Bearing Witness to Change: Forensic Psychiatry and Psychology Practice

This is a thoughtful and ambitious effort, edited by leaders of the Law and Psychiatry program at Yale University School of Medicine. (Disclosure: The first two editors are editors of the Journal, and three of the editors are past presidents of the American Academy of Psychiatry and the Law.) Their premise is made clear in the first pages: It is in contemplating past events in the context of their development and evolution that we may find ways to modify our present activities and even design a pathway for the future. Change is influenced by a variety of events, people, political activity, fiscal considerations, scientific discoveries, legal decision-making, and other circumstances. It is in understanding their interactions and effect on our work that we can become better practitioners and more able theorists [p xii]. The editors have gathered 20 chapters written by accomplished authors, exploring historical and future change. The book is organized in four general sections: major external influences; forensic disciplines as their own change agents; changes in the traditional evaluative and consultative roles of the forensic practitioner; and forensic practice in the treatment and care of patients.

Opening his Introduction on “Legacy of Change for Mental Health Professionals,” Dr. Howard Zonana takes us on a whirlwind historical tour. In short order, he touches on patient civil rights, U.S. Supreme Court decisions on the death penalty and mental health matters, involuntary medication, transformation of state mental hospitals into forensic facilities, sex offender civil commitment, mental health treatment in jails and prisons, and ethics guidelines and expert witness testimony, all in a spare 24 pages (not including references)! Were it not for the fact that Zonana was a major participant and observer in nearly all of the events, the reader might be left breathless and dizzy by this necessarily concise overview; however, he pulls it off admirably given his “front row” involvement in much of the history he describes.

The 20 chapters, many contributed by leaders in their respective fields, cover the familiar and not-so-familiar topics one would expect in a volume exploring historical changes. I especially appreciated efforts to include topics often under-represented in our forensic literature (e.g., psychodynamic therapy with forensic offenders and forensic practice in religion, although this chapter focuses almost exclusively on Roman Catholicism with little reference to other traditions). As a history buff, I applaud the authors' efforts to ground present status and future directions within a historical context. I found the chapters on neuroimaging and on correctional and institutional psychiatric treatment particularly rich in their well-researched historical detail.

For a book with 5 editors and 24 contributors, it is not surprising to find considerable variety in writing style and approach. To the editors' credit, I found few historical errors or inconsistencies (e.g., different dates or factual inconsistencies from chapter to chapter), often seen in volumes with less consistent quality editing. Sometimes the difference in authors' voice and style was more jarring going from chapter to chapter: the first-person, near-lyrical style of Dr. Griffith's chapter on narrative and performance contrasted with the much more prosaic and concrete dry history found in several other chapters. Chapters also fluctuated widely of length and depth: two 12-page chapters on global developments and on veterans compared with 27 pages (plus 4 pages of detailed references) on the mental health system–criminal justice interface. The result sometimes felt more like a compendium of individual articles rather than a unified and systematically edited consistent approach.

The “Yale-centrism” is easily detected: all 5 editors and 17 of the contributors hail from Connecticut. The authors are clearly thoughtful experienced leaders, clinicians, and forensic practitioners. Dr. Norko's chapter on legislative consultation makes fascinating reading, but I would have preferred more examples and perspective beyond New Haven and Hartford. Although the title gives equal billing to both forensic psychiatry and psychology, the content felt much more weighted toward psychiatry. Remarkably little attention is paid to different perspectives or approaches taken by psychology versus psychiatry. A final criticism of the published volume itself (not the content): the paperback felt inexpensively produced, with frequent incompletely inked pages in this reviewer's copy.

Overall, I enjoyed reading this book, learning quite a lot of new history and perspective along the journey. The editors have achieved what Dr. Griffith described as “my hope that this text has fulfilled its promise to bear witness to the decades-long process of progressive change in forensic psychiatry and psychology practice” (p 381). He concludes: “Looking back, both forensic disciplines have made substantial strides and have established solid foundations. Thus the future is bright for both groups of professionals … there is work to do, despite the fact that much ground has already been covered” (p 392). This volume is a worthy addition to the bookshelf of forensic practitioners, trainee and senior clinician alike, as we forge into the decades ahead. As Dr. Paul Amble noted in his chapter, citing the oft-quoted chestnut of Santayana and Churchill: “Those who do not learn history are doomed to repeat it” (p 361). This thoughtful book makes those important history lessons a little easier to absorb and contemplate.

• © 2017 American Academy of Psychiatry and the Law