Forensic Forensic PsychiatryPsychiatry

What is forensic What is forensic psychiatry?psychiatry?

Forensic psychiatry is a branch of Forensic psychiatry is a branch of medicine which focuses on the medicine which focuses on the interface of law and mental health. interface of law and mental health.

It may include psychiatric It may include psychiatric consultation in a wide variety of consultation in a wide variety of legal matters legal matters expert testimonyexpert testimony clinical work with perpetrators and clinical work with perpetrators and

victims. victims.

What is a forensic What is a forensic psychiatrist? psychiatrist?

A A psychiatristpsychiatrist is a medical doctor (M.D. is a medical doctor (M.D. or D.O. in the U.S.) who has completed or D.O. in the U.S.) who has completed several years of additional training in the several years of additional training in the understanding, diagnosis, and treatment understanding, diagnosis, and treatment of mental disorders. of mental disorders.

A A forensic psychiatristforensic psychiatrist is a psychiatrist is a psychiatrist who has additional training and/or who has additional training and/or experience related to the various experience related to the various interfaces of mental health (or mental interfaces of mental health (or mental illness) with the law. illness) with the law.

Forensic psychiatrist vs Forensic psychiatrist vs Forensic psychologist Forensic psychologist

Psychiatrists are physicians with specialty Psychiatrists are physicians with specialty training in the understanding, diagnosis, and training in the understanding, diagnosis, and treatment of mental disorders. treatment of mental disorders.

This includes:This includes: biological evaluations and treatments biological evaluations and treatments

(such as laboratory tests and medications)(such as laboratory tests and medications) psychotherapy, and family & social issues. psychotherapy, and family & social issues.

Doctoral-level psychologists do not go to medical Doctoral-level psychologists do not go to medical school, school, Have special expertise in topics not usually studied in Have special expertise in topics not usually studied in

detail by psychiatrists (such as psychological testing). detail by psychiatrists (such as psychological testing).

How is forensic psychiatry How is forensic psychiatry useful to the legal process?useful to the legal process?

When legal matters involve issues outside lay When legal matters involve issues outside lay (general public) expertise, lawyers and judges (general public) expertise, lawyers and judges regularly seek consultation from professionals in regularly seek consultation from professionals in a wide variety of fields, including medical a wide variety of fields, including medical specialties. specialties.

Such professionals are often called "experts" or Such professionals are often called "experts" or "expert witnesses." "expert witnesses."

Forensic experts usually are truly knowledgeable, Forensic experts usually are truly knowledgeable, the criteria for "expert" designation in such cases the criteria for "expert" designation in such cases are legal ones, and not necessarily scientific. are legal ones, and not necessarily scientific.

Sometimes the expertise is sought in an effort to Sometimes the expertise is sought in an effort to provide the best possible information to judges or provide the best possible information to judges or juries, but there are many other situations in juries, but there are many other situations in which a prudent attorney, judge, or other party which a prudent attorney, judge, or other party may request consultation. may request consultation.

Are forensic psychiatrists Are forensic psychiatrists "advocates" for one side or the "advocates" for one side or the

other in legal matters?other in legal matters? Usually not. Usually not. Ethical forensic psychiatrists try to avoid bias. Ethical forensic psychiatrists try to avoid bias. They focus on the data or evidence within their areas They focus on the data or evidence within their areas

of expertise, and comment objectively on the of expertise, and comment objectively on the information as they see it.information as they see it.

Are often consultants to advocates (lawyers) or Are often consultants to advocates (lawyers) or courts, and at other times may participate in courts, and at other times may participate in advocacy strategy, but consider it unethical to advocacy strategy, but consider it unethical to combine our expert opinions (testimony, reports, or combine our expert opinions (testimony, reports, or affidavits, for example) with advocacy affidavits, for example) with advocacy per seper se. .

Ethical forensic psychiatrists do not accept Ethical forensic psychiatrists do not accept contingency fees or otherwise conduct themselves in contingency fees or otherwise conduct themselves in ways that may interfere with, or imply, a lack of ways that may interfere with, or imply, a lack of professional objectivity. professional objectivity.

Doesn’t the expert have an incentive to Doesn’t the expert have an incentive to agree with the lawyer, so he or she can agree with the lawyer, so he or she can

testify and make money?testify and make money? In most cases, no. In most cases, no. Ethical experts are paid for their Ethical experts are paid for their timetime, not , not

their testimony. their testimony. Since the time spent forming the opinion Since the time spent forming the opinion

usually far exceeds time spent testifying, usually far exceeds time spent testifying, most payment is received regardless of most payment is received regardless of whether or not the expert testifies.whether or not the expert testifies.

