In the professional world, we’re all supposed to have an “elevator speech”: a brief description of the work we do that can be delivered in the time it takes for a typical elevator ride—somewhere between 30 seconds and two minutes. And of course, in social encounters one of the most common questions is “What do you do?” In both situations, I take a breath—because I know that this is not going to be a simple explanation– and answer: “I’m a psychiatrist and direct the forensic psychiatry program at Massachusetts General Hospital.”
That is usually met with a blank stare, because while people generally know what the Massachusetts General Hospital is, they are not sure what to make of “forensic psychiatry program.” Trying to be helpful (but rarely succeeding) I add, “I’m a forensic psychiatrist.”
In the majority of encounters–including with other physicians—that just gives rise to another question: “What in the world is a forensic psychiatrist?” Sometimes this is asked with a particularly quizzical and troubled look, in which case I’ve probably encountered someone who is thinking of forensic pathology (the work that medical examiners do in performing autopsies as part of investigations, usually in criminal cases, and frequently featured on TV crime shows like CSI). In that case, I know I need to respond quickly: “No, that does not mean that I do psychotherapy with dead people.” That generally elicits some relief, and keeps people from acting on their urge to check for text messages or get out of the elevator at the next floor, but they still need an answer.
So, here it is. Or at least my version of it. Forensic psychiatrists are psychiatrists (physicians who complete a four year residency in psychiatry after medical school) who specialize in forensic psychiatry: the application of clinical and scientific aspects of psychiatry to matters that are related to, or are directly involved in, the legal system. Most forensic psychiatrists spend at least some portion of their time serving as expert witnesses in criminal and civil matters. In criminal cases, the typical role for forensic psychiatrists involves evaluations of and testimony about the defendant’s competency to stand trial or criminal responsibility—which we’ll discuss in a later blog post. In civil matters, [among other things,] forensic psychiatrists are asked to evaluate the type and extent of emotional distress damages a person did (or didn’t) experience as a result of an injury.
The amount of time a given forensic psychiatrist spends doing expert witness work varies. Some spend their time almost entirely as clinicians in correctional facilities, treating criminal defendants or convicted criminals who have mental health problems. Others, like me, spend a good portion of their time consulting to organizations or government agencies on issues ranging from workplace violence, fitness for duty, and mental health issues in the workplace to school shootings and terrorism.
It is important to note that forensic psychology is a related and extremely important discipline. The definition is essentially the same: the application of the clinical and scientific aspects of psychology to matters that are related to, or are directly involved in, the legal system. Each field, psychiatry and psychology, brings their own expertise to these problems, and complements the efforts of the other.