Dr. William J. Newman, MD: Promoting Wellness in Forensic Psychiatry - American Academy of Psychiatry and the Law
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Winter 2021 • Vol. 46, No. 1
2020 AAPL Presidential Address self, and work-life imbalance. Studies
show that medical errors are higher for
Dr. William J. Newman, MD: Promoting individuals with burnout. On the other
hand, higher levels of empathy are a
Wellness in Forensic Psychiatry protective factor against burnout.
Britta K. Ostermeyer, MD, MBA, DFAPA National data shows that 45%
and 54% of physicians in 2011 and
cognitive impairment, fatigue, depres- 2014, respectively, reported burnout.
sion, anxiety, and visual changes. In Although a 2013 Stanford University
particular, Neuropeptide-Y (NPY), survey of physicians yielded only a
synthesized in the hypothalamus, is 26% reported rate of burnout, three
becoming increasingly understood years later burnout had increased
as having an important role in stress, to 39% despite Stanford’s burnout
anxiety, and resiliency. Chronically prevention efforts. The Stanford study
stressed individuals have higher serum also looked at professional fulfillment
NPY levels than patients diagnosed and found that 24% of physicians
with PTSD or MDD. reported fulfillment in 2013, which
Dr. Newman shared that he was subsequently decreased to 14% in
stalked by a former patient who had 2016. Dr. Newman highlighted that
serious plans to kill him. Severe, reported burnout rates increased even
chronic stress due to stalking often is though Stanford as an institution is
followed by inflammatory conditions, very committed to burnout prevention.
including cancer. He was diagnosed On the topic of helping to promote
with metastatic cancer some time after wellness and preventing burnout,
Dr. Newman, AAPL’s 46th President, experiencing severe and chronic stress Dr. Newman explained the Stanford
was introduced by Charles Scott, MD. due to the stalking. model, called “Well MD Center.”
Dr. Newman is Professor and Interim Burnout, defined as emotional, phys- Its priorities are: (1) “The Culture of
Chair in the Department of Psychiatry ical, and mental exhaustion caused by Wellness,” meaning that leadership is
and Behavioral Neurosciences at the prolonged stress, has been classified engaged; (2) “Efficiency of Practice,”
St. Louis University School of Medi- by the World Health Organization as ensuring that physicians have the
cine in St. Louis, Missouri. an occupational phenomenon. Of note, resources they need to practice at the
In his introduction, Dr. Newman while medical students start with high- top of their license; and (3) “Personal
stated that we tend to speak very little er levels of resilience than other grad- Resilience,” which facilitates building
about well-being despite being psy- uate students, after medical school, one’s own self-appreciation and how
chiatrists, and that this topic has been physicians experience burnout at a to recognize one’s limitations as well
an infrequent part of presentations at higher rate than other matched profes- as strengths.
AAPL. He has had personal experi- sionals. It is a real concern for organi- Physicians are an unusual group,
ences that led him to focus more on zations to place the onus for wellness psychiatrists an unusual subset of
wellness and staying healthy. onto physicians, as they are already physicians, and forensic psychiatrists
He explained that while acute stress prone to self-reproach. In his opinion, make up an even more unusual sub-
in response to danger is important and physician burnout must be addressed class. A 2014 Canadian survey found
adaptive, a prolonged stress response through a variety of systemic changes that 62% of physicians self-identify
is maladaptive and leads to negative within medicine. “It’s not enough to as having “Type A personality,” 53%
long-term emotional and physical focus on individual physicians fixing agreed that they are a “workahol-
sequelae. Chronic stress causes themselves or addressing this problem. ic,” and 35% agreed that they are a
inflammatory processes which can There really need to be some big-pic- “control freak.” He commented that in
cause a host of medical conditions, ture goals.” Factors promoting burnout particular “within forensic psychiatry
including cancer, cardiovascular include sleep deprivation, perfection- probably a lot of people would identi-
disease, and neurological conditions. ism, demands, financial struggles, fy with these descriptors.”
Brain inflammation due to peripheral unreasonable expectations, negative Identified maladaptive physician
pro-inflammatory cytokines crossing relationships, lack of support, high traits include neuroticism, anger, and
the blood-brain barrier can lead to workload, call, overstretching one-
(continued on page 2)
American Academy of Psychiatry and the Law Newsletter Winter 2021 • 1
American COVER STORY
Academy of
Psychiatry Presidential Address of this group, he has learned to identi-
fy more with the term “work engage-
and the Law continued from page 1
ment,” which is defined as “a positive,
pride. We as forensic psychiatrists may fulfilling, work-related state of mind
Editor
Joseph R. Simpson, MD, PhD have identified ways to channel neu- that is characterized by vigor, dedica-
roticism, such as being detail-oriented tion, and absorption.” According to Dr.
Associate Editors and somewhat obsessive. Anger in Malissa Clark (a 2020 AAPL pre-
Philip J. Candilis, MD physicians may not necessarily surface senter), workaholism includes feeling
Ryan C. W. Hall, MD compelled to work because of internal
Stephen P. Herman, MD
as temper outbursts but is more likely
Neil S. Kaye, MD to manifest as impatience and intoler- pressures; having persistent thoughts
Britta K. Ostermeyer, MD, MBA ance. Physicians must learn to recog- about work when not working; and
Karen B. Rosenbaum, MD nize anger and think through ways to working beyond what is reasonably
Renée M. Sorrentino, MD address it, much like in a CBT-type expected, despite the potential for
Joel Watts, MD model. Lastly, pride in itself is not negative consequences and impact on
AAPL Photographer unhealthy but may become problemat- personal relationships. Interestingly,
Eugene Lee, MD ic when it comes across as arrogance Dr. Clark found that workaholism is
and begins to impact others negatively. only moderately correlated with actual
Former Editors Dr. Newman noted, “One thing I often hours worked, and that it has more
Susan Hatters Friedman, MD (2016-2018) to do with the way one interprets and
tell my trainees is that in forensic
Charles Dike, MD, MPH (2008-2016)
psychiatry I think it’s a good thing to relates to one’s work. Workaholism is
Victoria Harris, MD, MPH (2003-2008)
Michael A. Norko, MD (1996-2003) be confident but you have to stop short highly correlated with Type A person-
Robert Miller, MD PhD (1994-1996) of being arrogant, “and that’s a chal- ality and perfectionism; early studies
Alan R. Felthous, MD (1988-1993) lenge...Take your work seriously but show it likely correlates with narcis-
Robert M. Wettstein, MD (1983-1988) try not to take yourself too seriously.” sism, which does not have to do with
Phillip J. Resnick, MD (1979-1983) He further suggested it is important to the amount that somebody works, but
Loren H. Roth, MD, MPH (1976-1979) the way it is impacting them person-
obtain feedback from others, including
Officers constructive criticism. “Being open to ally.
