Forensic Psychiatry

The word combination “Forensic Psychiatry” (German = Forensische Psychiatrie) is itself a reference to an independent complex. It also emphasises the point of contact between two normally independent areas, namely law and psychiatry as a division of medical science.

The historical roots of forensic psychiatry reach back into the pre-Christian era. Roman law had special rules and regulations for dealing with the mentally ill. Roman tabular law (Lex duodecim tabulorum) from around 480 BC differentiated between “furiosi” - the raving mad, and “prodigi”, the wasters.

The raving mad, the stupid and the fools were innocent according to Roman law. Drunkenness and crimes of passion were also subjected to mild sentences.

Some 2000 years later, Paolo Zacchia (1584 - 1659) recommended for the first time that medical influence should be exerted in certain cases. He understood mental illness to be associated with a defect of the brain and that only a medically qualified person could diagnose the symtoms.

Zacchia differentiated between three types of mental illness:
  • Fatuitas: feeble mindedness, apathy.
  • Phrenitis: mania, hallucination, delirium.
  • Insania: insanity or total loss of reason.

The law-philosopher Pufendorf (1632 - 1694) proposed the theory that freedom of will was the basis of human responsibility and that a mental defect or disturbance led to loss of responsibility of one`s actions.

The development of forensic psychiatry over the ensuing centuries has led to forensic psychiatrist being integrated as an advisor and as an expert in many areas of law. As part of his reaponsibilities, he must state his opinion in legal cases upon the degree of guiltiness, as well as make recommendations as to whether the accused should be transferred to a psychiatric hospital or put in prison. A profound knowledge of the psyche is necessary in order to be able to forecast a criminal`s future conduct, as well as to assess the ability of the offender to stand trial.

In civil law, the forensic psychiatrist must be able to assess the legal competence, the ability of the accused to stand trial and testify in court, or indicate the need for psychiatric caThe forensic psychiatrist also plays an active role in social law and upholding the highway code. He must be able to judge the necessity for legal accomodation as well as determine the sex of an offender in the case of the transsexual laws.

Let us now turn to the main area in which the forensic psychiatrist is active, namely criminal law, as this demonstrates the complexity of a given situation.

In the evaluation phase, the psychiatrist has the judiciary as a client. In many cases, the expert opinion is not only based on psychiatric data, but on reports and results from psychologists, laboratory tests, medical examination, electroencephelogram and comuter tomography, to name but a few examples.

When the court has ordered the criminal to be sent to a psychiatric hospital or to be admitted to prison a complex and multiprofessional therapy is needed to obtain optimal results. A psychiatric disease or disorder, which led to criminal action, must be compensated by a whole series of therapeutic activities and integrational schemes in different occupational therapy groups in order to combat the disease or disorder. Not only medical staff and psychiatrists, but also social workers, ergotherapists and creative work groups have equal responsibility for the patient, whereby the occupational therapy group must be adjusted to meet the needs of the individual concerned.

It goes without saying that the inclusion of therapeutic settings outside moral bounds and contacts is, in our opinion, of cardinal importance in winning the support of the patient and his cooperation in the course of therapy. The therapy of psyciatrically-ill criminals demands a high standard of collegiality and teamwork-support in the initial phase of treatment. This teamwork should be oriented on life ouside the prison or hospital boundaries, even when the decisions are those taken by the authorities within these boundaries.

Many things have to be taken into account when time arises to see whether the psychatrically-ill criminal has been rehabilitated enough to be able to live within the community once again, without relapsing into former habits. Cooperation between the clinic and the community must play an integrating role in supporting the patient as well as preparing the community to support the reintegration process.

If the therapeutic treatment has shown a definite improvement in the patient, steps must be taken to prepare for reintigration into the community -i.e. for his transfer from “inside” to “outside”. Thes include the release under surveillance with accompanying aftercare. The creativity of clinical staff is of utmost importance in this third stage of preparation for reintegration, especially in the finding of allies in the community for this process.

This transitional period is described as “test-living” and is carried out over a 6 - 12 month period. During this time, the patient still “belongs” to the hospital, but lives in a complementary or in an aftercare appartment, or in his own house. He is under care and observation from the social-psychiatric services of the community, or from volunary organisations such as self-help groups. Through such organisations it is hoped that the patient can be helped in the reintegration into the community. Partners in this phase include, alongside the clinic, workers from the social-psychiatric services, therapists, social services, employment exchange and probation officers.

In conclusion we wish to emphasise that the forensic psychiatry/criminal law/legal executive regulation must be understood as a complex network involving a timely and client-oriented acceptance of responsibility together with the intervention of a multiprofessional team in cooperation with the person affected, with the aim both of his well-being as well as that of society as a whole.