Who's Afraid of Forensic Psychiatry?

13 Pages·2005·0.67 MB·English

Who's Afraid of Forensic
Psychiatry?
Robert D. Miller, MD, PhD
Forensic psychiatry has come under mounting criticism from the press and other
medical professionals, largely for its participation in the insanity defense. The author
argues that the expertise available from the specialty is of increasing importance to
psychiatry as a whole, as more and more legal issues become relevant to the
practice of general psychiatry, and should be actively encouraged and legitimized
rather than ostracized. All psychiatrists should be exposed to forensic principles
and practices during their training, and the ability of forensic psychiatrists to serve
as transducers between the clinical and the legal/judicial should be increasingly
used to present the clinical viewpoint effectively in courts and legislatures.
Alan Stone surveyed forensic psychia- The ivory tower perceives itself as being
try from his ivory tower and concluded under siege on a number of fronts and
that it has nothing to offer the law.' has selected forensic psychiatry as a con-
Another president of the American Psy- venient scapegoat for many of its public
chiatric Association, Paul Fink, in his relations difficulties instead of viewing it
1988 address to the American Academy as a potential ally in the development of
of Psychiatry and the Law,2 stated that
solutions. In this presentation, I shall
the spectacle of opposing expert psychi-
argue that forensic psychiatry as a
atric witnesses in court was an embar-
profession is more than a few psychia-
rassment to the profession and called
trists testifying in notorious criminal
upon the Academy to solve the di-
trials, and that its expertise is essential
lemma.
in assisting a profession whose ivory
Such editorial comments echo those
tower has become as protective as the
of many past leaders of our profession
Maginot Line.
over the years who have suggested that
we should not become involved in prob- Definitional Issues
lematic areas of practice which might
One of the major difficulties which
embarrass our more retiring colleagues.
arises in discussing the subject of foren-
sic psychiatry is the threshold question
Dr. Modlin is training director, Forensic Center Men-
dota Mental Health Institute, Madison; clinical profes- of definition. Although in most discus-
sor of psychiatry and lecturer in law, University of sions it is tacitly assumed that forensic
Wisconsin-Madison; and associate clinical professor of
psychiatry, Medical College of Wisconsin, Milwaukee, psychiatry is synonymous with evalua-
WI. This talk was presented as the Manfred S. Gutt-
tions of criminal defendants, particu-
macher Award Lecture at the Joint Meeting of the
American Psychiatric Association and the American larly evaluations of their sanity at the
Academy of Psychiatry and the Law, San Francisco,
May 7, 1989. times that they committed notorious
Bull Am Acad Psychiatry Law, Vol. 18, No. 3, 1990 235
Miller
crimes, such a limited definition is nei- law."6 Robey and Bogard7 emphasized
ther theoretically nor practically sufi- that forensic psychiatrists must be fa-
cient. One cannot (and should not) sep- miliar with the latest in diagnosis, treat-
arate the evaluation of criminal respon- ment, and research, and be able to trans-
sibility (which has led to the great late their knowledge into terms under-
majority of criticism of forensic psychia- standable by lay decision-makers. Dietz,
try, both from within and outside the as far back as 1978,~(p . 13) stated that
profession) from the variety of other "in an era in which virtually every psy-
functions subsumed under the broader chiatrist must take cognizance of certain
term "forensic psychiatry" as I shall use medicolegal principles, an argument
it for the purposes of this presentation. could be made that 'forensicity' is a con-
Seymour Pollack has distinguished tinuous variable distributed unevenly
"forensic psychiatry," which he charac-
over the entire population of psychia-
terized as "the application of psychiatry
trists."
to legal issues for legal ends,"3 (p.2) from
The "official" definition of forensic
the broader term "psychiatry and law,"
psychiatry promulgated by the Ameri-
which "can be considered the broad,
can Board of Forensic Psychiatry and
general field in which psychiatric theo-
adopted in the Ethical Code of the
ries, concepts, principles, and practice
American Academy of Psychiatry and
are applied or related to any and all legal
the Law9 is "a subspecialty of psychiatry
mattersv3 (p.2); as such, it relates to
in which scientific and clinical expertise
other areas such as social and adminis-
is applied to legal issues in legal contexts
trative psychiatry. Pollack emphasized
embracing civil, criminal, correctional,
the difference in goals for the two cate-
or legislative matters."