President that, I think, is a major part of devel- Next, Dr. Newman shared insights
Liza H. Gold, MD oping throughout your career.” about the psychology of hate, which is
President-elect Dr. Newman noted that forensic generally viewed as a distraction from
Susan Hatters Friedman, MD psychiatrists are unusual in part due internal feelings such as helplessness,
Vice President to unique challenges. Looking at the inadequacy, and shame. It provides
Hal S. Wortzel, MD job description, there is (1) a heavy a temporary release of such internal
Vice President emphasis on public speaking, which discomfort. Knowledge and educa-
Britta K. Ostermeyer, MD creates significant anxiety in about tion are the most effective tools for
Secretary one-third of the U.S. population; addressing hate. There are increasing
Karen Rosenbaum, MD (2) exposure to chronic stress, both reports about the long-term physical
Treasurer internally and externally, via real and emotional impacts of hate, related
Stuart A. Anfang, MD to chronic stress and its impact. “The
and self-imposed deadlines; (3) great
Immediate Past President potential for punishment for any Dalai Lama gives a very nice quote to
William J. Newman, MD this point: ‘Don’t let the behavior of
career imperfections, such as failing
The AAPL Newsletter is published by an exam; and (4) repeated exposure to others destroy your inner peace.’”
AAPL, One Regency Drive, PO Box potentially traumatizing content with a Dr. Newman listed useful habits that
30, Bloomfield, CT 06002. Opinions high risk of vicarious trauma, defined can counteract chronic stress and re-
expressed in bylined articles and columns as experiencing repeated or extreme duce inflammation, including a healthy
in the Newsletter are solely those of the diet, regular exercise, enough sleep,
authors and do not necessarily represent
exposure to aversive details of the
the official position of AAPL or traumatic events(s), which may lead to relaxation, engagement with family,
Newsletter editors. PTSD. Dr. Newman pointed out that travel, mindfulness, job satisfaction,
Manuscripts are invited for publication in our 2020 AAPL program included a yoga, Netflix, and knitting. He pointed
the Newsletter. They should be submitted presentation by Dr. John Bradford on out that “every individual has to deter-
to the editor via email to NewsletterEdi- this topic. mine what makes a healthy Wellness
tor@aapl.org Dr. Newman moved on to discuss Wheel for them. While it is different
The Newsletter is published in for different people, it is some combi-
Winter (deadline for submission is
workaholism, which was first de-
November 15), Spring (deadline scribed in the 1970s by psychologist nation of elements for each person.”
March 1), and Fall (deadline July 1). Dr. Wayne Oates as “the compulsion It is very important to foster good
or the uncontrollable need to work relationships, while relieving oneself
www.aapl.org
incessantly.” While Dr. Newman of those that do not bring positive
© 2021 AAPL. ALL RIGHTS RESERVED.
reflected that he probably is a member
(continued on page 7)
2 • Winter 2021 American Academy of Psychiatry and the Law Newsletter
PRESIDENT’S REPORT
AAPL Post-COVID: able to combine the advantages of
online education with the social and
Pivoting to a New Normal educational advantages of being in
the same place at the same time with
Liza H. Gold, MD
colleagues. For example, the Annual
I hope this pandemic, but also into the future. Meeting call for submissions usually
issue of the To that end, with the support and yields far more proposals for presen-
newsletter finds assistance of Executive Council tations than can be accommodated. If
everyone safe and members, and again, Jackie Coleman, online CME courses are successful,
well. By the time her staff, and the second iteration of courses might become a primarily on-
you read this, I the Virtual AAPL Task Force, we are line learning modality, thus allowing
also hope we will developing “AAPL OnLine.” Some more panels, workshops, and other
be turning the of these new endeavors are likely to presentations at the Annual Meeting.
corner on a year be very successful; others maybe not In addition, AAPL will be adver-
of loss, hardship, and uncertainty. so much. But there can be no doubt tising our online offerings to mem-
My heart goes out to all who have that trial and evaluation of innovative bers, nonmembers, and all psychi-
struggled to meet the challenges this online offerings will result in AAPL atric residencies. Topics in forensic
year presented, especially our AAPL being able to advance its educational psychiatry are often of great interest
members who have been providing mission in new ways as part of the to nonforensic clinicians, and many
frontline care despite the personal “new normal.” psychiatric residencies do not have a
risks to themselves and their fami- Projects currently underway in- forensic fellowship program. Online
lies. I have never been prouder of my clude: offerings could result in significant-
medical colleagues and the health care • Organization of “open house” ly increased attendance and elevate
professionals with whom we work, as committee meetings, coordinated AAPL’s profile, which might lead to
they have risen to meet an unimag- with Forensic Fellowship Train- increased membership and increased
inable challenge. ing Directors, for fellows (and recruitment of forensic fellows.
Although we are not “post-COVID” others) to have an opportunity to Certainly, for the next two years
yet, eventually and together we will explore and meet with commit- or so, AAPL’s ability to translate the
get there. But what will the “new tees in which they might have an unique teaching talents and expertise
normal” look like? The need to adapt interest; of our members to online offerings
to the pandemic has resulted in many • Development of live-stream will be critical to the strength of the
changes, including some profound online courses and other types of organization. So I encourage mem-
changes in perspective. Some of presentations for CME credit; bers to propose additional innova-
these were not optimal. For example, • Organization of members-only tions. Please get in touch with any
many of us look forward to the AAPL Town Hall meetings to address is- ideas or proposals you might have
Annual Meetings as a highlight of our sues and current events affecting (lhgoldmd@gmail.com); no idea or
professional year. There is no doubt AAPL and forensic psychiatry; suggestion will be rejected without
that not being able to hold our Annual • An “Expert Lecture” series, consideration!
