Clarifying Human Dignity in Forensic Practice.

The notion of human dignity remains a relatively complex concept that has roots in classical Greek and Roman antiquity and links to religious teachings and Kantian philosophical notions. From the Latin dignitas, human dignity means worth and implies excellence and distinction. Human dignity, also found in 20th century constitutions and international declarations, has been considered in bioethics, general medicine, and psychiatry. The application of dignity to forensic psychiatry practice has received less attention. Through a review of texts in medicine and related fields, such as philosophy and anthropology, we aim to clarify the concept of human dignity and its application in forensic psychiatry practice. We first outline the historical origins of the term. We then consider several varieties of human dignity applied in medical ethics and psychiatry. We review individuals' lived experiences of indignity and dignity's place in forensic practice in different loci. We present recent scholarship related to human dignity and highlight the importance of dignity in forensic practice. Focusing on dignity in evaluator-evaluee and doctor-patient relationships should improve forensic work. Training in dignity-imbued forensic practice should remind us of the human dimensions of those we serve in the forensic arena.

Illuminating Sociocultural and Ethnocultural Consciousness in Forensic Practice.

In recent decades, there has been an evolution in forensic psychiatry and psychology toward closer examination of the professionals' attitudes and intentions in their practice. We theorize that the progressive change reflects increased attention to the experiences of evaluators and evaluees in their social worlds. This cultural focus complements the traditional emphasis on biomedical elements, such as neuropsychiatric disorders. We suggest that sociocultural factors (such as poverty, trauma, and sexual orientation) and ethnocultural factors (such as those related to ethnic status, discrimination, and racialized application of risk assessment) have contributed substantially to these developments in forensic practice. We utilize past and current literature to illustrate the change and to frame it as a way of improving practice. This is a call for forensic practitioners to enhance their awareness of the impact of social and ethnocultural factors. We recommend further examination of these ideas by training programs and broader scholarly discussion in educational forums.

Dignity and Transcultural Forensic Consultation.

We analyze and comment on a legal case (Edward Gatherer v. Drexel Gomez, 1989) from Barbados. We theorize that in this kind of case a forensic psychiatrist consultant could helpfully advise the principals regarding pitfalls to avoid in resolving their conflict. Use of the consultant has certain advantages over taking such disputes to courts of law. In this case the rector of an Anglican Church in Barbados sued the bishop of his diocese. At question was whether the mandatory retirement age of 65 years applied to the rector. The case was eventually appealed to the United Kingdom's Judicial Committee of the Privy Council, and their decision was rendered in June 1992 in favor of the plaintiff. We describe a reference framework of techniques and methods that we think would be useful in this hypothetical forensic consultation. One important aspect of the analysis and case commentary is that going to court circumvents the obligation of those having disputes in this unique space to safeguard each other's dignity. The court system ignores reconciliation of the disputants to each other and to the Church body. We explore the complexity that attaches to transcultural forensic consultation.

The risks and responsible roles for psychiatrists who interact with the media.

Journalists often turn to psychiatrists for analysis of medical, social, political, and cultural events that involve human behavior and illness. Once journalists seek their expertise, psychiatrists often rush to be helpful, which can lead to ineffective performance and to statements that may run afoul of principles of professional ethics. In this article, we discuss the bases on which the professionalism of psychiatrists may be impugned when they commit errors in their media presentations. Found within the Principles of Medical Ethics with Special Annotations Especially Applicable to Psychiatry, the Goldwater Rule prohibits certain behaviors when psychiatrists share professional opinions with the public. We first discuss the Goldwater Rule, highlighting the events that led to its development and the professional response to its enactment. We then present a method to guide psychiatrists in their interaction with the media that will help them avoid violating ethics principles or the law. The method encourages knowledge of a framework of ethics principles that in turn guide the psychiatrist's behavior and thinking as he contemplates accepting invitations to interact with the media. The ethics-based roles include the Teacher, the Storyteller, the Celebrity Commentator, the Hollywood Consultant, the Clinician, and the Advertiser.

