Forensic psychiatry and malpractice.

This paper concerning the last 87 malpractice cases referred to the Department of Psychiatry and Law, Menninger Clinic, includes 57 suits against mental health practitioners and/or institutions, and 30 nonpsychiatric suits against general hospitals, surgeons, obstetricians, etc. A patient was available for interview in only 12 percent of the psychiatric cases; in 88 percent we reviewed medical records and consulted with attorneys. In the psychiatric cases the crucial question was whether a generally accepted standard of care was breached. The inherent problems of applying appropriate criteria to standards of care by practitioners and institutions are discussed. In half the psychiatric cases we found no significant deviation from acceptable clinical performance; in half we concluded that negligent practice had occurred. We did see a litigant for evaluation in 90 percent of the nonpsychiatric cases. The main issue involving them concerned harm or disability related to presumed negligence by medical personnel. How we evaluate such cases and apply disability criteria is discussed.

Forensic pitfalls.

The lives of forensic psychiatrists are complicated and subject to stressful experiences because they have elected to interact with a social system very different from their own. This article presents discussion of these frequently troublesome areas commonly encountered by forensic psychiatrists in trying to respond to the law's requests and needs without sacrificing their medical integrity: (1) legitimate definition of expertise; (2) reasonable medical certainty; (3) generally accepted standard of care. They are explored with emphasis on the exercise of self-assessment by the involved forensic psychiatrists lest their incautious application of knowledge and expertise become pitfalls of their own making.

Forensic psychiatry in private practice.

This paper presents statistical and explanatory analyses of 637 forensic psychiatry cases in a private practice setting during the past 12 years, highlighting the remarkable variety of clinical and legal issues addressed by forensic psychiatrists. Emphasis is on how and why forensic psychiatrists need to be expert diagnosticians and clinicians, and ways in which they may respond to difficult clinical and legal opinions are recommended.

Compensation neurosis.

The concept of compensation neurosis developed in the wake of the nineteenth century Industrial Revolution and subsequent enactment of workmen's compensation laws. The nosologic designation of traumatic neurosis was not consensually accepted until after World War II; the compensation label was epithetically applied as a simplistic explanation of puzzling postaccident disability. In diagnostic evaluation of postaccident symptoms not attributable to tissue damage; these factors are relevant: secondary gain and loss; alteration in family dynamics; iatrogenic influences, particularly from industrial medical departments; liberalization of workmen's compensation laws; the symbolic significance of money in our culture; the climate of creeping socialism. One consequence stemming from the conceptualization of a compensation neurosis is implicit adherence to the anachronistic mind-body dichotomy.

Traumatic neurosis and other injuries.

This article examines the dynamics involved in traumatic events, providing a historical perspective and presenting symptoms and treatment of such clinical syndromes as post-traumatic stress disorder, conversion disorder, somatization disorder, and others.

Mental health centers and the criminal justice system.

Through questionnaires, interviews, and site visits, the authors undertook to ascertain to what extent the 26 community mental health centers in Kansas were contributing to the resolution of problems that concern the criminal justice system. They found that in all large communities some reciprocal programs have developed between the two systems, but meaningful collaboration is rare in small communities. Juvenile courts, urban law enforcement agencies, and county probation officers are most receptive to collaborative programs. An evaluation of several effective programs revealed three basic conditions that attribute to their success: an urban community setting, individual initiative by staff from each system, and location of the program within the criminal justice system.