1. Forensic Psychiatry

2. Chapter 17 Forensic Psychiatry
Antisocial Personalities
Stalkers
Competency to stand trial

4. What is forensic psychiatry?
Forensic psychiatry is a branch of medicine which focuses on the interface of law and mental health.
It may include psychiatric consultation in a wide variety of legal matters
expert testimony
clinical work with perpetrators and victims.

5. forensic psychiatrist vs. psychologist?
A psychiatrist is a medical doctor (M.D. or D.O. in the U.S.) who has completed several years of additional training in the understanding, diagnosis, and treatment of mental disorders.
A forensic psychiatrist is a psychiatrist who has additional training and/or experience related to the various interfaces of mental health (or mental illness) with the law.

6. Forensic psychiatrist vs Forensic psychologist
Psychiatrists are physicians with specialty training in the understanding, diagnosis, and treatment of mental disorders.
This includes:
biological evaluations and treatments
(such as laboratory tests and medications)
psychotherapy, and family & social issues.
Doctoral-level psychologists do not go to medical school,
Have special expertise in topics not usually studied in detail by psychiatrists (such as psychological testing).

7. How is forensic psychiatry useful to the legal process?
When legal matters involve issues outside lay (general public) expertise, lawyers and judges regularly seek consultation from professionals in a wide variety of fields, including medical specialties.
Such professionals are often called "experts" or "expert witnesses."
Forensic experts usually are truly knowledgeable, the criteria for "expert" designation in such cases are legal ones, and not necessarily scientific.
Sometimes the expertise is sought in an effort to provide the best possible information to judges or juries, but there are many other situations in which a prudent attorney, judge, or other party may request consultation.

8. Are forensic psychiatrists "advocates" for one side or the other in legal matters?
Usually not.
Ethical forensic psychiatrists try to avoid bias.
They focus on the data or evidence within their areas of expertise, and comment objectively on the information as they see it.
Are often consultants to advocates (lawyers) or courts, and at other times may participate in advocacy strategy, but consider it unethical to combine our expert opinions (testimony, reports, or affidavits, for example) with advocacy per se.
Ethical forensic psychiatrists do not accept contingency fees or otherwise conduct themselves in ways that may interfere with, or imply, a lack of professional objectivity.

9. Doesn’t the expert have an incentive to agree with the lawyer, so he or she can testify and make money?
In most cases, no.
Ethical experts are paid for their time, not their testimony.
Since the time spent forming the opinion usually far exceeds time spent testifying, most payment is received regardless of whether or not the expert testifies.
Forensic psychiatrists are similar to most other professionals in their respect for their work and their clients. The minority who "cheat" in some way risk severe censure and loss of credibility.

10. What Does a Forensic Psychiatrist Do?
Most forensic psychiatrists don't specialize in criminal matters.
The word "forensic" refers to anything that has to do with the law.
When may Forensic psychiatrists be involved with:
criminal matters
civil litigation (such as malpractice lawsuits)
competence to do things (like make a will, consent to medical care, or take care of children)
child custody
treating and working with mentally ill people who get in trouble with the law
helping victims of crimes
helping lawyers and judges understand the psychological aspects of their cases.

11. Here are three things they are not:
(1) We're not lawyers. We may work with lawyers, or try to understand the legal aspects of the matter we're working on, but our job is to be good doctors who can translate what we know into something useful for the legal system, not to be lawyers ourselves.
(A few forensic psychiatrists and psychologists have law degrees as well as medical ones. In my view, those folks usually do best when they pick one role or the other.)
(2) We're not judges. We don't interpret the law or tell judges or juries how they should rule. Most of the time, psychiatric issues are only a small part of the entire legal matter being considered. Sometimes we're asked to give an opinion about those psychiatric issues, but that's to help the judge or jury decide, not to tell them what to do.
(3) We're not cops. We aren't the folks who protect the community, deal with dangerous or criminal situations, or contain the bad guys. That's not our area of expertise, and nobody gives us permission to do it anyway.

12. Antisocial Personalities
Many use the terms sociopath, psychopath and antisocial personality disorder (APD) interchangeably.
Anti-social personality disorder results in extremely violent acts.
Though psychiatrists often consider and treat sociopaths and psychopaths as the same, criminologists treat them as different because of the difference in their outward behavior.

