An introduction to Forensic Psychiatry

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    • 00:18

      SAM: Uh, it was a habit of mine when I got up in the morningto make a cup of tea.And to take my wife a cup of tea and a biscuit,

    • 00:39

      SAM [continued]: or a piece of cake, upstairs.This particular morning I had-- I went to do the same thing.I went downstairs and I lit the fire and let the dog out.

    • 01:04

      SAM [continued]: Then I-- I should say rather it wasthe dog that brought me around.It was licking my face.And I must've gone right out.Because when I looked up at the clock then, more than an hour

    • 01:31

      SAM [continued]: had gone.And I didn't understand.The kettle was boiling.Anyway, in the end I made the tea

    • 01:52

      SAM [continued]: and went upstairs, and found my wife dead, with bloodall over her.And I looked and I also noticed there was blood all over me.

    • 02:15

      JOHN GUNN: You've just been watching a re-staged interviewwith a patient of mine.It's a real patient.And the words of the interview are real.And we're going to call him Sam, for the purposesof this program.But the part of the patient has been acted on this occasionto preserve confidentiality.And what I want to do in this program

    • 02:36

      JOHN GUNN [continued]: is to illustrate some of the key issues and conceptsin forensic psychiatry, by using Sam's case.But before we get to the details,perhaps we'd better just consider at the outsetwhat forensic psychiatry is.Well the word forensic simply means legal.And so forensic psychiatry is that part of psychiatrywhich deals with legal issues.

    • 02:57

      JOHN GUNN [continued]: It's the part of psychiatry that concerns itselfwith the problems which patients present sometimesby misbehaving, getting into trouble with the law.Sometimes other kinds of legal questions are raised.But it's really simply a central part of general psychiatry.And I want to emphasize that point rightfrom the very beginning.

    • 03:18

      JOHN GUNN [continued]: Because it's sometimes thought of as a ratherdifferent and special part of psychiatry.It's nothing of the kind really, because every psychiatristwill have to comment on patients behavior from time to time.Every psychiatrist will meet occasionswhen he has to write reports.And every psychiatrist will have to spend a few times when

    • 03:41

      JOHN GUNN [continued]: he goes into court to give evidence about patients,and on behalf of patients.Now to illustrate the way in which forensic psychiatry isa central part of general psychiatry,I want to begin with just a few words about the conceptof responsibility.

    • 04:03

      JOHN GUNN [continued]: This is a word which tends to raise anxietyin the hearts of many doctors, simply because theythink that the concept of responsibilityis purely a legal one.It's a special idea which lawyers have,and which is alien to their way of thinking.In fact that's not the case at all,because responsibility is part and parcel of everyday life.

    • 04:26

      JOHN GUNN [continued]: Or at least the concept is.We tend to regard one another, our friends, acquaintances,and people we come into contact with,as responsible human beings.It's the way we distinguish man from other animals.We think of man as having free will.We think of man as capable of taking blame

    • 04:46

      JOHN GUNN [continued]: for things he does wrong.We think of colleagues as praiseworthyon occasions, when they do things well.We think of them, in fact, as responsible for their behavior,and deserving the consequences of that behavior.Now of course that concept is modified to some extent

    • 05:08

      JOHN GUNN [continued]: under certain circumstances.We don't attribute the same levels of responsibilityto everyone.For example, we don't attribute to childrenthe same degrees of responsibilitythat we attribute to adults.Similarly, we don't attribute to the mentally handicappedand the mentally ill the same degree of responsibilityas to other people.

