The psychiatric-forensic perspective on violence

INVITED EDITORIAL

The psychiatric-forensic perspective on violence

Jorge O. Folino

PhD in Medicine. Professor of Medical Sciences and associate professor of Psychiatry. Head, MSc. in Forensic Psychiatry, Universidad Nacional de La Plata, La Plata, Argentina. Expert I, Office of the General Prosecutor, Judicial Power, Province of Buenos Aires, Argentina. In charge of the Pilot Program of Risk Assessment of Discharged Prisoners. Counselor, International Association of Forensic Mental Health Services. E-mail: [e-mail]

Forensic psychiatry is a psychiatric subspecialty that has violence as one of its main topics.^1-3 It shares the same epistemological configuration of general psychiatry. Its basic sciences are biology, psychology, sociology and anthropology, and it benefits from contributions from law and criminology. It includes clinical work and scientific study in multiple areas in which legal and mental health issues are interrelated.⁴

Thus, forensic psychiatry provides a wide and integrated perspective that allows for application of scientific knowledge to the legitimate social response against violence. Some examples will illustrate the statements above.

Forensic psychiatry investigates violence as soon as it is produced. The fast implementation of the psychiatric study of someone who committed a violent offense, when allowed by legal and factual issues, provides data of immeasurable value, since it limits the interposition of new memory elaborations and distortions of clinical presentation, while it allows for verification of occasional mental disorders or particular emotional states.

Forensic psychiatry may also collaborate with reconstruction and/or development of models of conduct and/or personal profiles, which can be applied to the search for a suspect or to understand certain peculiarities of the offense. One example is the collaboration in the interpretation of elements at a crime scene, which may be related to some form of psychopathology or to a given conduct pattern.^5,6

At the initial stages of a penal process, it is common to have the forensic psychiatrist's opinion of the accused to make decisions regarding the course of the process.⁷ In previous stages of the penal process and/or trial, the forensic psychiatrist assesses whether the accused has suffered, at the moment the offense was committed, any mental disorder that has impaired his psyche in a way that prevented him from understanding the criminality of the act or from guiding his actions (legal demand is formulated with variants, depending on each country).⁸

Cases of sexual violence have connotations that strongly mobilize social concern in general, and have judgment difficulties that are of particular concern for judges and attorneys. In this context, forensic psychiatry gives a major contribution to the conceptualization of sexual abuse (are these pathological conducts or merely offenses? Is rape a type of paraphilia? If it is defined as a type of paraphilia, does it imply lack of legal liability?). It also studies the accused, as an attempt to diagnose the specific nature of the sexual interest and the subtype of paraphilia, rebuild the chain of events that lead to abuse, verify factors of general and specific violent recurrence for sexual violence. In addition, among other important functions, assessment of psychic sequelae in the victim of a sexual abuse stands out.

Once the person who committed a violent offense enters the judicial system, new instances are opened, in which it is common to request violence risk assessment. This is so when there is a proposal of progressive system, anticipated discharge, safety measure for those absolved due to lack of legal liability, choice of type of institution, etc. In all these circumstances, the forensic psychiatrist contributes to the assessment of risk factors that affect the person in their potentiality to commit aggressive acts and protective factors that could contribute to a prevention of these acts and minimize their negative consequences.^9-11

In the civil judicial setting, the forensic psychiatrist also plays important roles related to the theme of violence. On the one hand, they evaluate the existence of psychic sequelae of violent events, the impact they have on the individual's functional capacity, prognosis, type and duration of treatments. Expert opinion is useful to establish the occasional causal relationship between the violent event and a given psychic disorder and its severity. Based on this information, judges, for example, can impose payment of damages. On the other hand, the forensic psychiatrist assists judicial authority when a mental patient has a risk of self- or heteroaggressions, providing legitimate implementation of prevention actions.

The intervention of forensic psychiatry is not limited to application of scientific knowledge. Its particular work area places it in good conditions of contributing to the increase in this type of knowledge. A testimony of that are the many articles and master and doctorate dissertations produced in forensic psychiatry, and the emphasis given to research in the main forums of forensic psychiatric treatment.^12,13

Finally, it is worth stressing that both practice and research in Forensic Psychiatry are performed in a space that is strongly protected by ethical norms of the profession and by the conditioning of the judicial system. Thus, it consists of a perspective with rigorous respect toward people's rights.

Doubtlessly, violence is a multidimensional phenomenon and the society calls for varied professions to try to understand and prevent it. Forensic psychiatry, because it originates from a synthetic discipline - psychiatry - and due to its specific application to the Judicial System, provides a remarkable contribution to the search for these objectives.

References

• 1. Folino JO. Una subespecialización psiquiátrica: la psiquiatría forense. In: Suárez Richards M, editor. Introducción a la psiquiatría. 2ª ed. Buenos Aires: Salerno; 2000. vol 2. p. 441-9.
• 2. Gutheil TG, Appelbaum PS. Clinical handbook of psychiatry and the law. 3rd. ed. Philadelphia: Lippincott Williams & Wilkins; 2000.
• 3. Nedopil N. Forensische psychiatrie. Munich: Georg Thieme; 1996.
• 4. Folino JO. La psiquiatría y el sistema judicial. In: Suárez Richards M, editor. Introducción a la psiquiatría. Buenos Aires: Polemos; 2006. vol 3.
• 5. Daéid NN. Differences in offender profiling in the United States of America and the United Kingdom. Forensic Sci. Int. 1997;90:25-31.
• 6. Ressler RK, Burgess AW, Douglas JE. Sexual homicide: patterns and motives. Lexington: Lexington; 1988.
• 7. Folino JO, Castillo JL, Roesch R. Escala de evaluación de capacidad para actuar en proceso penal (EECAPAPP). La Plata: Interfase Forense; 2003.
• 8. Folino J. Psiquiatría forense comparada y la inimputabilidad. In: Folino J, editor. Interfase psiquiátrico judicial. Buenos Aires: Lema S.R.L.; 1994. p. 186-244.
• 9. Folino JO. Risk assessment and violent recidivism risk management in convicts from Argentina. Res Soc Prob Public Policy. 2005;12:75-88.
• 10. Folino JO, Marengo C, Marchiano S, Ascazibar M. The risk assessment program and the court of penal execution in the province of Buenos Aires, Argentina. Int J Offender Ther Comp Criminol. 2004;48(1):49-58.
• 11. Folino J. Nuevos paradigmas en la evaluación de peligrosidad. Doctrina Judicial; Editorial La Ley. 2004;XX(29):871-6.
• 12. Folino JO, Raverta MJ. Forensic psychiatry in Argentina: a training forum for Latin America. Am Acad Psychiatry Law News. 2006;31(1):28-9.
• 13. Bloom JD. Commentary: authorship and training in forensic psychiatry. J Am Acad Psychiatry Law. 2007;35(1):32-3.

Publication Dates

• Publication in this collection
  01 Dec 2008
• Date of issue
  Apr 2008