No excuses: televised pornography harms children.

All youngsters are at some risk from exposure to televised pornography, as described above. At particular risk for harm, however, are the most vulnerable children in our society--children in single-parent homes, children with mental and emotional disturbances, mentally challenged children, children who have been physically and/or sexually abused, and children in dysfunctional families. Youngsters for whom television serves as a babysitter or parental surrogate unfortunately are exposed to few competing influences to television viewing. In addition, parents in such homes are least likely to know what their children are viewing and to be able to pass on their own values about sex and sexual behavior. The main possible effects of televised pornography that must concern us as clinicians, educators, and parents are modeling and imitation of language heard and behaviors observed in televised pornography; negative interference with children's normal sexual development; emotional reactions such as nightmares and feelings of anxiety, guilt, confusion, and/or shame; stimulation of premature sexual activity; development of unrealistic, misleading, and/or harmful attitudes toward sex and adult male-female relationships; and undermining of family values with resultant conflict between parents and children. Much more research is clearly needed on this topic. Because of the ethical and procedural problems surrounding research on children exposed to pornography, ideal research designs may never be possible. Nonetheless, we hope that this article will stimulate further discussion and work. To devise public policy that protects children from potentially harmful material while at the same time respecting the media's First Amendment rights, such public discourse and responsible research are essential.

Factors associated with weapon use in maternal filicide.

The objective of this study was to identify factors associated with weapon use in a group of filicidal women. Clinical data were gathered from the charts of sixty filicidal women evaluated at Michigan's Center for Forensic Psychiatry or through Connecticut's Psychiatric Security Review Board from 1970 to 1996. Factors associated with weapon use were determined using chi squares, ANCOVAS, and a logistic regression. Results were compared to national statistics for child homicide from the Department of Justice Uniform Crime Reports (UCR). Weapon was defined as knife or gun for the study. Weapons were used by one of four women in our study. Guns were used by 13% of filicidal women and knives by 12%. Odds ratio showed that psychotic women were eleven times more likely to kill their child with a weapon than their non-psychotic counterparts (11.2; p = .008). Psychosis was present in every mother who killed her child with a knife and in seven of eight women who killed their children with a gun. Younger children were less likely to be killed with weapons (ANCOVA; F = 8.28; p = .006). This finding was independent of presence or absence of maternal psychosis. These results show that psychotic women are more likely than non-psychotic women to kill their children with weapons. They also show that mothers are more likely to use weapons to kill older children than younger children.

Criminal responsibility and solvent exposure.

This case report contains the history of a man's exposure to benzene, trichloroethylene, and toluene. J suffered acutely from classic symptoms of toxic exposure to these compounds, such as fatigue, clumsiness, staggering, and hematopoietic depression. During his medical hospitalization, he was exposed to further organic insults, such as being treated with medications like Cytoxan and medications to treat an abscess in his right parietal lobe. After the acute exposure and after the abscess had resolved, his functioning on neuropsychological testing was still depressed, as he had a Full Scale IQ of 105, whereas at the time of the forensic evaluation he had a Full Scale IQ of 114. It would therefore appear that he did have some mild deficits when originally discharged from the hospital. While he reported having continual mental status changes at the time of the offense and even at the time of the forensic evaluation, it was not felt that these played a significant role in the commission of the offense. Comprehensive forensic evaluation suggested that psychological reactions to his illness and an underlying personality disorder were more direct contributors to the criminal acts. J was therefore recommended and ultimately found to be responsible for his behavior, according to the law.

Cognitive dysfunction in a patient with long-term occupational exposure to ethylene oxide. Role of ethylene oxide as a causal factor.

This case illustrates a comprehensive approach to assessing causality in a woman with apparent cognitive dysfunction, as measured by neuropsychological testing, and a 10-year history of occupational exposure to ethylene oxide. The analysis included a multidisciplinary examination of the patient, which took place several years after the termination of her exposure. In addition, all of the patient's prior medical and psychiatric records were reviewed, as were the records of her employer to ascertain her exposure history. Our evaluation revealed a pattern of neuropsychological findings not consistent with nervous system damage secondary to an organic effect of ethylene oxide. A more likely causal hypothesis is adopted: the patient's apparent cognitive dysfunction had a psychiatric etiology. This case also illustrates the potential impact of a patient's involvement in legal proceedings related to claims of neurocognitive dysfunction.

The sexual abuse victim in the courts.

This article explores the impact of court procedures on victims of sexual abuse and on the process of psychotherapy. Differences between civil and criminal litigation are described as is the psychiatrist's role in these cases. Recommendations are made as to how to render the experience of testifying in court less traumatic for the victim.

Premenstrual syndrome: a view from the bench.

The author reviews the use of premenstrual syndrome (PMS) as a complete or partial legal defense in the United States. The basic arguments supporting and opposing the use of PMS in the insanity defense, in the diminished capacity defense, and as a mitigating factor in sentencing are briefly explained. The PMS defense has been unsuccessful in the United States, and its future success is unlikely. More likelihood exists that PMS will cease to be a continuing subject of law review articles and a basis for judicial determinations and instead will continue to be studied in the proper arena, the psychological/psychiatric community.

The child as a witness.

The increasing participation of children in judicial proceedings raises two central issues: the competency of the child as a witness and the effects on the child of testifying about a traumatic experience. After discussing these issues, the authors present the recommendations of forensic child psychiatrists on how to improve the judicial process to elicit more accurate testimony from child witnesses--for example, by videotaping a child's testimony to avoid repeated interrogations, using anatomically correct dolls and pictures to allow the child to recount events through displacement, and using one skilled interviewer throughout the proceeding to allow rapport to develop between interviewer and child. They then discuss the role of the child psychiatrist in court proceedings involving child witnesses.

Forensic child psychiatry: an emerging subspecialty.

Forensic child psychiatry emerged as a subspecialty in the early 1900s. Although there are still few formal training programs, a core curriculum of training and experience is described.

Custody and visitation. Problems and perspectives.

Child custody and visitation remain vexing problems requiring input from mental health professionals as public policy decisions are formulated. Difficult problems do not have easy solutions, but through continued exploration of the issues using clinical and research methods, perhaps innovative programs will be developed and evaluated. Ultimately, this may lead to better ways of helping families cope with the trauma and the consequences of the family break-up and the resulting attempt to establish custody and visitation.

Examining the application of the guilty but mentally ill verdict in Michigan.

The insanity defense has come under increased criticism after the highly publicized acquittal of John Hinckley, Jr. A variety of proposals have been suggested to rectify the perceived injustices of an insanity acquittal. In 1975 Michigan passed a guilty but mentally ill statute that allowed for individuals to be found mentally ill at the time of the offense but still criminally responsible for their actions. The authors review the history of the Michigan statute, scrutinize an empirical study of the statute's effectiveness, and debate a number of controversial issues. They suggest that guilty but mentally ill may be a misleading verdict established because of purely political motives.