I read “Bridging Two Worlds: Consulting in the Yates Trial” by Lucy J. Puryear [TAP 36/3].
It seems to me that she failed to differentiate the role of a forensic psychiatrist — even a psychoanalytically informed one — from [that of a] treating psychiatrist.
Ms. Yates' case was strictly confined between areas of moral wrong (as discerned by a psychotic mind) and legal wrong (the only one upheld in Texas courts).
I disagree with Dr. Puryear's conclusion that a forensic expert looks at behavior to explain motivation and intent. A lawyer does. A jurist assumes free will, independent of emotional motivation. We look at conduct as prompted and fueled by emotions. Our goal is not to exculpate or inculpate. A forensic psychiatrist is not a trier of fact, but a link in the factfinding process.
We work at the borderline between psychiatry and law, at integrating the two perspectives and presenting the conclusions in a comprehensive, persuasive, and scientific manner. As psychoanalysts, we ought to be able “to tell the story,” helping the trier of fact to subject to scrutiny what (s)he takes to be evident, taking a thorough consideration of alternate lines of exploration and reasoning. Empathy, as described by Jacob Arlow ought to be present in both forms of encounters, clinical and forensic.
We must constantly keep a balance in our role, separating our position of advocate, caring for our patients and accepting their symptoms and complaints, from that of examiner, who scrutinizes (psychoanalyzes) every verbal and behavioral production of the patient.
Psychoanalysts are also trained to do what Dr. Puryear understood that Dr. Dietz was doing. Dr. Dietz, in his function as an examiner, needs to adhere to only one of these aspects. He does not participate in, nor does he promote the establishment of, a doctor/patient relationship. Let's not forget that our training encourages us to be as detached as Dr. Puryear describes the forensic expert as being, and also to recognize that we deal with a person in pain.
Alberto M. Goldwaser, M.D.
Forensic Psychiatric Associates