Pursuing the journal mission.

The mission of The Journal of the American Academy of Psychiatry and the Law, as articulated in its Instructions for Authors, is to be a forum for the exchange of multidisciplinary ideas and thoughtful and respectful scholarly analyses related to the theory and practice of forensic psychiatry. Recent refinements of The Journal's structure and policy can be understood as an effort to articulate a vision for emphasizing vibrant exchange of diverse scholarly activities and ideas expressing the highest levels of professionalism and concern for the ethics of forensic psychiatry and publishing. In this article, we explore the challenges encountered in realizing that vision, including managing the tone and level of discourse, creating structure without inhibiting creativity, demonstrating respect for persons in the use of case report material, expanding and guiding the utilization of peer review, promoting the new voices of authors with less writing experience, defining conflicts of interest for publishing purposes, and maintaining editorial independence in the context of serving organizational needs. We illustrate these challenges with recent experiences, explicating the decisions of the senior editors in an effort to be transparent about The Journal's processes and to encourage feedback from our readers about the adequacy of these practices.

Cultural competence in correctional mental health.

Cultural competence is an essential aspect of competence as a mental health professional. In this article, the framework of cultural competence developed in general psychiatry-acquiring knowledge, attitudes, and skills necessary to understand the interaction between culture and the individual-is applied to the prison setting. Race and ethnicity, extremes of age, gender, and religion are highlighted and examined as elements of the overall culture of prisons. The model of the cultural formulation from the DSM-IV is then adapted for use by clinicians in the correctional setting, with particular emphasis on the interaction between the inmate's culture of origin and the unique culture of the prison environment.

Ethics in forensic psychiatry publishing.

Several organizations have developed guidelines to help authors and editors of medical journals negotiate ethics dilemmas in publishing, but very little is known about how these guidelines translate to the context of forensic psychiatry. In this article, we explore the important topic of ethics in forensic psychiatry publishing. First, we review the historical development of ethics principles in medical and psychiatric publishing. We then analyze eight ethics dilemmas that have arisen in the publication of The Journal of the American Academy of Psychiatry and the Law (The Journal) from 2000 to 2009, including disputes about authorship, conflict of interest, redundant publication, bias in peer reviewers, confidentiality in case reports, and others. We identify ethics principles that were relevant to the dilemmas and discuss how they were resolved by the editors of The Journal. We conclude by using the principles identified in the practical resolution of ethics dilemmas to derive a conceptual foundation for ethics in forensic psychiatry publishing.

Oral performance, identity, and representation in forensic psychiatry.

The specialty of forensic psychiatry is advancing in practice and in its scholarship. One task for an evolving discipline is to define and master the nature of its work. In this article we assert that the work of testifying in court is more than the sharing of specialized knowledge. It is performance. Anthropology, religious studies, political science, and psychology (among other disciplines) have investigated elements of face-to-face human interaction set within ritual and credentialed it as worthy of attention and belief. Such is the nature of expert testimony within forensic psychiatry. This is our position, but we also consider well-founded concerns about the ethics of highlighting oral performance. These topics emphasize the need for the discipline to recognize the unique nature of testimony, to master the work and control standards that assure excellence and ethics-based practice.

Conceptualizing the forensic psychiatry report as performative narrative.

Forensic psychiatry has evolved into a recognized specialty. Two core competencies, often overlooked but commonplace in forensic psychiatry, are the constructing of forensic reports and the presenting of oral testimony. This article concerns the written forensic report and conceptualizes it as performative writing. We first review the development of the forensic report's structure over the past 30 years or so and then apply constructs from other disciplines as we propose a process for creating narrative forensic reports. Such writing is grounded in the discipline of psychiatry, relies on ethics-based principles of respect for persons and truth-telling, and uses language to tell a story that persuades the legal audience. We examine the impact of voice, pitfalls to avoid, and the concepts of witnessing and labeling, as we describe the process of formulating the narrative through the voice of the forensic expert.

