Forensic Self Assessment

Front 1

All the following are true of forensic psychiatry except
A. It is a subspecialty of psychiatry that is attracting more interest among clinicians.
B. It developed in conjunction with the specialty of psychiatry in the mid-nineteenth century.
C. It requires a detailed knowledge of the law.
D. It is intimately connected with the practice and precepts of clinical psychiatry.
E. It requires specialized training beyond that of clinical psychiatry.

Back 1

The correct response is option C.
The field of psychiatry developed in the first decades of the nineteenth century. Forensic psychiatric
practice played an important but underrecognized role in the development of clinical psychiatry. The
first “mad-doctors” or psychiatrists were asylum doctors. They combined their interest and experience
in mental disorders with the traditions of medical jurisprudence and considered forensic practice an
integral part of their professional role. In past decades, more psychiatrists have been receiving
specialized training in forensic psychiatry through continuing education and forensic fellowships. The
practice of forensic psychiatry is based on that of clinical psychiatry but requires specialized training.
This training familiarizes clinicians with the areas of law relevant to forensic psychiatric evaluation and
testimony. However, the practice of forensic psychiatry does not require a detailed knowledge of the
law. That is the attorney’s job. (p. 4)

Front 2

The “moral treatment” of insanity, the basis for reform of the treatment of the insane in the
nineteenth century,
A. Emphasized the need to use somatic treatments, such as bloodletting, to cure insanity.
B. Relied heavily on physical restraints and punishment.
C. Was based on the belief that humane treatment of the insane in a carefully constructed social
environment could effect a cure for madness.
D. Became popular only in Europe.
E. Was developed by the early German psychiatrists.

Back 2

The correct response is option C.
At the end of the eighteenth and the beginning of the nineteenth century, physicians and laypeople
began to call for more humane and humanistic treatment of the insane. Philippe Pinel in France and
William Tuke in England simultaneously concluded that insanity could be cured by treating the mad
with dignity and kindness while carefully controlling their social environment. Mechanical restraints,
intimidation, and bloodletting were either not permitted or discouraged. Vincenzio Chiarugi in Italy
and Benjamin Rush in the United States also played roles in the development of moral treatment. The theories of moral treatment were instrumental in the development of the asylum movement of the
nineteenth century and the development of the specialty of psychiatry. (pp. 10–12)

Front 3

The M’Naghten rules (1844) carried an authoritative weight and guided the Anglo-American law of
insanity for the next century. These held that a defense based on insanity must establish that
A. The person was mentally retarded.
B. The person was delusional only in regard to the act in question.
C. The person had been considered insane prior to committing the act.
D. The person committing the criminal act did not know the nature and quality of the act, or could
not tell right from wrong, due to defect in reason.
E. The person was unable to control his impulses.

Back 3

The correct response is option D.
In 1843, Daniel M’Naghten was found not guilty of murder by reason of insanity (McNaughten’s case
1843). The verdict resulted in an outpouring of resentment. The House of Lords asked the judges of
England to clarify points of law raised by the trial by posing five questions. The answers to these
questions, which became known as the M’Naghten Rules (1844), addressed the increasingly
controversial role of medical experts and the legal definition of insanity. The M’Naghten rules defined
the legal standard of insanity as the inability to distinguish right from wrong on the basis of mental
defect. This formula scotched the psychiatric claim for the recognition of disorders of partial insanity
without disorder of cognition. (pp. 28–29)

Front 4

The first trial to introduce the concept of partial insanity—that is, that an individual could be insane
even though he did not suffer any impairment in his ability to reason—was
A. Rex v. Arnold (1724).
B. Rex v. Ferrers (1760).
C. Rex v. Hadfield (1800).
D. Regina v. Oxford (1840).
E. Durham v. United States (1954).

