What is Forensic Psychiatry? with Mark Levy

WEBVTT

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Cultural altitudes have certainly changed in my
fifty year career. Homosexuality has moved from

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being listed as a mental disorder in
the Diagnosticatistical Manual to gay marriage. That's

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a huge social transition. In the
same period that that, thank Goodness has

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evolved, that our social thinking about
choice of people to love has evolved,

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Worthy Wade has gone backwards. Welcome
to the Santhra Life. We're curiosity Sparks,

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dialogue and dialogue sparks change. I'm
your host, Adam Ganwell. Today's

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episode, we're diving into the fascinating
intersection of psychiatry and the justice system with

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doctor Mark Levy, a leading forensic
psychiatrist, as a trailblazer who navigates the

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complex pathways between how we understand mental
health now it's interpreted in the courtroom.

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Doctor Levy brings a perspective that's both
enlightening and essential his insights into how subtle

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nuances and human behavior can swing the
scales of justice. We'll leave you with

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a new view on the deep connections
between our minds and the laws that govern

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society. This is an episode that
you don't want to miss. Stay tuned.

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Awesome, So just want to to
kick off and say, Mark,

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really excited to have you on the
podcast today and excited to dive on in.

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So thank you for joining me today, thank you for inviting me.

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It's good to be here. Awesome. So to kick us off, there's

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there's kind of two you know words
in terms of framing how you do your

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work. You know, forensic in
psychiatry that oftentimes people may not think about

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as going together, you know,
very frequently it's kind of a maybe a

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new area area for some folks.
So can you kind of kick us off

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by giving us a sense of this, like what is what is forensic psychiatry

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as a as a as a frame
and as a field, as a discipline,

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and then let's dive into your story
about how you got into that in

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the first place. Sure, that's
a good place to start. Forensic psychiatry

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actually what has been done for probably
centuries, but it's not being recognized or

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even a trained area of medicine.
But because psychiatry deals with human behavior and

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the law deals with human behavior,
there have been instances when psychiatrists have been

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called into court to offer opinions,
particularly in criminal matters. But today forensic

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psychiatry is probably one of the newest
medical subspecialties. It is in fact the

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only area of medicine where there is
a fellowship trading and board certification. Even

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though doctors from all specialties can be
called upon in legal matters, in particularly

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to testify in court when their specialty
is called in the question. You know,

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somebody is suing about a complication of
a delivery, then obstetricians are very

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important to educate the court. That's
the judge or the trier of fact,

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which is usually the jury unless it's
just what's called the bench trial of it

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just a judge. The experts necessary
to educate them about the specific issues in

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the obstetric that come to bear on
the issues that's in dispute. But in

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general, because psychiatry deals with human
behavior, there is a much wider range

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where psychiatric expertise is all upon.
So there's a big difference between a treating

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psychiatrist and a forensic psychiatric experts.
And I can summarize pretty quickly what the

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difference is. And I wear both
hats, but never both hats, never

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two hats with the same person.
That is, I'm a treater and I'm

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also a forensic psychiatric expert. But
I would never be the independent expert for

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a patient whom I'm treating, nor
would I take a plaintiff who I am

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the independent expert about and make them
my patient, because they are all kinds

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of role distinctions and even ethical complications. So in a nutshell, the role

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distinction is this. Let me just
say before I get into this. Forensic

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psychiatry is the interface of law and
psychiatry, and in some respects it goes

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very easily, but in some respects
it's quite different because medical terms and legal

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terms are not identical or even interchangeable. A good example is uh, not

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guilty by reason of insanity, and
this is a decision that's made usually in

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a murder case when someone doesn't appreciate
the wrongfulness of their act because of a

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mental illness. But insanity is not
a medical term. It doesn't equate to

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psychosis. It's a legal term.
It's defined in case law and it's defined

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in statute. So one of the
roles of forensic psychiatry is a translation role.

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And just like translating between languages,
there aren't always identical words in two

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different languages, So you have to
get clothes. That's an approximation, but

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it's not. It's not equivalent necessarily, and certainly on a nuanced basis not

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equivalent. So forensics psychiatry, like
the law, is divided between criminal and

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civil. And if you'd like,
I could talk about that later, but

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I wanted to make this distinction between
the roles. The treating psychiatrist and the

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independent forensic psychiatric expert have entirely different
missions, methods, and ethical duties.

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There's a huge distinction between these roles. The mission of a treating doctor under

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the Hippocratic is to alleviate suffering,
and and that's why people come to a

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doctor physically or mentally their suffering and
they want some help and relief from the

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pain. The method of a treating
psychiatrist is to rely almost entirely on their

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patient's subjective self report. There are
exceptions to that, but generally, if

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a patient comes in and TELP me. Patient comes to me, and as

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part of my taking their history,
they tell me that their father beats them.

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I accept that. I don't go
and interview family members to determine is

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this objectively true or is this sort
of slightly off based, is this completely

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wrong? I accept that with the
exception that if someone comes in who's psychotic

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and tells me that the television talking
to them that is so far out of

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our consensual reality that I know this
isn't necessarily objectively accurate, although this is

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their subjective experience, and the ethical
duty of a treating doctor, also under

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the Hippocratic oath, is to do
what the doctor feels is in their patient's

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best interest. In the Hippocratic oath, it comes from a Latin phrase,

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but it translates into first dudento harm. But the application of that is you

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do what you think is going to
be helpful to this person. In contrast,

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the mission of the forensic expert is
to determine what is objectively true as

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best as possible. The gold bully
On standard is the ballistics expert who says

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the shell came from the gun or
it didn't. It's much more difficult in

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behavioral medicine than it is in ballistics. Not to understate how difficult it may

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be in ballistics, but that's the
gold bully On standard, and the method

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is entirely different because, particularly in
outpatients psychiatry, a treating doctor, as

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I said, relies on their patients
subjective self report in they don't even it's

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very rare for a treating a treating
psychiatrist to get medical records on their patient,

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let alone request outside psychological testing to
help determine their diagnose. It happens,

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but it's rare. It's not the
rule at all. In forensic psychiatry,

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you want to see all available data, so that's years of medical records

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on the person you are examining.
We always get a forensic psychologist or forensic

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neuropsychologist if there are clear brain issues
like a traumatic brain injury or someone has

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dementia, and that's very objective data. We get all depositions that Those are

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transcriptions of under oath interviews that are
taken as part of a legal process,

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usually in civil matters, and in
a sense they are elaborate witness interviews or

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interviews of the plaintiff under oath by
usually opposing counsel with their own council present,

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and we read those and other legal
documents. You know, there may

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be a police report in a criminal
matter. There may be employment records in

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a civil employment issue where somebody's alleging
they've been discriminated against or harassed or wrongfully

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terminated and then we do a multi
hour interview of the plaintiff in the civil

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matter or the defendant in a criminal
matter. And although that is by definition

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their subjective self report, it's very
important to see not only what they say,

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but the way that they say it. And that's a big difference between

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the deposition, which is a formal
interview with all kinds of rules of how

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what can be asked and how it
can be asked, and a psychiatric interview,

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which often goes although we cover many
areas that we need to cover,

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you know, let's say the person's
history, their childhood, their relationship history,

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their employment history, et cetera.
Our method is more of an associative

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method. So somebody you ask,
somebody you know, tell me about yourself,

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open ended questions, and then you
take it from there and see what

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they pick up and tell you about
and ask questions about that and circle back

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and fill in blanks. And the
ethical duty of the forensic psychiatrist is not

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to the plaintiff, even if they
are retained by the plaintiff's council. It

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is to the trier of fact,
and that's the person or the people who

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decide who weigh the facts and decide
what is true and what is not.