gories-forensic psychiatry addresses le-
I shall use an extension of Pollack's
gal ends, whereas psychiatry and law
broad definition of "psychiatry and
preserves clinical goals and approaches
law." This approach emphasizes, I be-
to problems at the psychiatry-law inter-
lieve correctly, the essential process of
face. Other forensic psychiatrists have
applying clinical knowledge and experi-
also attempted to define the field:
ence to legal or administrative decision-
Diamond4 would include writing law re-
making, and is not distracted by at-
view articles and legal briefs as part of
tempting to differentiate among evalua-
what he conceives as a missionary role
for forensic psychiatry. Robitscher5 in- tions of which various practitioners or
cluded professors, trainers, evaluators, theorists approve or disapprove. I be-
testifiers, treaters, and even critics in his lieve that this conceptualization leads to
definition and argued that the forensic the development of a coherent role for
psychiatrist is the main emissary of psy- forensic psychiatry which has not been
chiatry to society at large; he preferred fully explored previously, but which is
the term "social-legal psychiatry" corre- becoming increasingly important to the
sponding to Pollack's "psychiatry and profession of psychiatry as a whole.
236 Bull Am Acad Psychiatry Law, Vol. 18, No. 3, 1990
Who's Afraid of Forensic Psychiatry?
The Insanity Defense tion before volunteering for the judicial
Although I believe that the issues in- arena.
volved in the insanity defense are con- Unfortunately, organized psychiatry
ceptually indistinguishable from other continues to play the ostrich in public,
areas of forensic practice, it is important reacting to intractable social problems
to address them initially in order to place which don't affect the practices of the
them in the broader context of our dis- majority of its members directly by call-
cussion. The real reason, of course, why ing for psychiatry to abandon the insti-
the insanity defense has been the recip- tutions society has created to deal with
ient of so much attention from both legal them. From Solomon's call for psychia-
and clinical critics is not that clinicians trists to refuse to work in state mental
are less competent to offer those partic- hospitals because of the (admittedly ter-
ular opinions, but that such opinions rible) conditions existent at the time,18
have (or at least appear to have) a pow- to present calls for the abolition of the
erful and direct impact on decisions of insanity defense (or at least psychiatric
direct interest to society, and are pre- participation in its operation), the
sented publicly, often with widespread profession has attempted to deal with
media coverage.1° No other clinical difficult problems by disclaiming re-
opinion has the effect or enabling de- sponsibility for them.
fendants to be found "not guilty" of Critics from within the profession
criminal acts which can be proven that have argued largely on theoretical
they committed, or to be released from grounds that psychiatry should abandon
custody earlier than would be the case if the criminal courts altogether. Hal-
they had been found responsible for pern,19 Goldstein and Kat~,~a' nd
their behavior. Morse2' have called for the abolition of
Psychiatry is, of course, not without the insanity defense; and Menninge?2
fault in the creation of our current prob- and Halle~kha~v~e argued that psychia-
lems with the insanity defense. From the trists should not participate in its imple-
psychiatrists at McNaghten's trial who mentation. In a purely political response
made confident pronouncements on his to the post-Hinckley backlash, the
sanity from observing him in the dock,12 American Medical Association's Board
through Isaac Ray, the patron saint of of Trustees initially voted to recommend
forensic psychiatry who proclaimed that abolition of the insanity defense,24
only psychiatrists were competent to de- whereas the American Psychiatric
termine the criminal responsibility of Ass~ciationre~c~om mended abolition of
defendants,13 to contemporary practi- the volitional prong of the American
tioners who seek either to excuse or con- Law Institute insanity test and also rec-
demn criminal defendants through the ommended that psychiatrists not express
manipulation of clinical jargon to imple- opinions on the ultimate issue of respon-
ment their ideological agendas,14-I' psy- sibility. After behind-the-scenes negoti-
chiatrists have not waited for an invita- ations, the two organizations issued a
Bull Am Acad Psychiatry Law, Vol. 18, No. 3, 1990 237
joint statement emphasizing their essen- ternal evaluation and regulation of the
tial agreement (while maintaining their practice of medicine in general prolifer-
original separate position^).^^ ates, psychiatrists have increased their
involvement as consultants to regulatory
Other Forensic Evaluations
organizations such as insurance compa-
The process of formulating opinions
nies, workers' compensation boards, so-
on criminal responsibility, however,
cial security disability panels, and peer
does not differ significantly from that
review organizations. The increase in
applied to a wide variety of other legal
malpractice suits against psy~hiatrists~~
questions. In addition to the other eval-
has also drawn other psychiatrists into
uations which are considered to be "fo-
the court to provide opinions on the
rensic," such as competency to stand
profession's standard of care.
