By Alberto M. Goldwaser, MD
"Make Everything As Simple As Possible, But Not Simpler." – (Albert Einstein)
A Forensic Psychiatrist is a physician that holds a psychiatric expertise and applies it to legal matters. The objective of a forensic psychiatrist is to give expert opinion to a reasonable degree of medical certainty, in the form of a written report, deposition or courtroom testimony in legal cases. It relates to the application of psychiatric knowledge and techniques to legal procedures.
As such, the Forensic Psychiatrist contributes clarifying specific questions in diverse legal contexts, such as civil, criminal, correctional, and others.
We state our opinion regarding psychiatric disability. Right to treatment, as well as right to refuse treatment, are issues of importance, as are those regarding correctional psychiatry and involuntary civil commitment.
We work on areas such as violence risk assessment, psychic harm in workers compensation and personal injury events, as well as complaints of sexual harassment in different environments. We evaluate the dynamic mind of the aggressor, whether through negligent infliction of emotional pain or not, as well as the mind of the victim, not only in the present context, but by reconstructing the mind frame at the time of the event in question. This may prove to be a valuable deciding factor.
Evaluating Competence, in the civil and criminal arena, is a vast area we are commonly asked to address. For example, we assess competency to make or change a will, to be a witness, to stand trial, to refuse taking medication, or a necessary medical procedure. We address issues of competency to be a parent, or to parent a child with a serious medical illness, such as an acute condition that requires solicitous and intelligent caring and fast decision making abilities.
We participate in the evaluation to determine insanity, or diminish responsibility due to altered states of mind, in cases of extreme emotional disturbance (including the dated 'heat of passion' petition), or in areas of involuntary or voluntary intoxication, with insufficient elements to conclude mens rea. We work closely with lawyers in cases involving child abuse, and in those requiring decisions on child custody.
Basic examples of involvement include the assessment of sexual harassment cases, in which the question of pre-morbid conditions require expert clarification regarding if and how the person's background play a role in what happened and its aftermath. We participate in the elucidation of cases regarding the negligent infliction of psychological pain, as occurs in driving accidents in which we observe the development of Post Traumatic Stress Disorders. This could also be present as result of work related events, with disfiguring and/or incapacitating physical injuries.
A Forensic Psychiatrist helps to discern if a defendant had the capacity to form the intent to commit actus reus, or if, not addressing that capacity, he can assess whether he formed such intent or not.
It is also important to determine that a person was, or was not of such a state of mind, when he or she signed an agreement, or made a will, etceteras, not to be misled by involved persons. It is all about having and using the necessary aptitude to discover and uncover, in order to explain. A psychiatrist looks at conduct as fueled by emotions. A jurist assumes free will, independent of emotional motivation. The goal is not to exculpate or inculpate. A Forensic Psychiatrist is not a trier of fact, but a link in the fact-finding process. We work at the borderline between Psychiatry and the Law, at integrating the two perspectives and presenting the conclusions, in a comprehensive, persuasive, and scientific manner. We ought to be able 'to tell the story', helping the trier of fact to subject to scrutiny what one takes to be evident, taking a thorough consideration of alternate lines of exploration and reasoning.