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A jury and a jury trial,
there are bench trials where there's just a

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judge doing it. That's to whom
we owe a duty. We have a

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fiduciary duty to the attorney who has
retained us. But our job is to

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be is to call balls and strikes
as we see them, and to support

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it with evidence, not just the
authority that I've done this for so many

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decades, therefore it's true. But
here's the evidence that I have found that

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supports this. So those are the
distinctions, and frequently I might say one

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another thing. There are fewer than
two thousand board certified forensic psychiatrists. To

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become board certified, you have to, after a psychiatrist, do a full

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time one year fellowship in law on
psychiatry. There are seventy thousand board certified

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psychiatrists. Many psychiatrists who are not
trained in forensic psychiatry, UH put themselves

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out there to be retained as forensic
experts, and they don't understand their role

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distinctions. They end up being advocate, which is the lawyer's job. You

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know, they their advocate or abused
children or their advocates were you know,

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worthy causes, but it's a real
corruption and misunderstanding and unfortunately for many of

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them, well of potholes that they
step into because they don't really understand the

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landscape. That's that's an interesting challenge
point though, because oftentimes on the to

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your point, like when you think
about the distinction of the roles they're on

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the kind of treating psychiatrists doctor role, you have some kind of feeling of

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advocacy right for you your patient.
You want to kind of get their subjective,

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real view and help them kind of
work through those problems. But interestingly,

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like on the forensic law side here
you're saying, it's that we're not

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here to advocate, where we're here
to sort of determine what are the what

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are the facts at play, and
let them let those then pass on to

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the adjudicating body. That's an interesting, interesting kind of thing to know,

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because I think something else that's interesting
there. We said there's this kind of

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seventy thousand certified psychiatrists out there,
right, but I think there's many fewer

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certified forensic psychiatrists, right. It's
a much much like what's what's the different

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the different number there? We have
seventy thousand certified psychiatrists. Yeah, fewer

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than two thousand. But let me
just pick up what you said, because

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you're correct. A treating doctor is
an advocate for their patient, rightly so,

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and sometimes a treating doctor needs to
be called into a legal process.

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Most treating doctors hate it, and
they they regard being deposed as an opportunity

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to be humiliated. And it's really
doctors in general avoid litigation like the plague

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because it's scary and they don't know, they don't understand it. But it's

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okay to testify as the treating doctor. But you are what in the legal

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terminology is a precipient witness. You're
a witness. Your point of view is

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defined as subjective, and within that
context you can advocate for what you think

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is in your patient's best interest.
But you're not an independent expert. You

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may be an expert in your field, but you're not an independent expert.

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And that's the important distinction. And
when the doctors say the psychiatrists who don't

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have training in forensic psychiatry all for
themselves as independent experts, invariably they're doing

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it from the mindset of being a
treating doctor. And therefore it seems quite

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natural to them to advocate. But
in a stude attorney, certainly a cross

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examining attorney who's been down this road
or who is being coached by a forensic

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psychiatrist who he or she has retained, can really destroy their credibility when they

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do that. Which is the problem
in testimony is if you get caught in

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one instance of finessing your answer,
not to mention lying, but just finessing

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it. In litigation attorneys, that's
like blood in the water and a pool

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of sharks. You get devoured because
of that lack that one answer that was

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shady, and everything that you said
loses its credibility. So that's when you

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practice in this area. It's very
important to stay within the guardrails. This

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is my area of expertise. This
I know is I have the evidence at

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the court and sometimes attorneys will try
to pull you out of that. But

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doctor, you know you you're a
psychiatrist, but you're an MD, aren't

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you? What do you think about
this hysterectomy that was done? Never answer

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that I'm not an ob gyn.
I'm a psychiatrist. Yes, I'm a

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physician. You need a ob guyn
to answer that question. That's interesting.

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So it even seems that in a
student lawyer thinking about both how can they

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either poke holes in a defendant's case, right or a plaintiff's case, to

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your point, can try to go
through a forensic psychiatrist and try to ask

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questions that are sort of outside that
they're in the independent expert category. That's

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not what you're there to even do
in terms of just presenting, you know,

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evidence that that's interesting and it does
kind of show also you can see

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where it's like the especially if you
get called, you know, you get

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proposed to go act as a as
a percipient witness, but on an independent

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expert. That can be that challenge
there of not wanting to say too much,

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right, but then kind of say, well, I'm an expert in

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this field. But you know that's
not really what you're being You're being asked

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in that regard that that's a really
interesting thing. I mean, you know

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this is I'll sound like a super
amateur here because I've served on jury duty

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a number of times and that's you
know, my experience in the courtroom.

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But you always interested in this notion
too of uh, the you know,

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the kind of process, you know
it is it's it's set up in a

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very specific way, right when you
know, you can have your different opposing

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sides, you know, make their
arguments that you can. Then you'll see

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them, you know, talk to
to the witnesses and ask different questions,

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and that interesting process of like when
they have to bring in an expert or

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you know, in a forensic psychiatrist
to to kind of pay attention to what

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kind of language is used, right
in Like it's it's not almost as this

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pure kind of On the one hand, I guess it's like, you know,

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as a friendly psychiatrist, you're there
to provide expert testimony in the sense

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of saying, here's the facts that
we see, like determining kind of objective

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truth. Yet a lawyer might ask
you questions that pull you into subjectivity yourself,

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right, so you're gonna have to
have to walk that fine line,

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as it were, to make sure
that you don't accidentally do that. What

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I find so interesting about this field, this sub specialty field, is how

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nuanced it is. It's nuanced in
what do you know and what is your

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subjective opinion? And most importantly,
what are your biases? Because we all

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have biases and the more you can
be aware of them, the better you

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are at limiting your opinion to things
that you objectively can support and not just

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drifting into areas of bias. And
attorneys are very good at trying to find

