Introduction
This overview of forensic psychology and psychiatry first gives a distinction between the two disciplines, primarily in terms of professional training. Taking a historical perspective, the development of the two disciplines and their subject matter is then discussed in detail. This historical perspective is then used to set in context current practice within forensic psychology and psychiatry.
Psychology and Psychiatry
What are forensic psychology and forensic psychiatry? The basic answer is that forensic psychologists have initially qualified as psychologists, then trained at postgraduate level to practice in the forensic field. Forensic psychiatrists, on the other hand, have qualified in medicine, then taken further training to qualify as psychiatrists with a forensic speciality. In practice, forensic psychiatrists also hold statutory powers and responsibilities, such as prescription of medication and supervision of patients, not given to other professions. Thomas Grisso has suggested that there are several further distinctions that can be drawn between forensic psychology and psychiatry. First, psychiatrists are trained to consider abnormalities in an individual’s biological and medical functioning; psychologists do not have this speciality, but are trained to focus on personality, behavior and broader social dimensions. Second, psychiatrists tend to draw their knowledge from clinical observation and research with clinical samples; psychologists are inclined to rely more heavily on experimental data. Third, psychiatrists lean towards assessment through clinical interview and observation; psychologists are more likely to use psychometric and other psychological tests.
Traditionally, forensic psychology and psychiatry have their roots in the application of psychological knowledge and expertise to gather evidence for judicial purposes. It is undoubtably the case that this traditional use of the term ‘forensic’ is closest to the dictionary meaning. For example, The Concise Oxford Dictionary entry for ‘forensic’ gives, ‘of, used in, courts of law’. In recent years the use of the term ‘forensic’, particularly by psychologists, has broadened considerably to encompass not just the courts, but any topic connected with crime and law. Thus, some texts on forensic psychology cover subjects such as the police, treatment of offenders, risk assessment and theories of criminal behavior. Now, as will be seen, there is a very strong case for etymological correctness in defining the boundaries of forensic psychology.
Ronald Blackburn, a leading British psychologist, has criticized this indiscriminate use of the term forensic to refer to any psychological activity ‘vaguely connected with the law’. Blackburn’s case is that unless it adheres to the correct, dictionary definition of the term ‘forensic’, then a profession that calls itself forensic psychology struggles to find an identity. Without a professional identity, we are left with the question of what are the unique skills and abilities that the forensic psychologist can offer? The root of the issue is that the term ‘forensic psychology’ has metamorphosed from a description of an application of psychology to describing a kind of psychology.
Discussion of forensic psychology and psychiatry here will be limited to the traditional sense and use of the term. In seeking to understand forensic practice, it is illuminating to look at the historical development of the two professions.
Historical Development
Forensic psychology
It is generally taken that forensic psychology dates from 1896, when Albert von Schrenk-Notzing appeared as an expert witness in a Munich court, offering testimony at the trial of a man accused of murdering three women. The specialist knowledge that von Schrenk-Notzing, a student of Wilhelm Wundt, the founder of the first psychological laboratory, was able to put before the court was based on experimental psychological evidence on the workings of memory. Specifically, von Schrenk-Notzing argued that the memory of the witnesses to the crime before the courts was unreliable because the witnesses had become confused between their own memories for the event and the pretrial publicity. While a string of great figures in the history of psychology, including James Cattell and Alfred Binet, made contributions to the emerging field of forensic psychology around the turn of the century, the greatest of the early luminaries was another of Wundt’s pupils, the German psychologist Hugo Munsterberg (1863-1916).
In his topic On The Witness Stand, published in 1908, Munsterberg argued that the emerging discipline of psychology could be beneficial to the process of justice. These benefits, Munsterberg claimed, lay not only with the application of psychological knowledge to the eyewitness, but extended to other matters such as the working of the jury. Thus, Munsterberg made the case for the psychologist’s role in the courtroom as an expert witness to inform the process of justice on matters psychological. Munsterberg’s arguments drew fierce attack from some quarters of the legal profession, anxious to resist the forays of psychologists into the courtroom.
In parts of the world other than Germany, psychologists also began to offer a contribution to courtroom proceedings. In America in 1921 a psychologist argued in court that a victim’s testimony was doubtful because of low intellect. Similarly, in France Alfred Binet worked on the issue of the reliability of eyewitness memory.