Meetings in person in October 2020, live-streaming a member present- In 2020, we did not have control of
and now again in October 2021, are ing a 60-90 minute lecture for many aspects of our lives. We fell into
losses. CME credit; our current circumstances unprepared
But necessity being the mother of • Development of the capability for the changes and challenges we
invention, 2020 Program Chairs Ryan to access on-demand materials, have been forced to confront. How-
Wagoner and Trent Holmberg, Exec- such as recordings of courses and ever, we can have control in defining
utive Director Jackie Coleman and meetings, podcasts, and other AAPL’s “new normal,” especially
her staff, and the “Virtual AAPL Task digital modalities; in regard to our primary mission of
Force” headed up by Annette Hanson • Redesign of the AAPL website, education. Your suggestions for in-
organized an excellent live-streamed the “Digital Face” of AAPL, to be novation and your evaluations of our
Annual Meeting. Renée Sorrentino, more dynamic and interactive, for online endeavors will be invaluable
our 2021 Program Chair, is well on members and nonmembers. in determining which of these will
her way to building on that experi- The most obvious advantage of on- help AAPL thrive through and after
ence. Our in-person Annual Meetings line learning (aside from being able to these difficult times. I know AAPL is
will resume as soon as possible, hope- attend in your pajamas) is time flex- up to the challenge. I leave you with
fully in New Orleans in 2022. In the ibility. Before the pandemic, almost Hurin’s words of hope (J.R.R. Tolk-
meantime, AAPL can and must have a all of AAPL’s annual activities took ien, The Silmarillion): “Aure entulu-
robust online presence for the organi- place in one hectic week at the Annual va! Day shall come again!”
zation to thrive, not only through the Meeting. Going forward, we will be
American Academy of Psychiatry and the Law Newsletter Winter 2021 • 3
MEDICAL DIRECTOR’S REPORT
Jonas R. Rappeport, in Memoriam Jonas was a true giant of forensic
psychiatry. He mentored all of us.
Jeffrey S. Janofsky, MD May he rest in peace.
— Renee Binder
I am devot- for a psychiatrist – that’s a ques-
ing my AAPL tion for an ophthalmologist!” I have been thinking about Jonas
Medical Direc- — Peter Ash overnight and concluded that the
tor’s column to best way I could characterize
Sad news to waken to here in the Jonas was as a master build-
the memory of UK. His personal qualities epito-
Jonas R. Rap- er. The goal for Jonas as leader
mized the unique characteristics and for those around him was to
peport, who died of the very special organization
on September 8, build a new medical specialty. If
which he created. you want to do this follow his
2020 after a long — John Baird
illness. (1) He was a founding father plan. Start by creating a new or-
of AAPL and was AAPL’s first Pres- Jonas was a “mensch” in every ganization, AAPL, with a singular
ident and first Medical Director. (2) sense of the word. He was a role goal, continuing education for the
Jonas was an important figure to many model, a wonderful teacher, a practitioners of the dark arts of
of us. He was my teacher, mentor, and good friend, and a devoted spouse. forensic psychiatry with a yearly
friend. After AAPL announced Jonas’ I knew him in many of these roles conference and its own profession-
death I received anecdotes from all and admired him in all. I turned to al journal. Soon follow this up by
over the world describing how Jonas him many times for support and creating a committee dedicated to
advice and he was always patient advancing sub-specialty training
was important in helping others in
and generous. I will miss him in this new specialty, and as soon
their professional and personal lives.
greatly. as these fellowships were suffi-
I thought the best tribute to Jonas
— Elissa Benedek ciently up and running develop
would be to print excerpts from those
your own certifying exam and a
comments, which I have edited for Like many others, I owe my foren- darn good one it was. And most
content and space: sic career to Jonas. I had 2 areas important insist from the very
I will never forget the time I was of special relationship with Jonas, beginning that only psychiatrists
doing grand rounds at the Uni- photography and the Michael Re- could be full members of AAPL
versity of Maryland and Jonas ese Hospital. In about 1990, Jonas and further that they had to be
and Joan showed up at the talk in approached John Beahrs and me members of APA, potentially
matching orange shirts and black at an AAPL meeting. He noticed AAPL’s best friend, and at the
pants, and took me right from that we each carried cameras. He same time its biggest obstacle to
there to the Orioles game at Cam- asked us to help him take photos at recognition. And, finally when the
den Yards. He was a great guy. the AAPL meetings. John dropped time came you had to give up your
— Paul S. Appelbaum off after a couple years, but I own darn good exam in favor of
continued as Assistant Photog- more important recognition. That
Jonas was so helpful to me in rapher. When I would describe was a hard one. But you cannot
my early years in AAPL and so my appointment as the Assistant be a master builder just by having
supportive later when we were Jonas, people knew what I meant. ideas in your head. You had to
developing the website for AAPL. In my forensic work, I learned to have the positive personality
I relished his wit - he had so many answer only the question asked. attributes, political adroitness, and
wonderful ways of putting things. As the Assistant Jonas, I learned the absolute dedication to accom-
My favorite was his advice about to do only the assigned task, not plish the goal. Jonas had all this
risk management: “When in doubt, more. He did let me know that he plus personal warmth, an ability
shout!” (Get a second opinion, appreciated my doing my assigned to listen and to formulate ideas
formal or informal, and docu- tasks. Jonas did his internship at clearly and positively. All were
ment it). The first time I cited his Michael Reese Hospital in Chi- part of his makeup. Jonas was a
saying in a chapter draft, the editor cago in about 1950. He met Joan help to most all who sought out his
wrote, “Love It!” next to it. I still there. She was a psychiatric nurse. help and support, and the most he
say it whenever I am teaching I did my internship at Michael ever asked of anyone in return was
residents about risk management Reese in 1972, and then psychia- arranging a good fishing trip.
situations. Another favorite was try residency there, too. I enjoyed — Joe Bloom
when he talked about the “nature reminiscing about Michael Reese
and quality of the act” clause in with Jonas and Joan on several I interviewed Jonas for an article
the M’Naghten Rule. “The nature occasions. Nothing lasts forever. in the Journal of Forensic Psychi-
of the act? What? The defendant Now Michael Reese Hospital and atry in 1997, when I worked in
thought he was shooting at a tree, Jonas are both gone. the UK. He suggested we talk in
not a man. That’s not a question — Steve Berger
(continued on page 5)
4 • Winter 2021 American Academy of Psychiatry and the Law Newsletter
MEDICAL DIRECTOR’S REPORT
In Memoriam Society events, at AAPL, at APA, I first met Jonas in 1979 at the
continued from page 4 at GAP, at committee meetings, in Del Coronado meeting. I was so
his woodshop, and once fishing for impressed that I followed Joe
his hotel bedroom in Denver at an bluefish. He made it possible for Bloom’s advice to me to join
AAPL meeting. He spent part of me to survey Maryland psychi- APPL and pursue certification in
the time sat propped up on his bed atrists for my PhD dissertation forensic psychiatry. It was the best
and part of it getting dressed. He research. It seemed he spent every thing I ever did in my profession-
was generous and helpful through- evening on the phone doing work al career. We will all miss Jonas.
out to someone he had never heard for all the committees and organi- What a visionary and kind mentor.
of who was asking him a series zations for which he volunteered. What a sad loss.
of slightly impertinent questions. No one was more generous than — Robert P. Granacher, Jr.