Back 4

The correct response is option C.
The Hadfield case was the first successful use of a partial insanity defense. Hadfield had sustained a
head injury during military service, after which he became delusional. He was acquitted of attempting
to assassinate King George III as the result of his delusions, and not as a result of a defect of reason.
This case also established an expert role in the courts for psychiatrists, since forms of partial insanity
might not be detectable by laymen.
The Arnold case was notable for setting the precedent of the “wild beast” test of insanity. The
Ferrers case was notable for the psychiatric testimony of Dr. Munro, the first such use of expert
testimony. The Oxford case was important in that the determination of insanity was said to turn on
the ability to distinguish right from wrong, ultimately encoded as the M’Naghten Rules (1844). The
Durham case was an experiment in establishing that an individual was not guilty by reason of insanity
if the crime was a product of mental disease or defect. (pp. 15–16)

Front 5

Isaac Ray’s A Treatise on the Medical Jurisprudence of Insanity (1838), the most comprehensive and
systematic presentation of the new nineteenth-century understanding of insanity in the context of
litigation,
A. Was not widely known outside the United States.
B. Became the standard text on the subject of forensic psychiatry throughout the nineteenth century.
C. Presented a new classification of mental disorders.
D. Resulted in the founding in 1844 of the Association of Medical Superintendents of American
Institutions for the Insane (AMSAII), which eventually became the American Psychiatric
Association.
E. Was the product of Ray’s years of specialization in the treatment of mental disorders.

Back 5

The correct response is option B.
The name of Isaac Ray is associated with the development of forensic psychiatry more than that of any
other nineteenth-century physician. Ray’s A Treatise on the Medical Jurisprudence of Insanity,
published in 1838, resulted in his gaining an international reputation. At the time he wrote the
Treatise, Ray was 31 and a general practitioner in Maine with no particular experience in treating the
insane. Ray’s Treatise laid out the various types of mental disorders postulated by experts through
1837 and described the ways in which enlightened courts should deal with each type. It did not
present a new classification of mental disorders.
The Treatise became the standard text on the subject throughout the nineteenth century and
established Ray as a leading authority in this field. It was widely known in the United States and
Europe and was quoted extensively at the trial of Daniel M’Naghten in 1843. Although Ray was one of
the founding members of AMSAII, his work did not precipitate the founding of this organization, the
first medical specialty organization in the United States. (pp. 20–21)

Front 6

In Daubert v. Merrell Dow Pharmaceuticals, Inc. (1993), the Supreme Court offered judges criteria to
help them determine the scientific reliability of proffered expert testimony. These criteria include all
of the following except
A. Whether the technique or theory had been or could be tested.
B. Whether it had been subjected to professional scrutiny through peer review and publication.
C. Whether it yielded an acceptable rate of error.
D. Whether it had been accepted in the relevant scientific community.
E. Whether it had been proven to be true.

Back 6

The correct response is option E.
Until 1993, the test governing the admissibility of expert evidence arose in a federal court of appeals
decision in Frye v. United States (1923). The Frye test allowed judges to base the determination of the
reliability of scientific testimony on its general acceptance within the relevant scientific community. In
1993, the U.S. Supreme Court concluded that the Federal Rules of Evidence adopted in 1975
superseded the Frye test. The criteria put forward include A, B, C, and D and are grounded in Karl
Popper’s conceptualization of falsifiability as the hallmark of the scientific enterprise. Answer E is not
a requirement in regard to the acceptance of a scientific theory or a criterion for admissibility.
(pp. 49–50)

Front 7

Federal Rule of Evidence 704(b) restricts experts testifying in an insanity defense in federal court
from testifying that
A. The defendant was unable to appreciate the nature and quality or the wrongfulness of his acts as a
result of a severe mental disease or defect at the time of committing the offense.
B. The defendant was suffering from psychotic delusions.
C. The defendant was under psychiatric treatment and taking psychiatric medication.
D. The defendant had an Axis I psychiatric disorder.
E. The defendant had an antisocial personality disorder.

Back 7

The correct response is option A.
Experts are barred from expressing opinions on the ultimate issue in an insanity defense in federal
court. Common law courts once assiduously excluded any expert testimony that touched on the
ultimate legal issue as an intrusion upon the province of the jury. When the Federal Rules of Evidence
were adopted in 1975, their drafters rejected the “ultimate issue rule” as a legal artifact that no longer
served a useful purpose. A decade later, the reaction to the John Hinckley not guilty by reason of
insanity verdict led to a partial reintroduction of the ultimate issue rule in federal criminal trials. This limitation on ultimate issue testimony by experts does not apply in federal civil cases or the vast
majority of state courts, which have not adopted this provision. (pp. 50–51)

Front 8

Which of the following terms refers to the limitations on the process used by the government to
deprive a citizen of life, liberty, or property that are addressed under the Fifth and Fifteenth
Amendments of the Constitution?
A. Substantive due process.
B. Procedural due process.
C. Habeas corpus.
D. Prima facie evidence.
E. Judicial restraint