After World War II, the profession of psychology grew in scope with the establishing of specialist educational and clinical psychologists. At first, these specialists provided psychological material for inclusion in medical court reports. However, as time passed, psychologists were permitted to submit court reports in their own right, rather than have their work subsumed into a report written by another profession. As the discipline of psychology progressed from the 1950s to the present day, so psychologists gave their attention to an increasing range of courtroom issues. Importantly, the role of the psychologist as expert witness developed considerably: several surveys, summarized in Table 1, showed that contemporary psychologists are testifying in court on a range of topics. However, psychologists were also cultivating a research agenda that would impact on two areas: first, research that would lead to greater levels of understanding with respect to the
Table 1 Typical subjects found in UK psychologists’ court reports
Post-traumatic stress disorder
Compensation
Childcare
Suitability for treatment Fitness to plead/stand trial Reliability of witness statements Reliability of confessional evidence Diminished responsibility reliability of evidence; second, research that would increase dramatically the level of psychological insight into law and its application in the courtroom. Some of this research will be considered in detail in the entry on forensic psychology.
Forensic psychiatry
If the discipline of psychology has a short history, most often seen with its genesis in Wundt’s laboratory, as noted above, quite the opposite is the case for forensic psychiatry. The medical profession, of which psychiatry is a branch and forensic psychiatry a speciality within that particular branch, has a long history. Indeed, the medical historian Roy Porter traces the evolution of medicine to the end of the last Ice Age, around 10 000-12 000 years ago, as the organization of societies shifted from hunter-gatherer to farming in order to sustain life. Porter suggests that the transmission of pathogens from animal to human led to an explosion in diseases such as tuberculosis, smallpox, measles and typhoid. As the population settled together in ever greater numbers, so the spread of parasites such as worms, flukes and lice increased. Similarly, changes in diet as agriculture became the main means of food production brought about conditions related to low protein intake and other dietary factors. Thus, population growth and changes in societal structure heralded the onset of epidemics such as the plague. As history unfolds, each evolutionary shift brings its benefits but also has a health cost. The industrial revolution brought prosperity (to some) as well as illness caused by pollution; the demands of modern-day living are associated with stress-related conditions such as hypertension and excessive use of drugs and alcohol.
As illness and disease took their toll in terms of human suffering, so people tried to find ways to heal the sick. With the advent of healing, medicine was born. The historical record shows that throughout antiquity civilizations developed their own understandings of the causes and cures of illness. As history unfolds, so important advances were made: we see, for example, improved understanding of human anatomy, appreciation of the complexity of disease, discovery of new drugs, and technological progress from microscopes and X-rays to brain scans and microsurgery.
It was long recognized that there were some people whose illness was of a special type; madness was as familiar to the ancient Greeks as it is in contemporary society. However, there was no special branch of medicine dedicated to relieving the suffering of the mad. The treatment and care of the mad was left to families and communities or, if all else failed, to madhouses run by charities or religious groups. It was not until the middle of the eighteenth century that psychiatry began to appear as a specialized branch of medicine. The rise in the use of asylums for the insane across much of Europe, and later America, heralded the increasing involvement of members of the medical profession with those suffering from mental disorder. The treatment of those people held in asylums was not always gentle: shock treatments, confinement, purging and physical restraint were common practices in the struggle to find a cure for insanity.
The great pioneers of psychiatry, including Benjamin Rush (1745-1813), Henry Maudsley (18351918) and Emil Kraepelin (1856-1926), set in train a change of thinking, emphasizing the need for medical understanding and treatment of the mentally disordered. The influence of such thought, coupled with social reaction against the conditions in the asylums and the discovery of psychoanalysis as a treatment for mental disturbance, culminated in the birth of the psychiatric hospital. So it came about that the treatment of the mentally ill became the province of the medical profession. As psychiatry found a professional identity, so psychiatrists became the experts on mental disorder.
In law, the insane have traditionally been accorded a special status, in that it is accepted that they should not be punished for criminal acts. The reasoning behind this is plain: the legal concept of mens rea holds that if a person is to be held responsible for his or her actions then it must be the case that in committing a crime they have acted of their own free will. Can it be said that the mentally ill are responsible for their actions, including criminal acts? Two particular legal cases are seen as critical in developing an answer to this question.
James Hadfield, soldier and member of the Duke of York’s bodyguard, received head injuries from sabre wounds when fighting in the Battle of Lincelles, Flanders, in 1794. From accounts of the case, it is evident that Hadfield must have suffered brain damage, precipitating bouts of mental instability. It was said that during these bouts of insanity he would threaten the life of his child because God so commanded. Further, he proclaimed that he must die to save the world, yet he must not kill himself. Such statements would be taken now as clear evidence of delusions following head injury.
