MENTAL HEALTH EVIDENCE BLOG


The Clinical & Forensic Psychology Practice of Dr. Glen Skoler

DRGlenSkoler@Gmail.com • (240) 605-2988

 
 
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This blog is intended to educate attorneys and judges about the uses, and abuses, of mental health expert testimony. It contains clear information on how attorneys can assess, and challenge, the reliability and validity of psychological and psychiatric evidence and testimony.


All blog entries: © Dr. Glen Skoler, 2010, All Rights Reserved.







Charles Dickens:

Legal Education &

Bleak House


At the height of his powers, Charles Dickens crafted this masterpiece around the interminable lawsuit of Jarndyce v. Jardyce, which lasted for  generations. The case becomes a metaphor implicating hypocrisies at every level of modern society, from the wealthy and powerful, to orphaned and homeless children.


Like most great writers, Dickens believed in the absolute truth of fictional satire. Before he could support himself as a writer, he worked as a law clerk, and then, after learning shorthand, as a courtroom and parliamentary reporter, spending years of his life listening to the droning details of convoluted legal cases.


Following the publication of “Bleak House,” Dickens was clearly irritated and offended at those who dared to suggest that the interminably litigated case of Jarndyce v. Jarndyce was nothing more than implausible satire. In response, Dickens cited for the public actual court cases which had been litigated even longer than Jarndyce & Jarndyce.


“Jarndyce and Jarndyce drones on. This scarecrow of a suit has, in course of time, become so complicated that no man alive knows what it means.”




DSM-V Controversies


The DSM-V is the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. Although it contains generally accepted diagnostic criteria for mental health disorders that are  accepted by courts and insurance companies, the DSM-IV is not without controversy.


I often find that attorneys “cave” on DSM-V issues because the DSM-V is recognized as such an authority by judges. However, if judges and attorneys receive any training in the DSM-V at all, it is often very cursory, involving boring and brief descriptions of the various diagnostic categories: psychotic v. mood v. anxiety v. personality disorders. But rarely are legal professionals trained to think about the DSM-V critically, or to truly challenge a DSM-V diagnosis, whether they are prosecutors or defense attorneys. An exception might be a lawyer specializing in such testimony. For example, an attorney who prosecutes sex offender cases might become very knowledgeable about DSM-V criteria for pedophilia.


The best approach in court is not to attack the criteria for a certain DSM-V diagnostic category, but to raise the issue of “differential diagnosis,” i.e. what were the other pathological or non-pathological diagnoses that could have also been assigned, and how did the clinician rule them in or out?


Here are a few of the debated DSM-V issues:


1) The DSM-V is criticized for relying on a “medical” or “disease” model of mental disorder and distress. After all, it is published by the American Psychiatric Association, an organization of MDs.


2) Millions of adults, and children, can “look” like they fit various DSM-V diagnoses at different times in their lives, diagnoses such as depression, or bipolar disorder, or ADHD.


3) The simple diagnostic and behavioral criteria of the DSM-V often have little to do with any kind of biological or chemical definition of mental disorder and stress. Yet  often these criteria are used to diagnose people in a matter of minutes, who are then immediately told that, based on meeting such diagnostic criteria, they may have a life-long“biochemical imbalance” requiring medications affecting the brain.


4) There is the logical fallacy of: “If it isn’t in the DSM-V, it doesn’t exist.” There is no rape, incest or spouse abuse syndrome in the DSM-V. Does this “prove” a victim can’t suffer from any of these syndromes? Sounds ridiculous, but this argument is often made about whether parental alienation syndrome really exists.

 

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