The forensic in forensic psychiatry derives ultimately from forum, the open area where disputes were aired and resolved; a similar historical origin attends the word court, from the courtyards where the same process took place. Some of the earliest forensic psychiatrists who aided the court were called alienists, and that term does capture nicely one aspect of forensic work: To most practicing clinicians, going to court for any reason is about as alien an experience as anything they have encountered. There are, of course, those hardy--or foolhardy--few that plunge into the legal system with enthusiasm and relish the tension, drama and battle of wits that the courtroom provides. Those are the forensic psychiatrists of today.
This review will address the role of forensic psychiatry as a specialty, or perhaps more accurately, a subspecialty, of psychiatry. In spite of the salient and defining differences from clinical psychiatry, good forensic psychiatry rests firmly on a clinical foundation.
What Is Forensic Psychiatry?
The code of ethics of the American Academy of Psychiatry and the Law (AAPL) (1995) defines forensic psychiatry as follows (adopted May 20, 1985):
Forensic Psychiatry is a subspecialty of psychiatry in which scientific and clinical expertise is applied to legal issues in legal contexts embracing civil, criminal, and correctional or legislative matters: forensic psychiatry should be practiced in accordance with guidelines and ethical principles enunciated by the profession of psychiatry.
Forensic psychiatry honors familiar ethical principles, namely confidentiality, consent and the need for appropriate qualifications (AAPL, 1995). However, it also stresses as core principles, honesty and striving for objectivity. Another way to express this is to say that the task of the forensic psychiatrist is to protect the truth from both attorneys, each attempting to sway the psychiatrist toward that respective side of the case (Gutheil et al., 2003). As the discussion of the British debate will show, however, forensic psychiatry proceeds from a markedly different ethical base compared to clinical work.
In practice, forensic psychiatry embraces a spectrum of activities at the interface of psychiatry and law. Two major divisions are participation as expert witness functions in criminal and civil litigation. In essence, this process involves teaching the attorney about the psychiatric elements of the case and then teaching judges or juries the same.
Yet another segment of the forensic population performs institutional forensic work in prisons or forensic hospitals. Other forensic psychiatrists consult to legislatures and regulatory bodies such as licensure boards and ethics committees of professional organizations.
AAPL (1995), Ethical guidelines for the practice of forensic psychiatry. Available at:www.emory.edu/AAPL/ethics.htm. Accessed April 7, 2004.
Appelbaum PS (1990), The parable of the forensic psychiatrist: ethics and the problem of doing harm. Int J Law Psychiatry 13(4):249-259.
Gutheil TG (1998), The Psychiatrist as Expert Witness. Washington, D.C.: American Psychiatric Press.
Gutheil TG, Hauser M, White MS et al. (2003), "The whole truth" versus "the admissible truth": an ethics dilemma for expert witnesses. J Am Acad Psychiatry Law 31(4):422-427.
Stone AA (1984), The ethical boundaries of forensic psychiatry: a view from the ivory tower. Bull Am Acad Psychiatry Law 12(3):209-219.