Forensic psychiatrists are similar to most Forensic psychiatrists are similar to most other professionals in their respect for their other professionals in their respect for their work and their clients. The minority who work and their clients. The minority who "cheat" in some way risk severe censure "cheat" in some way risk severe censure and loss of credibility. and loss of credibility.

What Does a Forensic What Does a Forensic Psychiatrist Do? Psychiatrist Do?

Most forensic psychiatrists don't specialize in Most forensic psychiatrists don't specialize in criminal matters. criminal matters.

The word "forensic" refers to anything that has to The word "forensic" refers to anything that has to do with the law. do with the law.

Forensic psychiatrists thus may be involved with:Forensic psychiatrists thus may be involved with: criminal matterscriminal matters civil litigation (such as malpractice lawsuits)civil litigation (such as malpractice lawsuits) competence to do things (like make a will, consent to competence to do things (like make a will, consent to

medical care, or take care of children)medical care, or take care of children) child custodychild custody treating and working with mentally ill people who get treating and working with mentally ill people who get

in trouble with the lawin trouble with the law helping victims of crimeshelping victims of crimes helping lawyers and judges understand the helping lawyers and judges understand the

psychological aspects of their cases.psychological aspects of their cases.

Here are three things Here are three things they are they are not:not:

(1) (1) We're not lawyers.We're not lawyers. We may work with lawyers, or try We may work with lawyers, or try to understand the legal aspects of the matter we're to understand the legal aspects of the matter we're working on, but our job is to be good doctors who can working on, but our job is to be good doctors who can translate what we know into something useful for the legal translate what we know into something useful for the legal system, not to be lawyers ourselves. system, not to be lawyers ourselves. (A few forensic psychiatrists and psychologists have law (A few forensic psychiatrists and psychologists have law

degrees as well as medical ones. In my view, those folks degrees as well as medical ones. In my view, those folks usually do best when they pick one role or the other.) usually do best when they pick one role or the other.)

(2) (2) We're not judgesWe're not judges. We don't interpret the law or tell . We don't interpret the law or tell judges or juries how they should rule. Most of the time, judges or juries how they should rule. Most of the time, psychiatric issues are only a small part of the entire legal psychiatric issues are only a small part of the entire legal matter being considered. Sometimes we're asked to give matter being considered. Sometimes we're asked to give an opinion about those psychiatric issues, but that's to an opinion about those psychiatric issues, but that's to help the judge or jury decide, not to tell them what to do. help the judge or jury decide, not to tell them what to do.

(3) (3) We're not cops. We're not cops. We aren't the folks who protect the We aren't the folks who protect the community, deal with dangerous or criminal situations, or community, deal with dangerous or criminal situations, or contain the bad guys. That's not our area of expertise, and contain the bad guys. That's not our area of expertise, and nobody gives us permission to do it anyway. nobody gives us permission to do it anyway.

StalkingStalking

"Even if I did do this, it would have to have been because I

loved her very much, right?" - OJ Simpson

Do Now: Do Now:

Is stalking socially acceptable? Is stalking socially acceptable?

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

-Kristin Ohlson

Well Is It? Well Is It?

"The Lloyd Dobler Effect". Emily, like me, is an a crazy fan of John's, specifically of his Lloyd Dobler role in Say

Anything

What is Stalking ?What is Stalking ? a set of "behaviors that last more a set of "behaviors that last more

than two weeks and involves than two weeks and involves repeated and persistent attempts to repeated and persistent attempts to impose on another person unwanted impose on another person unwanted contacts and/or communications contacts and/or communications which induce fear or distress." which induce fear or distress."

--Paul Paul Mullen, M.D.Mullen, M.D.“He always told me he would make me sorry,”

“I never dreamed he would do it by killing our child.”

Who is doing the Who is doing the Stalking ?Stalking ?

____% of the stalkers were male____% of the stalkers were male ____% of the stalkers were ex partners of the victims____% of the stalkers were ex partners of the victims ____% had some form of relationship with the victim____% had some form of relationship with the victim

Who is stalked the most?? Who is stalked the most?? ex-partners professional relationship, fellow employees, ex-partners professional relationship, fellow employees, customers casual acquaintances customers casual acquaintances

the stalkers who assaulted were most likely to be the stalkers who assaulted were most likely to be ____?____?