What made the strongest impres- Jonas in donating time and energy
sion on me was the complete lack to the betterment of the profession, One of the giants, fallen; he was
of pretension in a figure who was and his most prolific channels of the seed crystal for AAPL so many
regularly described as the doyen of influence were organized psychia- decades ago.
US forensic psychiatry. try and mentorship. Jonas did not — Thomas G. Gutheil
— Alec Buchanan keep his opinions to himself. He
had a way of telling you that you Jonas was very kind and nurturing
I remember Jonas not only for were wrong without giving offense to all of us up-and-coming young-
his foundational contributions or insisting you come around to er forensic psychiatrists. AAPL
to forensic psychiatry and his his point of view. By 1982, when will be emptier without him.
remarkable capacity to change we were teammates with Jim — Bruce Harry
his mind, but also as a welcoming Cavanaugh and John Monahan in
mensch for all seasons. May his the evaluation of John Hinckley, A rare kind of genius and founding
memory be a blessing to us all as Jonas treated me as a colleague. greatness. “Reasonable medical
we continue to learn to change our I like to think that Jonas took me certainty is not what I thought it
own minds. under his wing, as he has so many was. It is neither reasonable nor
— Harold Bursztajn others, and then set me free to find certain.” His words and deeds
my way in the world. remain with us.
I will always remember Jonas as a
We will all miss him, his kindly — James L. Knoll, IV
warm, kind, supportive, inspiring
leader who blazed the trails that smile, and the way he emanated
love. May we all have the positive im-
we now traverse. His spirit and
— Park Dietz pact that Jonas had...
influence lives on in each one of
— Jeffrey L. Metzner
us. That is a wonderful gift from I am so sad and sorry too. I had
a generous man. May he rest well the privilege of sharing Jonas’ APPL’s loss is Heaven’s gain. We
in peace. birthdate October 16, so we’ve will miss him. We are sad.
— Michael Champion exchanged birthday greetings over — Richard Rada
So sorry to hear that Jonas has the years. He meant so much to
died. He was a large and important many of us and was such a spiri- Lost a very good man. Worth
figure in our field. tual and instrumental force in the remembering for a long time.
— Brian Crowley development of AAPL, indeed of — William H. Reid
our forensic psychiatry discipline.
Jonas was the father of AAPL and — Alan Felthous (continued on page 6)
the father figure to generations of
AAPL members, many of whom
he nurtured and mentored. I first
met Jonas the evening before the
1971 APPL meeting in Pittsburgh,
and he invited me to look him up
if I were ever in Baltimore. Herb
Thomas gave me his number, and
when I moved to Baltimore as a
medical student in 1972, Jonas
invited me to his home to meet
his family. For the next 10 years,
we were in weekly contact, at his
Court Clinic, at lectures he gave
at Hopkins and the University of
Maryland, at Maryland Psychiatric Dr. Rappeport, AAPL’s first president, cutting the cake at our 40th Annual Meeting celebration in Baltimore.
American Academy of Psychiatry and the Law Newsletter Winter 2021 • 5
EDITOR’S COLUMN
AAPL Post-2020: More Reasons to Get and other groups, this is preaching
to the choir. But for those who are
Involved new to AAPL, or who for whatever
Joseph R. Simpson, MD, PhD reason have remained on the sidelines,
we encourage you to start partici-
The world idential Address from AAPL’s first pating – join a committee, submit a
is increasingly virtual Annual Meeting, as well as proposal for one of the 2021 AAPL
complex. Scientific summaries of the Meeting’s featured virtual events, or write an article for
advances accumu- speeches: Dr. Giamberdino’s talk on this newsletter. After the juggernaut
late at a dizzying the substance abuse recovery journey, of 2020, the benefits of being part of
pace. Keeping and Dr. Clark’s talk on workaholism an active, responsive and supportive
up with the latest and how to have a better relationship professional organization are hard to
technology in with work. You’ll also want to read overstate.
computers and Dr. Burrows’ contribution from the On a different note I would like
cell phones seems like practically a Early Career Committee on physician to thank those AAPL members who
full-time job in itself. (Being helped burnout, and the proposal for a new filled out our brief survey. The results
with tech by your children—or even Wellness Committee by Drs. Perkins suggest that the state of the Newsletter
grandchildren—may be somewhat and Newman. is strong. While we welcome future
embarrassing, but for many it is now Through that committee and other feedback and suggestions, for now
just a fact of life.) Individuals, regions initiatives, AAPL is developing we plan to continue on pretty much
and nations are more and more inter- resources for maintaining and increas- as before. Despite 2020 and the years
connected for good and ill. The US ing your wellness. Participation in preceding it, technological changes
political scene has reached a level of AAPL is a great way to remain con- haven’t completely swept away all the
turmoil not seen for half a century. nected; it provides opportunities for old media paradigms yet, and we will
The COVID-19 pandemic and networking and for a collegial expe- not be eliminating the print version
several other national and internation- rience. These benefits are in addition any time soon.
al developments in 2020 have made to the opportunities to increase your
these recent trends in human affairs professional knowledge and expertise
crystal-clear. To take just the scientific by attending AAPL educational events
In Memoriam
arena, whereas previously it typically and reading its publications. The em- continued from page 5
took at least 10 years to produce a phasis on wellness, and on improving Jonas could just easily say he or
successful vaccine, several companies diversity and equity within the orga- we were wrong about something
made COVID-19 vaccines, using nization, promises to add even more as insist on a truth or opinion.
different approaches, in less than one value to your membership in AAPL. He fathered a profession.
year. Meanwhile, the governments of You need not limit yourself to — David Rosmarin
China, France and the US have ac- engagement with one professional
knowledged their interest in using ge- body; you might want to consider He was enormously supportive to
netic engineering or other biological volunteering with others (always us all and brought me into AAPL.
methods to improve the performance keeping AAPL as your first priority, He played a major role in the
of military personnel – or as some of course). There are numerous large establishment of our modern field.
more sensationalistic media outlets and small professional organizations We will miss him.