    • 05:30

      JOHN GUNN [continued]: If we take someone who develops dementia in later life,we modify their responsibility.Indeed that may be one of the ways in which the psychiatristis brought in to consider a question of responsibility.A patient may be coming, may be getting senile

    • 05:52

      JOHN GUNN [continued]: as they get older.And they, the relatives, question whether or notthey're now capable of looking after their affairs.And the psychiatrist may be brought into comment upon that, make a diagnosis, and if necessary,bring in the court of protection to take over the affairs

    • 06:13

      JOHN GUNN [continued]: to protect the patient from the consequencesof their now failing brain, and their lack of responsibility.Now the layman understands all these issues.And he sets up institutions to deal with them, to some extent.And one of those institutions is the psychiatrist.He, as I've just illustrated, is brought

    • 06:35

      JOHN GUNN [continued]: in when there are doubts about the mental healthof a particular patient.Let's take a classic example.If I go manic, and suffer from this very pernicious and severeillness, then I hope that someonewill come along to make the diagnosis correctly.

    • 06:57

      JOHN GUNN [continued]: And if the illness becomes very severe, take over my affairson a temporary basis.And indeed, use the powers of the Mental Health Actto admit me to hospital, so that I am protected from the worstravages of illness.To take over responsibility for my affairs,in fact, for a short period.

    • 07:18

      JOHN GUNN [continued]: So all these ideas, which are notreally unfamiliar to the psychiatrist,or indeed to layman, are part and parcelof the concept of responsibility.Now if we take the concept into court, all that happensis that we narrow it a bit.In court, responsibility tends to really mean punish ability.

    • 07:43

      JOHN GUNN [continued]: And the same sorts of issues are brought into playand discussed in the court, as some of thosethat I've mentioned just now.The fact is that if I carry out an antisocial act, one whichwould normally carry some form of punishment,because I break the criminal law,there are ways in which I can be excused

    • 08:04

      JOHN GUNN [continued]: the consequences of that act.There are ways in which my responsibility can be regardedas either lacking, or reduced sufficiently,to allow complete or partial remission of punishmentfor my otherwise punishable actions.Now I'd like to show you the list of excuses which

    • 08:26

      JOHN GUNN [continued]: are used in a criminal court.[Excuses.Youth.Accident.Mistaken identity.Provocation.Threat or duress.Self defence.Madness.]You'll see they include such thingsas the age of responsibility, which I mentioned earlier,which in England is 10 years.And several others, which are notof great importance to the psychiatrist.But at the bottom of the list thereis madness, which actually includes a number

    • 08:46

      JOHN GUNN [continued]: of psychiatric factors.And this is the one which concerns us.And it in fact concerns us at all stages of the hearing.A criminal trial, as it's commonly called,is actually a hearing, and dividedinto three phases, a pre-trial, a trial, and a sentence phase.[Pre-trial. Fitness to plead.]

    • 09:06

      JOHN GUNN [continued]: Now in the pretrial phase, the one big issuefor the psychiatrist is fitness to plead.And I'll come back to this later on.But for the moment, just note that it means whether or notthe defendant is able to go into the trial.Now if he goes into the trial, the question is, was he so--

    • 09:28

      JOHN GUNN [continued]: [Pre trial.Fitness to plead.Trial.Mens rea (McNaughton rules).]--mad, or lacking in responsibilityat the time of the crime, that he must be found not guilty?And this one uses the concept of Mens rea, which I thinkis simply translated for our purposes as intent.And to do that we use the McNaughton rules.Again, these will be shown to you in a few minutes.

    • 09:50

      JOHN GUNN [continued]: [Pre trial.Fitness to plead.Trial.Mens rea (McNaughton rules).Sentence.Mitigation.]Past the trial stage we come to sentence.This is where most psychiatric evidence is brought in.It's brought in mitigation.It can reduce the sentence, the severity of the sentence,or sometimes replace the sentenceby a psychiatric disposal.

    • 10:11

      JOHN GUNN [continued]: Now as I said, I want to come backto all those points in a moment.But before we do so, I'd like to return to our interviewwith Sam, who will tell us the buildup to the crime that hecommitted, the killing of his wife.And as we go through the interview,I'd like you to consider the various points I've mentionedso far, to see where you think the issues that he brings up

    • 10:36

      JOHN GUNN [continued]: can be brought into the criminal process.