13. Antisocial Personalities
To receive a diagnosis of Antisocial Personality Disorder (APD), a patient would likely exhibit difficulty or refusal conforming with social norms and laws.
Someone with APD would also show:
a chronic lack of remorse for actions they have committed that have hurt others.
Their conscience does not weigh heavy with mistakes that they've made that have caused others pain.
would be able to justify their behavior without feeling shame or regret about the way that it has affected others.
Those with APD may also display:
a pattern of lying and deceitfulness,
impulsive behavior,
disregard for the safety of themselves and those around them.
They may also exhibit difficulty sustaining regular work and be unable to fulfill their financial obligations.( but not always)

14. Antisocial Personalities J.M.s Macdonald triad
The Macdonald triad is also known as the triad of sociopathy. It was first identified by a forensic psychiatrist, John Marshall Macdonald (November 7, December 16, 2007), in a 1963 paper in the American Journal of Psychiatry titled "The Threat to Kill".
The Macdonald triad is a set of three behavioral characteristics which are associated with sociopathic behavior. These behavioral characteristics are found in the childhood histories of individuals with sociopathic behavior:
Enuresis (bedwetting)
Fire setting
Torturing small animals
The Macdonald triad is considered predictive of future criminal behavior.

15. What is the difference between a Psychopath and Sociopath?
Both have a complete disregard for the feelings and rights of others.

16. Psychopaths and Sociopaths
Both have a complete disregard for the feelings and rights of others.
These traits are distinct and repetitive, creating a pattern of misbehavior that goes beyond normal adolescent mischief.

17. Psychopaths and Sociopaths
Outward Behavior of a Psychopath
a psychopath would calmly and carefully plan revenge in a way that would avoid them getting caught
Can be almost obsessively organized.
Maintain normal social relationships.
may take care of aging parents or be married with children.
Will often be very successful in their careers.
Their need for organization is coupled with an ability to make others like and trust them.
Because they intellectually understand human emotions but are unable to experience them themselves, they are masters at emotional manipulation.
They often live in a normal house or apartment, completely indistinguishable from healthy people.
Psychopaths will take years to plan out acts of violence and revenge.
They are very difficult to catch because they will carefully plan each step of the act to ensure they will commit their crime undetected.
Outward Behavior of a Sociopath
A sociopath would be a person who lashed out at someone they were angry with
Sociopaths tend to be extremely disorganized.
They are unable to maintain normal relationships with family, friends, or co-workers.
They are often unable to keep steady employment or housing.
They often live literally at the fringes of society.
Their outbreaks of violence are erratic and unplanned.
Sociopaths are easier to identify and apprehend as they generally leave behind a large trail of clues.

18. Classic Psychopaths and Sociopaths
Outward Behavior of a Psychopath
Outward Behavior of a Sociopath

19. Why might a person stalk a celebrity?
Do Now :
Why might a person stalk a celebrity?
From today’s headlines:
Woman stalked for ten years:
Paula Goodspeed, 30,,

20. Do Now: Is stalking socially acceptable? Logically Defend your answer.
As a dad how would you react to this story?

21. "The Lloyd Dobler Effect".
Emily, like me, is a crazy fan of John's, specifically of his Lloyd Dobler role in Say Anything
Well Is It?

22. Stalking Eight million American women -- or one in 12 –
will be a victim of stalking at some point in their lives.
-Kristin Ohlson

23. How does this note sound?
I've been alone with you inside my mind And in my dreams I've kissed your lips a thousand times I sometimes see you pass outside my door Hello, is it me you're looking for?
I can see it in your eyes I can see it in your smile You're all I've ever wanted, (and) my arms are open wide 'Cause you know just what to say And you know just what to do And I want to tell you so much, I love you ...

24. How does this note sound?
Broke into the old apartment This is where we used to live Broken glass, broke and hungry Broken hearts and broken bones This is where we used to live
Why did you paint the walls? Why did you clean the floor? Why did you plaster over the hole I punched in the door? This is where we used to live
Why did you keep the mousetrap? Why did you keep the dishrack? These things used to be mine I guess they still are, I want them back

25. How does this note sound?
Every move you make Every bond you break Every step you take Ill be watching you Every single day Every word you say Every game you play Every night you stay Ill be watching you Oh, cant you see You belong to me How my poor heart aches With every step you take

26. What is Stalking ?
a set of "behaviors that last more than two weeks and involves repeated and persistent attempts to impose on another person unwanted contacts and/or communications which induce fear or distress."
-Paul Mullen, M.D.
“He always told me he would make me sorry,”
“I never dreamed he would do it by killing our child.”