Back 8

The correct response is option B.
Issues of process are based on considerations of fairness and justice. The due process clause is
contained in the Fifth Amendment (applicable to federal governmental action) and Fourteenth
Amendment (applicable to state governmental action) of the Constitution. Due process has two
important but different constitutional meanings. Substantive due process refers to the power of the
courts to declare legislation unconstitutional because it does not reasonably advance a legitimate
governmental goal. Procedural due process refers to limitations on the process used by the government
to deprive a citizen of life, liberty, or property. The hallmark of procedural due process is a meaningful
opportunity to be heard.
Habeas corpus is a writ applied to bring a person before a court, most often to ensure that the
party’s imprisonment or detention is not illegal. Prima facie evidence is evidence that will establish a
fact or sustain a judgment unless contradictory evidence is produced. Judicial restraint refers either to
a restraining order, injunction, or judgment imposed by a court or a philosophy of judicial decision
making whereby judges avoid indulging their personal beliefs and merely try to interpret the law
according to precedent. (pp. 43–44)

Front 9

The Supreme Court heard and rejected a challenge made to Kansas v. Hendricks (1997), Kansas’s
statutory scheme for civil commitment of a dangerous sex offender who suffers from a mental
abnormality. This challenge was based on
A. The Fifth Amendment right against self-incrimination.
B. The constitutionality of an Alford plea.
C. Violation of privacy.
D. Substantive due process.
E. Violation of attorney-client privilege.

Back 9

Substantive due process refers to the power of the courts to declare legislation unconstitutional
because it does not reasonably advance a legitimate governmental goal. In Kansas v. Hendricks (1997),
the U.S. Supreme Court heard and rejected a substantive due process challenge to Kansas’s statutory
scheme for civil commitment of a dangerous sex offender who suffers from a mental abnormality.
The Fifth Amendment to the Constitution allows individuals the right to avoid self-incrimination. An
Alford plea is a plea entered by a defendant in connection with a plea bargain without actually
admitting guilt. Violation or invasion of privacy is an unjustified intrusion into one’s personal activity,
which is sometimes actionable under constitutional law. Violation of attorney-client privilege refers to the client’s right to refuse to disclose and to prevent any other person from disclosing confidential
communications between the client and the attorney. (pp. 43–44)

Front 10

The legal process in the United States is based on an adversarial system of justice, in which two sides
present their views of the facts and the court rules on the ultimate legal matter in question. This
process influences forensic psychiatric practice in all the following ways except
A. Imposing a time schedule on evaluations and the formulation of opinions.
B. Imposing limits on the type of testimony an expert may offer.
C. Imposing limits on the types of legal cases permitted to utilize expert testimony.
D. Imposing limits on patients’ privileges, such as confidentiality.
E. Imposing limits on the degree of consent needed to perform a forensic evaluation.

Back 10

The correct response is option C.
The adversarial system of justice seeks to achieve truth by placing the responsibility for its discovery in
the hands of those who have the greatest interest in the outcome, the parties. That approach to the
discovery of truth contrasts starkly with the methods of science, and this difference accounts for
much of the frustration on the part of experts schooled in the methods of scientific investigation. In
addition, the avoidance of unnecessary delay, the need to contain costs, and competing ethical
concerns regarding evidence such as issues of confidentiality and consent can affect forensic
evaluations. Experts are not limited by law in the types of cases in which they can provide testimony.
(pp. 40–42)

Front 11

The four major components involved in planning any business, including a forensic psychiatry practice,
include all of the following except
A. The mission.
B. The vision.
C. The core values.
D. The strategies.
E. The cash flow.

Back 11

The correct response is option E.
Whether forensic psychiatrists are solo practitioners adding forensic work to a clinical practice or part
of a larger group providing forensic services, developing a successful forensic practice requires
forethought. The mission statement is a statement of the overall philosophy of the practice and the
driving force behind, or “heartbeat” of, the practice. The vision of the forensic psychiatry practice is a
statement describing how the practice will proceed from point A to point B as it seeks to fulfill the
mission of the practice. It is the description of where the practice is heading as guided by the mission
statement. The core values should express in simple terms the ethics and values (the business culture)
that will be used to guide the mission and vision of the practice. The strategies describe how the
mission and vision of the practice will be accomplished, and involve strategic thinking and strategic
planning. Cash flow assessments are not part of the business planning stage. (pp. 58–60)

Front 12

Forensic psychiatrists who utilize an Internet Web site for purposes of either communication or
advertising should be aware that
A. Attorneys appreciate the business value of a Web site to a forensic psychiatrist’s practice.
B. Attorneys prefer to retain experts who are proficient with the Internet and who have their own
Web sites.
C. Attorneys often wish to use such Web sites to discredit experts at trial.
D. The use of Web sites is a widely accepted and noncontroversial practice for forensic psychiatrists.
E. Juries in this age of computers have more respect for experts who have their own Web sites.