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your bias. For example, it's
a deposition one oh one question every law

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student must learn in some you know, in some course that has to do

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with the practice of law. Doctor, what percentage of your cases have been

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defense and what percentage have been plaintiff? And that's an effort to presumably show

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your bias eight percent or plaintiff cases. You know, what is what I

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sometimes say, But you have to
be careful not to be a smart alec

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in a deposition. Is it is? What it is? In my case,

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it's usually two thirds to seventy percent
defense in civil matters and the rest

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is plaintiff. But that's how the
phone rings, and I don't control who

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calls me. If you're asking about
bias, then the question really is,

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doctor, how often do you come
to an opinion that you know it doesn't

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support the inquiring attorney's theory of the
case. That's the integrity question, you

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know, and that's you know,
for me, around ten percent, But

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that's the question that they're never taught
to ask, and that's really you know,

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the meaningful question about bias. Mm
hmm. That's interesting too, just

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to to give us that question,
right, because we often see in in

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a broader business context too. Right, there is this there's been engaging in

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ongoing conversations of understanding things like unconscious
bias, right in terms of what are

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you bringing to the table, whether
it could be you know, tells in

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a in a you know, poker
context of like, you know, my

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my left eyes twitching when i'm you
know, when I get a when I

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get a you know, ace of
spades or something. But then also this

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idea of like how I discuss topics, right, and so I understand this

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this idea in terms of if I'm
being asked a question, it's it's kind

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of like the philosopher Kwame Apia has
said that it's, you know, a

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lot of life is not figuring out
necessarily had to play the game, but

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understand what game you're playing in the
first place, you know, And so

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this kind of question exactly. Yeah, yeah, And that's I mean,

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that's really interesting in this in this
context too, because also obviously, like

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the I want to get into some
of the subjects matter areas that we'll we'll

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kind of see in a case in
some of the cases that you've worked on

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as part of that, because it
seems like there obviously because if you're working

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in in cases around you know,
sexual abuse or domestic violence, uh,

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you know, and areas are around
dementia, right, there can be some

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challenge like there's they're emotionally charged spaces, right, there's there's there's people that

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have been wrong, you know,
the people have been hurt and so uh,

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even that, I think it's an
interesting kind of pasway to think about

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how you how you can go go
into these spaces and like sit with the

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you know, the ethics, the
methods and the and the mission of the

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work in order to not get pulled. And if if if a lawyer is

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kind of trying to pull you into
an emotional argument or something that takes you

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outside of that that space, does
that happen? You know, I don't

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know frequently, but just like what's
the percentage of times that you know,

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if you might get pulled or that
that's kind of like you you'll see,

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I guess is that a thing is
do do you find that attorneys respect the

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space or do they do you do
you find that you often will get asked

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questions that sort of try to pull
folks into an emotional argument away from a

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more of like a I can support
with evidence kind of answer. It was

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such a very good question, and
like the variation among people, it has

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a lot to do with the different
with the variation among lawyers, I mean

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the cross examining attorney and we the
prob The our litigation system is an adversarial

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one, you know, It's it's
each side pulling for what they want and

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then the trier of fact trying to
decide who has authentic, capable, genuine

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facts on their side and who doesn't, and therefore who wins the argument.

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That's different from just if I can
divert direct grass for a minute. It's

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different from the European that it's called
the Napoleonic system, where the judge is

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the person who weighs the balance,
and the expert, the forensic psychiatrist in

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a French court is employed by the
court. Yeah, so in a sense

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it's a much fairer and more balanced
since except there are other problems with that

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when you have people from a particular
class and walk of life and biases,

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et cetera, being the sole arbiters
rather than our concept of a jury of

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one's peers. But you know,
it's a very difference. Isn't much less

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adversarial. So in our adversarial it
doesn't to answer your question. Even gentlemanly

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attorneys need to try and find the
holes in your argument, even if you're

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honestly saying, well, I'm not
sure about that. So in other words,

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it could be the attorney will say. In other words, it could

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be the opposite as much as it
could be what you're saying it is.

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Isn't that correct? Doctor? That's
an easy style of cross examining. But

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there are also attorneys who are works, in my opinion, and who want

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to play Perry Mason with gotcha,
and which is sometimes dramatic and theatrical and

279
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effective with a jury. Sometimes it's
off putting to a jury if they like

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the expert and the attorney who's crossed
examining the expert is trying to crucify them.

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That doesn't necessarily win points for the
crucifier. So it depends, you

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know, if the expert is pompous
and aloof and you know, talks like

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an academic and jargon, and there's
a feeling of the jury that they're being

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condescended to. Then the gotcha cross
examiner, you know, may be very

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effective in in poking holes in the
credibility of the expert, but in general,

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one of them when you what one
learns to do when you're trained in

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this, which most doctors are not
and therefore feel great anxiety about being cross

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examined is listen to the question and
take as much time as you need before

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answering, and control the pace because
across examining, attorney may try to fire

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00:26:22.680 --> 00:26:26.039
stuff at you like this, you
know, and get you off balance,

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and you just take it down a
notch and say, well, let me

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think about that, counselor, and
that gives you time to think about just

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00:26:38.920 --> 00:26:48.200
what you're saying, but also to
listen because the attorney who has retained you

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may stand up and say objection your
honor. This goes to blah blah blah,

295
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and that is a signal to what
you should be considering or not saying

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in respond. So there's a lot
of theatrics to this, you know.

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It's not unfortunately or just understandably because
it's a human activity, and it's adversterial.

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It's not all about justice. A
great deal of it is about procedure.

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00:27:18.480 --> 00:27:22.559
A whole watch of litigation is about
procedure. You could have a great

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case, but you file it too
late and it is out of time and

301
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so procedurally you don't have a chance
it'll be dismissed. But even in when

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you're in litigation, the procedures that
go on in the courtroom are important to

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00:27:40.880 --> 00:27:45.759
understand if you're a witness, so
that you can so it can to the

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00:27:45.799 --> 00:27:52.839
extent appropriate guide how you respond.
And also if just want to think,

305
00:27:53.119 --> 00:27:57.359
but you know, if the attorney
who has retained you stands up and objects

306
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to the question you've just been asked, and the court sustained the objection,

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you don't have to answer. It
gets you off the book easier that way,

308
00:28:06.359 --> 00:28:10.160
right, Yeah, yeah, yeah, it's it's interesting to think about

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that too, where because it's oftentimes
and for the most part, right,

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it's one person talking at a time, right, it could be the cross

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00:28:15.119 --> 00:28:18.559
examining attorney, right, But then
often say objection and it'll it'll stop it,

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00:28:18.640 --> 00:28:21.039
you know. Or that's the interesting
point too, when you see when

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it becomes a team sport. Then
it also tells you, all right,

