James L. Knoll IV, MD

Here, Psychiatric Times presents the first recorded version of Dr James Knoll's Tales from the New Asylum-Yesterday. "He was five floors up, grasping the outside railing of a medium-security prison dormitory balcony . . ."

Attempting to write an article about 9/11 is fraught with peril from the outset. What can be said that is not repetitious? Then there is the ever present risk of offending those whose lives were forever changed in an overawing, tragic manner.

Here’s why it is painful to see a man cry: he's not supposed to. Emotions are arresting when society tells us they should not be expressed. In the case of a grown man crying, there are some thousands of years of cultural training laying down the prohibitive regulations.

Amidst sexting congressmen, philandering French IMF directors, and gallivanting governors, I suspect many psychiatrists have been accosted with questions from friends and colleagues. Such questions generally conform to some permutation of “What makes a person do that?”

The usual response is that the new requirements are too "confusing." Here, Dr Knoll offers his suggestions and advice?

Physicians are required to fill the compartment of their neuro-crania with much in the way of thought content. Many years later, they may find the surplus of that content resurfacing.

Can the death of a terrorist be something to celebrate? Should it be? What can this tell us about ourselves? What is the "proper" reaction?

Whenever a suicide happens in the New Asylums, a palpable, muted dread descends over the institution. It stays there in full force for weeks and months afterwards, sometimes longer. After that, it is added as another sedimentary layer to the strata and culture of the particular institution. Before things get too deeply buried, it is important to excavate.

II would have to wait until the next day, when K’s internal flames of resistance had died down, to learn why he had burned so fiercely. When we finally sat across from one another, his embers still glowed, and I learned that the source of his combustion had been the classic lose-lose scenario.

Addressing a few subjects that may have the potential to create a more insidious and enduring form of misrepresentation ... namely, the implications that psychiatrists must now “play the game,” and resign themselves to a bleak future of harried pill dispensing. 

Pascal’s “Wager” uses “reason” to conclude that even though the existence of God cannot be determined, one should nevertheless “wager” as though God exists, because one has everything to gain, and nothing to lose.

I recently shared a research article on “no-suicide contracts” with a colleague who is very knowledgeable about suicide. That article concluded--as virtually all the previous literature had-that use of suicide prevention contracts (SPC) remains a questionable clinical practice intervention.

The psychiatric emergency room (ER) is an intense, stressful work environment where psychiatrists must perform rapid assessments and make swift treatment decisions.

The movie Bronson loosely follows the true story of the infamous "most violent prisoner" in the UK -- a man named Michael Peterson who later changed his name to Charles "Charlie" Bronson on the advice of his bare knuckle boxing promoter.

Consider your pearly whites. You probably take 'em for granted anyway. When was the last time you flossed?

A funny thing happened to me on the way back from the New Hampshire Governor’s Statewide Conference on Domestic & Sexual Violence. I don’t mean funny in a comedic sense, but rather in an unexpected, shocking sense.

The next I heard of the Prince, my hopes that he had reshaped his consciousness in a more healthy direction were dashed. The Prince was in solitary confinement as punishment for another attempt to establish his empire.

Morally motivated decision making has been increasingly studied by the social sciences, and distinctive patterns are emerging. Most subjects begin to have serious moral reservations as their decisions come closer to directly affecting a human life.

He had returned to a familiar place, and his peers welcomed him back. The word "recidivist" comes from the French word "recidiver," meaning to "fall back." This was not the first time he had fallen back. He would surely tell you that his return was not by choice, but sometimes such things are hard to determine.

As I came closer, I could see Mr P more clearly. He was in his own world, wearing a Walkman with earphones on. I puzzled for a brief moment over this-was this to shut out attempts to talk him down? I could also see more clearly the rivulets of blood dripping from the incisions on his wrists to the concrete ground below.

The subject of physician participation in interrogations continues to surface as an issue of debate.

A small percentage of educators use their position of power to sexually exploit their students. While it is assumed that men are often responsible for this type of behavior, in recent years, a number of high-profile cases of female educator sexual misconduct have been covered by the media.

It is rather difficult for me to avoid turning this greeting article into an homage to Dr Pies. My mirroring of his farewell piece2 with my title and preliminary quotes was meant to signify my great respect for him. How much I have learned and benefited from his wisdom, patience, knowledge, and compassion over the past 4 or so years cannot be measured.

The subject of physician participation in interrogations (either military or law enforcement related) continues to surface as an issue of debate. Why? Allow me to state what I believe undergirds most debates on this issue: terror. No, not terrorism per se, but terror of death.

Perhaps one of the positive things to come out of the Kansas v Hendricks wave of sexually violent predator (SVP) commitment laws during the past decade is that our knowledge base on sex offenders has grown tremendously.

I had lunch with Death some 12 or so years ago, as a chief resident in psychiatry. He was a bit hard to converse with. In fact, the exact opposite of how he had been when presenting grand rounds just an hour before.

It is my privilege and pleasure to highlight this Special Report on forensic psychiatry. (The first articles in this series appeared in the November issue and are posted on www.psychiatrictimes.com.) The respected authors provide us with the most recent thought on subjects that should be of interest to every practicing psychiatrist.

The process of adapting to prison life, or “prisonization,” exerts a dehumanizing effect that may result in feelings of hopelessness and alienation.

Clinicians who treat patients with strong antisocial traits commonly struggle with the tension between conceptualizing them as either man or beast.2 On one hand, there is the well-intended goal of helping the offender develop into a more functional “human being.” On the other, there are the common emotional reactions of anger, disgust, and even fear of predation.3

The insanity defense represents a prominent symbol of the relationship between law and psychiatry. Despite the fact that it is infrequently raised and seldom successful, the insanity defense is the subject of intense legal and public scrutiny.