-(Mullen, Pathe, Purcell, Stuart, 1999: 1244)-(Mullen, Pathe, Purcell, Stuart, 1999: 1244)

Who is doing the Who is doing the Stalking ?Stalking ?

79% of the stalkers were male79% of the stalkers were male 30% of the stalkers were ex partners of the victims30% of the stalkers were ex partners of the victims 86% had some form of relationship with the 86% had some form of relationship with the

victim, victim, including ex-partners (36%), including ex-partners (36%), professional relationship (23%) professional relationship (23%) fellow employees or customers (11%) fellow employees or customers (11%) casual acquaintances (19%)casual acquaintances (19%)

36% (52) of the stalkers attacked their victims, 14 36% (52) of the stalkers attacked their victims, 14 involved sexual assaultinvolved sexual assault

the stalkers who assaulted were most likely to be the stalkers who assaulted were most likely to be rejected ex partners.rejected ex partners.

’ ’ (Mullen, Pathe, Purcell, Stuart, 1999: 1244)(Mullen, Pathe, Purcell, Stuart, 1999: 1244)

According to a 1998 study According to a 1998 study by the Department of by the Department of

Justice. Justice. 8% of women will be 8% of women will be

stalked in their stalked in their lifetime lifetime

Women Women aged 18 to 35 (11%)aged 18 to 35 (11%) aged 36 to 55 (8 %) aged 36 to 55 (8 %) 56 or older (4%)56 or older (4%)

-Paul Mullen, M.D., at -Paul Mullen, M.D., at APA’s 2001 APA’s 2001

2% of men will be 2% of men will be stalked in their lifetime stalked in their lifetime

Men Men ages of 18 and 35 (8%)ages of 18 and 35 (8%) aged 36 to 55 (4%) aged 36 to 55 (4%) aged 56 and older (3%), aged 56 and older (3%),

Professor of forensic Professor of forensic psychiatry at Monash psychiatry at Monash University in Victoria, University in Victoria, Australia. Australia.

Do Now: Do Now: In what ways can stalkers In what ways can stalkers

communicate with their victims?communicate with their victims?

““I have to eliminate what I cannot obtain.”I have to eliminate what I cannot obtain.” Bardo,in a letter to his sisterBardo,in a letter to his sister

Later he killed Rebecca Schaeffer Later he killed Rebecca Schaeffer

Do Now: AnswersDo Now: AnswersIn what ways can stalkers In what ways can stalkers

communicate with their victims?communicate with their victims?

telephone, e-mail, fax, letters, notes, telephone, e-mail, fax, letters, notes, gifts gifts

Attempt to be physically close to the Attempt to be physically close to the victim by approaching, following, victim by approaching, following, surveilling, and loitering near that surveilling, and loitering near that personperson

Do Now 11/12:Do Now 11/12:What might concern you What might concern you

about this letter? about this letter?

How might you describe the How might you describe the stalker’s profile?stalker’s profile?

“He always told me he would make me sorry,” “I never dreamed he would do it by killing our child.”

How might you describe the How might you describe the stalker’s profile?stalker’s profile?

Usually an Usually an isolatedisolated and and shy person shy person , , May be May be unemployedunemployed

Social Failure:Social Failure: one who lives alone, lacks any one who lives alone, lacks any type of important intimate relationship type of important intimate relationship

Narcissistic personality disorderNarcissistic personality disorder and and very low very low self-esteem. self-esteem. The stalker feels that they're the most The stalker feels that they're the most

important person in the world." important person in the world."

Many people stalk someone they have Many people stalk someone they have only met only met brieflybriefly Someone they don't really know, or barely Someone they don't really know, or barely

know. know.

What are Mullen’s Five What are Mullen’s Five Categories of Stalkers Categories of Stalkers

Types Types of of

StalkersStalkers

Mullen’s Five Categories of Mullen’s Five Categories of Stalkers Stalkers

The The PredatoryPredatory

StalkerStalker

The The Resentful Resentful

StalkerStalker

TheThe Incompetent Incompetent

SuitorSuitor

IntimacyIntimacy SeekerSeeker

Rejected Rejected SuitorSuitor

Types Types of of

StalkersStalkers

1. The Rejected Suitor1. The Rejected Suitor

Sometimes a partner rejected by their Sometimes a partner rejected by their spouse or lover may vacillate between spouse or lover may vacillate between overtures of reconciliation and revenge. overtures of reconciliation and revenge. They have a They have a narcissistic narcissistic sense of sense of entitlement and belief this is the only entitlement and belief this is the only relationship they are going to have. relationship they are going to have.

