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Psychiatry and Criminal Culpability.

Psychiatry and Criminal Culpability Ralph Slovenko. Wiley--Interscience, New York, NY, 1995, 436 pp.

Ralph Slovenko, a law professor at Wayne State University, ranges widely over rocky legal and clinical terrain in Psychiatry and Criminal Culpability. Written for an interdisciplinary audience, the book is an effort to examine the relation-ship of psychiatry to legal determin-ations of criminal responsibility. Most of the book is given over to insanity defense issues, although other questions such as "syndromal" evidence are briefly discussed. A third section deals with issues and criticisms pertaining to psychiatric testimony. A final brief section asks the question "Whatever happened to sin?"

Meaningful treatment of the insanity defense demands a synthesis of law, psychiatry, social science and public policy, all placed within the perspective of historical development. The author attempts this approach but soon leaves the reader marooned or puzzled by abrupt and terse conclusions which lack overarching summary and integration. The tone varies from scholarly to almost chatty with a tendency to insert off-handed asides which may work in the classroom but seem out of place in print (e.g., "The label "psychopath", "sociopath" or "antisocial personality" is not as informative as the street term "son-of-a-bitch" and that is what the psychiatric label really means.") More problematic is the author's broad generalizations which do not stand up to scrutiny or are contradictory. Thus, for example, Slovenko suggests that the insanity defense is less common today because the range of capital offenses has diminished ("Today, with fewer capital offenses on the books, there is less resort to the insanity defense" p. 21), but later he concludes the opposite: "Given the short-term institutionalization, there has been an increase in the number of insanity pleas in recent years" (p. 181).

The chapter devoted to clinical disorders of legal significance seems particularly distorted in its unbalanced focus on diagnoses such as multiple personality disorder which, although controversial, have relatively little relevance in court. In contrast, little space is devoted to psychotic disorders which animate most successful insanity pleas. While the author accurately notes in passing that schizophrenia "characterizes the majority of insane defendants," little discussion of why this should be the case is advanced. Yet in the short two pages devoted to schizophrenia, Slovenko claims, "The diagnosis of schizophrenia remains a source of controversy, as any perusal of the literature will quickly indicate." Footnotes for this assertion include four references, the most recent from 1983. The author also offers his own opinion that "it is questionable whether any mind not totally incapable of coherent thought can fail to appreciate the wrongful-ness of a criminal act--most schizophrenics included."

Yet after this cursory treat-ment of schizophrenia (mood disorders only get a page), over twelve pages are devoted to multiple personality disorder. Professor Slovenko does the reader a disservice in this disproportionately long section by suggesting that multiple personality is a significant disorder in criminal matters: "With increasing frequency, the criminal justice system is confronted with defendants who claim to be multiple personalities." Statistically, however, the condition remains extremely rare in insanity pleadings. Bulimia gets as much space as mood disorders (Joyce Brothers is cited here) with the author suggesting that the condition could be the basis for an insanity plea although apparently no such case has ever been tried.

Slovenko's approach of citing the individual case (often from newspaper coverage) while failing to clearly present the empirical facts about insanity is a major short-coming and lends the book an almost sensationalistic quality at the expense of analysis and meaningful overview. He also repeatedly embeds ill-founded statements in otherwise interesting discussions which color and detract from entire sections. He suggests, for example, that all experts become "advocates" when accepting cases (p. 235), but ignores the data which reveal that nearly 90% of cases evaluated result in findings unsupportive of insanity. He also implies that contested trials are inevitable ("... when the plea of insanity is raised, the prosecutor scours the country in search of a psychiatrist, even if he is senile, alcoholic or worse, for an opposing opinion. The "battle of the experts" is really set up by lawyers who take great pains to make sure they locate a psychiatrist sympathetic to their side's cause so as to "cancel out" the adversary's expert." p.234), but does not point out that most insanity acquittals result from cases where experts on both sides agree on diagnosis and opinion.

Two recent developments which have great importance for the insanity defense, conditional com-munity management of acquittees and the abolition movement of several states, receive only the briefest mention even though an entire chapter is devoted to dis-position of insanity acquittees. By the end of the book, the reader has been presented with many criticisms and questions for psychiatry and the law but few constructive sugges-tions. Overall, Psychiatry and Criminal Culpability adds more smoke than light to an issue of continuing significance to the law and society. More troubling, and perhaps unintentionally, the book reinforces some of the myths and misconceptions which surround psychiatrists in court.
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Author:Hawk, Gary
Publication:Developments in Mental Health Law
Article Type:Book review
Date:Jan 1, 1997
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