Views And Reviews

Forensic Psychiatry: Clinical, Legal and Ethical Issues

BMJ 1994; 308 doi: http://dx.doi.org/10.1136/bmj.308.6939.1309 (Published 14 May 1994) Cite this as: BMJ 1994;308:1309
  1. P Bowden

    Ed John Gunn, Pamela J Taylor Butterwoth-Heinemann (pounds sterling )125, pp 1151 ISBN 0-7506-0349-6

    A series of scandals and notorious cases over the past 20 years has led to positive action to develop forensic psychiatry. The editors of this text-book have benefited more than most from what has been on offer and they have been very influential in the way in which this small branch of psychiatry has expanded. The book is the fruit both of their hard work and of what they have received and it should provide a vision of how the specialty will look in the future. The reader expects excellence.

    Most of the book's 23 sections have an editor or editors, and in the 16 where Gunn and Taylor have undertaken this task their individual styles come across very strongly. Each section is headed by a list of those who have contributed to it and further names appear under the heading “With additional material from.” It is thus mostly impossible to know who has written what. A few sections have other specialist editors, each with their own list of writers.

    The clinical parts bear the stamp of the editors. They carry a sense of certainty, conviction, and mission; the reader is told the right way of doing things; there is no room for the delights of exploring uncertainty. The legal and ethical sections seem to be the work of psychiatric factotums; this is law and ethics by psychiatrists. Parts of the book are impenetrable but revealing. For example, following a quotation from Billy Budd, the opening sentence reads: “Forensic psychiatry is not just a way of getting paid for trying to answer unanswerable legal questions, although it does have a germ of that danger within it.” Although the paragraph goes on to say what forensic psychiatry is, why begin so negatively and with a false premise?

    In a similar vein court work is portrayed in an unfavourable light. I have found the role of expert witness challenging and rewarding. What then is to be made of: “Court work should never, for the psychiatrist, become an end in itself. It should always be possible to explain easily and openly why a particular piece of court work is of benefit to a patient or to patients as a group. Court work should be strictly limited and, if the benefits are not obvious, avoided”? There are several other references to the “daunting business” of appearing in the witness box.

    Gunn and Taylor have recruited contributors who reflect their own interests and strengths. This has been at the expense of aspects such as civil and child and adolescent forensic psychiatry, which is to be regretted as the editors carry a great deal of responsibility for encouraging the development of those parts of the specialty in which they themselves have least knowledge and experience.

    These comments aside, Gunn and Taylor can be justly proud of their work; it is an excellent book, which has been well presented by the publishers.