Dr. Liza H. Gold, MD: AAPL Post-COVID: Behind the Mask
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Winter 2022 • Vol. 47, No. 1
2021 AAPL Presidential Address create year-round virtual AAPL pro-
gramming, including a new non-CME
Dr. Liza H. Gold, MD: AAPL Post-COVID: format, a town hall, that we hoped
would stimulate member interest and
Behind the Mask participation. Dr. Gold then appoint-
Britta K. Ostermeyer, MD, MBA, DFAPA ed Dr. Charles Scott to be the inaugu-
ral Program Director of Virtual AAPL
AAPL meetings usually take years (VAAPL), first as a volunteer and now
of planning, AAPL’s 2020 and 2021 confirmed as a formal position. This
meetings had to be “converted” into placed AAPL in a position to host a
virtual Zoom meetings in very little number of exceptional educational
time. For many AAPL members, the programs.
fall Annual Meeting represents their Dr. Gold remarked that VAAPL’s
social and educational highlight of attendee evaluations have been
the year. Not meeting in person had “extremely positive,” and VAAPL
its impact on collegial membership was able to generate approximately
networking. While AAPL had been $45,000 in revenue. However, the re-
losing members prior to COVID, the cording of these programs and issuing
pandemic accelerated membership of CME certificates poses challenges
decline: in October 2016, AAPL had yet to be solved. Dr. Gold also em-
2,074 members. In October 2019, just phasized that AAPL lacks policies and
before the pandemic, membership had infrastructure to manage recorded and
declined to 1,890, a loss of almost stored educational content.
10%. In October 2020, AAPL had Clearly, AAPL needs to create and
1,728 members, a loss of just over manage an online learning program
17% from the 2016 high. Dr. Gold as soon as possible. To that end, Dr.
expressed concern that membership Gold appointed the Virtual AAPL
Dr. Liza H. Gold, AAPL’s 47th loss was unlikely to be reversed Task Force II, chaired by Dr. David
President, was introduced by her long- without in-person annual meetings. Of Burrow, Chair of the Technology
standing, close friend and colleague, note, a significant amount of AAPL’s Committee, and Dr. Anne Hanson,
Dr. Carmel Heinsohn, MD. Dr. Gold operating income dissipated with no Co-chair of the Education Commit-
acknowledged and thanked many in-person meetings. Dr. Gold stated tee. While the first VAAPL task force
AAPL members and AAPL leadership that nothing was business-as-usual, selected the platform used for the
for their contributions, including Dr. past experience did not suggest a path 2020 and 2021 meetings, this new
Renée Sorrentino, AAPL’s Program forward, and everyone was reeling committee was tasked with develop-
Chair for the 2021 annual meeting. from the impact of COVID on their ing an RFP for soliciting proposals
Dr. Gold struggled with the idea of own lives. However, AAPL rose to the from technology companies for an
delivering the traditional Presidential challenge and organized a successful, online learning management system.
AAPL Address because it has been online 2020 annual meeting. In ad- VAAPL Task Force II completed its
anything but a typical presidential dition, the American Board of Psy- mission, and AAPL Council voted
year. Dr. Gold’s term was heavily chiatry and Neurology (ABPN) gave unanimously to approve a three-year
branded by the impact of COVID. AAPL a $100,000 educational grant contract with a company which AAPL
She acknowledged that many AAPL in 2020 and again in 2021, which sub- will be “onboarding” at the end of
members and/or their family members stantially helped AAPL fiscally plan 2021. Dr. Gold explained that AAPL’s
had fallen ill with COVID or had lost during these challenging times. next steps should be to create an
loved ones. Therefore, she decided Dr. Gold stated that if AAPL was online infrastructure system for live
to present an insightful review of to survive the pandemic as well as streaming and a library of on-demand
AAPL’s accomplishments and chal- prosper post-COVID, then AAPL had educational recordings.
lenges under COVID and discussed to make a number of changes. First of Importantly, Dr. Gold stressed that
how AAPL can and should position all, we had to make major CME pro- the development of an informative,
itself in the post-COVID era. gram changes. Dr. Gold worked with communicative, and interactive
Dr. Gold explained that while major Executive Director Jackie Coleman to
(continued on page 27)
American Academy of Psychiatry and the Law Newsletter Winter 2022 • 1
American AAPL ANNUAL AWARDS
Academy of
Psychiatry
and the Law
Editor
Joseph R. Simpson, MD, PhD
Associate Editors
Philip J. Candilis, MD
Ryan C. W. Hall, MD
Stephen P. Herman, MD
Neil S. Kaye, MD
Britta K. Ostermeyer, MD, MBA
Karen B. Rosenbaum, MD
Renée M. Sorrentino, MD
Joel Watts, MD
AAPL Photographer
Eugene Lee, MD
Former Editors
Susan Hatters Friedman, MD (2016-2018)
Charles Dike, MD, MPH (2008-2016)
Victoria Harris, MD, MPH (2003-2008)
Michael A. Norko, MD (1996-2003)
Robert Miller, MD PhD (1994-1996)
Alan R. Felthous, MD (1988-1993)
Robert M. Wettstein, MD (1983-1988)
Phillip J. Resnick, MD (1979-1983)
Top row, left to right: Jeffrey L. Metzner, MD; Patricia R. Recupero, MD, JD; Donna Vanderpool, JD
Loren H. Roth, MD, MPH (1976-1979) Bottom row, left to right: Annette L. Hanson, MD; Reena Kapoor, MD; Anne B. McBride, MD
Officers
President
Susan Hatters Friedman, MD
President-elect SEYMOUR POLLACK AWARD 2021
James Knoll, MD
Vice President
Patricia R. Recupero, MD, JD
Karen Rosenbaum, MD
Vice President
Britta Ostermeyer, MD
Secretary GOLDEN AAPL AWARD 2021
Trent Holmberg, MD Jeffrey L. Metzner, MD
Treasurer
Stuart Anfang, MD
Immediate Past President
Liza Gold, MD RED AAPL AWARD 2021
The AAPL Newsletter is published by Annette L. Hanson, MD
AAPL, One Regency Drive, PO Box
30, Bloomfield, CT 06002. Opinions
-and-
expressed in bylined articles and columns Reena Kapoor, MD
in the Newsletter are solely those of the
authors and do not necessarily represent
the official position of AAPL or
Newsletter editors.
