Asbestos exposure and cancerphobia.

In 48 cases of claims of psychic injury due to asbestos exposure, seven were diagnosed as "cancerphobia". Cancerphobia is a concept primarily used in personal injury cases with little support in the medical community. Analysis of standards for phobia indicates that the term is inappropriate for such legal claims.

Asbestos exposure and posttraumatic stress disorder.

In 48 cases of claims of psychic injury due to exposure to asbestos, posttraumatic stress disorder (PTSD) was alleged as a basis for damages in nine (19%). PTSD as currently defined refers to a specific syndrome following exposure to a life-threatening traumatic event, one outside the general range of people's experiences such as military combat, floods, earthquakes, bombing, torture, death camps--events either natural or man-made. The symptoms include reexperiencing of the event with intrusive thoughts or nightmares of the event, startle reactions, psychic numbing, and survival guilt.

The trial of Louis Riel: a study in Canadian psychiatry.

The Riel case in 1885 is one of the most striking cases in the history of forensic psychiatry. On the one hand, Riel was the hero of the underprivileged, French Canadian-Indian halfbreeds whose futile revolt in the Canadian Northwest captured the imaginations of French Canadians in Quebec, for whom he became a hero and a martyr. Prior review in this journal has detailed the clinical data referrable to his mental condition.

Misidentification of self and the Riel Phenomenon.

Misidentification syndromes or phenomena are found in a number of psychiatric situations that may become the subject of forensic science review. One of the most curious is misidentification of self in which the individual perceives himself or herself as another being while able to explain the loss of the original identity. Recognizing these phenomena may be helpful in accurate diagnosis, in considering such conditions as psychosis of whatever type, multiple personality disorder, and other amnesia and fugue states, and in understanding the person's psychopathology.

Asbestos exposure and psychic injury--a review of 48 claims.

Asbestos exposure has been a common occupational risk resulting in much litigation. Where pulmonary dysfunction has been minimal or even absent, psychic injury has been made an element in claimed damages. Analysis of psychiatric and psychologic claims in 48 cases reveals that diagnoses often do not conform to professional standards, are based on insufficient data sampling, lack adequate overall history as well as medical history, and do not comport with the standard of probability usually required for litigation.

Alleged brain damage, diminished capacity, mens rea, and misuse of medical concepts.

As focus on the insanity defense diminishes, defendants may place emphasis on a lack of knowing or purposeful behavior in order to negate a criminal charge. This use of a mens rea defense in accord with Model Penal Code principles is exemplified by the current New Jersey statute. Such a defense may result in a lesser charge or a finding of not guilty.

Crime and multiple personality disorder: a case history and discussion.

The application of the concept of multiple personality disorder (MPD) is one of the most complex and controversial issues facing forensic psychiatrists. The case presented is one in which a diagnosis of multiple personality disorder is not only well documented, but was so diagnosed at least 10 years before the ultimate homicide. Nonetheless, consideration of the legal issues was difficult.

"False confessions" and identification with the aggressor: another forensic misuse of a psychiatric concept.

Some psychiatrists misuse theoretical concepts beyond their generally accepted dimensions in an attempt to support a conclusion favorable to a litigant or defendant. In the case presented, the concept of identification with the aggressor was used in an attempt to eliminate or minimize the effect of a confession and to buttress the claim that the confession itself was false. Quotations from the actual reports and testimony are used to reflect both this tactic and the context in which these issues were pursued, including a rather startling admission by the psychiatrist dealing with the thoroughness of his professional effort.

Claims of psychiatric injury after alleged false arrest.

Litigation has increased rapidly in the United States; those who feel aggrieved sue readily for damages. Police officers and security people may be sued after arrests or detention followed by unsuccessful prosecution or dropping of criminal charges. Claims of psychiatric injury may be made where there are no discernible damages otherwise.

Pathological intoxication and alcohol idiosyncratic intoxication--Part II: Legal aspects.

The law does not generally allow alcohol intoxication as a defense in a criminal matter. Among the exceptions may be pathological intoxication, or PI, or its current psychiatric correlate, alcohol idiosyncratic intoxication (AII). Because of the lack of specificity in the medical concept and the varying approaches by different authors, careful analysis and adherence to current standards are necessary.

Pathological intoxication and alcohol idiosyncratic intoxication--Part I: Diagnostic and clinical aspects.

The concept of pathological intoxication and its successor term, alcohol idiosyncratic reaction, has been one of ambiguity and professional disagreement. The history of such an entity reveals contradictions and varying usage--particularly in regard to the amount of alcohol required. Some feel that the current classification system is broad enough to include such reactions without the use of such terms.

Legal problems in inpatient psychiatry.

This paper has discussed broadly a panorama of legal issues which may arise in the practice of inpatient psychiatry. Such a discussion can only be general and may not apply in a specific jurisdiction. Psychiatrists in inpatient settings should be familiar with all the issues raised and with local practices.

Liability of the mentally ill and their insurers in negligence and other civil actions.

Although familiar with the insanity defense, psychiatrists know little about the liability of mentally ill persons in civil actions or the secondary liability of their insurers. Generally the mentally ill are responsible civilly for their actions regardless of mental state except where the law requires specific intent and the illness negates such intent. Psychiatrists and other mental health workers may thus have grounds for suit against patients who injure them.

The insanity defense: the case for abolition.

The author discusses psychiatrists' objections to the insanity defense, including the negative publicity generated by murder trials in which psychiatrists provide expert testimony. He also examines the legal profession's attitudes toward the defense and the pressure applied to expert witnesses through our adversarial system of justice. The abolition of the insanity defense might expedite the legal process, the author concludes, but it would not greatly affect the courtroom role of psychiatrists.

Medical and legal problems in psychiatric coding under the DSM and ICD systems.

The various diagnostic systems in psychiatry have differed in their terminology and associated numerical codes. Lack of attention to coding variations in the DSM and ICD systems during the review of patient records can lead to misinterpretation and confusion; reliance on historical or statistical studies that use differing systems may be questionable. Two cases illustrate the problems caused by lack of awareness of these factors.

The insanity defense: a tale of two cities.

The M'Naghten case and the Hinckley matter are in some ways remarkably similar. The attempted assassination of a ruling figure, the public discomfort with the insanity defense, and problems in the application of the legal rules characterized both. An explosion of media criticism occurred in 1843, as it did in 1982.