27. Who is doing the Stalking ?
____% of the stalkers were male
____% of the stalkers were ex partners of the victims
____% had some form of relationship with the victim
Who is stalked the most??
ex-partners professional relationship, fellow employees,
customers casual acquaintances
the stalkers who assaulted were most likely to be ____?
-(Mullen, Pathe, Purcell, Stuart, 1999: 1244)

28. Who is doing the Stalking ?
79% of the stalkers were male
30% of the stalkers were ex partners of the victims
86% had some form of relationship with the victim,
including ex-partners (36%),
professional relationship (23%)
fellow employees or customers (11%)
casual acquaintances (19%)
36% (52) of the stalkers attacked their victims, 14 involved sexual assault
the stalkers who assaulted were most likely to be rejected ex partners.
’ (Mullen, Pathe, Purcell, Stuart, 1999: 1244)

29. Do Now: Michael Barrett vs. Erin Andrews'
Barrett is suspected of renting hotel rooms next to Andrews three times and shooting two videos of her. He is accused of posting the videos online.
Andrews called the experience a nightmare in a September interview with Oprah Winfrey.
What kind of stalker would he be?

30. According to a 1998 study by the Department of Justice.
8% of women will be stalked in their lifetime
Women
aged 18 to 35 (11%)
aged 36 to 55 (8 %)
56 or older (4%)
-Paul Mullen, M.D., at APA’s 2001
2% of men will be stalked in their lifetime
Men
ages of 18 and 35 (8%)
aged 36 to 55 (4%)
aged 56 and older (3%),
Professor of forensic psychiatry at Monash University in Victoria, Australia.

31. Do Now: In what ways can stalkers communicate with their victims?
“I have to eliminate what I cannot obtain.”
Bardo,in a letter to his sister
Later he killed Rebecca Schaeffer

32. Do Now: Answers
In what ways can stalkers communicate with their victims?
telephone, , fax, letters, notes, gifts
Attempt to be physically close to the victim by approaching, following, surveilling, and loitering near that person

33. How might you describe the stalker’s profile?
“He always told me he would make me sorry,”
“I never dreamed he would do it by killing our child.”

34. How might you describe the stalker’s profile?
Usually an isolated and shy person , May be unemployed
Social Failure: one who lives alone, lacks any type of important intimate relationship
Narcissistic personality disorder and very low self-esteem.
The stalker feels that they're the most important person in the world."
Many people stalk someone they have only met briefly
Someone they don't really know, or barely know.

35. What are Mullen’s Five Categories of Stalkers

36. Mullen’s Five Categories of Stalkers

37. 1. The Rejected Suitor
Sometimes a partner rejected by their spouse or lover may waver between overtures of reconciliation and revenge. They have a narcissistic sense of entitlement and belief this is the only relationship they are going to have.
More than 80% of rejected stalkers in Mullen’s study had personality disorders.
Therapeutic treatment of the rejected stalker involves helping him or her come to terms with the end of the relationship.
"Even if I did do this, it would have to have been because I loved her very much, right?" - OJ Simpson

38. 2. The Intimacy Seeker
The intimacy-seeking stalker intends to establish a relationship with his "true love" regardless of her wishes.
More than half of the intimacy seekers Mullen evaluated were delusional, believing that their love was reciprocated, and nearly a third had a personality disorder and a delusion that their quest would be ultimately successful.
Legal actions do not work well with intimacy seekers, who may justify their behavior with the belief they must pay a price for true love.
The court may order treatment, which should focus on treating their delusions or other mental disorders.

39. 3. The Incompetent Suitor
This type is typically a man who had been rebuffed after asking a woman for a date.
He’s often socially inept, and when rejected, begins to stalk with the hope that his persistent behavior will change the woman’s mind.
The incompetent suitors can be responsive to judicial sanctions but are also likely to relapse.

40. 4. The Resentful Stalker
These offenders express anger in response to a perception that they have been humiliated or treated unfairly by the object of their obsession.
They thrive on having a sense of power and control over the victim, and are hard to treat because they often see themselves as the victim.

41. 5. The Predatory Stalker
Predator plans their attack, rehearses it, has lots of sexual fantasies about it.
Derives pleasure from gathering information about the target and fantasizing about the assault.
Doesn't necessarily know the victim.
The victim may not know she is being stalked.
They often have prior convictions as sexual deviants.