Manuscripts are invited for publication in
AMICUS AWARD 2021
the Newsletter. They should be submitted Donna Vanderpool, JD
to the editor via email to NewsletterEdi-
tor@aapl.org
The Newsletter is published in
Winter (deadline for submission is
November 15), Spring (deadline
BEST TEACHER IN A FELLOWSHIP PROGRAM 2021
March 1), and Fall (deadline July 1). Anne B. McBride, MD
www.aapl.org
© 2022 AAPL. ALL RIGHTS RESERVED.
2 • Winter 2022 American Academy of Psychiatry and the Law Newsletter
PRESIDENT’S COLUMN
“The Times, They Are A-Changin’” this, we need to consider how AAPL
continues to be our professional home
Susan Hatters Friedman, MD
as we respond to contemporary chal-
When Bob work by many AAPL members and lenges. Finally, this Task Force is also
Dylan wrote leaders, as well as Dr. Jeff Janofsky, considering how we might increase
his folk anthem Executive Director Jackie Cole- the profile of AAPL membership, and
more than half a man, and AAPL staff. Through this the importance of our ethical rules
century ago, the we’ve been able to use technology to and practice guidelines—to non-mem-
lyrics referred to increase collaboration and connection bers in the field of psychiatry, other
the Civil Rights with members throughout the year in medical sub-specialties, other forensic
Movement. When addition to annually at our October sciences, and the legal field.
I first heard meeting. Dr. Charles Scott, at the helm Grammy-winning Cleveland
Dylan’s harmonica and warbling voice of Virtual AAPL, has been helping us native Tracy Chapman was born in
in 1988, in front of our family TV navigate this course. 1964, the year “The Times, They Are
watching The Wonder Years, it was This is a time of much change in A-Changin’” was released. She does
a throwback to a generation before, our society and in organizations. The an excellent cover of the song. She
along with songs by Joan Baez, the Presidential Task Forces that I’ve wrote in her iconic “Fast Car” that
Byrds, and Joni Mitchell. I pulled out appointed for this year are already “we gotta’ make a decision, leave
my parents’ old records, stacked them hard at work. Again, I’m not a Bob tonight or live and die this way.” This
on the turntable, and played them for Dylan scholar (I’m one generation off line has stuck with me for decades.
days. in each direction, more a scholar of There reaches a point where we need
Bob Dylan was awarded the Nobel either Duke Ellington or Robert Smith to do something, or we have decided
Prize for Literature in 2016, “for and The Cure, depending on the day). that we are not.
having created new poetic expressions But our windows have been shaking, Another Presidential Task Force will
within the great American song tradi- and our walls rattling. focus on the topic of Understanding
tion.” I am not a Bob Dylan scholar, AAPL has been my professional Disparities in Evaluations and Ad-
but as we reflect on where we are to- home for two decades, and one of my dressing our Biases in Forensic Prac-
day in 2022 (and when there is a Won- goals for the upcoming year is for us tice. Drs. Sandy Simpson and Gary
der Years reboot), “The Times, They to re-invigorate AAPL membership in Chaimowitz are the co-chairs for this
Are A-Changin’” might well again be these complex times. Dr. Beesh Jain is Task Force. They are rigorously con-
an anthem. Building on all that has chairing the Task Force for Member- sidering the literature about race, cul-
come before, we find ourselves in a ship Engagement, Recruitment, and ture, and poverty increasing the risk
unique place in time with technology Retention (MERR). This Task Force of becoming involved in, and staying
and the pandemic. Yet there are still is charged with making recommen- involved with, the criminal justice
inherent biases within the justice sys- dations about recruiting and retaining system. As forensic psychiatrists,
tem in which we practice. new and diverse members, including we practice in this space daily. Bob
My theme for the 2022 AAPL U.S., Canadian, and international Dylan’s anthem reminds us “Don’t
Annual Meeting is “The Whole Truth: forensic psychiatrists. This is with criticize what [we] can’t understand.”
Recognizing Culture and Gender in the recognition that our field is broad, We need to make further strides to
Forensic Psychiatry.” Culture and gen- including academia, various sub-spe- understand, at this crossroads. Being
der, and their intersection, is critical in cialties, correctional psychiatry, fo- mindful that AAPL is an educational
all of our work. International perspec- rensic hospitalist services, community organization rather than an advoca-
tives have much to teach us too. As forensics, court psychiatry, and private cy organization, the Task Force is
forensic psychiatrists, we need to be practice. This will be accomplished by considering how these issues manifest
thoughtful about how we work in this leveraging the experience of early ca- in our day-to-day practice as forensic
space now and in the future. Many of reer, midcareer, and long-term AAPL psychiatrists—our tools, our methods.
us AAPL members have been writing members, with the experiences of the But the hypnotic song is about hope
and teaching about culture, gender, Membership committee, Forensic for the future, “as the present now
and inequities for years, but I want Training of Residents committee, and will later be past.” We must consider
to encourage all of us to think along Early Career Psychiatry committee. the ethical implications on our work
these lines during this AAPL year. Virtual AAPL should help us to all of this evidence, and figure out how
We know our “old road is rapidly feel more connected to our home or- to understand these impacts and our
agin’.” During the COVID-19 pan- ganization in these challenging times. personal biases (be they related to
demic, AAPL has had to rapidly shift The MERR Task Force will also make socio-economic status, race, gender,
from in-person to online-only meet- recommendations regarding how to culture, ethnicity, religion, migration,
ings, under the leadership of Drs. Will make AAPL more valuable to mem- or sexual identity) impact our profes-
Newman and Liza Gold, with hard bers (and potential members). To do sional roles now and into the future.
(continued on page 27)
American Academy of Psychiatry and the Law Newsletter Winter 2022 • 3MEDICAL DIRECTOR’S REPORT
Best Practices for Forensic Psychiatric continuing threat to society; or
• Any other facts which the jury or
Participation in Death Penalty Cases the court specifically sets forth in
Jeffrey S. Janofsky, MD writing that it finds as mitigating
circumstances in the case.