    • 10:46

      SAM: According to my mother, I did have fits for a bit.But I don't really remember.

    • 10:54

      JOHN GUNN: That was just after you were born?

    • 10:56

      SAM: Uh yes.Up to the age of five.I had a brother and a sister then,but I think they was all right.

    • 11:06

      JOHN GUNN: Now I think you did get into trouble a bitas a boy.Is that right?

    • 11:10

      SAM: Yes.[CLEARS THROAT]At about the age of 12 I got into troublewith the police for stealing.After that it happened a lot.

    • 11:26

      JOHN GUNN: What sort of things happened?

    • 11:29

      SAM: Well petty things, really.I stole money, bikes, and a wallet once, things like that.And I was sent to industrial school in [INAUDIBLE].

    • 11:51

      SAM [continued]: They sent me to prison in the end,after I started house breaking.

    • 11:55

      JOHN GUNN: That was in 1953?

    • 11:58

      SAM: Yes.

    • 11:58

      JOHN GUNN: Now I've a note here that youwere admitted to Selly Oak Hospital once,while you were at industrial school.Now what was that for?Can you remember?

    • 12:07

      SAM: Um yes, I woke up in hospital, with my motherand father beside me.And they said that according to the doctors I'd had a fit.But I don't remember.

    • 12:24

      JOHN GUNN: Yes, I see.Now how old would you have been then?

    • 12:30

      SAM: 15, I suppose.

    • 12:31

      JOHN GUNN: Now later on these blackouts cropped up again,didn't they?Because I've a record here that youmust have been in prison at the time.You were complaining about them.Can you describe what they were like?

    • 12:47

      SAM: Well my head used to shake.And I seemed to lose control.And if I was holding anything, like a cup of tea,I'd spill it all over me.I did feel weak.

    • 13:10

      SAM [continued]: But I didn't actually go unconscious.

    • 13:17

      JOHN GUNN: Now in 1962, you've been given a probationsentence, and were living at one of the Langley House Hostelsfor probationers and ex-prisoners.And that's where you met your future wife, isn't it?

    • 13:28

      SAM: Yes.

    • 13:29

      JOHN GUNN: And you got married?

    • 13:31

      SAM: March, 1963, yes.

    • 13:35

      JOHN GUNN: So during the three or four months of the marriage,did you in fact have any problems?

    • 13:41

      SAM: No problems at all, no.In fact, if anyone was in love with each other,Trixie and I were.

    • 13:47

      JOHN GUNN: No difficulties over money?

    • 13:49

      SAM: No, no.

    • 13:51

      JOHN GUNN: Complaints about where you were living,or any sort of stress that might happen in any marriage?

    • 13:57

      SAM: No, no.

    • 13:58

      JOHN GUNN: Not as far as you can remember.

    • 14:00

      SAM: Not as far as I can remember.And in fact I know there weren't.

    • 14:11

      JOHN GUNN: Well we know from the clip at the beginningthat Sam killed his wife.And I've got a contemporary record of the trial here,which gives us a few details.His wife's body was found lying in bed,under the coverlet and eiderdown,hands having been crossed on the chest after death.There was severe injuries to the face and head,

    • 14:31

      JOHN GUNN [continued]: and defensive injuries to the right arm and hand.Post mortem examination shows that at least 11 blowshad been delivered with a one and a half pound claw hammerto the front and side of the head.He himself gave the doctors a variable, and in some respects,contradictory account of having sufferedhead injuries, nervous disorders,attacks of dizziness, and partial blackouts

    • 14:52

      JOHN GUNN [continued]: throughout his life.These phenomena, the record suggests,must've been insignificant.For a perusal of prison records shows that in all the yearshe spent in prison, at no time had such an occurrence beennoted by a prison doctor.Nor had he ever been thought to showsigns of mental abnormality.The EEG investigation however showed unequivocally

    • 15:13

      JOHN GUNN [continued]: that his brain was subject to epileptic activity.And at the trial, his defense was oneof diminished responsibility.Doctor Hill was called by the defenseto give evidence about the EEG findings,and his interpretation of them.He said that abnormality of the kind produced by brain damagewould be capable of impairing a person's mental responsibilityfor his acts.