Stone's views of 25 years ago have now shifted incrementally.

Twenty-five years ago, a major article by Professor Alan Stone on ethics in forensic psychiatry was published. It caused reverberations on a national scale. After the seismic shocks that he had provoked settled down, several thoughtful forensic psychiatrists set out to take serious stock of his critique and to articulate ways in which corrective actions could be taken. Indeed, slightly more than a decade later, I critiqued Stone's ideas in my Presidential Address to the Annual Meeting of the American Academy of Psychiatry and the Law. It is a unique privilege now to evaluate what Stone currently says about ethics in forensic psychiatry. While his present positions are slightly different from his arguments of 25 years ago, Stone still holds dearly to his ivory tower, which remains almost impermeable to the voices of those working in the trenches.

Commentary: the place of performative writing in forensic psychiatry.

In this issue of the Journal, Robert Simon has explored the subject of the place that writing should occupy in the professional life of forensic psychiatrists. We have taken the platform so elegantly constructed by this erudite and prolific author and used it to discuss the quotidian and concrete task of writing the customary forensic psychiatry report. We look to other disciplines for mechanisms to analyze the written forensic report: concepts of voice, portraiture, and narrative. We ultimately conclude that preparing these reports is a complex undertaking and that writing with clarity, precision, and artistry in forensic psychiatry should be viewed as a core competency.

Cultural stereotypes die hard: the case of transracial adoption.

Transracial adoption (commonly understood as the adoption of black children by white families) has been the subject of a persistent debate among adoption specialists, legal advocates, mental health professionals, and even civil rights advocates in this country for a long time. This has been so despite cumulative research evidence indicating that transracial adoptees can thrive and develop into confident adults with strong senses of identity and self-esteem. We contend that the evidence undergirding transracial adoption has not been effectively persuasive because of the tenacious and ubiquitous cultural belief that children and their potential adoptive parents should be matched along racial lines. However, the cultural principle of racial matching has also been diluted by judicial decisions that have narrowly allowed the use of race as one factor rather than as the controlling factor in adoption decisions. This article focuses on the use of a third element--federal statutory attempts intended to remove race as a controlling factor in child placement decisions. We will show how as a matter of public policy, the statutory efforts were meant to promote race-neutral approaches to adoption and to support transracial adoptions. However, in practice, the statutory attempts may still leave the door open to continued race-matching, which suggests that the cultural preference for race-matching in the construction of families remains powerfully ingrained and difficult to eradicate. As a consequence, transracial adoption appears to maintain its status as a culturally suspect phenomenon.

Pathological lying revisited.

Although pathological lying was first described in the medical literature over 100 years ago, it remains a poorly understood concept. Psychiatrists continue to grapple with the full ramifications of the condition, even though interest specifically in pathological lying seems to have waned in recent times. The impact of pathological lying deserves critical attention from forensic psychiatrists because of the implications that untruths have in a legal context. In this article, the authors review the considerable vagueness and confusion that has surrounded this concept and examine the extent to which a person can control lying behavior and the related question of whether pathological liars have responsibility for their actions. While providing a structured framework for considering pathological lying in the forensic context, the authors conclude that further systematic research is needed to resolve the questions raised in this article.

Personal narrative and an African-American perspective on medical ethics.

In recent years, there has been increasing interest in how medical professionals develop and articulate a moral foundation on which to base a way of leading their professional lives. In this essay, however, the author focuses more narrowly on how black physicians do it. The author explains that black physicians confront a unique set of circumstances and experiences that define reality for black doctors and other professionals from non-dominant groups in the United States. From this particular background, black physicians go on to develop a unique perspective on medical ethics. The author uses his own narrative to demonstrate his argument and to show its application to a current debate on the ethics of forensic psychiatry practice.