The Ameri- this was also rejected by the Supreme
can Psychiatric Court as unconstitutional. In contrast, the Texas death penalty
Association’s Other states adopted specific sen- scheme requires the jury to determine:
(APA) Committee tencing standards to guide discretion • Whether there is a probability
on Judicial Action and adopted procedures to ensure that the defendant would commit
(CJA) reviews those standards were enforced. This criminal acts of violence that
amicus briefs was held constitutional in Gregg v. would constitute a continuing
written by other Georgia (2). State legislatures decide threat to society;
organizations to which homicides should warrant the • Whether, taking into consider-
decide whether APA should sign on to death penalty, but must provide a ation all of the evidence, includ-
the brief and perhaps suggest modifi- meaningful basis for distinguishing ing the circumstances of the
cations. As AAPL’s Medical Director the few cases in which the death offense, the defendant’s character
I represent AAPL’s interest as a mem- penalty is imposed from the many and background, and the personal
ber of CJA. CJA recently reviewed cases in which it is not. Sentencers moral culpability of the defen-
two death penalty petitions for certio- must then be allowed to consider any dant, there is a sufficient miti-
rari to the US Supreme Court (USSC) available evidence which might con- gating circumstance or circum-
that were brought to our attention by vince them that the defendant should stances to warrant that a sentence
the American Psychological Associa- not be put to death, no matter how of life imprisonment rather than
tion (ApA). For various reasons, CJA severe the offense or reprehensible a death sentence be imposed
decided not to sign on to the ApA’s the defendant’s past. (3, 4) States have (Added by Texas legislature after
amicus brief. However, during the discretion in their capital sentencing Penry v. Lynaugh). (5)
deliberation of one of the cases, it schemes, but individualization of sen- Capital defendants under both
became clear that a psychologist hired tencing selection is mandatory. schemes could benefit from psychi-
by the defense did not follow best At least two capital sentencing atric evaluation to look at potential
practices for psychological evalua- schemes had been found constitution- mitigating circumstances. The Texas
tion. This led to a discussion in CJA al by the USSC. In one scheme (for scheme always requires an assessment
regarding a recurring theme: poor example Maryland’s former process) of future dangerousness as an aggra-
performance by mental health evalua- aggravating circumstances are based vating circumstance.
tors, including psychiatrists, in many entirely on the severity of the crime Under a separate series of cases the
of the death penalty cases we review. charged (for example the defendant USSC has held that it is unconstitu-
Furthermore, neither AAPL nor APA committed more than one offense of tional under the Eighth Amendment to
has ever proposed best practices for murder in the first degree arising out execute persons with Developmental
psychiatric forensic evaluation in of the same incident). Only if the jury Disability. (6-8) Although this issue
death penalty cases. I was tasked by finds beyond a reasonable doubt that is primarily the realm of psycholo-
CJA to bring this to AAPL Council’s an aggravator is present does the jury gists, forensic psychiatrists may also
attention. proceed to mitigating circumstances. have a role in those assessments.
As a reminder for those AAPL These statutory mitigators include The use of the insanity defense in
members who do not do work in many factors where forensic psychiat- capital cases is also unusually prob-
capital punishment cases, in 1972 in ric evaluation and testimony might be lematic. A failed insanity defense in a
Furman v. Georgia (1) the Supreme useful including: trial’s guilt/innocence phase might be
Court held that the then-existing death • The murder was committed while perceived as an aggravating circum-
penalty framework in the US was the capacity of the defendant stance by a capital jury in the sentenc-
unconstitutional, finding that death to appreciate the criminality of ing phase. (9)
sentences had been imposed on only his conduct or to conform his AAPL had signed on to four capital
a small minority of death-eligible conduct to the requirements of case amicus briefs to date:
defendants without any guidelines or law was substantially impaired • Petition for certiorari to the USSC
standards, and that this represented as a result of mental incapacity, in Moore I (7) (with the Consti-
cruel and unusual punishment under mental disorder or emotional tution Project and The Southern
the Eighth Amendment. Some states disturbance; or Center for Human Rights)
then attempted to overcome this prob- • It is unlikely that the defendant • USSC case-in-chief in Moore I
lem by making the death penalty man- will engage in further criminal (7) (with APA, ApA and others)
datory in a specified class of case, but activity that would constitute a • Ex parte Bobby James Moore
(continued on page 27)
4 • Winter 2022 American Academy of Psychiatry and the Law NewsletterEDITOR’S COLUMN
How Do Forensic Psychiatrists and all the other specifically forensic
topics covered in fellowship. The
Add Value? ability, acquired through practice, to
Joseph R. Simpson, MD, PhD think clearly about the medicolegal
question being asked, and avoid being
Years ago, I had as maintaining open communication, led off-track by extraneous factors,
the privilege of such as timely notification when more can definitely separate a forensical-
being interviewed time is needed to complete a report, so ly-trained psychiatrist from one who
for a National the retaining party isn’t surprised by is not, particularly in cases with more
Public Radio a last-minute request for an exten- gray areas, ambiguities, and complex-
broadcast. The sion. Attorneys and judges do not like ities.
topic was firearms surprises in the course of their work Readers who have been out of train-
and mental illness, day! Another example is thoroughly ing for a while can undoubtedly think
and I was invited reviewing reports for typographical of many other examples of how a
on because I had published some ar- and other errors (such as forgetting to forensic psychiatrist adds value. Cases
ticles on mental health firearms laws. change a name or case number when where you changed your opinion in
Although I spoke with the interviewer using text from a previous report). the process of writing up your report,
for about 20 minutes, in the piece that This may seem mundane, even pica- or where it seemed like things were
aired, they only used one statement yune, but a report with multiple errors going in a bad direction until you got
from me, which was about the fact undermines the confidence of the re- to the heart of the issue and helped
that people who have serious mental cipient that the author spent adequate the trier-of-fact understand the true
illness are not, statistically speaking, time and reached sound conclusions, picture. I hope that reading this brief
substantially more violent than those as opposed to rushing through, trying column stimulates you to think about
who do not have such a diagnosis. to make a quick buck. When learning what you bring to the table, and may-
This was something that did not a musical instrument, a sport, or a sec- be helps you a bit in your approach to
require expertise in firearms laws, or ond language, most people wish they teaching if you work with trainees as
even in forensic psychiatry – most could skip all the boring, repetitive they build up their own “storehouse of
psychiatrists could have and probably stuff and go straight to the exciting value” to use in their chosen profes-
would have said the same. parts. But neglect of fundamentals sion.