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I either have to continue or I
have to stop now, you know,

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00:28:26.279 --> 00:28:29.079
right, which is what could be
helpful. I think that, right,

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I think this is this is super
fascinating, and I think that you know,

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part of it I'm curious about,
like maybe we can we dive into

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because something you set up top two
that that I want to spend some time

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00:28:38.519 --> 00:28:41.799
with, is this idea that right
human behavior is is can be difficult to

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you know, map out objectively,
right, I mean, obviously we all

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have subjective experiences, right, and
you set a good example of of the

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if I either having a bad day
or I think my television is talking to

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me, there's there's also an objective
kind of standard that we've all agreed upon

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that televisions typically don't talk to you. I mean besides when they're on,

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but you know the tea it selfie
doesn't talk to you, right, And

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so that can that can kind of
say, okay, well, there may

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00:29:03.960 --> 00:29:07.039
be something objective that we can talk
about even though your subjective experiences is x

328
00:29:07.119 --> 00:29:08.599
y Z. So let's talk about
like that, like the kind of complexities

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of how do we evaluate mental health
in legal context? When when we're looking

330
00:29:12.039 --> 00:29:17.079
at scenarios like this, or maybe
you can pick if there's a case that

331
00:29:17.079 --> 00:29:18.799
has jumped out to you. I
mean you mentioned before that I think it

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is really interesting to the insanity is
a legal term, not a medical term,

333
00:29:22.680 --> 00:29:25.839
and that's something that we know who's
using that wear can have some important

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00:29:25.839 --> 00:29:27.960
implications, right, But yeah,
walk me through that a little bit like

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00:29:29.119 --> 00:29:33.599
these complexities. Well, a case
that I was involved in quite a few

336
00:29:33.640 --> 00:29:41.039
years ago, which was a civil
case, that is, people were suiting

337
00:29:41.480 --> 00:29:49.839
other people or damages which results only
in money being paid to if they win

338
00:29:51.160 --> 00:29:55.960
or not paid if they lose by
the defendant. Did it plane to it?

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00:29:56.400 --> 00:30:02.839
It touched on a murder and a
criminal matter, and it was a

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00:30:02.880 --> 00:30:12.559
man who was diagnosed in his teens. When in his late teens when psychotic

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disorders like schizophrenia usually present themselves.
That is, people start becoming symptomatic with

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illusions and illucinations if they have schizophrenia, which is probably a group of diseases,

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00:30:27.400 --> 00:30:33.240
but it is a labeled mental illness
in their late teens or very early

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twenties. You don't develop schizophrenia,
you know, at forty nine too much?

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00:30:38.960 --> 00:30:42.359
Would it had to have happened before
to stignal that you may have the

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00:30:42.480 --> 00:30:52.200
psychosis which is deviating from consensual reality, having problems with the term of art.

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00:30:52.279 --> 00:30:56.799
In psychiatry or psychology, it's called
reality testing. But it's of a

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different It could be from drugs,
it could be from brain disease, it

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00:31:00.279 --> 00:31:07.880
could be from some other mental illness. So this was a man who became

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was diagnosed with schizophrenia after he was
violent at home. He was punching hole

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00:31:15.000 --> 00:31:21.160
he was his parents were Asian immigrants
and said they were kind of old world

352
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from Asia, and he would punch
holes in the wall and then he assaulted

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00:31:26.160 --> 00:31:32.079
his father on a couple occasions.
I don't even know what the disputes were,

354
00:31:33.000 --> 00:31:36.079
but the police were involved and as
a result of that, he was

355
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diagnosed and treated for schizophrenia, and
he did very well when he took his

356
00:31:41.759 --> 00:31:52.279
medications, and then he was in
a different state where he As many people

357
00:31:52.319 --> 00:32:00.000
who have severe mental illness like schizophrenia, he was economically marginal as an adult.

358
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He couldn't hold he couldn't really have
a career or hold high paid jobs.

359
00:32:07.880 --> 00:32:13.200
So he worked intermittently and he was
on you know, benefits, public

360
00:32:13.200 --> 00:32:22.880
benefits. Intimately and this date we
had outsourt to a corporation the treatment of

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00:32:22.160 --> 00:32:34.519
the indigence severe mentally ill. The
highest training level expert in the treader in

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00:32:34.559 --> 00:32:40.119
the system that this company had in
this state was a nurse practitioner psychiatric nurse

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00:32:40.200 --> 00:32:51.880
practitioners. And he stopped appearing for
his regular monthly of check in appointment,

364
00:32:52.079 --> 00:32:54.079
I think when his meds would be
renewed, et cetera. He lived on

365
00:32:54.119 --> 00:32:59.880
his own the time, he was
probably in his early forties, was a

366
00:33:00.079 --> 00:33:07.640
solitary guy. And she was alarmed
about this, and they had like a

367
00:33:07.680 --> 00:33:13.200
home visiting team. So they sent
out the home visiting team and they knocked

368
00:33:13.200 --> 00:33:15.519
on the door and they heard dog
barking. All the blinds were closed,

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and they did nothing. He didn't
answer. They did nothing. They did

370
00:33:22.400 --> 00:33:28.880
this a couple of times, and
then he sort of drifted from really any

371
00:33:29.039 --> 00:33:35.480
active coverage. Over six months,
he became he had stopped taking his meds,

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00:33:35.519 --> 00:33:39.319
and he had stopped getting them refilled, and became increasingly psychotic. He

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00:33:39.480 --> 00:33:47.359
did believe that the TV was sending
him messages. He believed that license plates

374
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were coded messages to him from the
Chinese embassy. And one day and he

375
00:33:55.799 --> 00:34:02.440
had another social problem in our society. He had a gun and one day,

376
00:34:02.480 --> 00:34:07.760
at one in the afternoon he went
to a Walmart parking lot and shot

377
00:34:08.199 --> 00:34:15.079
repeatedly two strangers dead in the parking
lot. I was an expert for the

378
00:34:15.119 --> 00:34:25.760
plaintiff, which was the widow of
one of the murdered victims and her three

379
00:34:25.840 --> 00:34:38.079
young children. And the issue in
this case that was interesting was the failure

380
00:34:38.400 --> 00:34:50.079
of the outside corporation that hired the
people who were supposedly providing care for the

381
00:34:50.119 --> 00:34:54.960
indigen severely mentally ill failure to follow
up on this because in that state,

382
00:34:57.159 --> 00:35:01.840
it was very easy to compel the
police to pick up the person. Even

383
00:35:01.840 --> 00:35:06.920
a neighbor could say, I'm very
worried about this person. You can call

384
00:35:06.920 --> 00:35:09.480
the police. Would you please do
a wellness check and if you can't,

385
00:35:10.639 --> 00:35:16.280
you know, get evidence that things
are fine. Bring him to a mental

386
00:35:16.280 --> 00:35:24.199
health like an emergency room, a
crisis center where trained professionals can evaluate and

387
00:35:24.320 --> 00:35:30.480
take appropriate action, meaning provide care
if he needs it, you know,

388
00:35:30.519 --> 00:35:35.519
if he were if someone had,
if the police had come not he not

389
00:35:35.639 --> 00:35:38.800
responded and they broke down the door
and found that he was delusional, etcetera.

