Book Review
Forensic Psychiatry
Psychiatry on Trial: Fact and Fantasy in the Courtroom. Ben Bursten. Jefferson (NC): McFarland & Company; 2001. 210 p. US$35.00.
Reviewer
rating*: Very Good
Review by: Paul Ian Steinberg, MD, FRCPC
Edmonton, Alberta
This book is an engaging and very readable description of the uses and limits of psychiatry in forensic venues, both civil and criminal. The author is clearly an experienced forensic psychiatrist who is an expert in his field. The book is divided into 15 chapters and deals with a wide variety of medicolegal concerns. Bursten describes the danger of expert witnesses becoming prostitutes or junk scientists. He discusses the limitations of expert testimony and deals with the question of causality in forensic work. A chapter on psychiatric impairments seems aimed at the layperson, employing terms and concepts a bit simple for the average psychiatrist. Bursten also deals with the question of permanent impairment and long-distance evaluations, for example, in regard to patients who are dead when their testamentary capacity is questioned. When introducing this chapter, Bursten cleverly and effectively uses the analogy of George III’s “psychiatric illness,” which is now thought to have been porphyria. He describes what is prudent in forensic psychiatry and deals with questions of child abuse and false memory syndrome. He divides complex issues into more digestible points and is open and clear about the limits of forensic testimony. He describes the legitimate but limited involvement of psychiatrists in custody battles and in lawsuits in which sexual abuse is claimed. In dealing with the question of fitness for duty, Bursten makes it clear that psychiatrists are on safer grounds when posing the question in terms of whether an applicant or employee is fit for duty rather than whether he or she is unfit. Bursten turns again to history in a chapter called “Trouble Makers” wherein he describes an American woman who was committed to an institution by her husband in 1860, an act which was within the limits of the law despite there being no evidence of insanity. Bursten describes the conflicts in one’s role as a forensic psychiatrist and the difficulties of being an impartial witness. He states that the forensic psychiatrist owes primary allegiance to the court in a legal process, as opposed to helping the patient. He also describes the pitfalls inherent in having an allegiance to the attorney who hires one and the allegiance to oneself and one’s career, which may interfere with how conclusions are reached in the forensic arena. The last allegiance he mentions is to society at large: forensic psychiatrists use personal expertise to protect unknown people who may be killed if a potentially dangerous person is released on the basis of their testimony. The penultimate chapter discusses which psychiatric conditions “count” regarding patients’ responsibility in criminal cases. In the last chapter, Bursten indicates that the baby should not be thrown out with the bath water; that is, in spite of the difficulties and misuses of psychiatric testimony, psychiatrists still need to offer legitimate independent opinions in the legal arena.
This is a very good text, which will be helpful to many psychiatrists and lawyers. At times I felt it was too easy a read, though much information and professional wisdom are packed into this short volume. This book will be especially useful for psychiatrists who are contemplating or beginning forensic practice. It covers many useful and practical points.
Bursten’s vignettes are reasonably brief, but they cover the salient details and illustrate his points well. He approaches difficult questions in an organized fashion. His approach appears to be based on common sense and is even- handed, indicating where the limits of our scientific knowledge prevent us from drawing conclusions. Bursten stresses the need to maintain objectivity and to avoid becoming an advocate. He frequently reminds the reader of the importance of being an independent consultant and of “calling it as you see it.”
This volume is written briefly and clearly, is attractive in layout, and is free from typographical errors. It is not inexpensive, but the content justifies the price.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
|