In addition to being a good lesson because they are considered boring or Finally, how does one maintain
about the vagaries of the media, the trivial generally ends badly. This is as one’s knowledge and skills? The
experience got me thinking about true in forensic psychiatry as in other journey of learning certainly does not
what it is that forensic psychiatrists pursuits. end after fellowship. AAPL should
have to offer by virtue of their train- Forensic training and experience be an essential resource for every
ing in fellowship or their experiences also hone our ability to keep an open forensic psychiatrist. Attend AAPL
in the field. In other words, if we mind and search for data to confirm meetings and courses (in person and
stipulate a certain level of common or disprove our working hypotheses now online) when feasible, and read
knowledge and skills among psychi- about a case. A diligent forensic psy- the Journal and Newsletter. That is
atrists as a group, what is the added chiatrist does not draw conclusions a solid strategy for making yourself
value, to use a business term, of hiring prematurely, and changes her formu- an asset to those who will use your
a forensic psychiatrist, instead of an lation when new data are obtained. I services.
otherwise well-trained psychiatrist once evaluated a criminal defendant
who doesn’t have the forensic back- who had written letters to the FBI and
ground? While the answer may seem the US President regarding a local,
self-evident, it might be helpful to personal grievance. This sounds like SAVE THE DATE
pause and reflect on the question from behavior driven by delusions, but
time to time. Naturally, each of us there was no psychosis present. My
wants to do a high-quality job for the report explained why the defendant
AAPL 2022
party, court, or agency that engages was competent to stand trial, avoiding 53 Annual Meeting
rd
our services. How do we do that? And a trip to the state hospital for resto-
how do we help others learn to do it? ration, and also the psychological
Of course this is a huge subject. motives for his actions, assisting his October 27-30, 2022
I will just offer what I hope will be public defender in securing a proba-
a little food for thought. Forensic tionary sentence for charges that could
psychiatrists should add value through have carried prison time. Sheraton,
their understanding of the funda- Of course, there is great value in New Orleans, LA
mental mechanics of medicolegal understanding legal standards, case
work. This includes such elements law, principles of risk assessment,
American Academy of Psychiatry and the Law Newsletter Winter 2022 • 5ASK THE EXPERTS
Ask the Experts which I might testify at any level of
the case. I was also asked to provide
Neil S. Kaye, MD, DLFAPA copies of any testimony in any and
Graham Glancy, MB, ChB, FRC Psych, FRCP (C) every case in which I have ever had
any role and a copy of every article
Neil S. Kaye and Graham Glancy photographs, charts, reports, inter and or publication I have ever authored,
will answer questions from members intra-office communications, record- co-authored, or reviewed. Of course,
related to practical issues in the real ings, contracts, agreements, invoices, a full accounting of any research into
world of Forensic Psychiatry. Please bills and any other forms or preserved the topic of the case was expected
send questions to nskaye@aol.com. information in my possession, custo- and copies of all articles and materi-
This information is advisory only, dy or control and/or in the possession, als I read regardless of their influence
for educational purposes. The authors custody, or control of my agents, on my opinions.
claim no legal expertise and should servants, employees, attorneys, or Finally, I was asked to produce
not be held responsible for any action any person acting on my behalf, or copies of anything that I might use
taken in response to this educational of which I have knowledge, whether at trial including but not limited to:
advice. Readers should always con- or not in my possession, custody or diagrams, models, photographs, vid-
sult their attorneys for legal advice. control. eos, drawings, images, films, scans,
The documents I was “required X-rays, electronic media, and en-
Q: I need some advice on how to to produce” included but were not largements of any page or portion of
respond to lengthy detailed discov- limited to: all documents I reviewed; any record or reference material that
ery requests and do I really need to all documents to which I might, did, may form any part of the basis of any
provide drafts of my reports? will, or would refer to in writing a of my opinions or be used in any way
report or formulating an opinion, to proffer testimony or to explain any
A. Kaye: or might rely on at any deposition opinion to the trier of fact.
A great com- or testimony; all medical records Clearly, this was overreaching!
pound question! associated with the examinee or any After catching my breath, I called the
Discovery is a other person involved in any way retaining lawyer and expressed my
pre-trial proce- with the case; all correspondence dismay at being asked to provide a
dure in which and all electronic correspondence copy/proof of everything I have ever
each party can including that between me and any read in my nearly 40 years of medical
obtain evidence lawyer, expert, treater, family mem- education and life-long learning. The
from the other ber, or party involved in the case; any patient lawyer, donning her hat as
party or parties by means of “discov- notes, memoranda, or other materials councilor-at-law, calmed me down,
ery” devices such as interrogatories, related in any way to the case; any and explained that the rules in the
requests for documents, requests for documents produced by anyone else state in which the case was calen-
admissions, and deposition. In Law, about any person/party involved dared did not allow for such an “over-
“discovery” is the exchange of legal or potentially directly/indirectly or ly broad” request and clarified what
information and known facts of a peripherally in the case; any and all actually needed to be produced: my
case. Think of discovery as obtaining work product generated by me with notes (if I had any), my report, and, if
and disclosing the evidence and posi- any potential relevance to the case; I had them, any references on which
tion of each side of a case so that all all invoices related to work in the I relied for this specific case. She
parties involved can decide what their case; all notes taken while evaluating further clarified that only if the case
best options are before deciding to the litigant or anyone else evaluated was to go forward to trial would we
move forward toward trial or negoti- for any reason; a copy of any tests be discussing courtroom exhibits.
ate an early settlement. administered including test booklets So, what must an expert typically
Over the last 35 years, the de- and answer sheets with raw scores; provide as part of discovery and how
tailed requests for records and work all engagement agreements; a listing is this best done? Certainly, expect
product have become longer and of all forensic cases in which I have that a copy of any written correspon-
more complex. In a recent case, I was had any involvement at any level in dence, electronic correspondence (if
asked to provide: the original or any the last five years, including but not available) and report(s) issued will be
copy of a writing or other form of limited to the names of the parties, discovered as are any test results for
record-preserving system including the lawyers with a designation of who tests you ordered or conducted. If you
without limitation, anything, either hired me, the judge, court, and case keep billing records for a case these
typed, printed, handwritten, visually citation, a summary of my opinion will generally be discoverable but not
reproduced, electronically generated and the results of the case; and a copy everyone keeps these records once a
including computer files, records, of any/all articles, journals, texts, bill is paid.