390
00:35:38.880 --> 00:35:42.760
They'd bring him to such an ability, he would have been hospitalized and

391
00:35:42.840 --> 00:35:49.360
medicated and treated. They hadn't done
that. So the defense in this case

392
00:35:49.480 --> 00:35:54.039
position was the lack of foreseeability.
How could we know this guy was going

393
00:35:54.079 --> 00:36:00.679
to go kill people? And the
plaintiff's case was that's not the issue,

394
00:36:01.239 --> 00:36:07.800
the excellence on the wrong styll abl
The issue is you didn't take appropriate action

395
00:36:07.719 --> 00:36:13.119
to get this person evaluated. You
knocked on the door, there was no

396
00:36:13.239 --> 00:36:16.679
answer, and you left. Basically, Hey, an interesting analogy would be

397
00:36:19.440 --> 00:36:30.840
if he were a woman with a
suspicious papsmere. Most hospitals or insurance systems

398
00:36:30.920 --> 00:36:37.280
like in the West Coast Kaiser have
elaborate checklist procedures to go through. You

399
00:36:37.320 --> 00:36:44.599
know, now that's not a potentially
violent situation, but not just to call

400
00:36:44.960 --> 00:36:50.039
to send letters and certified letters.
They'll send out a nurse practice, They'll

401
00:36:50.039 --> 00:36:55.480
go to great lengths to follow up
and get that person back in for the

402
00:36:55.519 --> 00:37:00.559
follow up evaluation of their suspicious papsmere. But in this case, and I've

403
00:37:00.559 --> 00:37:05.199
been involved in other cases, it's
kind of like too much effort, and

404
00:37:05.320 --> 00:37:09.360
so they dropped the ball. And
the consequence it's not that it wasn't foreseeable

405
00:37:09.400 --> 00:37:16.159
that this man would kill people rather
than uh, you know, running in

406
00:37:16.199 --> 00:37:22.480
the street naked or something that was
not violent, but it or the issue

407
00:37:22.519 --> 00:37:28.440
was that they hadn't provided the appropriate
follow up. So I've kind of lott

408
00:37:28.519 --> 00:37:32.679
my my plot here and talking to
you. But I think that that was

409
00:37:34.639 --> 00:37:40.239
in response to, you know,
a real case where which no, well

410
00:37:40.280 --> 00:37:44.800
it was yeah, and and the
kind of question there was also thinking about

411
00:37:44.880 --> 00:37:46.480
this idea of the I mean,
you illustrated it perfectly. It's just the

412
00:37:46.480 --> 00:37:52.119
complexities of when we're evaluating mental health
and a legal context, like what does

413
00:37:52.159 --> 00:37:53.119
it mean? You know, and
you brought it. I think you brought

414
00:37:53.159 --> 00:37:58.199
a number of really really relevant examples
and in points there were just in terms

415
00:37:58.239 --> 00:38:04.360
of when we're we have a case
around somebody that has a mental illness and

416
00:38:04.400 --> 00:38:10.039
then especially with something like schizophrenia,
and then there's a challenge around their lifestyle.

417
00:38:10.239 --> 00:38:14.679
You know, you canotically marginal marginalized
like they're not quote unquote used to

418
00:38:15.320 --> 00:38:17.800
you know, living a quote normal
life, or like the norms and standards

419
00:38:17.840 --> 00:38:23.360
of maybe answering your door when you
when you someone knocks right or obviously having

420
00:38:23.400 --> 00:38:29.000
delusions or things where we are hallucinating
that a license plate is sending us signals

421
00:38:29.800 --> 00:38:32.360
uh, and then how that translates
to the kinds of actions or in this

422
00:38:32.400 --> 00:38:36.360
case, like the kinds of help
they do or do not get in a

423
00:38:36.400 --> 00:38:40.400
social work medical context. And then
how that might translate over into into a

424
00:38:40.440 --> 00:38:43.719
legal case. To me, I
mean, I've seen like there's like three

425
00:38:43.719 --> 00:38:45.360
steps there that are quite challenging to
kind of work with. Right, so

426
00:38:45.440 --> 00:38:51.519
you can both determine did a murder
take place? Yes, and then what

427
00:38:51.920 --> 00:38:53.480
happened as part of that right?
And then the synderty argument where you said

428
00:38:53.440 --> 00:38:57.159
that the defense was saying that there's
a lack of foreseeable action we did we

429
00:38:57.159 --> 00:38:59.239
couldn't. How could we know he's
going to do that? Right? And

430
00:38:59.280 --> 00:39:01.519
then this argument I think interesting there
was like, well, no, that's

431
00:39:01.559 --> 00:39:05.559
not the point. The point was
actually that there was not treatment, adequate

432
00:39:05.559 --> 00:39:10.840
treatment in place. An interesting sidebar
on this was obviously there was a criminal

433
00:39:10.880 --> 00:39:15.000
case. I was in the civil
case. A criminal case usually takes precedent

434
00:39:15.079 --> 00:39:21.159
because it involved the deprivation of liberty. It's a higher priority than money settlement

435
00:39:21.280 --> 00:39:27.320
for damages. And he was found
incompetent to stand trial, and he would

436
00:39:27.320 --> 00:39:36.360
send to what's called a competency restoration
program at a state hospital and they could

437
00:39:36.360 --> 00:39:40.199
not. There were several attempts and
they could not restore competency. And at

438
00:39:40.199 --> 00:39:45.920
the end of this process, he
was by default found not guilty by reason

439
00:39:45.960 --> 00:39:51.639
of insanity because his competency that sand
trial could not be restored, which meant

440
00:39:51.679 --> 00:39:54.920
that that doesn't mean he walks free, meant that he was basically he received

441
00:39:54.920 --> 00:40:01.400
an indefinite sentence that wasn't called that
to a state mental health hospital until such

442
00:40:01.559 --> 00:40:07.679
time as he was deemed no longer
a danger to society. And I don't

443
00:40:07.719 --> 00:40:12.880
know what happened after that. I
mean, medicine has evolved. There are

444
00:40:12.920 --> 00:40:20.039
now good what are called depot medications. You can get antipsychotic injections. What's

445
00:40:20.079 --> 00:40:24.199
a month. It's like slow release, and so people like this can be

