Psychiatric Annals

Introduction

M J Martin, MD

Abstract

Howard P. Rome spent 30 years of his career at the Mayo Clinic as consultant, head of the Department of Psychiatry, and senior consultant in adult psychiatry. He contributed significantly to the development oí psychiatry as an integrated specialty in a large multidisciplinary medical center. Consultative and liaison psychiatric techniques were developed and perfected under his guidance long before the current emphasis on this aspect of psychiatric practice came into vogue.

One aspect of consultative psychiatry that is often overlooked is the frequent association of forensic matters. Psychiatric consultation is often requested when it becomes apparent that compensation problems, neurotic symptoms secondary to trauma, issues related to testamentary capacity, psychiatric evaluations with reference to responsibility before trial, or a myriad of other legal matters complicate the medical evaluation of patients. Psychiatrists are often reluctant to be involved in their patients' legal problems because of a lack of knowledge about forensic issues or fears of prolonged entanglement with attorneys and the time-consuming and often humiliating testimony that may ensue.

Dr. Rome, in addition to his years of productive concern at the clinical level for patients with legal problems, has had a much broader and more pervasive interest in forensic psychiatry. His interest in forensic matters has been furthered by his friendships with important jurists of our time - Burger, Blackmun, and Bazelon - as well as by his opportunity to debate legal issues with his lawyer-brother and his lawyerson . Those who know Howard know him to be a person of deep commitment, but his knowledge of and interest in forensic psychiatry have been especially important to those of us who have worked side by side with him at the Mayo Clinic.

Readers of this journal have also been exposed to Dr. Rome's cogent insight into legal problems. For example, his review of the legal, moral, and psychiatric aspects of the Quinlan case* was perceptive and current. Therefore, when we in the Department of Psychiatry and Psychology at the Mayo Clinic and Mayo Medical School decided to honor Dr. Rome at the time of his retirement from our institution, it seemed appropriate to hold a symposium on forensic psychiatry. This area of psychiatry is not only meaningful to the honorée but important to psychiatrists in general. The ramifications of forensic psychiatry go far beyond our practice and individual lives.

The symposium committee, chaired by Dr. Wendell M. Swenson, head of the Mayo Clinic Section of Psychology, felt that a conference as important as this should be presented by eminent speakers who could give both philosophic and pragmatic views of many facets of forensic psychiatry. As a consequence of this view, Judge David Bazelon, Dr. Gene Usdin, Dr. Dana Farnsworth, and Dr. Francis Tyce were invited to participate in the program.

Judge Bazelon, a member of the District of Columbia Court of Appeals for almost three decades, is well known in psychiatric circles. He is an honorary fellow of the American Psychiatric Association and has participated in many discussions concerning the role of psychiatry in legal matters. As the author of the landmark Durham decision in 1954, he became known as a juristic advocate of the right of the mentally ill offender. In a superbly reasoned line of cases, the District of Columbia Court of Appeals delineated clearly what effective psychiatric testimony should look like. Many procedural questions were clarified in these opinions. Although the dictum of criminal responsibility was far from settled by the Durham decision, it resulted in much thought by both lawyers and psychiatrists concerning the issue of responsibility and directly led to the modification of the criminal code…

Howard P. Rome spent 30 years of his career at the Mayo Clinic as consultant, head of the Department of Psychiatry, and senior consultant in adult psychiatry. He contributed significantly to the development oí psychiatry as an integrated specialty in a large multidisciplinary medical center. Consultative and liaison psychiatric techniques were developed and perfected under his guidance long before the current emphasis on this aspect of psychiatric practice came into vogue.

One aspect of consultative psychiatry that is often overlooked is the frequent association of forensic matters. Psychiatric consultation is often requested when it becomes apparent that compensation problems, neurotic symptoms secondary to trauma, issues related to testamentary capacity, psychiatric evaluations with reference to responsibility before trial, or a myriad of other legal matters complicate the medical evaluation of patients. Psychiatrists are often reluctant to be involved in their patients' legal problems because of a lack of knowledge about forensic issues or fears of prolonged entanglement with attorneys and the time-consuming and often humiliating testimony that may ensue.

Dr. Rome, in addition to his years of productive concern at the clinical level for patients with legal problems, has had a much broader and more pervasive interest in forensic psychiatry. His interest in forensic matters has been furthered by his friendships with important jurists of our time - Burger, Blackmun, and Bazelon - as well as by his opportunity to debate legal issues with his lawyer-brother and his lawyerson . Those who know Howard know him to be a person of deep commitment, but his knowledge of and interest in forensic psychiatry have been especially important to those of us who have worked side by side with him at the Mayo Clinic.