lists, papers, notes, memoranda, treatises, writing, that forms any If you relied on or cite specific ar-
correspondence, e-mails, schedules, portion of the basis of any opinion to
(continued on page 7)
6 • Winter 2022 American Academy of Psychiatry and the Law NewsletterASK THE EXPERTS
Ask the Experts Kaye has pointed out, lawyers try everybody else in court, but not for
continued from page 6 to intimidate and bully us, and one your opinion.
of the ways of doing this is to make In a recent case, I made what some
ticles, books, and references you can unreasonable requests. As Dr. Kaye may consider a rookie mistake. I was
be asked to provide copies, although I points out, generally speaking, the entering the second day of virtual
usually don’t and tell the lawyer that retaining lawyer can deal with these cross-examination on a difficult case,
the other side can obtain these public issues and save us from unnecessary which split the cross-examination
materials at their time and expense burdens. into one day in December, followed
and that I won’t, so long as I provide Nevertheless, it is incumbent upon by one day in January, followed by
the correct citations. Testing answers us to retain all of our records in a one day in February. In order to keep
are fair game, but many test ques- psycholegal case. This may include track of where I thought counsel
tions or booklets are proprietary and any handwritten or typed records of was going, I made some handwrit-
many courts have upheld the right interviews with an evaluee or other ten notes at the end of the first day
of the expert and testing company to interested parties. It may also in- and had them in front of me ready
not provide the actual questions or clude copies of billing documents or for the next day. The perspicacious
scoring algorithms. I do not generally invoices. The issue of draft reports counsel noticed me shuffling pieces
provide a copy of everything I have is an interesting one. Whether or not of paper and asked me what was in
reviewed as it all came from retaining draft reports have to be produced is front of me. Under oath, I had to tell
counsel so they have it and they can dependent upon the rules or precedent him the situation and of course he
share it with the other side. I also in each particular jurisdiction. As Dr. demanded to see the notes. Since I
think it’s important NOT to give dis- Kaye points out, many of us in this was testifying virtually from home, I
covery materials directly to the other day and age add incrementally to a had to scan the notes and send them
side (such as duces tecum materials at report in a computer file as various to the parties and wait for him to
depositions). I almost always give my sources of information come into cross-examine me. The notes were to
materials to the lawyer who retained our possession. For instance, when a remind me of the crucial points that
me, for transmittal to the other side as collateral source contacted me, I may I wanted to hammer home-including
appropriate, allowing them to remove add a section on that interview. The the unreliability of the history given
items they believe aren’t discover- issue really is whether the retaining by the evaluee, the tendency of the
able. lawyer has influenced you to change evaluee to control information, and
As for “draft” reports, there are your report. Hopefully you can be the fact that these issues supported
substantial differences from state to convincing about this issue. It might my contention that he suffered from
state regarding these being discov- be possible to get ahead of this and psychopathy and antisocial person-
erable. Therefore, you need to know assure the parties that of course you ality traits. I was, rather cynically,
what are the rules or precedents. would never change your opinion due duly cross-examined about this, but I
Today, many of us don’t have drafts to pressure from the retaining lawyer, believe that it only strengthened my
as we create an initial document in but you did add to the report as infor- position in the end, because I was
word-processing software and simply mation came in as we have discussed able to repeat these points yet again.
continuously edit until it is finalized. above. If you have changed the There is, nevertheless, a lesson to be
report, it is not unreasonable again to learned from this: if you’re going to
A. Glancy: explain that yes, you did make some be a forensic psychiatrist, you have to
Hamlet contem- changes because the lawyer pointed learn to suffer the slings and arrows
plates the pain and out some of the dates or facts were of outrageous lawyers and to ensure
unfairness of life: mistaken or not in evidence and so that you do not let it get to you and
“To be or not to you removed or changed certain throw you off your stride.
be? Whether tis points. If this is the case you would of
nobler in the mind course have some record to jog your Take Home Points:
to suffer the slings memory of what changes were made, The rules of discovery are deter-
and arrows of outrageous fortune, Or and you would have to expect some mined by each state and codified.
to take arms against a sea of troubles, questions about this in deposition. Like many things in forensic psychia-
And by opposing end them.” (1) It may also be helpful to ensure that try, it is critical to know the rules spe-
One of the facets of a career in you retain any billing documents or cific to the jurisdiction. It is appropri-
forensic psychiatry is that there are invoices, which are often raised either ate to ask the retaining lawyer about
times when we must endure the slings in depositions or at trial, generally discovery rules applicable to the case
and arrows of the various parties of with the inference that you would and we advise so doing.
the legal system. To a certain extent say anything considering the amount
we are in the hands of lawyers in the that you have been paid. You will Reference:
system and we have to accept that of course try to make the point that (1) Shakespeare W. Hamlet. Act 3, scene 1
this is the case. Sometimes, as Dr. you are paid for your time, just like
American Academy of Psychiatry and the Law Newsletter Winter 2022 • 72021 ANNUAL MEETING SPEAKER
Addressing Sexual Violence and toms of forgetting, unawareness, not
telling; depression; anxiety; shame;
Gender Discrimination: Moving from PTSD, dissociation; physical illness;
hallucinations; self-harm; problematic
Institutional Betrayal to Institutional substance use; and revictimization.
Courage: Jennifer J. Freyd, PhD Dr. Freyd also found that women/girls
are at higher risk than men/boys of
Karen B. Rosenbaum, MD betrayal exposure.
Dr. Freyd then asked the question,
The Friday by cheating and betrayal. She said can institutions betray? And if so, is
October 22, 2021 that when empowered, people have it harmful and is there institution-
virtual lunch- exquisite sensitivity to cheating and al betrayal blindness? She defined
time speaker for betrayal. institutional betrayal as institutions
the 52nd AAPL Regarding Betrayal Trauma theory, harming those dependent on the in-
conference was humans are profoundly dependent on stitution which includes the failure to
Dr. Jennifer others. The attachment system pro- prevent or respond supportively and
Freyd, a Profes- tects the dependent person. The baby creating an environment in which the
sor Emerita of has a “job” which is to engage love experience was more likely to occur.
