Treating ‘Morally Objectionable’ Patients


James L. Knoll IV, MD, shares insights from his decades in forensic psychiatry, where he has treated some of the criminal justice system’s most difficult and dangerous patients.


Psychiatrists are not strangers to difficult and even potentially dangerous patients, but James L. Knoll IV, MD, has made these populations one of his specialties. With decades of experience in forensic psychiatry, Knoll takes listeners deep into the US criminal justice system, where he treats both inmates suffering from detention-related psychiatric disorders and an especially challenging group that he has dubbed morally objectionable patients.

In this conversation, Psychiatric TimesTM and Knoll cover:

  • What he means by the term morally objectionable patients.
  • How prisons’ strict social hierarchies can contribute to psychiatric illnesses.
  • The high prevalence of bipolar disorder and schizophrenia in corrections—and their potential causes.
  • The different challenges of treating patients in prisons vs jails.
  • Why inmates with psychiatric illnesses end up in the correctional system for longer than those without psychiatric illnesses.
  • The role of mental health courts in improving psychiatric care in the correctional system.
  • The challenges of treating patients who are high in psychopathy or have anti-social personality disorders.

This is the first half of the Psych Pearls podcast with Dr Knoll. Listen to the second half of our interview, in which Knoll talks about how he first became interested in forensic psychiatry (at age 10).

Dr Knoll is professor of psychiatry and director of forensic psychiatry at SUNY Upstate Medical University in Syracuse, New York, and clinical director of Central New York Psychiatric Center in Marcy, New York. He is Emeritus Editor-in-Chief of the Psychiatric TimesTM and President-elect of the American Academy of Psychiatry and the Law (2022-23).

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