like to say, creating “super-soldiers.” to get involved in, such as the APA, — Howard Zonana
The events of 2020 have been dif- the AMA, the AAFS (see the report
ficult and stressful for many of us, in by Drs. Freitas and De Crisce in this References:
our personal or professional lives, or issue), and the NCCHC, as well as (1) Kelley J. Dr. Jonas R. Rappeport,
both. Of course, an impact in one do- state and local medical and psychiat- retired forensic psychiatrist who
main of life almost always influences ric groups. In addition to educational worked on cases of attempted presi-
others. By what could only have been benefits, many of these organizations dential assassinations, dies. Baltimore
coincidence, AAPL’s immediate past monitor the legal and regulatory land- Sun. September 9, 2020. www.balti-
president, William Newman, chose scape for our profession, endeavoring moresun.com/obituaries/bs-md-ob-jo-
“Wellness in Forensic Psychiatry” as to improve bills that seek to change nas-rappeport-20200909-2imb-
the theme for his presidential year. regulations on psychiatry, and to pre- v47htbcvner7cr4jv6zyv4-story.html
And a fortuitous coincidence it turned vent bad bills from becoming laws. (accessed 10/22/2020)
out to be. In this first post-2020 issue Forensic psychiatry can be a very (2) Janofsky JS, Tellefsen C. Jonas R.
of the AAPL Newsletter, you will isolating specialty, particularly if one Rappeport, MD: Founding Father of
find several articles addressing issues practices it exclusively. For those the American Academy of Psychiatry
related to physician wellness and of you who already understand the and the Law. J Am Acad Psychiatry
burnout. There is Dr. Newman’s Pres- benefits of engagement with AAPL Law 35: 290-293, 2007
6 • Winter 2021 American Academy of Psychiatry and the Law Newsletter
FEATURED SPEAKERS
“Working Hard or Workaholic? Fostering Presidential Address
continued from page 2
a Healthy and Productive Relationship
aspects to one’s life unless they are out
with Work” by Malissa A. Clark, PhD of necessity. Compartmentalization—
Renée M. Sorrentino, MD not bringing stressful work aspects
home—is a very worthwhile endeavor,
In keeping with this year’s AAPL correlated with workaholism, and especially for forensic psychiatrists.
Annual Meeting theme, Malissa A. was a risk factor for cardiovascular Studies show fewer inflammatory
Clark, PhD, presented on the topic conditions. proteins and lower stress hormones in
of “Working Hard or Workaholic? “Work engaged” is distinct from individuals with strong social support
Fostering a Healthy and Productive workaholism. Work engaged refers networks. He emphasized that peer
Relationship with Work.” Dr. Clark to an individual who is pulled as support is beneficial for addressing
is Associate Professor of Industrial/ opposed to pushed to work and is burnout and workaholism as it can
Organizational Psychology at the Uni- generally related to positive work mitigate the risks of chronic stress.
versity of Georgia. According to Dr. outcomes. Having personally experienced severe,
Clark and her research group, about Dr. Clark pointed out, however, that chronic stress and supported others
one-fifth of us spend 60 hours or more one can be “too engaged” which can who have been stalked, he stated
per week working, one-half of us feel lead to exhaustion and poor outcomes that it is important for him as AAPL
overworked, and 77% of us fail to use over time. Dr. Clark addressed the President to develop an AAPL peer
all of our earned paid time off. This impact of COVID-19 on work hours. support system for members to share
“hustle” culture, highlighted by Elon Remote work in general tends to in- work experiences and provide support
Musk’s proclamation of working an crease work hours. However, studies to each other.
80-hour work week, is embedded in examining work hours in the setting Dr. Newman explained that a dis-
our society. But working long hours of COVID-19 have found that most cussion on burnout and stress should
is only one component of “workahol- people have maintained their pre-pan- include a conversation about resilien-
ism,” a term coined in the 1970s by demic work hours. cy, which is the process of adapting
Wayne E. Oates, who authored the In conclusion, Dr. Clark identified well in the face of adversity, trauma,
book Confessions of a Workaholic. an approach to fostering a healthy and tragedy, threats, or significant stress.
Workaholism, or a marked compul- productive relationship with work. He also introduced the concept as
sion towards work, consists of four Psychological detachment, a strategy referred to as “grit,” which stands for
key dimensions: excessive hours or to decrease our cognitive ruminations “perseverance and passion for long-
time beyond expectations, persistent, and rest for the next week is one ap- term goals,” and that this may be a
uncontrollable thoughts about work, proach. Others included physical de- more useful tool for individuals to
an inner pressure or compulsion tachment such as frequent, scheduled build with. He recommended a book
towards work, and experiencing nega- break and psychical activity. Competi- by Dr. Angela Duckworth, who has
tive emotions when not working. tive sports were the most effect sports been identifying and studying suc-
Dr. Clark’s research included the activity in terms of reducing work-re- cessful and resilient individuals with
development of a brief self-assess- lated stress. The number of steps “grit.”
ment tool to evaluate one’s relation- traversed per day was correlated with Finally, he talked about endocrinol-
ship with work. They found that greater end-of-the-day satisfaction ogist Hans Selye, who was one of the
behavioral and motivational dimen- and work-life balance. Individuals earliest researchers on chronic stress.
sions correlated with individuals who who were forced to take breaks and Dr. Selye said, “It’s not stress that
were “perfection striving” compared days off were found to have higher kills us. It is our reaction to it” and,
to individuals who were motivated job satisfaction and improved work “Adopting the right attitude can con-
by perfectionist concerns or fears performance and delivery. In summa- vert a negative stress into a positive
that their work would be criticized. ry, workaholism is associated with one.” These statements go hand-in-
Research examining the outcomes more negative outcomes compared hand with “grit;” reframing the ways
of workaholism include a variety of to being work engaged. Both can be in which one experiences work can be
negative outcomes. Dr. Clark summa- detrimental and have the potential to the difference between work satisfac-
rized the following outcomes: lower cause negative outcomes. tion and workaholism and burnout.
life satisfaction, greater burnout, poor Dr. Newman ended his 2020
emotional and mental health, lower Presidential Address by relating that
job satisfaction, relationship stress AAPL has been his professional home
and greater work-family conflict. throughout his career, and sincerely
Interestingly there was no significant thanked AAPL members for allowing
relationship between workaholism him to serve as AAPL President.
and work performance. Sleep was
American Academy of Psychiatry and the Law Newsletter Winter 2021 • 7
FEATURED SPEAKERS
Anthony Giamberdino, MD: took oral naltrexone.