Psychology, University of Oregon; an and to be loveable. The child rewards Dr. Freyd and her colleague Dr. Smith
Adjunct Professor of Psychiatry and the engaged parents with eye contact, developed the Institutional Betrayal
Behavioral Sciences in the School cooing and hugs. The attachment Questionnaire. (3) They found that
of Medicine at Stanford University; system is biological. With varying institutional betrayal exacerbates
and the Founder and President of the degrees, dependence and attachment trauma symptoms including anxiety,
Center for Institutional Courage. (1) continue throughout life including in dissociation, sexual problems, and
Dr. Freyd is an expert in memory and school, in the workplace, and toward sexual-abuse related symptoms.
trauma and is also the editor of the one’s country. Dr. Freyd and colleagues also found
Journal of Trauma and Dissociation. The question becomes: What hap- that institutional betrayal exposure
She is the author of Betrayal Trauma: pens when the caregiver is also the and then staying in the institution
The Logic of Forgetting Childhood betrayer, and what does the depen- is also associated with dissociative
Abuse. She developed and published dent person do when betrayed? The symptoms (unawareness, forgetting)
her theories of institutional betrayal dependent person cannot afford to feel even when controlling for the betrayal
and DARVO, which stands for Deny, betrayed by the person or institution trauma exposure. She explained that
Attack, Reverse Victim and Offend- the person is dependent on and so institutional betrayal is also associat-
er. This is a common psychological there is a conflict. This conflict can ed with racism and homophobia and
strategy employed by those accused lead to “betrayal blindness.” Un- that it is costly for the institutions
of abuse. The abuser claims that he awareness and forgetting are some- perpetrating the betrayal. People
or she or the institution is the actual times an adaptive response to betray- disengage from the system, it leads to
victim in the situation, attempting to al. The dependent person cannot see illness, absenteeism and high rates of
reverse the reality for the victim and something right in front of their eyes turn-over. There is a loss of potential
the offender. that is apparent to others. In the short talent. There is internal rot, corrup-
Dr. Freyd began her talk discuss- run, this ability helps with survival tion, and eventual collapse. There is
ing Betrayal Trauma and Betrayal but there is a long-term cost. also a reputational cost. Not trusting
Blindness, using the example of Frank Dr. Freyd explained that Betrayal institutions has risks for democracy
Fitzpatrick, who after nearly thirty Trauma theory suggests that there are and society as a whole.
years uncovered memories of having two primary dimensions of traumatic The harm of institutional betrayal is
been molested by Reverend R. Porter. events. She showed a graph where so- both pragmatic and psychological. An
A New York Times article from July cial betrayal (low to high) was on the example of pragmatic is: There is lead
21, 1992 used this and other cases to Y axis and terror/fear-inducing (low in the water when the government
illustrate the controversy surrounding to high) was on the X axis. Examples says there is no lead in the water.
uncovered childhood memories. (2) given that were high in social betray- But institutional betrayal also hurts
Dr. Freyd proposed that the reasons al and high in terror/fear-inducing feelings. Dr. Freyd’s solution is to
individuals forget or are unaware of were: sadistic abuse by a caregiver make institutions more trustworthy as
past abuse is due to betrayal trau- and the Holocaust. Dr. Freyd asked people cannot help being vulnerable
ma. She asked that we consider our if rates and symptoms of forgetting and loving institutions. It goes back
sensitivity to betrayal. The ability depended on these dimensions. She to the attachment system discussed
to evaluate trustworthiness is highly explained that twenty-plus years of earlier. An example given was that
important to our survival. We depend research has shown that high betrayal after a rape allegation in March of
on social contracts and we are harmed is associated with increases in symp-
(continued on page 9)
8 • Winter 2022 American Academy of Psychiatry and the Law NewsletterFreyd Lunch 9. Use the organization to address
the societal problem
What is the
continued from page 8
10. Comment on on-going resourc- NCCHC?
2014 at the University of Oregon, the es to 1-9 Joseph Penn, MD, CCHP, FAPA
university had prioritized its athletic
In the Question and Answer session, AAPL Representative to the Na-
reputation over students’ safety and
let the basketball team (including the Dr. Freyd explained that the more tional Commission on Correctional
accused members) compete in March prestigious the institution, the more Health Care (NCCHC)
Madness. The students pushed the potential it has to commit institutional
university to make changes and apol- betrayal, including responding poorly The NCCHC provides voluntary
ogize and a survey showed that the to a whistle-blower or accusation. accreditation and technical assistance
changes helped. There was a question about medical to jails, prisons, juvenile, and opioid
Dr. Freyd also showed that there errors and Dr. Freyd explained that treatment programs within correc-
is an association between COVID research has demonstrated that when tional facilities in the United States.
risk and risk for sexual harassment institutions show courage vs. betrayal I serve as the AAPL representative
at universities. COVID risk practices it is better for patient outcome. She to the NCCHC Board of Directors, a
were associated with misogyny and explained that apologies are very multidisciplinary group composed of
gender/based violence and harassment powerful. People are afraid of law- over 30 different professional member
more than with personality disorders suits, so they do not apologize, but organizations [this includes the AMA,
or rule-breaking behaviors. they are more likely to have to deal both APAs (psychiatrists and psychol-
Dr. Freyd discussed the problem with a lawsuit if an apology has not ogists), ABA (bar association), ADA
with reporting, and how without occurred. When asked how to get an (dentists) to name a few].
reporting it is difficult to stop assault institution that has harmed through The NCCHC jail, prison, juvenile,
and harassment. Victims often do not betrayal to apologize, Dr. Freyd mental health, and opioid treatment
report: reporting is risky, due to poten- suggested that the survivor draft the standards are reviewed and updated
tial harmful responses such as blam- apology on behalf of the institution. every 3-5 years. The juvenile and
ing, invalidating, and punishing. Her The very act of drafting the apology mental health standards are now
research on DARVO helps illustrate can bring a kind of psychological re- up for revision/review. I have been
this. Deny: “it never happened;” At- lief; also, often the institution does not invited to serve on both work group
tack: “you’re a liar;” Reverse Victim know where to begin, and a draft can revisions. I recently chaired the juve-
and Offender: “I’m the real victim.” give them something to work with. nile standards work group and look
(4) Regarding mandatory reporting, An apology that is carefully worded forward to the mental health standards
the research suggests that taking away and meets the need of the victim for revisions, anticipated to begin in the
control of disclosure of information acknowledgment without putting the Spring 2022. I chaired the NCCHC
is harmful to survivors of sexual institution at terrifying legal risks can Board until the Fall 2021 meeting,
violence. Dr. Freyd suggested that a be very powerful. and am now serving as the immediate
better policy is survivor-directed. past chair.
