Psychiatry and the Law: Basic Principles

This book was edited and written by Yale-trained forensic psychiatrists. Dr. Wasser has elevated what at first appears to be a primer to a curriculum on the complex relationship between clinical psychiatry and the law. He sets the stage in the Introduction, by contextualizing forensic psychiatry within two domains, each with an accompanying table: the impact of the law in various practice settings and locating forensic psychiatry embedded in Accreditation Council for Graduate Medical Education (ACGME) residency training milestones. This grounding is carried through the succeeding chapters to make a resounding point: medicolegal matters have great relevance to psychiatric practice.

Wasser uses several pedagogical devices that make the work compelling. He maintains tight control of the narrative, format, and tone of the chapters. There is a uniformity of language and a pleasant user friendliness throughout. Indeed, the harmonization of voice among chapters is so well done that I am reluctant to identify standouts. The chapters begin with clinical vignettes, written to the reader with second-person pronouns, placing the reader in a problem-solving mode, leaving questions unanswered (What would you do?). The vignettes are immediately followed by a dose of reality with a different flavor: a landmark case illustrating a medicolegal problem's course through the legal system. Although the cases cannot always provide clinical guidance, they illustrate generic principles: for example, operational definitions of consent, confidentiality, civil commitment, and risk of harm.

Between the Introduction and Conclusion are 14 chapters: Informed Consent, Confidentiality and Privilege, Duties to Third Parties, Voluntary and Involuntary Hospitalization, Civil Commitment and Involuntary Outpatient Commitment, Involuntary Medication, Civil Competence, Ethics, Malpractice, Suicide Risk Assessment, Violence Risk Assessment, Substance Abuse and the Law, Child and Adolescent Forensic Psychiatry, and The Insanity Defense and Competence to Stand Trial. Each follows the template described and is followed by about 20 references (with a few exceptions).

Throughout the chapters, authors maintain focus on the necessity for the practitioner to consult applicable statutes and case law within each jurisdiction. Each chapter concludes with major teaching points. The use of graphics and tables is minimal but helpful, while mnemonics, less sparing, are not memorable. Although some of the topics are complex (for example, duties to third parties) the authors are careful to avoid losing the reader amid conflicting views within the literature. In the Tarasoff discussion, the author provides both a U.S. map and a narrative of state-by-state variation. The authors cover ethics organically within the discussions.

Psychiatry and the Law is intended neither as a comprehensive work on forensic psychiatry nor as a practical guide to carrying out the work of the forensic psychiatrist. Those approaches can be found in works of Rosner and Scott² and Gold and Frierson,³ respectively. De-emphasis of a how-to approach here was smartly intended, since it would have distracted the reader from Wasser's intention of conveying and illustrating principles. Nevertheless, there is enough material to satisfy early learners and more advanced practitioners. At the end, Wasser lists North American ACGME-accredited fellowship programs, followed by a table of forensic psychiatry “milestones,” to track progress of forensic fellows. He also provides resources for professional societies and scholarly journals, not limited to the American Academy of Psychiatry and the Law.

Choosing a forensic psychiatry textbook can be challenging. Psychiatry and the Law covers many of the essential points of the books of Rosner and Scott² and Gold and Frierson³. Each is meritorious and will enjoy significant popularity. Given Wasser's stated goal of “basic principles,” it is fair to say that the likely target audiences of Psychiatry and the Law are the interested psychiatric resident, followed by forensic fellows and practitioners with emerging interests. Overall, Psychiatry and the Law is delightful to read and will be gratifying for teachers to use in forensic curricula at all levels, as well as to refresh their knowledge of law and psychiatry.

• © 2018 American Academy of Psychiatry and the Law