446
00:40:24.360 --> 00:40:30.679
managed in terms of keeping them on
their medication because I mean, if they

447
00:40:30.679 --> 00:40:34.639
didn't show up for their monthly shot, you'd have the same situation deja bou

448
00:40:34.679 --> 00:40:37.199
all over again. But you know, and you'd need a system that was

449
00:40:37.280 --> 00:40:42.400
going to follow up and make sure. But it's conceivable that he could be

450
00:40:42.559 --> 00:40:52.800
released from this indefinite sentence as not
a danger to society if the civil authorities

451
00:40:53.079 --> 00:40:59.920
made sure that he got these monthly
shot but I don't know that that was

452
00:41:00.079 --> 00:41:04.639
the outcome. The last I heard
he was in a state hospital. But

453
00:41:04.800 --> 00:41:09.000
that's interesting too, So even this
idea of how medical practice evolves and changes

454
00:41:09.039 --> 00:41:13.079
over time, you know, and
I'm also thinking as anthropologist, you know,

455
00:41:13.480 --> 00:41:15.760
you know, do we see cultural
attitudes towards like mental health changing also,

456
00:41:15.800 --> 00:41:22.000
and does that affect you know,
how how like a deposition might happen

457
00:41:22.079 --> 00:41:23.639
or something. So I'm curious if
you have examples or you've seen that kind

458
00:41:23.639 --> 00:41:28.239
of in play too, either medicine
changing or kind of cultural attitudes about mental

459
00:41:28.239 --> 00:41:31.480
health, and like how that affected
a trial. The cultural attitudes have certainly

460
00:41:31.599 --> 00:41:38.480
changed. There's lots of examples.
In my in my fifty year career,

461
00:41:42.000 --> 00:41:47.559
homosexuality has moved from being listed as
a mental disorder in the Diagnostic Statistical Manual

462
00:41:49.119 --> 00:41:55.719
to gay marriage. So that's a
huge social transition. It's which I find

463
00:41:55.760 --> 00:42:00.360
is so interesting in that regard as
a digression, is in the same period

464
00:42:00.480 --> 00:42:09.000
that that thank Goodness has evolved,
that are social thinking about choice of people

465
00:42:09.039 --> 00:42:16.119
to love has evolved, rov Wade
has gone backwards. Yeah, So you

466
00:42:16.159 --> 00:42:22.079
know, it's it's weird when you
get to these social issues and which often

467
00:42:22.119 --> 00:42:30.000
have large religious components, and how
one, you know, at least in

468
00:42:30.519 --> 00:42:38.079
here evolves and the other regresses.
It doesn't even stay static. But so

469
00:42:39.039 --> 00:42:46.440
when I was I graduated from medical
school a long time ago in nineteen seventy

470
00:42:46.480 --> 00:42:52.400
one, and I moved from the
East Coast from New York to California and

471
00:42:52.400 --> 00:42:57.079
did my internship, and that ultimately
did my residency there, although I was

472
00:42:57.280 --> 00:43:04.119
supposed to do it in Boston,
and the that was a time when Ronald

473
00:43:04.199 --> 00:43:10.039
Reagan was governor of California and what
was the norm nationally of state mental hospitals

474
00:43:10.360 --> 00:43:17.119
were being emptied out. It coincided
with two factors. One was the advent

475
00:43:17.280 --> 00:43:29.280
of thorazine, the first antipsychotic drugs, which, like all technological changes,

476
00:43:29.400 --> 00:43:32.840
improvements, you know, brought with
it many fantasies that it would you know,

477
00:43:34.039 --> 00:43:40.199
liberate mentally ill people, et cetera. And it also coincided with a

478
00:43:40.280 --> 00:43:50.840
conservative effort to cut state spending.
And what the unintended consequence was beginning in

479
00:43:50.880 --> 00:43:59.519
California was homelessness because the efforts to
make community mental health facilities, both residential

480
00:43:59.559 --> 00:44:08.039
and tree where these warehoused mentally severely
mentally ill people would would be would move

481
00:44:08.119 --> 00:44:14.199
to from the state hospital and the
institutions was never was an unfulfilled promise.

482
00:44:14.239 --> 00:44:22.400
It was underfunded and understaffed and never
really worked. And coincidentally, severely mentally

483
00:44:22.440 --> 00:44:29.920
ill people often duly diagnosed with drug
addiction as well as severe mental illness ended

484
00:44:30.000 --> 00:44:35.320
up becoming the homeless population. And
they started in California like many things back

485
00:44:35.360 --> 00:44:43.519
then, and then became national.
So so that's that all was the beginning

486
00:44:43.840 --> 00:44:53.480
of reintegrating the warehouse mentally ill into
the community been a very bumpy road.

487
00:44:54.039 --> 00:45:01.760
But but that you know that I
think that has the homelessness is a severe,

488
00:45:01.880 --> 00:45:07.039
ongoing, unintended consequence problem. But
I think that this general social attitude

489
00:45:07.079 --> 00:45:15.559
about mental illness has become more accepting
and everyone either knows or may have a

490
00:45:15.599 --> 00:45:22.840
family member who has bipolar disorder or
some severe mental illness. And so that's

491
00:45:22.880 --> 00:45:28.719
been a big social change. And
you know, going back to the pre

492
00:45:29.000 --> 00:45:34.159
say seventies, when people will warehouse. To go back even further, Abraham

493
00:45:34.199 --> 00:45:38.719
Lincoln had his wife institutionalized. She
had depression, as did he and I

494
00:45:38.719 --> 00:45:42.920
think after the death of a child, maybe had a postpart of depression.

495
00:45:44.280 --> 00:45:46.679
In those days, women had no
rights, and he was a you know,

496
00:45:47.639 --> 00:45:53.960
Abraham Lincoln, viewed as a very
good man in our history, had

497
00:45:54.000 --> 00:45:58.840
his wife institutionalized for I don't know
how long, but for a long it

498
00:45:58.880 --> 00:46:01.360
wasn't like a two week in the
right. But we definitely call that like

499
00:46:01.440 --> 00:46:06.000
not not good now, right,
like not exactly not a positive trait.