    • 15:34

      JOHN GUNN [continued]: But that since he himself had not examined the patient,he was unable to say what would be the effect in Sam's case.He didn't suggest that he had an epileptic manifestation whenhe killed his wife.Two prison doctors were called by the Crownto give evidence in rebuttal.It was their opinion that the EEG evidenceof epileptic activity had no bearing on the commission

    • 15:55

      JOHN GUNN [continued]: of this offense.The logical sequence of Sam's actions,and the absence of any sign of the confusion whichwould inevitably accompany a state of altered consciousness,made it clear in their view that he had notbeen suffering from any epileptic conditionat the time of the crime.And after a two and a half hour retirement,the jury returned a verdict of manslaughter.And Sam was sentenced to life imprisonment.

    • 16:19

      JOHN GUNN [continued]: Well what were the issues there?And how did they come into the hearing?Let's go back to the three stages of the hearingto see where the psychiatric points could have been raised.First of all, pretrial.[Pre trial.Fitness to plead.Trial.Mens rea (McNaughton rules).Sentence.Mitigation.]I mentioned that fitness to pleadis a rare issue, as far as a psychiatrist is concerned.

    • 16:42

      JOHN GUNN [continued]: And it is rare because it is in fact followedby very serious consequences.It can only be raised by the defense.And it protects the man from going into a trial whichwould be unfair to him.Let's look at the criteria which wehave to examine to see whether man is fit to plead.[Fitness to plead criteria.Accused should be capable of-- instructing counsel,appreciate significance of pleading'guilty' or 'not guilty.']First of all, he should be capable of instructing counsel.

    • 17:04

      JOHN GUNN [continued]: He should appreciate the significance of pleadingguilty or not guilty.[challenging a juror, examining witnesses, understandingand following the evidence and court procedure]He should be able to challenge a juror,examine witnesses, and understandthe evidence in the procedure.Now this issue is raised in frontof a jury in a Crown Court.And if a person's found unfit to plead,the consequences is that they're taking to a hospitalindefinitely, at the pleasure of the Home Secretary.

    • 17:27

      JOHN GUNN [continued]: In other words, they're debarred from the trial.So it's a very serious matter.Sometimes though, if they recover quickly,they can be brought back for trial.But often they're released from hospital some years later,without the facts ever being tested.Well here we're not dealing with that kind of problem.Sam was fit to plead.

    • 17:48

      JOHN GUNN [continued]: So we now move to the trial itself--[Pre trial.Fitness to plead.Trial.Mens rea (McNaughton rules).Sentence.Mitigation.]--where the question of responsibilityis raised, in terms of the intentions.Mens rea, as you remember from what I said earlier,really can be translated as intent.First issue, however, is did he do it?

    • 18:08

      JOHN GUNN [continued]: What are the facts?In this case they weren't in dispute.Then the psychiatric issues are raised.Did he in fact have a guilty mind?Did he intend to do it?Did the psychiatric disturbance affect his intent?Now there's an old common law tradition about this.The defense raises the matter, and it's

    • 18:29

      JOHN GUNN [continued]: debated in front of the jury.But the common law tradition was fossilized to some extentby a famous trial in 1843.One Daniel McNaughton, who was a Scot,believed that the Tory party were after him.He had in fact a fairly typical paranoid psychosis.And he came down to London to prevent them getting him.

    • 18:52

      JOHN GUNN [continued]: And he decided that he would get them first by shooting them.And he went into Downing Street with two loaded revolvers.And he shot at the leaders of the Tory party.He managed to kill the Secretary to the Prime Minister,but was stopped from shooting the Prime Minister himself.

