Reply

Editor:

We are pleased by Dr. Nizny's close reading of our editorial and his agreement with its main tenet—that psychodynamic formulation still has a place in forensic practice. Dr. Nizny takes issue only with a few sentences in the introductory section of the paper, where we reviewed the seemingly settled matter of psychiatry's shift away from psychoanalysis and toward neurobiological models of mental illness. Several areas of scholarship support this claim, including discussions of the declining role of psychoanalysis in clinic practice,^1,2 in academic psychiatry and psychiatric training programs,³ and as a defensible treatment modality when faced with malpractice suits.⁴

Dr. Nizny is correct in his assertion that boundary violations alone are not responsible for the decline of psychoanalysis in the psychiatric profession. That would, of course, be too simplistic an explanation. However, we stand by the claim that public scandals certainly did tarnish the reputation of the field, much as high-profile scandals involving financial relationships with pharmaceutical companies have tarnished psychiatry in more recent years.

Dr. Nizny also objects to the use of the word “commonplace” to describe neuroimaging in the courtroom. Perhaps it would have been more precise to say that neuroimaging has become commonplace in the professional discourse around law and psychiatry,^5,6 and even in the lay media.⁷ Computed tomography, magnetic resonance imaging, and positron emission tomography scans are gaining increased acceptance in the courtroom, particularly in the context of high-stakes criminal cases and death penalty mitigation.^8,–,10