When he eventually made it to Step
Trudging the Road to Happy Destiny Nine, he made direct amends to peo-
Karen B. Rosenbaum, MD ple including to his colleagues at the
private practice job he had to leave,
On the final day of AAPL’s 51st an- cet it was an “instant love affair” with and to his residency program. The
nual meeting held over Zoom in lieu opiates and it was easy to continue his chairman of the anesthesia program
of Chicago due to the pandemic, anes- habit through the fentanyl that was there offered him a three-month po-
thesiologist Dr. Anthony Giamberdino left over from cases at work. He soon sition as a resident, and he gratefully
spoke candidly about his “experience, became a daily user and managed to accepted it. He said he needed his
strength and hope” in the tradition of live and work this way for a year. He ego to be broken so that he could be
a twelve-step meeting, and explained explained that at this point, he had lost humble and teachable again.
that he is a “recovering drug addict all illusion of control over his addic- A colleague eventually vouched for
and alcoholic.” He works with the Illi- tion. Despite having a new adopted him and he was able to get the job
nois Professional Health Program and baby, a private practice position with where he currently remains, west of
has practiced anesthesiology for thirty an academic appointment, and a life Chicago in St. Charles, IL. He said
years in the Chicago area. By telling that looked great on the outside, he that he was honest at his interview
his own inspiring story, he focused on felt miserable inside. and said that with the grace of God
physician wellness, the theme of the He said he tried every strategy to he is becoming someone who will
meeting. “fix” himself. He did not reach out not use again. He was able to get his
He explained that by telling his for help because he lived in fear of board certification when he had five
story, he hoped to increase under- the consequences and he worried he years of proven abstinence. He also
standing in case attendees ever find would lose his career and his mar- had to rebuild the trust in his marriage
themselves, or their friends, family, riage. He also did not know anyone in and was able to do that and raise three
or colleagues in a similar situation, recovery to speak to. children with his wife. The title of his
and so that attendees could potentially When he was finally asked by work talk is from the Big Book of AA, and
help a colleague in a similar situation to attend a meeting in which he was he feels that every day he is “trudging
reintegrate their career. confronted about his using, he drove the road of happy destiny.” (1)
Dr. Giamberdino explained that to a forest preserve and tried to kill Today Dr. Giamberdino is 31 years
he had a good childhood and that he himself with a lethal injection, but sober and still goes to two meet-
initially used “weed” and alcohol as instead woke up in an ICU two days ings per week; he has a sponsor and
a teenager and in college mainly as a later with multiple complications. A sponsors others in the program. He
reward, and for a long time even when doctor on the team recognized that explained that when someone shows
using daily, he was able to juggle his his problem was due to substances up, does the right thing and is hon-
use while being an excellent student. and discharged him to a program in est in this program, they naturally
He was also a musician in a rock band Atlanta for physicians. become a leader. He is currently the
growing up. In college, he did well In Atlanta, he learned the twelve medical director at the surgery center
on the MCAT and decided on medical steps of Alcoholics Anonymous, start- and has been for fourteen years. He is
school in the Chicago area where he ing with admitting he was powerless a leader in church, serving on coun-
became AOA and compartmentalized over drugs and alcohol and that his cils and various committees. He also
his using and drinking. He said that he life had become unmanageable. He maintained his affiliation with IPHP
married his wife before his last year in became willing to do whatever they and is currently on the advisory board.
medical school and stayed in Chicago told him to do. He explained that the While raising his children, he coached
for residency where she was attending next eleven steps outlined a plan of on soccer and baseball teams and was
graduate school. He said that initially action, which was a relief. involved with outdoor education and
because he was working 80 hours per After spending three and a half other trips.
week, the alcohol use toned down. months in the treatment center in Dr. Giamberdino explained that
However, there were two significant Atlanta, he had to face the Illinois unfortunately over the past five or ten
life events that occurred while Dr. licensing board. He was told that with years, healthcare has become more
Giamberdino was in residency that professional aftercare and supervision, corporatized, with negative effects.
accelerated his addiction. His mother he would be able to work again as an For example, he said that several
tragically died after battling a long ill- anesthesiologist. He said he worked funding sources have been withdrawn
ness and while cleaning, he found 100 the Twelve Steps and went to meet- from the IPHP. He has noticed that it
Percocet pills in her medicine cabinet. ings, completed an aftercare program, is now harder for a recovering physi-
Also, in residency, his wife was diag- and was able to secure advocacy cian to get a second start. He lamented
nosed with choriocarcinoma after a from the Illinois Professional Health that it is a “terrible, tragic irony” that
miscarriage and started treatment. He Program (IPHP). He complied with we have a healthcare system where
said that once he started using Perco- random drug screenings as well and
(continued on page 9)
8 • Winter 2021 American Academy of Psychiatry and the Law NewsletterAnthony Giamberdino There were numerous questions for spiritual program, not a religious one,
continued from page 8 Dr. Giamberdino after his talk. He and that someone only needs to find a
explained that sometimes recovering “higher power.” In addition, the only
our job is to help and heal people, physicians could potentially run into requirement for AA membership is a
but the system will not allow us to do patients at AA meetings, but worrying desire to stop drinking and/or using.
that for ourselves. He said that when about that should not keep a physi- He explained that just as a diabetic
the opportunity arises, it is rewarding cian from AA. The culture in AA is will risk going into DKA if they stop
to help people in this situation, but that everything is anonymous and insulin, someone with addiction could
they have to want to get better and be confidential. There are always other risk relapse if they stop going to meet-
willing to do anything. meetings to go to, especially now that ings. He acknowledged that although
Dr. Giamberdino clarified that peo- everything is on Zoom. Currently, a there are other recovery programs out
ple with good recovery are grateful person can go to a meeting anywhere there, AA is the only program that
and take full responsibility for their in the world. he knows of that has a decades-long
prior behavior. Physicians in recov- Dr. Giamberdino further explained track record of success.
ery admit the consequences of their that AA saved his life, and IPHP saved In conclusion, Dr. Giamberdino’s
past behaviors and are willing to his career. He said that sometimes he heartfelt presentation emphasizes the
comply with any reasonable request has a thought of using again like most importance of physicians, especially
to ensure the safety of their practice people in recovery, but he explained psychiatrists and forensic psychia-
and patients. He explained that people that a sponsor told him that the key trists, understanding the program of
with addiction cannot fix themselves is thinking it through and playing the Alcoholics Anonymous so that we
but that there is help available and it tape forward. He knows that using can educate our patients, colleagues,
is important to ask for it. He said that will eventually lead him to the back of friends, family members, and the
he is living proof that there is a life a pickup truck with an IV in his foot, courts when necessary on the benefits
beyond addiction, and that it is more so he does not take the first drink. He of the program, and dispel any myths
fulfilling than his wildest dreams. He explained the common triggers using that could keep people from getting
said that despite the difficult road, his the acronym HALT (Hungry, Angry, the help that they need.
story needed to be what it was so that Lonely, Tired) and that ties into the
he could be speaking to us on October importance of physician wellness and Reference:
self-care. He explained that AA is a (1) Alcoholics Anonymous Big Book-4th
25, 2020. Edition (2001)
SEEKING CLINICIANS AND FELLOWS FOR RESEARCH PARTICIPATION
Forensic Psychiatrist Joseph Penn
(COMPENSATED)
Is New Chair of NCCHC Board
We seek participants for a study of clinical decision-making in forensic
evaluations. Participants must be clinicians in the U.S. with a terminal Chicago – Joseph Penn, MD, CCHP-MH, has been elected
doctoral degree (e.g., M.D., Ph.D., Psy.D.) and some form of field experience chair of the National Commission on Correctional Health Care
in forensic evaluation (supervised or unsupervised). Those currently in Governance Board.
supervised practice (post-docs, fellows, residents) are eligible.