Dr. Freyd discussed institutional References: NCCHC holds three conferences
courage and ten steps to promote (1) Center for Institutional Courage. https:// per year, the spring and fall confer-
institutional courage: www.institutionalcourage.org/ ences and a summer conference with
(2) Goleman D. Childhood Trauma: Memo- a mental health focus. NCCHC also
1. Comply with laws and go be- ry or Invention? The New York Times, July oversees the peer-reviewed Journal of
yond mere compliance, beware 21, 1992. Available at: https://www.nytimes. Correctional Health Care, the nation’s
risk management mindset com/1992/07/21/science/childhood-trau- only professional journal dedicated to
2. Educate institutional communi- ma-memory-or-invention.html. Accessed scholarly inquiry in this field.
ty (especially leadership) November 11, 2021
NCCHC has a certified correctional
(3) Smith CP, Freyd JJ. Dangerous Safe
3. Respond well to victim disclo- health program (CCHP) program for
Havens: Institutional Betrayal Exacerbates
sures (and create a trauma-in- Sexual Trauma. Journal of Traumatic Stress. individuals who have demonstrated
formed reporting policy) 2013; 26: 119-124. mastery of national standards via a
4. Bear witness, be accountable, (4) Harsey SJ, Zurbiggen EL, Freyd JJ. Per- written examination. The CCHP-MH
apologize petrator Responses to Victim Confrontation: (Certified Correctional Health Profes-
5. Cherish the truth-tellers DARVO and Victim Self-Blame. Journal of sional-Mental Health) is an oppor-
6. Conduct scientifically sound Aggression, Maltreatment & Trauma. 2017; tunity for correctional and forensic
anonymous surveys 26(6): 644-663. psychiatrists, psychologists, and other
7. Regularly engage in self-study qualified mental health professional
8. Be transparent about data and staff to pursue this additional certifi-
policy cation.
For more information, go to www.
ncchc.org.
American Academy of Psychiatry and the Law Newsletter Winter 2022 • 9COMMITTEE PERSPECTIVES
Taking the BITE out of Disinformation scandal, with 72% of the country
reporting that they trusted news
and Cult Effects in the Time of COVID sources. (8) At that time, again, the
Karen B. Rosenbaum MD; Susan Hatters Friedman, MD; Ryan Hall, MD; majority of the population felt that
media were reporting the news fully,
and Cathleen Cerny-Suelzer, MD accurately, and fairly. In contrast, the
Media and Public Relations Committee most recent numbers in the Gallup
Poll for 2021 show that only 36% of
This panel discussion was present- for which there is intense commit- Americans view the media in such
ed at the 2021 Annual Meeting. Dr. ment, and which is shared by others in a manner. This is the second lowest,
Rosenbaum presented an overview the person’s subcultural group. Pierre with the lowest being 32% in 2016.
of the problem of disinformation (4). discussed “delusion-like beliefs” However, the news media has consis-
and how it can lead to indoctrination which only superficially resemble tently been below a 50% rating in the
into cults which can come in many delusions, such as conspiracy theories. Gallup Polls since roughly 2005. This
forms including multi-level marketing The “Incel” subculture was discussed is concerning because this suggests
(MLM) scams or pyramid schemes, as an example, and recommendations that over the past sixteen years, more
exemplified by the recent example of were made, including that evaluators Americans distrust the news media
the clothing MLM LuLaRoe, docu- become familiar with both the beliefs than trust them, which suggests that
mented in the Amazon Prime four-part and the lingo of the subculture as well there may be an entire generation
series LulaRich. (1). She explained as considering whether the evaluee of individuals who are raised with
how disinformation is different from has any non-delusional symptoms this view and perspective. This new
misinformation (false information) of a psychotic disorder. (5). Finally, reality will make it harder to provide
because it is purposely meant to fool Pierre (6) suggested that in identifying or identify trusted news sources and
or deceive the receiver of the false delusions, the evaluator consider the makes it more difficult to dispel myths
information. She went through several evidence or explanation given for the or conspiracy theories. Similar trends
examples of ways in which disinfor- belief, whether the belief is self-refer- have been found in other democracies
mation has led to cult involvement. ential, and whether there is overlap. as well. (9)
The belief that a group has the an- Dr. Hall discussed the current Dr. Cerny-Suelzer explained why
swers to someone’s underlying issues state of journalism. In his view, of it is necessary to provide our trainees
can be compelling to a vulnerable significant concern is the fact that with guidelines for evaluating what
person, which was the initial premise confidence in news journalism has they read in print and online so they
of NXIVM led by Keith Raniere, who been decreasing over the last 20 years. can separate fact from fiction and help
was called “Vanguard” by his fol- Although there may be a greater their patients do the same. Forensic
lowers and was recently sentenced to divergence in trust based on political psychiatrists do not have the luxury
120 years in prison for sex trafficking parties, the overall trends for members of burying our heads in the sand and
and racketeering, among other federal of both major parties have been a de- hoping that this “infodemic” resolves
crimes. (2) crease. Per the Pew Research Center without our active participation in
Next, Dr. Hatters Friedman dis- 2020 data, only 39% of the United combating disinformation. The World
cussed disentangling false beliefs States’ population have a fair amount Health Organization has a list of tips
from psychotic delusions. In review- to a great deal of confidence that jour- for spotting fake news that provide a
ing the history of the concept of nalists will act in the best interest of useful framework for learners at any
delusions, it was noted that histori- the public. (7) Although this is down level. (10). Going beyond provocative
cally, as reality was constructed by some from 2018, it may represent headlines and self-assessing for bias
the insider group, indigenous people aspects of the COVID-19 pandemic are key. Resisting oversimplification
were believed to have false beliefs. (In 2018 41% felt a fair amount of and doing additional background
By 1980 in the DSM-III, delusions confidence, 15% a great deal). The research are also helpful recommen-
were considered mainly as an individ- overall trend has been downward for dations. (11). These guidelines can be
ual belief due to incorrect inferences many years. Part of this decrease may used in psychiatric training journal
about reality. In contrast, Wernicke also be related to views of journalistic clubs and applied to information from
first described an ‘overvalued idea’ in ethics, with a majority of US adults popular media sources.