trial, testamentary capacity, psychic
In all these situations, including crim-
trauma, and child custody, there are
inal responsibility, psychiatrists are
many which are regularly performed by
being asked to perform clinical evalua-
"general" psychiatrists without the criti-
tions in order to address essentially non-
cisms that are applied to criminal re- clinical legal or administrative ques-
sponsibility evaluations by the profes-
tions. Each of these evaluations requires
sion itself. Most psychiatrists have been the psychiatrist to be familiar with the
involved in involuntary civil commit- nonclinical definitions and rules which
ment evaluations; and as a growing apply to the evaluation in question, to
number of states establish a qualified address those specific external concerns
right to refuse treatment, psychiatrists explicitly in their evaluations, and to
are providing opinions concerning their translate their clinical findings into con-
patients' competency to make treatment clusions useful to those requesting the
decisions as well. With the current em- e~aluation.~~
phasis on informed consent for all types The criticism most often directed at
of medical treatment, psychiatrists (par- psychiatric participation in the insanity
ticularly those in consultation-liaison defense, that we are being asked to an-
services) are being asked to provide more swer questions for which our clinical
opinions about the competency of med- training and experience do not prepare
ical and surgical patients to consent or is equally applicable to our conclu-
refuse treatment.27T hese evaluations are sions in many of the other legal and
usually unopposed, and less often sub- administrative evaluations mentioned
ject to legal challenge, and are therefore above. There we are being asked to an-
less likely to expose weaknesses in the swer equally difficult (if less publicized)
clinical reasoning involved. social and moral questions such the de-
As remuneration for direct care to gree of disability induced by a mental
mental patients diminishes and is dis- disorder, and the effects of that disability
tributed among a growing pool of men- on a person's ability to make important
tal health service providers, and as ex- personal decisions such as whether to
238 Bull Am Acad Psychiatry Law, Vol. 18, No. 3, 1990
Who's Afraid of Forensic Psychiatry?
accept hospitalization or treatment or to such as paraphilic rapism and premen-
whom to leave property, or a person's strual syndrome from the DSM-IIIR.
capacity to work or to be a parent. On even broader social fronts, psy-
chiatry has a long and often unfortunate
Organizational Forensic Decisions history of promising solutions to major
It has been demonstrated that the per- social problems, beginning with claims
sonal ideologies of individual psychia- of cures for mental illness in the nine-
teenth century,33w hich were resurrected
trists may be the determinative factors
in the 1930s as a basis for the plea to
in their opinions on criminal responsi-
convert all prisons into hospitals,34a nd
bilit~;~al't hough few data are available,
again in the 1960s as one of the corner-
it is unlikely that those who offer opin-
stones of deinstitutionalization. There
ions on these other issues are any less
are no signs that attacks of professional
free of personal bias or ideology. Indeed,
modesty are breaking out; as recently as
the profession itself has demonstrated its
1987, the Executive Vice President of
collective ideology in a variety of official
the American Medical Association pro-
nonclinical positions. I have already
claimed at the American Psychiatric As-
mentioned the American Psychiatric As-
sociation's annual Convocation of Fel-
sociation's call for the elimination of the
lows that psychiatry is now sufficiently
volitional prong from the criteria for the
knowledgeable about the causes of the
insanity defense.25 This position was
problems of adolescents (including drug
based in part on the assertion that it is
abuse, pregnancy, and suicide) to join
more difficult for clinicians to determine
with the pediatricians to solve them for
volitional than cognitive capacity; but
our
there are no data to support such a con-
As has been the case with individual
clusion, which has been challenged vig-
expert opinions regarding criminal re-
orously by R~gers.~It ' is also probable
sponsibility, there has been considerable
that a perception that elimination of the
disagreement among individual psychi-
volitional prong would be more restric-
atrists about each of these issues. For the
tive, and thus less troubling to the pub-
purpose of this discussion, it is not nec-
lic, also entered into the deliberations, essary to address the propriety or validity
as its adoption in the Durham and of such decisions and statements; they
American Institute tests of criminal re- are included to demonstrate that the
sponsibility was explicitly for the pur- same application of clinical judgment to
pose of making the test more inclu- nonclinical issues required in the insan-
~ive.~~OtAhPeAr positions on issues of ity defense is to be found throughout the
social significance which have been practice of psychiatry and the public
based largely on political considerations statements of its official organizations.