Hadfield devised a plan that would bring about his death: he would assassinate the monarch, King George III, for which the penalty would be execution. In 1800 he made his attempt, firing a pistol at the King as he entered a theatre. His shot missed and he was captured by bystanders, charged with high treason and brought to trial. Hadfield’s trial excited public interest and concern in the social context of both a growing awareness of the plight of the mentally ill, and widespread sympathy for Hadfield as a soldier wounded in battle.
During the trial, Hadfield’s defense, delivered by Thomas Erskine, sought to refine the arguments regarding the legal position of the mentally ill. Erskine could not use the so-called ‘wild beast test’ as Had-field was clearly lucid and able to comprehend the court proceedings. Instead, Erskine used a more subtle approach, advancing the argument that Hadfield’s delusions at the time of the offense must be taken into consideration. If the court agreed that Hadfield was deluded at the time of the assassination attempt then, Erskine argued, he cannot be considered guilty of a crime. Medical and lay evidence was called to support the defense’s position regarding Hadfield’s madness. Erskine’s strategy worked and the Lord Chief Justice halted the trial, directing the jury to find Hadfield not guilty, ‘he being under the influence of Insanity at the time the act was committed’.
This judgment had two important consequences: first, it created a new class of offender, then called ‘criminal lunatics’; second, it created a practical problem – if Hadfield was not a criminal then it follows that he could not be sent to jail. However, Hadfield was judged to be a danger to the public and therefore some form of secure detention was required. As will be seen presently, the solution to this dilemma was an important one in the development of forensic psychiatry. However, turning to the second important case, the name of Daniel McNaughton (spelt M’Naghten in some texts) rises to attention.
From case records dating back to the 1840s, it is highly likely that McNaughton was suffering from paranoid schizophrenia. Specifically, McNaughton believed that he was being persecuted by Catholic priests and by the Tories. This delusional belief led him to the decision that to end his persecution he would kill the Tory Prime Minister, Sir Robert Peel. In 1843, McNaughton made his attempt on the life of the Prime Minister but, through mistaken identity, shot and killed the Prime Minister’s private secretary. McNaughton was arrested at the scene of the crime and sent for trial. The weight of eminent medical opinion at the trial was that McNaughton was insane and the jury returned a verdict of not guilty on grounds of insanity. However, McNaughton’s insanity was not of a florid type, leading to obvious loss of control: it was clear from his own statements that he knew very well what he was doing at the time of the crime and acted deliberately and was fully aware of his actions. Despite McNaughton’s plea that he was driven by his persecutions, it was the calculated quality of the seemingly cold-blooded killing that brought about a wave of public protest after the trial. Accordingly, leading judges of the day were asked to inform the Government on the interpretation of the laws of the land with regard to the legal position for cases of insanity and crime. In response, the judges formulated the McNaughton test, or McNaughton rules as they are sometimes called.
The McNaughton test, given several caveats, elucidates several key principles. First, everyone who stands before a court is to be presumed sane and responsible unless proven otherwise. Second, an insane person is punishable if he or she knew at the time of the offense that the act was wrong. Third, to establish an insanity defence it must be proved that at the time of the offense the accused did not know the nature of the act; or if he or she were aware of their actions, then they did not know that their actions were wrong. Thus, to establish an insanity defense, the test is: does the accused know the nature of the act? If they do know, do they know it is wrong? These are powerful questions demanding fine skills and knowledge to provide answers: some members of the medical profession of the day began to specialize in understanding the criminal lunatic so as to inform the courts on just such matters.
As the courts began to grapple with the implications of cases such as Hadfield and McNaughton, the issues raised were not just legal but were also practical in nature. If such people were not criminals, could they be sent to jail? If they were judged to be dangerous, could they be released into the community? The judge in the Hadfield case did send Hadfield to jail but expressed doubts about his authority to do so under the law of land. A series of parliamentary acts from 1800 onwards therefore began to put in place legislation to allow criminal lunatics to be admitted to asylums for the mentally ill. Hadfield was duly taken from jail and admitted to Bethlem Hospital. Hadfield was not a model patient: he killed another patient and escaped from the hospital, spending time at large before his recapture and return to Newgate Gaol. Deep concern was expressed that asylums were being asked to admit patients for whom the facilities, personnel and buildings were not suited.