    • 19:15

      JOHN GUNN [continued]: I think we've got a picture of McNaughton.I'm not quite sure whether this shows the before and aftereffects of psychiatry.One is a wood cut at the time of his trial.Another one is several years later,when he was in a mental hospital.He was acquitted under the common lawprocedures of the time, and sent to a mental hospital.

    • 19:36

      JOHN GUNN [continued]: Because then, as now, the consequencesof being found not guilty by reason of insanityare indefinite detention at the pleasure the Home Secretary.But this not guilty verdict, and beingsent to hospital in such an infamous case,created an outcry.And there were letters to the Times,and all sorts of pressures in parliament.And the judges were asked to formulate

    • 19:58

      JOHN GUNN [continued]: some rules showing how they arrivedat this type of acquittal.And these have been enshrined as the famous McNaughton rules--[McNaughton Rules, 1843.Every man is presumed to be sane until the contrary be proved,and that to establish a defense on the ground of insanity itmust be clearly proved that at the time of committingthe act--]--which I'll show you briefly-- youwon't need to commit these to memory.But just have a look at them, and see how difficultit would be to fit any case into this framework.Every man is presumed to be sane until the contrary be proved.

    • 20:20

      JOHN GUNN [continued]: And that to establish a defense on the ground of insanity,it must be clearly proved that at the timeof committing the act--[--the accused party was labouring under such a defectof reason, from disease of the mind,as not to know the nature and quality of the act he wasdoing, or if he did know it, he did not know that what he wasdoing was wrong.]--the accused party was laboring under such a defect of reason,from disease of the mind, as not to know the nature and qualityof the act he was doing.Or if he did know it, that he didn't know what he was doingwas wrong.I should emphasize that this not guilty by reason of insanity

    • 20:41

      JOHN GUNN [continued]: verdict is available for any charge.But because of the difficulty of it,and because of the consequences of it,it's almost exclusively reserved in practice for murder.Now it has many problems, as you can see.And to get around those problems,in 1957 a new act was introduced to deal with the murderer.

    • 21:06

      JOHN GUNN [continued]: This is the Homicide Act.And it introduced into England, the Scottish conceptof diminished responsibility.[Homicide Act, 1957.Diminished responsibility. 'Where a person kills or isparty to the killing of another, he shall not be convictedof murder if he was suffering from such abnormalityof mind--]The act says that where a person kills,or is party to the killing of another,he should not be convicted of murder if he was sufferingfrom such abnormality of mind--[--as substantially reduced his mental responsibility for hisacts and omissions in doing or being party to the killing.']--as substantially reduced his mental responsibility

    • 21:26

      JOHN GUNN [continued]: for his acts and omissions in doing or beinga party to the killing.Well he's not to be convicted of murder.But the consequence is that he's convicted of manslaughter.That may not seem much of an advantage,but the point is that it gives to the courta range of sentences.It gives flexibility to the court.Manslaughter, like any offense, except murder,

    • 21:49

      JOHN GUNN [continued]: has available to it every possible sentence,from conditional discharges, fines, probation, all the waythrough to life imprisonment.And you'll remember that Sam was convicted of manslaughterby reason of diminished responsibility.And that he was sentenced to life imprisonment.So that takes us from the trial stage

    • 22:11

      JOHN GUNN [continued]: into the sentencing phase--[Pre trial.Fitness to plead.Trial.Mens rea (McNaughton rules).Sentence.Mitigation.]--the third phas of the hearing, where the psychiatrist is moreprominently seen.He in fact often gives evidence in mitigation.If the defendant is found guilty of any offense otherthan murder, there's a whole rangeof options available to the court.