include the decision that egosyntonic Critics have argued that to the extent
homosexuality is not a mental disorde?' that these activities embarrass the
and the exclusion of potential diagnoses profession, they should be aband~ned;~
Bull Am Acad Psychiatry Law, Vol. 18, No. 3, 1990 239
Miller
as with the law, the dignity of the profes- decision36h as been the most visible and
sion is thought to be of sufficient impor- certainly the most widely discussed sym-
tance to dictate its practices. I would bol of private psychiatry's involuntary
argue that there are two potential interface with the law over the past dec-
sources of any embarrassment derived ade;37b ut it is by no means the only, or
from such activities: the quality of the even the major, way in which general
reasoning involved in the opinions, and psychiatry has lost its legal virginity.
the degree of publicity attending them. Public concern about the efficacy and
Although we typically have less control the cost-effectiveness of our services has
than we might like over media accounts resulted in increased regulation from
of our pronouncements, we can (and peer review, organizations, licensing
should) affect the quality of our work boards, and credentials committee^.^^
products; and it is here that the expertise Perhaps the major concern of organized
of forensic psychiatry has the potential psychiatry at the national and state level
to inform our deliberations and to make is the inequities in third-party reim-
our recommendations more effective bursement between mental and other
outside our professional circles. Rather types of patients. Legal challenges from
than adopting a nihilist position by economic competitors to our hegemony
abandoning difficult tasks assigned to us over entrance to training opportunities,
(and thus leaving them to others argua- hospital privileges, direct reimburse-
bly even less qualified to perform them), ment, and perhaps even prescription of
we should improve our performances. medications, have also become increas-
Such an endeavor would not only de- ingly successful over the past decade.
crease legitimate criticism of our partic- In response to what many still per-
ipation in social arenas such as criminal ceive to be legal assaults on p~ychiatry,~~
courtrooms, but it would also enhance we can continue to cry "rape"; or we can
our ability to persuade courts and legis- learn not only to protect ourselves from
latures of the validity of our arguments. inappropriate intrusions, but also to be-
come proactive in our increasing in-
The Growing Impact of Law on
volvement with external regulatory bod-
the Practice of Psychiatry
ies, in hopes of helping to shape the
It is increasingly clear that privately
process and the procedures with which
practicing psychiatrists, who comprise
we must deal.
the majority of the profession, can no
longer avoid dealing with legal issues, The Forensic Approach
even if they want to do so (and I believe A forensic psychiatrist's approach to
that there are a growing number of sit- issues with both clinical and legal aspects
uations in which they should not even differs in several respects from that of a
want to). The duty of therapists to pro- general clinical psychiatrist. In perform-
tect third parties from the actions of ing evaluations for the courts or for other
their patients introduced by the Tarasoff social agencies, where those being eval-
240 Bull Am Acad Psychiatry Law, Vol. 18, No. 3, 1990
Who's Afraid of Forensic Psychiatry?
uated often have obvious motives for corroboration from sources other than
simulation or dissimulation, it is neces- the patient.42 For example, despite the
sary for a psychiatrist to be more skep- voluminous research demonstrating the
tical than in a private evaluation for inaccuracy of clinical predictions of fu-
treatment.' Because of their contact with ture dangerou~ness,n~o~t only do cer-
the legal system, forensic psychiatrists tain notorious psychiatrists confidently
are more conscious of the need for ex- continue to proclaim that they are ca-
ternal corroboration of statements made pable of predicting long-term future
by patients under evaluation, and for dangerou~nessb,u~t~ t he majority of cli-
longitudinal historical information. nicians responding to a questionnaire
Those who treat forensic patients de- survey after the California Tara~off~~
velop experience in recognizing and duty to protect case indicated that they
dealing with the significant differences believed that they could reliably predict
between such patients and those in gen- such behavior in their patients.45T hese
eral psychiatric populations. They be- claims have been widely cited in subse-
come expert in dealing with specific di- quent court decision^.^^,^^
agnostic groups not usually found in Long-term treatment experience with
psychiatric populations, either in uni- forensic patients can provide the oppor-
versity training hospitals or in private tunity to accumulate the research data
psychiatric hospitals, such as sex of- necessary to address a variety of ques-
fender~w,~ho~s e behavior is of signifi- tions of legitimate interest to ~ociety.~'
cant interest to society. They also learn Most prominent among these questions,
of course, is the issue of dangerousness,
how to deal with differences in style
which has received considerable atten-
between the two populations; because of
tion over the past two decades. There
their contacts with lawyers and the
have been a number of studies concern-
courts, forensic patients tend to take on
ing prediction of future dangerou~ness,~~
many of the operational characteristics
and also research, both biological and
of general criminal populations, partic-
sociological, on the causes4*a nd treat-
ularly the development of adversarial
ment/management49 of such behavior.
relationships with their treaters and re-
Such research depends, of course, on
liance on grievances and lawsuits as ma-
access to populations of presumably
jor techniques in dealing with those in
dangerous patients, and more practical
a~thority.~'
information is clearly necessary.