He is director of Mental Health Services for the University of
Participants review online case materials and conduct a mock criminal re- Texas Medical Branch (UTMB) Correctional Managed Care
sponsibility evaluation (prior criminal responsibility evaluation experience program, which provides health care services in approximately
not required). Approximately 60-90 minutes to complete. 90 adult and juvenile correctional facilities throughout the state
Participants receive $150.00 in compensation. of Texas. He is also a clinical professor in the UTMB Depart-
ment of Psychiatry.
To participate, follow the link below (or paste into your Internet Browser):
Dr. Penn has served on the NCCHC board since 2003 and
https://iup.co1.qualtrics.com/jfe/form/SV 4Gi8ZAwf5oAzPgx
was previously board chair in 2008-2009. He is currently the
Questions my be referred to the co-Pls: American Academy of Psychiatry and the Law board liaison;
previously, he was liaison of the American Academy of Child
Anthony Perillo, Ph.D. (aperillo@iup.edu)
and Adolescent Psychiatry. He has chaired the accreditation and
Jennifer Perillo, Ph.D. (jperillo@iup.edu)
juvenile health committees, served on multiple task forces to
Indiana University of Pennsylvania revise NCCHC standards, and served on the editorial board of
Department of Psychology The Journal of Correctional Health Care. He also is a physician
1020 Oakland Ave. surveyor for NCCHC.
Indiana, PA 15705
Dr. Penn is triple board-certified in general psychiatry, child and
This project has been approved by the Indiana University of Pennsylvania adolescent psychiatry, and forensic psychiatry by the American
Institutional Review Board for the protection of human subjects Board of Psychiatry and Neurology.
(irb-research@iup.edu; 724-357-7730
American Academy of Psychiatry and the Law Newsletter Winter 2021 • 9ASK THE EXPERTS
recognition of one’s limits, including
Ask the Experts the willingness to acknowledge ex-
Neil S. Kaye, MD, DLFAPA pertise beyond one’s own. It is very
difficult to walk this line, as over-
Graham Glancy, MB, ChB, FRC Psych, FRCP
confidence is associated with persua-
Neil Kaye and Graham Glancy will and with society’s tendency to reward siveness, especially when espoused
answer questions from members relat- projected confidence over humility. by a court admitted expert and hiring
ed to practical issues in the real world When scientists offer caveats instead lawyers look for persuasive experts.
of forensic psychiatry. Please send of absolutes, the uncertainty we are A recent New Jersey Appellate case
questions to nskaye@aol.com. trained to acknowledge makes it (4) provides some guidance specific
This information is advisory only, sound as if we don’t know what’s to psychiatric expert testimony. The
for educational purposes. The authors really happening. This creates op- court gave a thoughtful analysis of a
claim no legal expertise and should portunities for people who present as scientific report in terms of objectivity
not be held responsible for any action skeptics to undermine our profession and providing a basis for an opinion.
taken in response to this educational and our testimony. Although psychiatry has little in the
advice. Readers should always consult The idea that there are no experts way of objective diagnostic tests, the
their attorneys for legal advice. (Douthat) is overly glib (2). The issue court noted that expert reports cannot
is more that modern expertise tends to be admitted if they simply repeat
Q: How do you define “expert?” be deep, but narrow in their expertise. the subject’s reporting of subjective
Even within a hard science such as symptoms. There must be more. The
A. Kaye: epidemiology, someone who studies objective piece, then, should be what
Expertise is not infectious diseases knows more about the expert brings to the table. Al-
just about knowl- epidemics than, say, someone who though excellence is not necessarily
edge, but also studies nutrition. Our work as forensic the standard, expert witnesses must do
about the capacity psychiatrists demands both depth and more than fact witnesses–if they want
to spot errors. breadth of expertise. to give opinions. The court makes its
Without affirma- A major area of concern should be reasoning clear and insists on a stan-
tive action, efforts that knowledge is tinged by confirma- dardized diagnostic approach, gives
to be thoughtful, tion bias. When doing our work as credence to objective testing, and also
and practice, most of us are more scientists we should be happier when stresses methodology in reaching an
likely to fall in the former group than we find people, opinions, viewpoints opinion, which I favor and believe is
the latter. Humans hunger for infor- and/or facts with which we disagree. what Daubert (5) is about.
mation, but often lack the know-how This provides the opportunity to
to evaluate it or the sources that we reconsider our methodology and A. Glancy:
reference. This is the epistemolog- processes, and can enlighten our for- I remember
ical crisis of the moment: there’s a mulations, conclusions, and ultimate very early on in
lot of “expertise” around, but fewer opinions. my career being
tools than ever to distinguish it from Knowledge is often thought of as called as an expert
everything else. “Pure credentialism” a quantity of information. A person in Superior Court
doesn’t always work. A well-creden- who “knows” a lot is often referred and being cross-ex-
tialed person may not really be an to as knowledgeable. The Internet amined on my CV.
expert and their ability to teach to a has become the font of knowledge In particular I was asked how many
trier of fact may be woefully lacking. in today’s world. Many people turn times had I been qualified as an expert
Or, their viewpoint may be tainted to the Internet for answers and in the in court and I answered that I had
by significant bias or an undisclosed medical world, we are constantly been qualified on one occasion previ-
agenda. faced with the idea that “Dr. Google” ously. The distinguished judge peered
Real experts have experience in has the answer to all of our medical at me and, accepting me as an expert
making decisions and knowledge problems. In reality, Google is a great in forensic psychiatry, stated, “Well,
of how things usually play out in a example of endless knowledge with he is the only expert that we have here
similar set of circumstances. This no expertise. It is no surprise that so I suppose he’ll have to do.”