Readers of this journal have also been exposed to Dr. Rome's cogent insight into legal problems. For example, his review of the legal, moral, and psychiatric aspects of the Quinlan case* was perceptive and current. Therefore, when we in the Department of Psychiatry and Psychology at the Mayo Clinic and Mayo Medical School decided to honor Dr. Rome at the time of his retirement from our institution, it seemed appropriate to hold a symposium on forensic psychiatry. This area of psychiatry is not only meaningful to the honorée but important to psychiatrists in general. The ramifications of forensic psychiatry go far beyond our practice and individual lives.

The symposium committee, chaired by Dr. Wendell M. Swenson, head of the Mayo Clinic Section of Psychology, felt that a conference as important as this should be presented by eminent speakers who could give both philosophic and pragmatic views of many facets of forensic psychiatry. As a consequence of this view, Judge David Bazelon, Dr. Gene Usdin, Dr. Dana Farnsworth, and Dr. Francis Tyce were invited to participate in the program.

Judge Bazelon, a member of the District of Columbia Court of Appeals for almost three decades, is well known in psychiatric circles. He is an honorary fellow of the American Psychiatric Association and has participated in many discussions concerning the role of psychiatry in legal matters. As the author of the landmark Durham decision in 1954, he became known as a juristic advocate of the right of the mentally ill offender. In a superbly reasoned line of cases, the District of Columbia Court of Appeals delineated clearly what effective psychiatric testimony should look like. Many procedural questions were clarified in these opinions. Although the dictum of criminal responsibility was far from settled by the Durham decision, it resulted in much thought by both lawyers and psychiatrists concerning the issue of responsibility and directly led to the modification of the criminal code of several states. The same court set aside the Durham rule in 1972 and adopted the views of the American Law Institute. It will undoubtedly be a long time before agreement is reached in the ever-changing opinions of thinkers in the area of criminal responsibility. Judge Bazelon highlights the dynamic nature of the law and makes a well-reasoned plea for the participation of psychiatrists in the area of criminal responsibility. His logic is basic, lucid, and appealing.

The problem of psychiatrists who are unable to say what they do not know during testimony was noted in the symposium by both Judge Bazelon and Dr. Usdin. Progress, slow as it may seem in the field of forensic psychiatry, cannot be furthered without the involvement of psychiatrists. The resistance and anxiety that are common in legal matters must be understood to be effectively coped with. Dr. Usdin's vast experience in court and in conducting psychiatric evaluations on such notables as Jack Ruby made him a logical choice for this symposium. His article complements the cogent remarks of Judge Bazelon.

Those interested in forensic psychiatry must concern themselves with prevention. Crime of all types has increased. The recent rash of terrorist activities in various parts of the country, including the capital, may indicate a new wave of crime. No one is exempt from possible violence. As Dr. Farnsworth states, the recognition and subsequent prevention of dangerousness constitute a formidable task, but it is one in which psychiatrists must be engaged. Our knowledge of human behavior in its innumerable variations is woefully inadequate; however, this should not deter our efforts at a better understanding through careful assessment and research in the area of crime.

As Dr. Tyce points out, psychiatric concern with the rehabilitation of those convicted of crimes has been abysmal. This is despite the fact that all surveys have noted a high incidence of mental illness, drug dependency, and personality disturbances in people confined to prisons. It is past time for innovative approaches in the rehabilitation and treatment of convicted offenders. Dr. Tyce has been instrumental in the development of a rehabilitation program on the campus of the Rochester, Minnesota, State Hospital. The community corrections center entitled the Probation Offenders Rehabilitation and Training Program is an excellent attempt to incorporate psychotherapeutic and behavioral modification techniques into a humane approach that replaces the need for prison confinement for most offenders. This may be a step in the right direction, since it is clear that maximum-security prison confinement is usually not an effective means of rehabilitation for those who have been convicted of crimes.

It is apparent that the speakers were chosen because of special expertise in their fields. The goal of the symposium was to elucidate various aspects of an important yet poorly understood aspect of psychiatry. Interestingly, the speakers explained why the area is important; that is, we are all involved in one way or another, either directly or indirectly, in the legal aspects of our profession. They also explained why the area has been poorly understood: because of resistance and anxiety concerning an imperfect body of knowledge about forensic psychiatry. The participants took a big step towards the clarification of many aspects of the field.

10.3928/0048-5713-19770601-04

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