Book Review
Forensic Psychiatry
Forensic Psychiatric Evidence. Julio Arboleda-Flórez,
Christine J Deynaka. Toronto: Butterworths; 1999. 104 pages. CAN$83.00
.
Reviewer
rating*: Good
Review by Graham D Glancy, MB, ChB, FRCPsych, FRCP(C)
Toronto, Ontario
Professor Arboleda-Flórez is a leading and much-respected
figure in Canadian forensic psychiatry. He is currently Head of
the Department of Psychiatry, and Chair of its Forensic Division
at Queen’s University, Kingston, Ontario. He has built an international
reputation through his work as a consultant for the World Health
Organization, and the World Psychiatric Association. He is a recent
winner of the Bruno Cormier Award for distinction in Canadian forensic
psychiatry, being particularly known for the scientific rigour with
which he approaches any issue. He has written this book in conjunction
with Ms Deynaka, a practicing lawyer with a background in nursing.
According to the book’s preface, its purpose is to provide
lawyers and forensic clinicians with a simple reference guide on
basic scientific concepts and research methodologies as they impact
upon forensic psychiatry and psychology. Dr Arboleda-Flórez
notes the dearth of publications dedicated to understanding systems
as they are used by the criminal patients with mental illness who
interact with forensic specialists in these systems. In the preface,
the authors also point out that they have dedicated extensive areas
of the book to ethical matters that impact upon law and psychiatry.
Currently, no up-to-date Canadian textbook of forensic psychiatry
exists (1). Although the stated intentions of this book are not
necessarily to fill this void, the meat of the book, in fact, could
well serve this end.
Chapter 1 is an interesting disquisition on the nature of science.
This flows into a second chapter on expert evidence that is particularly
useful in describing how the Daubert standard has been interpreted
in Canada. The authors criticize both forensic psychiatrists and
the justice system for not using scientific knowledge in this field
with more discernment. However, they save their greatest cynicism
for the use of “syndrome evidence”—most particularly
in regard to recovered memories and the “child sexual abuse
accommodation syndrome.”
In Chapter 3, they refer to “the scientific paradigm,”
which includes a primer on probability and statistics—something
we can all afford to brush up on from time to time. Chapters 4,
5, and 6 are the core of this book. These chapters could serve as
an abbreviated textbook on forensic psychiatry in Canada; they are
useful for reference and make interesting reading as well.
Chapter 7, “Examining the Expert,” is presumably aimed
at lawyers, although having glanced through it, I suggest that anybody
who may face cross-examination will want to be forewarned by a more
detailed prior reading. No doubt this will send many of us rushing
back to our textbooks and journals, a result I am sure would be
applauded by the authors. An excellent chapter on ethical issues
follows. It includes a discussion of the ethics of forensic psychiatrists
and lawyers and a separate section on the confidentiality of medical
records.
The first page of the preface states that “while forensic
psychiatrists are usually up-to-date in clinical knowledge, they
are in a vacuum regarding research issues.” It then goes on
to say that “equally, lawyers, usually hail from liberal arts
degrees, have seldom been exposed to scientific methods or taught
research methodologies.” Since this book appears to be aimed
at forensic psychiatrists and lawyers, alienating both groups does
not seem the most diplomatic start!
Dr Arboleda-Flórez next chides us for the lack of publications
attesting to the scientific basis of assumptions made by forensic
witnesses. Unfortunately, he does not quote any scientific evidence
or research to support these stereotypical views and thereby is
subject to the same criticism. He states that there is a similar
dearth and knowledge in the area of the systems within which we
and our patients interact. Although they purport to right this wrong
by explaining these systemic interactions, nowhere in the book do
the authors mention the Canadian Academy of Psychiatry and the Law
(CAPL)—the body under the auspices of the CPA that represents
forensic psychiatrists in Canada. This apparent blind spot is again
demonstrated by the fact that the ethical guidelines of the American
Academy of Psychiatry and the Law are presented, but similar guidelines
instituted by CAPL are ignored. Through his work with international
organizations Dr Arboleda-Flórez, is able to give a world
view, but he sometimes neglects what is happening in his own backyard.
Inevitably, cases in textbooks are out of date before they are
published. In this case, the important Supreme Court of Canada cases
R v Mills (2) and R v Jones (3), which relate to the confidentiality
of patient records and the duty to warn third persons, are neglected.
The reader will have to keep up to date by reading The Canadian
Journal of Psychiatry and other journals to learn about the latest
important developments. The book also inevitably portrays the bias
of the authors—not bias according to the uneven glossary’s
statistical definition (“deviation or interferences from the
truth”) but bias as in partiality or interest. Only 1½
pages are devoted to young offenders or dangerous offenders, whereas
over 20 pages relate to statistics.
That said, my criticisms are merely nitpicking. Overall, the book
is an important contribution to the field and is essential reading
for all residents in psychiatry, for general psychiatrists who stray
into the field of forensic psychiatry, and for forensic psychiatrists.
It would also be most useful for lawyers who find themselves working
in this area. It is well-written and nicely presented in a handy
paperback form that fits easily into a briefcase. By now, we are
used to paying 10 times the price of the latest John Grisham paperback
for a similarly sized textbook, so the price is something with which
we have come to terms. I encourage anybody connected to the field
to buy this book and read it. Hopefully, specialists in forensics
and, more particularly, general psychiatrists and mental health
workers who stray into the field (for whom there is a greater need)
will respond to Dr Arboleda-Flórez’s challenge and introduce
greater scientific rigour into their work. If this is indeed the
result, the authors will have fulfilled the stated aim of this excellent
book.
References
1. Glancy G, Bradford J, Gagné P. Psychiatry
and the law in Canada: a proposal for subspecialization, Part I.
Bulletin of the Canadian Psychiatric Association 2000;32;20–3.
2. Regehr C, Glancy G, Bradford J. Canadian landmark
case: R v Mills. J Am Acad Psychiatry Law 2000;28:460–4.
3. Chaimowitz G, Glancy G, Blackburn J. Duty
to warn. Can J Psychiatry 2000;45;10:899–904.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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