idea is reflected in Gladwell’s book Internet-based medical diagnosing This is a simple question that is
Outliers. (1) Education, fellowship is accurate only about 50% of the very difficult to answer. I can ap-
training, and clinical practice are part time. (3) While the hope for artificial proach this in two ways: First ,what
of becoming an expert, but they alone intelligence remains high, there is is the legal definition, and second,
cannot substitute for experience. still no substitute for an experienced how is an expert defined outside of
A lack of expertise becomes espe- physician! the legal forum.
cially problematic when it is com- In court, the strongest attractor of
bined with extreme overconfidence, trust shouldn’t be confidence, but the
(continued on page 11)
10 • Winter 2021 American Academy of Psychiatry and the Law NewsletterASK THE EXPERTS
Ask the Experts The admissibility of expert evidence Take Home Points:
continued from page 10 has been subject to various legal The difference between knowledge
decisions. In Canada, the prevailing and experience is a critical distinction
At the most basic level an expert decision is R v Mohan (13), which set to keep in mind. You will notice Dr.
witness could be said to be somebody out four factors that should be consid- Glancy’s inclusion of his wife’s pub-
who possesses the necessary expertise ered. These included the relevance of lications in his citations. There is no
in a given field. Most particularly, the the evidence; the necessity of the evi- doubt he is a true expert!
expert must strive for objectivity and dence; the absence of an exclusionary
honesty (6, 7) and give their opinion rule; and the assurance that the expert References:
in a non-partisan manner, which is was properly qualified. In the Unit- (1) Gladwell M. Outliers : the story of suc-
free of conflict. Gutheil and Simon ed States, two major cases prevail, cess. New York :Little, Brown and Compa-
namely the general acceptance rule ny, 2008
(8) discuss the inherent tensions in the
(14) and more comprehensively, the (2) Douthat R. “In the fog of Coronavi-
relationship between forensic experts rus, there are no experts.” www.nytimes.
and lawyers, stemming from the Daubert decision (5). This case cited
com/2020/04/07/opinion/coronavirus-sci-
different roles that they adopt. Most three additional factors beyond the ence-experts.html. New York Times, Apr 7,
importantly, the expert witness must general acceptance rule, which includ- 2020
adhere to the duty to provide fair, ed whether the theory or technique is (3) Park A.: Should you diagnose yourself
objective, and non-partisan assistance testable and has been tested; whether online? time.com/5230797/online-symp-
to the courts. In a recent Canadian the theory or technique has been tom-checkers-is-it-safe/. Time Magazine.
case, the judge was charged with the subjected to peer review; and whether April 4, 2018.
gatekeeper function of ensuring this, the error or potential rate of error has (4) HKS v Kensey. Superior Court of NJ,
prior to admitting expert evidence been identified. Appellate Division, #A-1329-18T2
Perhaps most importantly for foren- (5) Daubert v Merrell Dow Pharmaceuti-
(9), as opposed to this issue going to
sic psychiatrists is a consideration of cals, [1993] 509 U.S. 579
weight as it did previously. A fre- (6) AAPL, Ethical Guidelines for the Prac-
quent role conflict is between the con- whether we can give an objective and tice of Forensic Psychiatry. (2015) Retrieved
cept of providing treatment and that of honest opinion that is not advocacy, from www.aapl.org/ethics.htm
providing expert opinion. Strasburger considering the limits of our expertise, (7) CAPL, Ethical Guidelines. (2018)
and others (10) describe this conflict and educating the courts. Retrieved from http://www.capl-acpd.org/
in an important paper, which has been Regehr (15) defines, at the basic ethical-guidelines/
enshrined in the ethical principles of level, an expert as one who pos- (8) Gutheil TG, Simon RI. Attorneys’ pres-
forensic psychiatry. sesses authoritative knowledge or sures on the expert witness: early warning
Interestingly, Canadian courts have basic skills. She emphasizes that the signs of endangered honesty, objectivity, and
expert’s expert possesses intuitive fair compensation. J Am Acad Psychiatry
come to an awkward compromise
decision-making and problem solv- Law 27: 546-553, 1999
on this issue, differentiating between (9) White Burgess Langille Inman v. Abbott
‘litigation experts’ who may be ing, beyond simple knowledge. She
and Haliburton Co, [2015] 2 SCR 182
forensic experts retained for the case; outlines the contrasting theories of (10) Strasburger LH, Gutheil TG, Brodsky
and ‘participant experts’, for instance, whether expertise is inherited or the A. On Wearing Two Hats: Role Conflict in
treating physiotherapists or rehabil- result of what Ericsson calls delib- Serving as Both Psychotherapist and Expert
itation specialists (11). The role of erate practice. I argued for the role Witness. Am J Psychiatry 154: 448-456,
forensic expert therefore is to under- of “deliberate practice” (16), the 1997.
take a search for the facts of the case, kind that makes you sweat, but with (11) Westerhoff v Gee Estate, [2015] ONCA
supported by evidence-based tests good coaching, delivering actionable 206
and come to an objective opinion. It feedback. This was supported by a (12) R. v. Lavallee, [1990] 1 SCR 852
qualitative study that I performed (17) (13) R v Mohan, [1994] 2 SCR 9
is common in forensic practice to
interviewing some of the “Greats” of (14) Frye v United States, [1923] D.C.Cir.
review collateral information, such as 293 F. 1013
that provided by informants who may forensic psychiatry, who all sponta- (15) Regehr C. Stress trauma in decision
have relevant information. A number neously said that working 60-80 hours making for social workers. New York:
of cases in Canada have reviewed this in at least the first ten years of their Columbia University Press, 2018.
practice (12) and have ruled that ex- career, corresponding to Gladwell’s (16) Glancy G. The Mock trial: Revisiting
perts are allowed to use what amounts 10,000 hours, helped them become a Valuable Training Tool. J Am Acad Psychi-
to hearsay evidence but, if these facts an expert’s expert. Most of us strive atry Law 44: 19-27, 2016.
are not proven in court, this goes to merely for “competence;” Dreyfus (17) Glancy G, Miller D. Perspectives on
the weight of the expert opinion. If (18) describes a five-stage model, Excellence in Forensic Psychiatry. Int J
relying on this evidence, therefore, it where the progression goes from nov- Risk Recovery, submitted.
ice to advanced beginner to compe- (18) Dreyfus H and Dreyfus SE. Mind Over
is important to communicate with the Machine: The power of human intuition and
retaining attorney and suggest that tence to proficiency to expert.
expertise in the area of the computer. New
this evidence be proven prior to your York: The Free Press, 2000.
final opinion.
American Academy of Psychiatry and the Law Newsletter Winter 2021 • 11You can also read