    • 22:31

      JOHN GUNN [continued]: Firstly there's ordinary penalties,such as Sam suffered.But the ones I want to concentrate onare the ones where a psychiatric component is included.And there are three main ones.The first one, a hospital-- the first oneis hospital orders, where a patient can besent to hospital compulsorily.Secondly, there are probation orders for conditions

    • 22:53

      JOHN GUNN [continued]: of medical treatment.And thirdly, there's imprisonment with the hope--although this can't be implementedin court-- that psychiatric treatment will follow.Now what I want to do is to try to illustratesome of these diagrammatically for you.Now first of all, I have here a chart showing the trial phase,

    • 23:13

      JOHN GUNN [continued]: and showing what happens if a man has committed an antisocialact.[Crime.Non insane automatism, acquitted.Insane, unfit to plead.Insane, no responsibility, no guilt. In patient treatment,special or NHS hospital.]The first verdict at the top here is a rare one,and not one to concentrate upon.This is something which is hardly ever used,and only occurs if someone is found unconscious,say, sleepwalking.But I want to dwell upon little more this important verdict

    • 23:37

      JOHN GUNN [continued]: here.This is the one where a man is found insane,is thought to have no responsibility,and therefore no guilt. You'll remember the McNaughtonrules apply here.This is the one where the patient is sent off to hospitalcompulsorily, indefinitely.And he often goes to a special hospital, the special hospitals

    • 23:59

      JOHN GUNN [continued]: being Broadmoor, Rampton, Moss Side, and Park Lane.But he can go to an ordinary hospital.But in any case he stays there until the Home Secretaryreleases him.And that's rather like the consequencewhich can occur in the pretrial phase,where he's found unfit to plead.

    • 24:19

      JOHN GUNN [continued]: He is also sent to hospital indefinitely and compulsorily.Although on that occasion, very rarely hecan be brought back to the court for trial.Well that was the trial and pretrial phase.I'd like now to turn to the sentencing phase.[Crime.Guilty.Guilty, diminished responsibility.Guilty, Section 3 PCCA 73.Prison.In patient or out patient treatment.Grendon.Visiting psycho therapist.Prison hospital.In patient treatment, special or NHS hospital.]And here we're dealing with a man who's

    • 24:40

      JOHN GUNN [continued]: been found guilty of a crime.And in the first option you'll seehe can be sent, as we found, to prison or to inpatient care,either National Health Service Hospital or a special hospital.This is under the Hospital Order Arrangements of the Mental

    • 25:00

      JOHN GUNN [continued]: Health Act 1959 in England.Two psychiatrists can make the recommendation.And the court can agree to send the patient therefor compulsory in-patient care.Usually they can be discharged at the behest of the doctor.But sometimes they can put on restriction orderso only the Home Secretary can discharge them.

    • 25:20

      JOHN GUNN [continued]: Now I've mentioned that in the case of murder,that option is not available for a person found guilty,because there's a mandatory life imprisonmentsentence for a murderer.But if the person is found guilty by reasonof diminished responsibility under a murder charge,they're then convicted of manslaughter.And the options are the same.

    • 25:42

      JOHN GUNN [continued]: In other words, they can go to prison,or they go to in-patient care, either special hospitalor inpatient treatment, under the Mental Health Act,in exactly the same way as all other guilty persons.Now the third and interesting option available on this chartis the probation order with a condition of medical treatment.

    • 26:04

      JOHN GUNN [continued]: Here the court makes a probation for for one, two,or three years.And a doctor has to agree to take a patient into in-patientor out-patient treatment, this time onlyin a National Health Service hospital.And it can-- it is timed in as muchthat it can only last up to three years.It's very flexible.The patient can be moved from in-patients to out-patients,

    • 26:27

      JOHN GUNN [continued]: according to clinical need.But I also mentioned earlier that if a person issent to prison, then there is the possibility whenhe gets there that psychiatry may follow even so.There are three types of psychiatric treatmentI've illustrated here.First of all there's the very special therapeutic community

    • 26:49

      JOHN GUNN [continued]: at Grendon.This is quite unique.It takes the psychopathic and neurotic prisoner,and deals with them with group treatmentin a therapeutic community.A very rare option, I'm afraid, because there's so few places.Secondly there is the possibilityof bringing the psychotherapist to the prisoner,and having sessions either individually or group sessions.