1892 and viewed them as ego-synton- identifying that journalists have either Forensic psychiatrists also need
ic and of lessened intensity. Over- low or very low ethical standards. to give trainees guidance for patient
valued ideas are not usually accepted According to the Gallup Poll report- interactions. The use of open-end-
by other members of the culture or ed on October 7, 2021, the highest ed questions should be encouraged.
sub-culture. Rahman and colleagues percentage of trust and confidence Trainees need to ask about early life
(3) described “extreme overvalued in “mass media such as newspapers, experiences, trauma and important re-
beliefs” as beliefs which may be am- television, and radio” occurred in lationships. It is important to provide
plified and more dominant over time, 1976 at the height of the Watergate
(continued on page 11)
10 • Winter 2022 American Academy of Psychiatry and the Law NewsletterCOMMITTEE PERSPECTIVES
Taking the BITE References:
(1) LulaRich Official Trailer. YouTube,
Public Safety and
continued from page 10
available at: https://www.youtube.com/
watch?v=nJgkwIHp1pc
Unrestorability:
residents and fellows with instruction
on how they can help their patients
(2) Hong N, Piccoli S. Keith Raniere, Lead-
er of Nxivm Sex Cult, Is Sentenced to 120
What is the end
with decision-making skills including
sharing how to evaluate information
Years in Prison. New York Times, October
27, 2020. Available at: https://www.nytimes.
game?
they are presented with. com/2020/10/27/nyregion/nxivm-cult-keith- Stephanie Maya Lopez, MD
As forensic evaluators, identifying raniere-sentenced.html Forensic Hospital Services
fake news and gathering full histories (3) Rahman T, Zheng L, Meloy JR. DSM-5 Committee
are crucial skills, but it is also crucial Cultural and Personality Assessment of Ex-
to understand the forces responsible treme Overvalued Beliefs. Aggression and In Oregon, the detention period for
for the false narratives. Malignant Violent Behavior. 2021; Jan:101552. competency restoration is three years
narcissists exercising undue influence (4) Pierre JM. Forensic psychiatry versus the or the maximum potential sentence
varieties of delusion-like belief. The Journal for each alleged crime, whichever
over unwitting victims do exist, and
of the American Academy of Psychiatry and
some of us may end up evaluating is shorter. If a defendant is found to
the Law. 2020; 48: 327-334.
them or their victims. Dr. Steven Has- (5) Tastenhoye C, Ross N, Dupre J, Bodnar be incompetent to stand trial and not
san’s BITE model provides a helpful T, Friedman SH. Involuntary Celibates and restorable (IST/NR) at or before the
framework for this effort. Forensic Psychiatry. The Journal of the end of this period, all charges must be
Dr. Hassan, discussant, began by American Academy of Psychiatry and the dismissed with or without prejudice
acknowledging that we do NOT live Law. in press. and the defendant released. While
in a “post-truth world.” He discussed (6) Pierre JM. Conspiracy theory or delu- civil commitment proceedings can be
the model he developed to explain sion? 3 questions to tell them apart. Current pursued, the bar is high and requires
authoritarian control, the ‘BITE Psychiatry. 2021; 20(9):44-60. a finding of dangerousness “in the
model,’ for behavioral, informational, (7) Gottfried J, Walker M, Mitchell A. near future,” a standard that has been
Americans are more negative in their broad- interpreted by appellate courts to be
thought, and emotional control. (12). er views of journalists than they are toward
He explained that someone exerting COVID-19 coverage. Pew Research Center,
dangerousness that is both high and
this control is exercising undue influ- May 8, 2020. Available at: https://www. imminent. (1)
ence and mind control. He explained pewresearch.org/journalism/2020/05/08/ As the census at Oregon State
that being influenced can happen to americans-are-more-negative-in-their-broad- Hospital (OSH) swelled with defen-
anyone who is in a vulnerable place, er-views-of-journalists-than-they-are-to- dants committed for trial competency
and he used his own story about when ward-covid-19-coverage/ restoration, some of whom were
he was young and three smiling wom- (8) Brenan M. Americans’ Trust in Media charged with dangerous crimes that
en approached him after he had been Dips to Second Lowest on Record Gallup, outraged the public, there was concern
“dumped” by his girlfriend, and he October 7, 2021. Available at: https://news. that dangerous defendants would be
gallup.com/poll/355526/americans-trust-me- released into the community without
subsequently joined the “Moonies,”
dia-dips-second-lowest-record.aspx
believing Sun Myung Moon was the treatment and supervision. In response
(9) Kellner P. The BBC is not alone in losing
messiah. public trust. The Guardian, November 13,
to this concern, Oregon Senate Bill
Dr. Hassan explained that in the 2012. Available at: https://www.theguardian. 426 was introduced in the state leg-
21st century, of the four means of com/commentisfree/2012/nov/13/bbc-not- islature in 2013. A public letter from
control, informational control is the alone-losing-public-trust the City Manager’s Office in Eugene,
most important to consider. In recent (10) World Health Organization. Let’s flatten Oregon explains the rationale:
years there have been widespread the infodemic curve. Available at: https://
lying, withholding or manipulation of www.who.int/news-room/spotlight/let-s-flat- As recent events have under-
information, propaganda, and using ten-the-infodemic-curve scored, Oregon’s justice system
information against one another. Dr. (11) Berntsen M. Is It Fact or Is It Fake? 10 needs work in this area, particu-
Tips for Navigating Online Media. Available larly with respect to dangerous
Hassan discussed how he created at: https://extension.psu.edu/is-it-fact-or-is-
a three-step intervention called the or homicidal offenders who
it-fake-10-tips-for-navigating-online-media are released from custody after
Strategic Interactive Approach (SIA) (12) The BITE Model of Authoritarian
where he helped create a network of being found “unable to aid and
Control: Undue Influence, Thought Reform,
trained individuals (family, friends, Brainwashing, Mind Control, Trafficking
assist” in their own defense...
ex-cult members, media, clergy, and and the Law. PhD Dissertation, 2020. Avail- SB 421 and SB 426 are an
therapists) to orchestrate a step-by- able at: https://freedomofmind.com/wp-con- attempt to improve Oregon’s
step, ethical influence program to tent/uploads/2021/01/Dr-Hassan-Disserta- statutory interface between the
empower an individual or set of indi- tion-Published.pdf criminal justice system and
viduals to think for themselves. dangerous offenders who are
mentally ill. (2)
(continued on page 12)
American Academy of Psychiatry and the Law Newsletter Winter 2022 • 11You can also read
