Abstract
Most of the criteria for competence in current use emphasize cognitive rather than affective dimensions. Our clinical experience indicates that affective disorders may impair competence in a detectable and identifiable way. In particular, patients with major affective disorders can retain the cognitive capacity to understand the risks and benefits of a medication, yet fail to appreciate its benefits. A case study of a pathologic grief reaction is introduced to illustrate how cognitive and affective impairments may coexist and require separate remedial strategies for restoration. Further empirical work on the role of affective disorder in impairing competence is warranted and planned.
Footnotes
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From the Program in Psychiatry and the Law, Mass. Mental Health Center, where Dr. Harding was chief resident in legal psychiatry, Dr. Bursztajn is co-director, Dr. Gutheil is co-director, and Mr. Brodsky is senior research associate. Dr. Harding was also clinical fellow, Dr. Gutheil is associate professor, and Dr. Bursztajn is associate clinical professor, Harvard Medical School. Reprint requests to Dr. Bursztajn at 96 Larchwood Dr., Cambridge, MA 02138. Discussion of some portions of this research appeared in Gutheil TG, Bursztajn HJ, Brodsky A, Alexander V (Eds.): Decision Making in Psychiatry and the Law, Baltimore, Williams and Wilkins, 1991.
- Copyright © 1991, The American Academy of Psychiatry and the Law
