Forensic Psychiatry

David and I were supposed to sit in on an ECT treatment today, but the doctor in charge of doing them had jury duty so we were redirected to shadow Dr. D, the forensic psychiatrist, instead. So what does a forensic psychiatrist do? He treats and evaluates the patients who have committed crimes under the influence of psychiatric disorders, and he reviews their history to decide whether or not they are competent to stand trial. At first we followed him on rounds, and at the behavioral ward, we heard one patient screaming non-stop (as one nurse pointed out, it sounded like an alarm. "AAH! AAH! AAH!"), and when Dr. D went to talk to him, we saw that two or three orderlies were holding the patient down in the recovery position. Needless to say he got some Ativan to calm him down. Later that morning we sat in the treatment room (which was very full b/c there were about 5 nursing students with us) and watched as he evaluated two patients. One, a young guy named MJ, didn't have a GED and couldn't answer questions about a judge, jury, defense attorney, or district attorney without quoting it verbatim from a cheat sheet he carried everywhere with him. When asked about his mood, he said, "Six." (thinking it was 6 out of 10 or something like that) The next patient, DP, was a twenty-seven year old woman known throughout the ward for being aggressive. So far she's spat on other patients, cussed nurses out, slammed doors, and thrown juice at the wall, just to name a few of her actions. The sad thing is, none of these symptoms happened until ten years ago, when a car accident left her in a coma for six weeks. The damage to her brain was so bad that her left pupil was blown; she can't see out of that eye at all. The worst part is that she'll probably never recover and have to be hospitalized for the rest of her life.

We were also supposed to be with the ECT doctor for lecture this afternoon, so after lunch Kyle and Sital joined David and me at Dr. D's office. There, Dr. D explained a little about what forensic psychiatry is all about and gave us some reports from a case he worked on in 1997. The patient in question had murdered his sister, and our job was to discuss amongst ourselves whether or not he could be found not guilty by reason of insanity. Insanity = not knowing that your actions were wrong. The patient definitely had characteristics of a paranoid schizophrenic, but there was no way he didn't know what what he did was wrong. He believed his sister wanted him dead, yet they spent time together shortly before she died. Does a person afraid for his life hang around the person he fears will kill him? On top of that, his sister was shot from behind, not from the front, which rules out killing by self-defense, and after her death, he turned himself in to a mental facility saying stuff like, "I didn't think I'd actually do it." GUILT, anyone? Months later he began saying stuff like how he mistook his sister for the devil with a goat's head, but again, if the "devil" was coming at him, he would have shot from the front, not from behind. At the end of our discussion, we told Dr. D that we felt like this man was not insane, and Dr. D agreed with us. The man in question has been convicted of murder and is serving a 25 year sentence.