42. Lets see who’s a stalker..
I love you

43. Do Now : What might concern you about this letter?

44. Is Stalking acceptable??
Do Now
Why might a person stalk a celebrity?
From today’s headlines:
Know this Commercial?
Is Stalking acceptable??
Burger King Stalker

45. Do Now 11/13: ANSWER Why might a person stalk a celebrity?
may focus on a celebrity, especially if they've seen him or her in person at a public appearance like a concert.
Develop a relationship through viewing
Learn about their family and who they are from TV or Radio
"They develop convoluted thoughts about this person.
They feel this person is the answer to their dreams,"

46. Looking inside the letters

47. Two Questions: 1. Why did we leave off the Predatory Stalkers. 2
Two Questions: 1. Why did we leave off the Predatory Stalkers? 2. Predict which stalker is the most to be concerned about causing harm?

48. What is most concerning about the data below ?
Threats (%)
Assaults (%)
Rejected Suitor
71%
54%
Intimacy Seeking
50%
23%
Incompetent Suitor
32%
27%
Resentful Stalker
87%
25%
Predatory Stalker
33%

49. Predict which is the most to be concerned about?
The rejected and predatory stalkers are most likely to assault their victims.

50. When to Be Concerned The red flags:
You immediately start getting several phone calls or s right after meeting this person.
The person is clingy, controlling, or upset if you want to spend time with friends and family.
Marlon Pagtakhan stalked Jerry Ryan

51. How to Take action:
Tell everyone you know that this is going on -- your employer, friends, family.
Gently but firmly tell the person you've decided to move on.
Don't get drawn into discussions of why. Just say, "This situation isn't right for me" or "I'm not ready.." -- whatever you need to say, but say it gently.

52. Treatments for Victims
Mullen has found that cognitive-behavioral therapy works well in managing the anxiety stalking victims experience.
Medications such as SSRIs for some patients.
"It is important to inform and educate family members about the stalking and enlist their help in managing it," he stated.

53. Treatments for Victims
Stressed that victims of stalking, like victims of sexual or physical abuse, often blame themselves for the situation.
Because they feel shame or misplaced guilt, they do not share their ordeal with others and become more isolated and afraid
Counseling the victim to realize that he or she is not responsible for the stalking.
Advises victims to file a complaint with the police if the stalking episodes continue for more than two weeks.
"To prove that the perpetrator is guilty of a crime and have the court order treatment, evidence is critical. Do not destroy answering-machine tapes, notes, letters, s, or gifts in a moment of distress," he advised

54. Professionals at Risk, What about the victims?
"Professionals who work with the lonely and unstable are at risk of being stalked," said Mullen.
Estimated that about 15 percent have been stalked by a patient during their career.
Victims are often forced to alter their lives to avoid the stalker.
Mullen’s study found:
53% of his subjects quit or changed jobs
40% moved to a different home
70% curtailed social activities.

55. Professionals at Risk, What about the victims?
In addition to the physical dangers, stalking takes a severe psychological toll on its victims.
83% Subjects were diagnosed with an anxiety disorder
37% with posttraumatic stress disorder (PTSD).
Additional 18% had PTSD symptoms but did not meet formal diagnostic criteria.
24% had ideas of suicide
25% percent increased their alcohol consumption and/or cigarette smoking

56. Pics

57. The Stalking Death that Changed the Law
In the late 1980s, a young actress named Rebecca Lucile Schaeffer was struggling to find her big break into show business. Born in 1967, the only child of a psychologist and a writer, Rebecca was sleek, svelte and beautiful. Her beauty landed her on the cover of Seventeen magazine. She was at the beginning of a promising career as an actress when an unemployed Tucson, Ariz., fast-food worker, who had developed an obsession with her, struck her down in 1989.

58. Insanity standards
In 1981, John Hinckley was found not guilty by reason of insanity (NGRI) for his attempted assassination of President Ronald Reagan.
Public outrage about the verdict led to demands for reform. As a result, the Federal Insanity Defense Reform Act of 1984 narrowed the insanity standard in federal jurisdictions. The revised federal standard is a McNaughtan standard with the requirement of a severe mental disease or defect at the time of the act:
“At the time of the commission of the acts the defendant, as a result of severe mental disease or defect, was unable to appre­ciate the nature and quality or the wrongfulness of his acts.”3

59. What information would you use/consider when evaluating a patient.

60. What Behavioral Evidence should be considered when evaluating the knowledge of wrongfulness?

61. Patterns of mental Disorders

62. -END