The Value of Research
Other questions of direct relevance to
Psychiatrists, particularly those with both psychiatry and law include the ca-
psychoanalytic training, have tradition- pabilities of patients to give informed
ally approached clinical questions phen- consent to various medical and psychi-
omenonologically, often basing their atric procedure^;^^ the efficacy of psy-
opinions largely on their personal clini- chotropic medication when adminis-
cal experience alone, rather than seeking tered in~oluntarily;t~h'e indications for,
Bull Am Acad Psychiatry Law, Vol. 18, No. 3, 1990 241
efficacy of, and risks of treatment with socialization of medical practice, the
newer antiaggression medication^;^^ and American Psychiatric Association re-
the effects of various judicial procedures fused to participate, even when invited,
on stap3a nd patients.54 in early court and legislative decisions
involving mental health practices, argu-
The "Selling" of Psychiatric
ing that courts should stay out of our
Knowledge
territory.62 The American Psychiatric
Once such data are available, it is still
Association has since recognized the
necessary to convince judicial and leg-
reality that such decisions will continue
islative professionals of their rele~ancy.~~
to be made with or without input from
Courts have frequently ignored the es-
practitioners, and has established the
tablished facts when they have not sup-
Council on Psychiatry and Law to dis-
ported the policy the judges have wished
cuss and formulate position statements
to further with their decision^,^^ and
on legal issues which impact on clinical
published court decisions in areas such
~ractice.a nd the Judicial Commission
as the right to refuse treatmenf7 and the
to react quickly to developing cases by
duty to warns8 have badly misinter-
providing amicus briefs to federal and
preted available clinical data. One major
state courts to inform them both of our
reason why psychiatry has not been able positions and the relevant data behind
to be more persuasive in court is its the positions.
persistent tendency to refuse to acknowl- District branches of the APA have
edge both the validity of opposing posi- begun to follow suit: my recent survey
tions and legal reality, and to be willing of presidents of district branches (4 1/52
to support compromise positions. At responding) revealed that 1 1 have psy-
least partially as a result, courts have chiatry and law committees, 35 (includ-
rejected official psychiatric positions on ing all with psychiatry and law commit-
a variety of issues, including the right to tees) have legislative committees, and
refuse treatment,59 the duty to warn,60 only six have neither (five because they
and admission privileges to hospitals reported they had too few members).
and psychoanalytic institutes for psy- Psychiatry and law committees provide
chologist~.~~ consultation and proactive analysis of
Until recently, organized psychiatry potential issues to branch executive
followed the path of organized medicine committees, consultation and testimony
in general in its response to legal issues to legislatures (including drafting legis-
affecting its practices-it ignored courts lation), prepare amicus briefs (often with
and legislatures as long as possible, and assistance from the APA Judicial Com-
only recently has it adopted a proactive mission), and provide education and
posture in dealing with the many com- consultation to individual members.
plex issues which affect its practice and Those branches without psychiatry and
its patients. Just as the American Medi- law committees obtain these services
cal Association opposed the inevitable chiefly through executive, legislative, or
242 Bull Am Acad Psychiatry Law, Vol. 18, No. 3, 1990
Who's Afraid of Forensic Psychiatry?
ethics committees, and through their tives and an additional 3 1 percent pro-
state medical societies. viding some information as part of other
Forensic psychiatrists have had some- courses. Only 10 percent of the schools
what more success in working with leg- offered a separate course on mental
islatures than with courts. It may be that health law.66
legislators are more used to dealing with Although the American Board of Psy-
interest groups than are judges, and are chiatry and Neurology requires that psy-
more likely to consult with those prac- chiatric residencies provide training in
titioners that their bills are likely to af- forensic psychiatry, there are few current
fect. It is also probable that the give-and- data which reveal how well this goal is
take characteristic of the development being achieved.67T he great majority of
of legislation is more congenial to clini- forensic psychiatrists continue to prac-
cians than the more absolute positions tice privately, mostly in the civil
often taken in briefs and arguments in Although the 197819 NIMH
court. For whatever reasons, in areas survey of 293 psychiatrists who listed
such as the duty to warn,37s exual abuse forensics as an area of their practice
by psychotherapist^,^^ malpractice re- (representing only a 20% response rate)
form,64 and reforms in civil commit- indicated that 64 percent listed teaching
ment,65 clinical input has increasingly as among their activities, the survey did
had the effect of convincing legislators not indicate whether their teaching was
in the area of forensic^.^^ Improvement
to modify bills in recognition of the le-
is clearly needed in the quality and
gitimate concerns of the clinicians who
quantity of forensic education provided
must live with the results of their imple-
in our medical schools and residencies.
mentation.