More than 80% of rejected stalkers in More than 80% of rejected stalkers in Mullen’s study had personality disorders. Mullen’s study had personality disorders.

Therapeutic treatment of the rejected Therapeutic treatment of the rejected stalker involves helping him or her come stalker involves helping him or her come to terms with the end of the relationship. to terms with the end of the relationship.

2. The Intimacy Seeker2. The Intimacy Seeker The intimacy-seeking stalker intends to establish a The intimacy-seeking stalker intends to establish a

relationship with his "true love" regardless of her relationship with his "true love" regardless of her wishes. wishes.

More than half of the intimacy seekers Mullen More than half of the intimacy seekers Mullen evaluated were delusional, believing that their love evaluated were delusional, believing that their love was reciprocated, and nearly a third had a was reciprocated, and nearly a third had a personality disorder and a delusion that their quest personality disorder and a delusion that their quest would be ultimately successful. would be ultimately successful.

Legal actions do not work well with intimacy Legal actions do not work well with intimacy seekers, who may justify their behavior with the seekers, who may justify their behavior with the belief they must pay a price for true love. belief they must pay a price for true love.

The court may order treatment, which should focus The court may order treatment, which should focus on treating their delusions or other mental on treating their delusions or other mental disorders.disorders.

3. The Incompetent 3. The Incompetent SuitorSuitor

This type is typically a man who had been This type is typically a man who had been rebuffed after asking a woman for a date. rebuffed after asking a woman for a date.

He’s often socially inept, and when He’s often socially inept, and when rejected, begins to stalk with the hope rejected, begins to stalk with the hope that his persistent behavior will change that his persistent behavior will change the woman’s mind. the woman’s mind.

The incompetent suitors can be The incompetent suitors can be responsive to judicial sanctions but are responsive to judicial sanctions but are also likely to relapse.also likely to relapse.

4. The Resentful Stalker4. The Resentful Stalker

These offenders express anger in These offenders express anger in response to a perception that they response to a perception that they have been humiliated or treated have been humiliated or treated unfairly by the object of their unfairly by the object of their obsession. obsession.

They thrive on having a sense of They thrive on having a sense of power and control over the victim, power and control over the victim, and are hard to treat because they and are hard to treat because they often see themselves as the victim.often see themselves as the victim.

5. The Predatory Stalker5. The Predatory Stalker

Predator plans their attack, rehearses it, has Predator plans their attack, rehearses it, has lots of sexual fantasies about it. lots of sexual fantasies about it.

Derives pleasure from gathering information Derives pleasure from gathering information about the target and fantasizing about the about the target and fantasizing about the assault. assault.

Doesn't necessarily know the victim. Doesn't necessarily know the victim. The victim may not know she is being stalked. The victim may not know she is being stalked. They often have prior convictions as sexual They often have prior convictions as sexual

deviants.deviants.

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

Do Now 11/13:Do Now 11/13:Why might a person stalk a Why might a person stalk a celebrity?celebrity?

Burger King Stalker

Know this Commercial?

Is Stalking acceptable??

http://www.youtube.com/watch?v=mhehKgU5oBs

From today’s headlines: http://abcnews.go.com/Entertainment/wireStory?id=6237229

Do Now 11/13:Do Now 11/13:Why might a person stalk a Why might a person stalk a celebrity?celebrity?

From today’s headlines: http://abcnews.go.com/Entertainment/story?id=6241069&page=1

Do Now 11/13: Do Now 11/13: ANSWERANSWER

Why might a person stalk a celebrity?Why might a person stalk a celebrity? may focus on a celebrity, especially if they've seen may focus on a celebrity, especially if they've seen

him or her in person at a public appearance like a him or her in person at a public appearance like a concert. concert. Develop a relationship through viewingDevelop a relationship through viewing

Learn about their family and who they are Learn about their family and who they are from TV or Radiofrom TV or Radio

"They develop convoluted thoughts about this "They develop convoluted thoughts about this person. person.

They feel this person is the answer to their They feel this person is the answer to their dreams,"dreams,"

Looking inside the Looking inside the lettersletters

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

From Jack Jordan

Why did we leave off the Why did we leave off the Predatory Stalkers ?Predatory Stalkers ?