500
00:46:08.079 --> 00:46:10.800
But I think that's that's a challenge, that's it's an interesting challenge point too,

501
00:46:10.800 --> 00:46:15.039
because even this, like those are
both great examples where we have the

502
00:46:15.360 --> 00:46:20.639
a kind of unintended social consequence,
right that comes from both a political move

503
00:46:20.679 --> 00:46:22.840
of defunding or cutting out you know, state spending. But then on top

504
00:46:22.840 --> 00:46:27.360
of that too, like we see
a medicine introduced into the into into the

505
00:46:27.360 --> 00:46:30.920
society, and then it's you know, there's kind of this desire to we

506
00:46:30.920 --> 00:46:32.159
can change I mean this, I
mean it's got me thinking too in terms

507
00:46:32.199 --> 00:46:37.639
of both you know, pharmaceutical culture
today and the rise of what we're seeing

508
00:46:37.719 --> 00:46:39.440
now. We're seeing you know,
some back and forth about things like for

509
00:46:39.480 --> 00:46:43.719
Alzheimer's drugs, you know, and
and weight loss drugs has been some back

510
00:46:43.719 --> 00:46:46.239
and forth, right but obviously there's
a massive fentanyl crisis too, from an

511
00:46:46.239 --> 00:46:51.840
opiate and you know, opioids into
into an epidemic of people getting coked on

512
00:46:51.880 --> 00:46:53.559
them, and so you know,
it's interesting to kind of think about it.

513
00:46:53.559 --> 00:46:57.360
I don't know if your work delves
into these these realms, but just

514
00:46:57.400 --> 00:47:00.920
like sometimes the role I think this
is not an anti antifarmer question, but

515
00:47:00.039 --> 00:47:04.679
just like just interesting in this idea
of like do we see medicine come into

516
00:47:04.719 --> 00:47:07.320
play? Because it has it come
to play more frequently? I wonder too,

517
00:47:07.320 --> 00:47:12.039
you know over the past fifty years
in terms of the where we see

518
00:47:12.039 --> 00:47:15.960
people talking about or is it not
not basically like seens as like something that

519
00:47:15.960 --> 00:47:17.679
we're looking to blame or the cause
of some problem, but just like as

520
00:47:17.679 --> 00:47:21.679
a part of that conversation, whether
it's like somebody's on some certain kind of

521
00:47:21.719 --> 00:47:24.360
med or they didn't take their meds
to to the other point, as part

522
00:47:24.360 --> 00:47:28.159
of that game. I think it's
an interesting thing because it's like in medical

523
00:47:28.159 --> 00:47:30.800
anthropology, you know, we we
we see conversations in terms of the increasing

524
00:47:30.880 --> 00:47:34.920
kind of medicalization in air quotes of
society, right that we can kind of

525
00:47:34.920 --> 00:47:39.480
medicalize an aspect of somebody's life and
actually homosexuality being in the DSM three or

526
00:47:39.480 --> 00:47:42.679
four at the time, and like
now not like there's an interesting that's a

527
00:47:42.679 --> 00:47:46.599
good point of like a a you
know, a social attitude and perception changing

528
00:47:46.679 --> 00:47:52.400
around around a social practice you know
that was then also incorrectly put into a

529
00:47:52.440 --> 00:47:54.599
mental category you know at the time. And so I'm just curious, like,

530
00:47:54.599 --> 00:47:57.920
do we see are the things like
this that guy stand out to you

531
00:47:58.039 --> 00:48:05.920
that we see you know, medicine
or the medicalization and things like this that

532
00:48:05.920 --> 00:48:08.320
that are that make for cases that
that seem interesting, Like they may not

533
00:48:08.400 --> 00:48:12.360
be we don't preat them to be
the kind of case. I guess in

534
00:48:12.400 --> 00:48:15.400
the future whe they're kind of changing
what cases are about. I guess it's

535
00:48:15.440 --> 00:48:19.119
a very vague question, but I
mean it's got me thinking about this idea

536
00:48:19.119 --> 00:48:22.519
in terms of like how cases are
formed. Like when there's murder in a

537
00:48:22.599 --> 00:48:24.559
and a person that has a schizophrenia
that that's that feels clear, you know,

538
00:48:24.679 --> 00:48:28.079
not great, but it feels clear. Right, if there's domestic abuse

539
00:48:28.119 --> 00:48:31.280
that feels clear. I guess do
we see anything that makes it kind of

540
00:48:31.360 --> 00:48:35.880
murky to know should this should we
be calling in a forensic psychiatrist? Right

541
00:48:35.920 --> 00:48:37.239
that there's something somebody who's on our
author mets or something like that does,

542
00:48:37.360 --> 00:48:39.840
is there Maybe you don't see that
part of it too in they're deciding who

543
00:48:39.840 --> 00:48:44.199
they need to call for for expert
testimony. But I'm curious if you've seen

544
00:48:44.280 --> 00:48:52.320
conversations around that idea. You're covering
a really uh I think it. Yes,

545
00:48:52.480 --> 00:49:01.639
there's been a medicalization in behavioral aspects
of medicine, So the prescription of

546
00:49:05.320 --> 00:49:08.719
stimulants for children who have a d
D, or the prescription of any depressant

547
00:49:09.440 --> 00:49:19.719
for adults who have even as mild
as situational depression. Let's say bereavement after

548
00:49:19.760 --> 00:49:24.880
the death. There there some people
will get medicated for that, and that's

549
00:49:27.039 --> 00:49:31.119
you know, that's debatable. It's
not necessarily wrong, but it is not

550
00:49:31.159 --> 00:49:37.920
necessarily right either because there, for
example, there are natural processes like bereavement

551
00:49:38.039 --> 00:49:46.199
that you want a person two that
are not pathological any more than pain during

552
00:49:46.320 --> 00:49:52.239
childbirth is pathological, although you might
use you know, analgesics, a pain

553
00:49:52.360 --> 00:50:00.519
medicine to reduce that pain. But
there is complicated bereavement. There are people

554
00:50:00.599 --> 00:50:07.119
who's who lose a spouse and they
stop functioning for years, and they're totally

555
00:50:07.159 --> 00:50:12.280
focused on the death of the spouts
they can't move on. That's if a

556
00:50:12.360 --> 00:50:19.719
situation that needs treatment, it may
involve medication and or psychotherapy whatever. So

557
00:50:20.559 --> 00:50:24.039
you know, I think it's another
ball to keep one's eye on of how

558
00:50:24.119 --> 00:50:30.920
much is medication being used and is
that overuse or is that justified. The

559
00:50:31.000 --> 00:50:37.519
other side of that is that fifteen
percent of severely depressed people kill themselves.