Back 12

The correct response is option C.
Although the use of Internet Web sites by forensic psychiatrists is more common now than it was a
few years ago, the use of such sites is still controversial, as it is clearly a form of advertising. As such,
they may be used to discredit the forensic psychiatrist who utilizes one, even if the primary purpose of
that Web site is communication. Therefore, it is recommended that a Web site be conservative,
accurate, and not embellished. Such Web sites might include information about the types of
examinations offered, a description of the office location and directions, and an abbreviated
curriculum vitae. However, Web sites, like any form of advertising, should be used with caution.
(p. 64)

Front 13

Some of the business principles that help establish a successful forensic practice include
A. Ensuring good communication among staff, even if staff consists of only one other person.
B. Establishing clear fee policies that are communicated at the outset of the relationship with the
client attorney.
C. Considering use of the widely accepted practice of obtaining a retainer contract and a retainer fee.
D. Having a person who can answer basic questions and take messages answer the phone rather than
using voice mail or an answering machine.
E. All of the above.

Back 13

The correct response is option E.
A number of common business practices can be adapted or modified to help ensure the success of a
forensic practice. For instance, even if the practice consists of only a psychiatrist and one employee,
meeting weekly with one’s staff to review upcoming forensic examinations and scheduled testimony is
both practical and efficient.
Productivity is enhanced by the secondary improvement in internal communication of the practice
that occurs as a result of weekly meetings. Clear written contracts with clients prevent professional or
ethical lapses. A retainer fee or prepayment of estimated costs ensures that no perception of
contingency fee arrangements exists and facilitates honesty and objectivity in the examination. The
practice of having a person answer the phone leaves a better impression on clients than the overused
and impersonal voice mail with menus. (pp. 66–68)

Front 14

Physical indicators used in formulating a strategic plan for the development of a forensic practice
should include all of the following except
A. The written analyses of the practices of competing forensic practices in order to mimic those
practices or compete directly with them.
B. The services offered by the practice and types of case to be evaluated.
C. The human resources and skills that the practice will need to obtain.
D. The customers (e.g., lawyers, institutions, courts, businesses) to be served.
E. The legal market segment in which the practice will compete (e.g., personal injury, criminal,
workers’ compensation, employment law).

Back 14

The correct response is option A.
The strategic plan should be proactively developed within the skill set and philosophy of the individual
psychiatrist. Whether psychiatrists commit the strategic plan to writing or not, they should review the
plan to find physical indicators that enable the practitioner to make analyses and decisions. Items B,
C, D, and E are important in order to develop a cohesive plan. Others include the budget for monies
intended to capitalize the practice and the facilities and physical plant needed to provide services.
Strategic plans should not be directed toward a target forensic psychiatric practice or competitor.
Awareness of the forensic competitors who practice in the area is useful for developing strategic plans;
analyses of competitors aimed to facilitate direct competition with or mimicking of a particular
practice may ultimately be destructive rather than productive. Psychiatrists should focus on their
“vision” and develop the practice to that vision. (pp. 59–60)

Front 15

The most critical factor in the success of any forensic practice is
A. Proper stewardship of practice resources.
B. The clinical skills and integrity of the forensic psychiatrist.
C. Maintaining a clinical practice.
D. Specialization in certain kinds of forensic evaluations.
E. Ethical marketing.

Back 15

The correct response is option B.
Starting a forensic practice is similar in many respects to starting any other kind of business. However,
the critical factor in its success is the clinical skill and integrity of the forensic psychiatrist. Many
elements relating to business plans, strategic planning, flexibility, and adaptability will contribute to
success in developing a forensic practice. However, if the novice forensic psychiatrist strives for
excellence, the marketing aspects will take care of themselves by word-of-mouth among lawyers and
by expert witness reporting services used by lawyers. (pp. 69–72)