The American Psychiatric Publishing Textbook of Forensic Psychiatry: The Clinician’s Guide

While general clinicians still conduct most forensic assessments, none of the previously published textbooks targets them. In the Preface, the editors of The American Psychiatric Publishing Textbook of Forensic Psychiatry: The Clinician’s Guide acknowledge that their main goal is to create a forensic textbook primarily for the general clinician. The textbook is designed to educate the reader in forensic subjects so that the reader becomes comfortable in case he or she has to “discharge forensic obligations.” The book includes 23 chapters with practice guidelines and suggested reading material. Recognized authorities in the field of forensic psychiatry contribute to the text, making it valuable to forensic specialists as well. Chapter 1, “Rediscovering Forensic Psychiatry,” by Liza H. Gold, MD, is an overview of the history of forensic psychiatry, the first true subspecialty of medicine. It contains interesting reading about “mad doctors,” in charge of “asylums for lunatics.” The author describes social, scientific, and cultural dynamics of the English and American society of the 18th and 19th centuries. It includes the first cases that involved the use of the insanity defense and testimony by medical professionals as expert witnesses. The chapter also provides historical facts that are not only fascinating to anyone who has an interest in the field, but also show important historical links with the past. This chapter clarifies how precedents of significant importance, such as James Hadfield’s attempt to assassinate King George III in 1800, found its way into today’s landmark cases. Not surprisingly, the challenges that psychiatrists of the past experienced remain valid today. Chapter 2, “Introduction to the Legal System” was written by Daniel W. Shuman, JD, and outlines the different roles psychiatrists play in clinical practice and the courtroom. He stresses the need to acquire relevant skills and knowledge to navigate unfamiliar waters. He discusses conflicts, including confidentiality, autonomy, and “irreconcilable differences” (distinguishing treating and forensic psychiatrists) that place an ethics barrier between the dual role as therapist and expert for the same patientlitigant. Perhaps the only negative comment that might be made is that the language the author uses, indisputably sophisticated, was at times too complicated for the intended readers to digest during the first and sometimes second readings. Robert P. Granacher, MD, wrote Chapter 3, “Starting a Forensic Practice.” This chapter describes the start of a practice (as any business) with formation of a mission, a vision, values, and strategies to become successful. He provides helpful hints for the “novice” forensic psychiatrist or general psychiatrist, adding forensics to existing clinical practice. He advises the psychiatrists how to avoid common problems and establish “strategic growth.” Thomas G. Gutheil, MD contributed Chapter 4, “The Expert Witness.” He offers a precise explanation of the expert witness and how to become one. Dr. Gutheil’s emphasis on “honesty and striving for objectivity” should be incorporated into the career of every expert witness. He talks about pitfalls that are common in forensic practice and advises how to recognize, anticipate, and avoid them. Obvious questions, such as what expert opinion is being solicited or who is paying fees, may become much more complicated, if the expert does not address them early. The best-prepared expert is frequently the most successful in the chaotic legal system. Robert Weinstock, MD, and Liza H. Gold, MD, are the authors of Chapter 5, “Ethics in Forensic Psychiatry.” They highlight the principal differences in practicing clinical and forensic psychiatry and the “challenging dilemmas” of working in the interfacing fields of psychiatric medicine and law. For example, the forensic psychiatrist does not enter a patientphysician relationship. However, general psychiatrists who are also treating psychiatrists provide most of the expert testimony. Mixing the role of factual and expert witness creates problems in ethical conduct, including conflicts of interest, questions of confidentiality, and ability to provide objective “legally relevant opinion.” Forensic testimony is considered by the American Medical Association (AMA) to be the practice of medicine. As a result, it is subject to