No one should be able to graduate from
Developing Forensic Expertise
medical school without receiving spe-
I am certainly not suggesting that all cific exposure to medicine and law, and
psychiatrists should specialize in foren- all psychiatric residents should have fo-
sics. But if the expertise available from cussed seminars of psychiatry and law
those who do is to fall on receptive ears, which deal with practical as well as the-
it will be necessary that the level of legal oretical aspects of forensics.
sophistication of all psychiatrists be con- Despite public and professional criti-
siderably higher than it is at the present. cism, and the general trend away from
One obvious way to accomplish this goal reliance on experts to resolve social di-
is to provide training during medical lemma~t,h~e ~nu mbers of those identi-
school and residency. The most recent fying themselves as forensic psychiatrists
comprehensive survey of all U.S. medi- continues to grow. Alan Stone, despite
cal schools from 198415 revealed, how- the criticisms noted previously, has
ever, that only 22 percent had specific pointed out that forensic psychiatry is
required courses on medicine and law, "one of the few growth stocks" in an
with another 20 percent offering elec- otherwise stagnant psychiatric market'
Bull Am Acad Psychiatry Law, Vol. 18, No. 3, 1990 243
Miller
(p. 58). Courts and other decision-mak- sic psychiatry fellowship programs are
ing bodies are asking for even more in- now in operation, with new ones being
volvement by psychiatrists. Even the Su- developed each year; and the number of
preme Court,70h ardly one of our more journals in forensic psychiatry has
ardent supporters over the recent past, grown from the lone Journal of Forensic
has recognized the importance of psy- Sciences (with few articles on psychiatric
chiatric consultation in insanity defenses topics) to at least seven at the present
beyond offering expert opinions on the time, in addition to a variety of forensic
defendant's mental state to the prepara- journals in other mental health fields.
tion of the defense case it~elf.~C'i vil
Conclusions
courts are inviting psychiatrists to par-
Forensic psychiatry is flourishing, de-
ticipate in their deliberations in ever-
spite public relations problems with its
increasing n~rnbers.~'
involvement in the insanity defense. In
Forensic psychiatry has responded in
addition to its traditional role of provid-
various ways to this demand. The most
ing direct testimony in court, the profes-
recent survey of psychiatrists indicates
sion has taken on the tasks of presenting
that 20 to 30 percent spend at least some
our expertise and viewpoints to courts
of their time in forensic an in-
and legislatures on the growing number
crease over the 5 to 10 percent reported
of issues in which judicial or legislative
from a 1970 ~urveyT.~h ere has been a
significant increase in the number of decisions affect our practice. It is crucial
forensic psychiatric organizations. In ad- that forensic psychiatry continue to de-
dition to the Psychiatry and Behavioral velop expertise in these areas through
Sciences Section of the American Acad- research and education, so that its con-
emy of Forensic Sciences, active since tributions will continue to be useful both
1948, the American Academy of Psy- to those charged with decision-making
chiatry and the has grown over the past and to the profession of psychiatry as a
20 years to its present membership of whole. It is equally crucial that forensic
1,295. The American College of Foren- psychiatrists be supported in their efforts
sic Psychiatry and the interdisciplinary to share their experience and expertise
International Academy of Law and with their nonforensic colleagues
Mental Health have also been estab- through tenured faculty positions which
lished in the past decade. The American provide access to students in formal
Board of Forensic Psychiatry was estab- training programs as well as through
lished in 1976, and to date has certified presentations made at meetings of gen-
220 forensic psychiatrists; the American eral psychiatrists. As Diamond4 points
College of Forensic Psychiatry has also out, without such support, even those
established a certification process. forensic psychiatrists who would prefer
Until recently, the great majority of to work within a more traditional aca-
forensic psychiatrists had to train them- demic framework will be forced to con-
selves in their field; but at least 20 foren- tinue to derive the major source of their
244 Bull Am Acad Psychiatry Law, Vol. 18, No. 3, 1990