    • 27:12

      JOHN GUNN [continued]: Thirdly there's perfectly ordinary psychiatric treatmentin a prison hospital.Drugs, ECT, other options which wouldbe available in any hospital.Prison medical department don't really likeis option very much.They feel that prison is not the placeto give ordinary psychiatric treatment.And they would much prefer to operatethe powers of the Mental Health Act, Section 72,

    • 27:35

      JOHN GUNN [continued]: to get a person from that positionout into an ordinary NHS or special hospital.Unfortunately that's all too rare,because of difficulties in transferring prisoners outto the National Health Service.But the option does exist.So those are the facilities whichare theoretically available.But you'll remember that Sam went to prison.

    • 27:58

      JOHN GUNN [continued]: And I think we should now go backto his interview to see what happened to him there.

    • 28:05

      JOHN GUNN: Well I was at Winchester for a bit.And then they sent me to the moor, Dartmoor.

    • 28:13

      JOHN GUNN: So what happened to you?

    • 28:17

      SAM: Well they eventually sent meto be investigated by Dr. Crow at the Burden Institute,Bristol.And they did all sorts of examinationsand x-rays and things.

    • 28:37

      SAM [continued]: They definitely agreed I was epileptic.

    • 28:41

      JOHN GUNN: And that was in 1968?

    • 28:44

      SAM: Yes.

    • 28:45

      JOHN GUNN: So how long after that did you stay in prison?

    • 28:51

      SAM: Another eight years.

    • 28:53

      JOHN GUNN: That's a long time.

    • 28:54

      SAM: Yes.On the sentence, 13 and 1/2 years,even though I'd only been convicted of manslaughter,not murder.

    • 29:04

      JOHN GUNN: Do you know the reason it was such a long time?

    • 29:08

      SAM: Well they did tell me the doctor in charge of meat Parkhurst, they told me that one of the reasonswas that they didn't have nowhere for me to go.

    • 29:24

      JOHN GUNN: But you're all right now in the hostel?

    • 29:26

      SAM: Very satisfactory, yes.

    • 29:28

      JOHN GUNN: But you still get fits?

    • 29:29

      SAM: Not as bad now, but I do get them, yes.

    • 29:32

      JOHN GUNN: Can you describe them?

    • 29:38

      SAM: Generally probably first thingin the morning, when I don't seem to get the warnings,before I go out sometimes for a day or two days.But the people in the hostel generallyknow when they're coming, and generally get me

    • 29:59

      SAM [continued]: to bed in time, before I go out.

    • 30:02

      JOHN GUNN: I bet you go unconscious.

    • 30:03

      SAM: Yes.

    • 30:05

      JOHN GUNN: Then what's it like when you wake up?

    • 30:12

      SAM: Well it's hard to explain.It's a semi-twilight.You know that something's gone wrong.But you don't think about epilepsy for a bit.

    • 30:36

      SAM [continued]: Because you know what is it.And then it gradually comes to youthat you've had another fit.

    • 30:51

      JOHN GUNN: But if my recollection's right,you can get very frightened during that phase.

    • 30:56

      SAM: Yes I can, yes.And the last one I had I was, I thoughtI was back in Langley, where-- that'sthe hostel where I met my wife.And Jane, that's the woman who's in charge of me nowadays,

    • 31:17

      SAM [continued]: I thought she was going to send me back into prison.And I cried my eyes out.And not always her.I think people are trying to harm me.Especially by sending me to prison.

    • 31:38

      JOHN GUNN: So you do get a bit confused and frightened.