The first response was the development of hospital ‘criminal wings’: these wings were secure, with locks, bolts and bars, but staffed by doctors and nurses to treat those detained. In 1816, Hadfield was sent to the criminal wing at the Bethlem Hospital where he remained until his death in 1849, when he was 70 years of age. While the criminal wings sufficed for a time, by the late 1850s concern was once again being expressed about the security, safety and standards on these wards. In 1860, permission was given for the building of Broadmoor Criminal Lunatic Asylum in Berkshire; Broadmoor opened in 1863 and began receiving its first patients, decanted from the criminal wings of hospitals, to fill its 500 beds.
Broadmoor proved to be the first of a series of secure institutions for the criminal lunatic: Rampton followed in 1914, then Moss Side in 1933 and finally Park Lane in 1974 (the latter two being amalgamated to form Ashworth); Carstairs in Scotland performs a similar function. More recent legislation has given these institutions the generic title of ‘special hospital’, and they are charged with detaining mentally disordered offenders under conditions of maximum security. Moving to much more recent times, a new wave of services has developed, including the Regional Secure Units, which offer treatment for mentally disordered offenders in settings of medium security, and in the community.
As services have expanded, so the importance of understanding the criminal lunatic has increased accordingly and forensic psychiatry has rapidly developed. Thus, legal thinking has produced the classifications of the mentally disordered offender in operation today; academic study of the relationship between mental disorder and criminal behavior has become increasingly sophisticated; decisions on competency to stand trial and risk assessment are more complex; and the design, running and evaluation of services for the mentally disordered offender engage the attention of many profrssionals. It is clear that these developments, while not identical, have followed a similar line in North America and many countries in Europe.
Current Practice
It would be wrong to draw an absolute line of demarcation between the practice of forensic psychologists and psychiatrists. The issues highlighted below are predominately but not exclusively the concern of the respective professions.
Forensic psychology
Taking a strict definition of forensic psychology, what might a forensic psychologist offer the court with respect to the evidence placed before it? There are two strands to follow in this regard. First, the psychologist can present the findings of psychological research on different types of evidence; second, the psychologist may offer an expert opinion in a given case. In terms of the first point, research has focused on both eyewitness evidence and confessional evidence. With respect to the second point, Lionel Haward, the most eminent British forensic psychologist, has described four roles that the forensic psychologist might take as an expert witness.
Actuarial role In this role the forensic psychologist presents evidence regarding the probability of an event, drawing on extant statistical information. For example, the psychologist might provide actuarial evidence regarding the sequelae of some psychological trauma and its impact on social functioning.
Advisory role The psychologist may be asked to provide an opinion on another expert’s report, advising on the accuracy and robustness of the report and which issues bear questioning when the report’s author is under examination. The advice may be given before the trial or during the trial as the other expert’s testimony unfolds.
Clinical/assessment role In this role the forensic psychologist is concerned to present the court with evidence regarding state of mind. This may relate to the presence of psychological disorder or dysfunction, as, for example, whether or not an individual manifests post-traumatic stress disorder. However, Haward extends this role to include not only the assessment of disorder or dysfunction but also the assessment of normal human functioning. For example, Gudjonsson and Haward note a case in which it was important to establish that the accused was left-handed: a series of observational, neurological and psychological tests were used to present evidence to the court regarding this issue.
Experimental role The credibility of evidence may hinge on whether human performance under given conditions is likely to be accurate. Could a witness have really seen a face under low levels of light? Is it possible to make accurate judgments of another car’s speed when travelling in a moving vehicle? Such questions are open to experimental investigation by simulating the conditions at the time of the incident and testing performance. Such investigations allow the psychologist to give the court an empirically informed probability of the reliability of evidence in a given case.
Forensic psychiatry
The role in court of the forensic psychiatrist may be identical to those defined by Haward for the forensic psychologist, although reflecting a different professional perspective. Thus, forensic psychiatrists might draw on the research on the relationship between mental disorder and criminal behavior. Alternatively, in a given case a forensic psychiatrist might be called on to give an expert opinion with respect to fitness to stand trial, or risk assessment, or treatability.
Concluding Comment
While there are differences between forensic psychology and psychiatry, it would be wrong to think that these differences must lead to adversity. In the labyrinth of forensic practice it would be a mistake for any profession to believe it had a monopoly on the truth. It is only when forensic psychologists and psychiatrists work together (and with other professions such as forensic nurses, probation officers and the police) that the true potential of each discipline can be achieved.
