.

The next I heard of the Prince, my hopes that he had reshaped his consciousness in a more healthy direction were dashed. The Prince was in solitary confinement as punishment for another attempt to establish his empire.