The Psychiatrist in Court: A Survival Guide • The Psychiatrist as Expert Witness

Whether by choice or by circumstance, the psychiatrist in court is indeed, as Dr. Gutheil suggests, a stranger in a strange land. In these two recent books, he provides invaluable pocket atlases for the psychiatrist traveling in this potentially treacherous territory. The author translates his wealth of experience and renowned knowledge in forensic psychiatry into informative and very practical companion monographs. The content of both, illustrated with numerous vignettes, surveys the foreign terrain of the legal system and suggests courses of lesser and greater peril.

By design, the books provide an overview of the core issues confronting the psychiatrist involved with the legal system and focus less on discussion of any one issue in depth. The author has the supportive and conversational style of an accomplished teacher, which is very effective and complements the theme of successfully coping with one's own anxiety as a critical objective in any legal proceeding.

The Psychiatrist in Court serves as an introduction to the interface between psychiatry and the legal system for the neophyte contemplating a career in forensic psychiatry or for the unfortunate psychiatrist thrust into that arena through no choice of his or her own. The Psychiatrist as Expert Witness is more specific to the specialized psychiatric practice of providing "expert" testimony in a variety of legal proceedings. The author clearly articulates his views on the functional, clinical, and ethical roles of the psychiatrist as witness. The discussion ranges from the technical aspects of working with the legal system to the practicalities of establishing a practice specializing in forensic psychiatry. Although these related books differ in focus, both are highly practical, enjoyably readable, and packed with enough pearls to satisfy student and veteran alike.

The Psychiatrist in Court is aptly subtitled A Survival Guide. The author likens the unfamiliar territory of the court to "a mildly hostile, mildly intolerant, chauvinistic foreign country, where they dress and speak quite differently." He alludes to the inevitable discomfort of the apparent assault on one's personal identity and professional integrity as the adversarial legal process seeks "truth."

The author describes the critical distinction for psychiatrists in court between the role of treater and the role of expert. An appended article expands on this concept in detail. Although acknowledging differing views, the author concludes that an inherent conflict exists between these two roles in the courtroom and strongly recommends against a psychiatrist's wearing both hats in any one proceeding.

In this section...

The interface between law and psychiatry is the topic of several books reviewed this month, starting with two guides for psychiatrists who appear in court. Included are books on blaming and accountability (see the review of Moral Judgement), the right to refuse treatment, and forensic aspects of sleep—not to exclude The Angel of Darkness, Caleb Carr's second novel about an early forensic psychiatrist. Imaginary characters of another type appear in The Ethical Way, in which the author uses the struggles of a fictional managed care company to address ethical challenges of managed care.

The reader is guided through a basic overview of the court, the players, the terminology, and the types of proceedings. Going beyond the mechanics of legal process, the author provides insight into the objectives of the attorneys in depositions and trials and strategies for interacting with attorneys on both sides of the issue. Education in the customs and taboos of the court extends to recommendations for appropriate appearance, manner, and use of language.

Experience is the best teacher. But trial-and-error learning can be very costly in the courtroom. The practical information and advice shared by the author succeeds in offering basic preparation for the psychiatrist's day in court and, at least, should serve to reduce the magnitude of counterproductive anxiety to a manageable level.

With appreciation of the manifold problems and pitfalls of involvement in legal proceedings, one might ask why any psychiatrist would choose to travel in this foreign territory. Dr. Gutheil shares his resolution of this seeming paradox in the second volume of the pair, The Psychiatrist as Expert Witness. Although the content is focused on the development of practice in forensic psychiatry, it also serves as an expansion of the basic principles and practices outlined in the first book. Discussions of strategies for case preparation, forensic evaluation, writing for the legal system, and testimony appropriate to the legal proceeding are broadly applicable and of particular value.

The Psychiatrist as Expert Witness succinctly covers topics ranging from a functional definition of an expert witness to forensic practice management. The author reviews the types of cases that a forensic psychiatrist may encounter, the reasoned decision to accept or reject a case, formal and informal negotiations with attorneys, and effective communication as an expert witness. Considerable emphasis is properly placed on the ethical challenges for the psychiatrist to avoid bias and maintain professional objectivity while compensated as an expert witness. The author proposes principles of ethical practice reducing the likelihood that the psychiatrist will act as or be regarded as a hired gun. Expanded discussion and alterative views on this and other more technical issues are deferred to an ample list of references and suggested readings.

In his writing, Dr. Gutheil demonstrates the effective blend of information, experience, and wisdom that takes teaching to the level of mentorship. These two books are written as companion volumes, but they are both complementary and complete in themselves. In both cases, the author succeeds admirably in the four virtues he endorses in forensic writing: clarity, simplicity, brevity, and humanity.

Dr. Sumner is associate professor and director of psychiatric residency training in the department of behavioral medicine and psychiatry at West Virginia University School of Medicine in Morgantown.