    • 31:42

      SAM: Yes, confused and frightened.

    • 31:49

      JOHN GUNN: Well that was Sam's account of whathappened to him in prison.And to put it in medical terms, the investigations he mentioneddiscovered that he did indeed suffer from temporal lobeepilepsy.And they noticed after each attack, very prolonged periodsof postictal confusion.

    • 32:09

      JOHN GUNN [continued]: And during those confusional episodes,he developed severe paranoid delusions,and sometimes became quite aggressive in a paranoid way.And indeed we've seen such postictal paranoid confusionalstates since he's been released from prison.And I think with hindsight we can speculate

    • 32:29

      JOHN GUNN [continued]: that the murder itself took place during oneof these confusional episodes.And also using the privilege of hindsight,I think it's possible to see that a strongerplea in mitigation could perhaps been mountedat the time of the sentence.And could have resulted in either a special hospitaldisposal for this man, or maybe a definite sentence,

    • 32:53

      JOHN GUNN [continued]: or at the very least, a shorter number of yearsspent behind bars.Which illustrates in itself the importanceof the accurate diagnosis, and the detail which is necessarywhen making a clinical judgment at a trial.Because on the day of the trial, a great dealwill hang upon the report given by the psychiatrists attending.

    • 33:19

      JOHN GUNN [continued]: Well this leads me then to the final aspectof forensic psychiatry.It's an aspect which we really haven't got timeto deal with in this particular tape.But one which I don't want to omit entirely,because it is so central.You may have gained the impressionfrom what's been shown you so far that forensic psychiatry issimply about the legal process, about going

    • 33:41

      JOHN GUNN [continued]: to court, about disposal in prisons, special hospital,and so on.But if you think about that final piece of interview,you'll realize that it's a lot more than that.It's about the long term care of the mentally abnormal offender.Very often patients with this kind of problemhave lifelong problems.And they need lifelong care.

    • 34:02

      JOHN GUNN [continued]: It was, after all, the lack of accommodationwhich prevented Sam from being released until he'dspent 13 years in prison.And as part of this process, we haveset up a special hostel for epileptic offenders in London.And that's the hostel which Sam has gone to.And I think that's an important component of forensic work.

    • 34:25

      JOHN GUNN [continued]: So if I do nothing else in this tape,I want to emphasize to you that one,central aspect of forensic psychiatryis long term care and rehabilitation of the mentallyabnormal offender.But what I hope also the tape will have donewill raise two issues in addition to that, three issues

    • 34:46

      JOHN GUNN [continued]: altogether, for your consideration and discussionafter you've seen it.The first is the question of responsibility.What is the concept?How does it play a role in general psychiatry?How indeed does it play a role in ordinary life?Where does it fit into our thinking about the offender?

    • 35:07

      JOHN GUNN [continued]: Secondly, the role of the psychiatrist in court.We'll all be going to court.We'll all be making judgments about patient's mental statesand recommending disposals.How can we do this to the best advantage of both the courtand the patient?And then thirdly, this very important issue,which I haven't had time to tackle in this program,

    • 35:29

      JOHN GUNN [continued]: but which bears a great resemblanceto the ordinary psychiatry, whichis called general psychiatry, the special problemsof long term care and rehabilitation.

An introduction to Forensic Psychiatry

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Professor John Gunn introduces the field of forensic psychiatry, which is the application of psychiatry within the criminal justice system. Using the case of a man who killed his wife during a post-seizure delusion, Gunn explains how psychiatrists help evaluate clients' fitness to stand trial, their level of responsibility, and the sentence that will be best for all.

An introduction to Forensic Psychiatry

Professor John Gunn introduces the field of forensic psychiatry, which is the application of psychiatry within the criminal justice system. Using the case of a man who killed his wife during a post-seizure delusion, Gunn explains how psychiatrists help evaluate clients' fitness to stand trial, their level of responsibility, and the sentence that will be best for all.

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