Archive for the ‘Forensic Psychiatry’ category

Pilots, Old People and Prediction

April 8, 2015

Unless you’ve been under a rock lately, you have probably heard about the pilot who appears to have purposefully crashed a flight full of 150 people.  There was another article recently too about a 100-year-old man who killed his wife and then himself.  Both of these incidents had some warning signs, that in hindsight, are felt to have been able to predict what ultimately happened.

I’m here to tell you that the belief that we can predict violence is absolutely false.  We (psychiatrists, police, people in general) have absolutely no ability to predict human behavior.  I have talked about this before, in my own work.  It makes people feel better to think that we can predict the awful tragedies that happen each and every day.  No.  All we can do is identify risk, and ideally, mitigate that risk as much as possible.  Unfortunately the way that most laws are written, we cannot do a whole lot unless there is evidence of imminent harm or danger.  This is what happened with the man that killed his wife–the police were called out to the home several times, but each time left because there was no evidence of acute risk.  Unfortunately there was not really any sign that this man would commit murder-suicide.  In retrospect, this man appears to have had signs of dementia, and some signs of aggression, but nothing (at least not reported) that would have led to what he did.

With our pilot, there appears to have been some premeditation.  Scary.  I had a conversation, or rather a debate last week with another psychiatrist and two psychologists about what the diagnosis for this man was.  We all had different ideas before some of this information came out.  We will probably never fully know what happened.  Regardless of what the underlying causes were, the whole thing is a tragedy.  Hopefully we learn and start to try to mitigate risk in a useful way, whether for the pilots who hold so many lives in their hands, or the older folks who seem to need some help.  I just hope we don’t fool ourselves into thinking that any of this could ever have been predicted.


Doctors Should Stop Wearing White Coats

September 8, 2011

I stopped wearing my white coat regularly about four years ago. I get questions from people at work about it all the time. Most commonly I get asked why it is that I don’t wear one. I admit, it might be easier for me if I did–and occasionally I will put it on, usually for an important meeting, or when I want to have a more authoritative role with a particular patient. A white coat makes a physician more recognizable as a doctor, and has big pockets, so a doctor can carry his or her important papers, reference books, and of course their cell phone.

That being said, I absolutely hate wearing my white coat. I have two of them, and find them to be a terrible nuisance. They get ring around the collar after one wearing, the smallest size could house a small football player, and can cause someone to be 10 degrees warmer, especially in a hospital where the air conditioning is unreliable, and the heat too high.

Also, and definitely most importantly, white coats are disgusting, and I mean that in a clinical way. White coats have been banned in the U.K. since 2007. While it is not clear whether the bacteria on white coats actually causes more infections in patients, to me it doesn’t matter. It gives me one more reason to not wear my white coat. Wearing one doesn’t make me a better doctor.

Dr. Kevorkian–Dead, But Not By Suicide

June 7, 2011

Four days ago Dr. Kevorkian (AKA Dr. Death) died and I’ve read a couple of articles about him. In yesterday’s print edition of the NY Times is this opinion, and I am linking to it because it coincides a bit with how I feel about this.

One of the things I consider part of my job description is suicide prevention. So Dr. Kevorkian’s activism for assisted suicide kind of annoys me. From everything I’ve read, there is a lot of controversy about how he proceeded to do his work. Lack of full psychiatric screenings to assess for depression or other treatable mental illnesses, significant number of patients without terminal illnesses, a few patients without any physical problems whatsoever at autopsy, and death for some patients within 24 hours of meeting with with Dr. Kevorkian for a consultation. There’s also reports of Dr. Kevorkian being interested in the very scientific process of vivisection, which is basically doing an autopsy while someone is alive. Finally, Dr. Kevorkian was not an internist, or oncologist, or psychiatrist. He was a pathologist! He practiced an area of medicine that has the least patient care. In fact, although pathologists are physicians, they really practice more like scientists–in a lab.

It’s all a little frightening, what he claimed he did, which was assist over 130 patients in suicide with a machine that he created to inject the medications. I also believe in our laws and government, and regulating such issues which are truly a matter of life and death. I’d love to hear anyone else’s thoughts on this controversial topic.

The Casey Anthony Trial

May 29, 2011

Another high profile case in the news this week! This week finally started the murder trial for Casey Anthony, accused of killing her baby daughter Caylee. The strange thing about this case is that Casey Anthony did not report her daughter missing for over a month! She was then found a mile away from the home six months later. From this article about the trial this week, it sounds like both the defense and prosecution are making accusations of murder, but the question is who did it? All I know is something seems fishy, and the allegations of sexual abuse/molestation by Casey’s father George (the baby’s grandfather) are new and unclear what part they will play in the trial. Although this may or may not be technically mental health related, it is again an interesting case and one I will continue to follow in the news–anyone else?

Jared Lee Loughner Declared Mentally Incompetent

May 26, 2011

Not a shock to have read this earlier today. This is a topic I have a lot of interest in, because it deals with people’s rights, in particular those with mental illness. As I’ve said before, it is impossible to make a diagnosis just by reading articles in the media, but the implication of this court ruling is that likely Mr. Loughner has a psychotic disorder of some kind, perhaps schizophrenia. There are laws that can force medication in order to make someone competent enough to understand the court proceedings. Once the defendant is able to understand the court proceedings, he can assist in his own defense and trial. He can still plead “not guilty by reason of insanity.” Only 1% of all pleas use this defense, making it fairly rare, as well as difficult to win. Basically the question is whether the defendant could understand right from wrong at the time of the crime. This is a difficult question to answer, and a person can be evaluated by numerous psychiatrists and get that many diagnoses and assessments. Only time will tell what the outcome will be in this case; I know I’ll be following this to see what happens. What are your thoughts–is this a fair way for Mr. Loughner to get through the legal system?