Threats (%)Threats (%) Assaults Assaults (%)(%)

Rejected Rejected SuitorSuitor

71%71% 54%54%

Intimacy Intimacy SeekingSeeking

50%50% 23%23%

Incompetent Incompetent SuitorSuitor

32%32% 27%27%

Resentful Resentful StalkerStalker

87%87% 25%25%

Predatory Predatory StalkerStalker

33%33% 50%50%

Predict which is the most to Predict which is the most to be concerned about?be concerned about?

The The rejected rejected and and predatory stalkerspredatory stalkers are most likely to assault their are most likely to assault their victims.victims.

When to Be ConcernedWhen to Be Concerned

The red flags: The red flags: You immediately start getting You immediately start getting

several phone calls or emails several phone calls or emails right after meeting this person. right after meeting this person.

The person is clingy, controlling, The person is clingy, controlling, or upset if you want to spend or upset if you want to spend time with friends and family. time with friends and family.

Marlon Pagtakhan stalked Jerry Ryan

How to Take action: How to Take action:

Tell everyone you know that this is Tell everyone you know that this is going on -- your employer, friends, going on -- your employer, friends, family. family.

Gently but firmly tell the person Gently but firmly tell the person you've decided to move on. you've decided to move on.

Don't get drawn into discussions of Don't get drawn into discussions of why. Just say, "This situation isn't why. Just say, "This situation isn't right for me" or "I'm not ready.." -- right for me" or "I'm not ready.." -- whatever you need to say, but say it whatever you need to say, but say it gently.gently.

Treatments for Victims Treatments for Victims Mullen has found that cognitive-Mullen has found that cognitive-

behavioral therapy works well in behavioral therapy works well in managing the anxiety stalking victims managing the anxiety stalking victims experience. experience.

Medications such as SSRIs for some Medications such as SSRIs for some patients. patients.

"It is important to inform and "It is important to inform and educate family members about the educate family members about the stalking and enlist their help in stalking and enlist their help in managing it," he stated.managing it," he stated.

Treatments for VictimsTreatments for Victims Stressed that victims of stalking, like victims of Stressed that victims of stalking, like victims of

sexual or physical abuse, often blame themselves sexual or physical abuse, often blame themselves for the situation. for the situation. Because they feel shame or misplaced guilt, Because they feel shame or misplaced guilt,

they do not share their ordeal with others they do not share their ordeal with others and become more isolated and afraidand become more isolated and afraid

Counseling the victim to realize that he or she is Counseling the victim to realize that he or she is not responsible for the stalking. not responsible for the stalking.

Advises victims to file a complaint with the police Advises victims to file a complaint with the police if the stalking episodes continue for more than two if the stalking episodes continue for more than two weeks. weeks. "To prove that the perpetrator is guilty of a "To prove that the perpetrator is guilty of a

crime and have the court order treatment, crime and have the court order treatment, evidence is critical. evidence is critical. Do not destroy Do not destroy answering-machine tapes, notes, letters, e-answering-machine tapes, notes, letters, e-mails, or gifts in a moment of distress," he mails, or gifts in a moment of distress," he advisedadvised

Professionals at Risk, Professionals at Risk, What about the victims?What about the victims?

"Professionals who work with the lonely "Professionals who work with the lonely and unstable are at risk of being stalked," and unstable are at risk of being stalked," said Mullen. said Mullen.

Estimated that about 15 percent have been Estimated that about 15 percent have been stalked by a patient during their career. stalked by a patient during their career.

Victims are often forced to alter their lives Victims are often forced to alter their lives to avoid the stalker. to avoid the stalker.

Mullen’s study found: Mullen’s study found: 53% of his subjects quit or changed jobs53% of his subjects quit or changed jobs 40% moved to a different home40% moved to a different home 70% curtailed social activities. 70% curtailed social activities.

Professionals at Risk, Professionals at Risk, What about the victims?What about the victims?

In addition to the physical dangers, In addition to the physical dangers, stalking takes a severe psychological stalking takes a severe psychological toll on its victims. toll on its victims. 83% Subjects were diagnosed with an 83% Subjects were diagnosed with an

anxiety disorderanxiety disorder 37% with posttraumatic stress disorder 37% with posttraumatic stress disorder

(PTSD). (PTSD). Additional 18% had PTSD symptoms but Additional 18% had PTSD symptoms but

did not meet formal diagnostic criteria. did not meet formal diagnostic criteria. 24% had ideas of suicide 24% had ideas of suicide 25% percent increased their alcohol 25% percent increased their alcohol

consumption and/or cigarette smokingconsumption and/or cigarette smoking

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