560
00:50:37.559 --> 00:50:44.480
If I'm treated, it's a significant
mortality. It's not you know, oh,

561
00:50:44.760 --> 00:50:46.880
you know, just go to the
gym and exercise and you'll feel better,

562
00:50:47.199 --> 00:50:52.360
you know, or take a walk, and so to some extent,

563
00:50:52.480 --> 00:51:00.280
the use of antidepressants liberally reduces that. But it's also complicated because I don't

564
00:51:00.280 --> 00:51:04.519
know if you remember quite a few
years ago, it's probably in the nineties,

565
00:51:06.159 --> 00:51:13.800
there were hearings in Congress about antidepressants
leading to adolescent suicide. And there's

566
00:51:13.880 --> 00:51:19.360
now you know, your listeners made
no But it's something called the black box

567
00:51:19.440 --> 00:51:27.400
warning, which means that in the
pharmaceutical companies insert in a drug package,

568
00:51:27.920 --> 00:51:32.000
there's something that has a literally black
box around it, and antidepressants all have

569
00:51:32.119 --> 00:51:39.360
this black box may cause suicide.
That's very controversial because many of the people

570
00:51:39.360 --> 00:51:50.639
who testified in Congress who tragically had
lost children were of a deep anti psychiatry

571
00:51:50.719 --> 00:51:54.519
conviction. You know, it wasn't
a random population. It was a very

572
00:51:54.559 --> 00:52:00.719
biased group who went to the trouble
of testifying and gave a tip the scales,

573
00:52:00.320 --> 00:52:07.519
particularly with politicians. Subsequent large studies
showed that the use of antidepressants with

574
00:52:07.639 --> 00:52:15.320
adolescens led to a reduction in suicide
on large scale, but of course there

575
00:52:15.320 --> 00:52:21.360
are suicides even with people taking antidepressant. The problem, though, that wasn't

576
00:52:21.480 --> 00:52:31.920
understood sufficiently, was that if you
have a tendency to becoming agitated or bipolar.

577
00:52:32.400 --> 00:52:37.679
You know, someone can present as
depressed, but they actually have really

578
00:52:37.760 --> 00:52:45.880
the neurobiology to be bipolar. They
go between very down and very elated and

579
00:52:46.000 --> 00:52:53.400
manic, and without judgment, you
can unmask mania in a person who's really

580
00:52:53.440 --> 00:52:59.639
bipolar by bipolar by just giving them
an antidepressant. And so what needs to

581
00:52:59.679 --> 00:53:06.119
be done at the first science is
at a mood stabilizer so they can benefit

582
00:53:06.159 --> 00:53:13.239
from the antidepressant without being launched into
really crazy and it can be psychotic mania.

583
00:53:13.400 --> 00:53:19.159
So what was happening to a large
extent is a GP or more likely

584
00:53:19.199 --> 00:53:22.800
a pediatrician would see, this kid's
depressed, I'll give them any depressant.

585
00:53:22.880 --> 00:53:27.559
I'll see you in six weeks,
where the psychiatrist would have said, i'll

586
00:53:27.559 --> 00:53:30.760
see you in two days, or
we'll talk on this, you know today,

587
00:53:30.880 --> 00:53:34.840
we'll talk on a video, you
know, before the end of the

588
00:53:34.840 --> 00:53:39.039
week, and to see how they're
responding. If they're going from being inert

589
00:53:39.280 --> 00:53:46.079
and depressed to being agitated and excited, that's an important warning sign that you

590
00:53:46.159 --> 00:53:52.559
need to you maybe be masking a
bipolar disorder, which doesn't mean the antidepressdant

591
00:53:52.639 --> 00:53:54.320
is not indicated, but it means
you got to add a mood stabilizer.

592
00:53:54.800 --> 00:54:00.599
And that is a dangerous situation because
a kid who's thinking about suicide but too

593
00:54:00.679 --> 00:54:06.519
inert to act on it may then
be activated and act on it and you

594
00:54:06.559 --> 00:54:08.960
know, a tragedy, uh,
you know, to say the least so

595
00:54:10.719 --> 00:54:17.840
that you know it's complicated more complicated
species, you know, right, But

596
00:54:17.920 --> 00:54:20.920
it's it's a good point too.
I mean, even what you're saying up

597
00:54:20.960 --> 00:54:25.119
top about there's the there's also the
treating psychiatrist, right, and then there's

598
00:54:25.159 --> 00:54:29.719
then there's the phrasy psychiatrist in the
in the law space, and like this

599
00:54:29.800 --> 00:54:31.639
is a great example of why those
two can't mix, right, because if

600
00:54:31.679 --> 00:54:37.000
you're if you're prescribing meds and working
with somebody and then you're on a case

601
00:54:37.039 --> 00:54:42.280
talking about how those two meds that
didn't interact in a potential scenario, right,

602
00:54:42.280 --> 00:54:44.159
you don't want it. You can't
be the treating doctor, you know,

603
00:54:44.480 --> 00:54:50.519
and also talk about the fact and
then objectively weighing all the objective evidence.

604
00:54:50.519 --> 00:54:58.440
And that's the that's the I think
the biggest difference is a treating psychiatrist

605
00:54:58.519 --> 00:55:07.239
is dealing with subjectivity because the state
at which psychiatry is today is primitive compared

606
00:55:07.239 --> 00:55:12.159
to the rest of medicine, whereas
a forensic psychiatrist is trying to look at

607
00:55:12.239 --> 00:55:15.719
as much object to that as that
they can gather and it will give a

608
00:55:15.719 --> 00:55:23.519
different perspective. And it's interesting.
I'm talking the other day to a prominent

609
00:55:23.639 --> 00:55:32.360
neuros psychopharmacologist. He's someone who is
like the caboose on the train of referral.

610
00:55:32.800 --> 00:55:42.199
So when people don't respond to medications
and this is all psychopharm this isn't

611
00:55:42.239 --> 00:55:49.519
psychotherapy a different issue, they get
to him. It's like a tertiary referral

612
00:55:50.079 --> 00:55:55.360
call. And he was saying,
you know, he was critiquing the DSM,

613
00:55:55.519 --> 00:55:59.880
which is a diagnostic and cistical manual
that you and I have referred to.

614
00:56:00.480 --> 00:56:06.559
That's the list of diagnoses for psychiatry, but the way that psychiatry still

615
00:56:07.079 --> 00:56:13.679
diagnoses things, for example, a
major depressive disorder. He said, the

616
00:56:13.840 --> 00:56:19.199
depression is a symptom, just like
fever is a symptom. It's not a

617
00:56:19.239 --> 00:56:24.239
disorder. It's a symptom. We
don't necessarily understand the disorders. But if

618
00:56:24.239 --> 00:56:32.519
you go back to the first two
decades of the twentieth century, there were

619
00:56:32.639 --> 00:56:37.199
elaborate descriptions of different kinds of fevers. You know, there was this kind

620
00:56:37.239 --> 00:56:42.639
of a fever disorder and that kind
of a fever disorder, and it's because

621
00:56:42.639 --> 00:56:47.760
they didn't understand the underlying biology that
was giving rise to the fevers. And

622
00:56:47.800 --> 00:56:53.960
he was likening that to where psychiatry
is today. That the biomarkers and the

623
00:56:54.000 --> 00:57:00.920
neurophysiology and general physiology that results in
things that we identify as patterns of a

624
00:57:01.000 --> 00:57:06.039
disorder, it's really at a primitive
state. That's interesting, I mean,

625
00:57:06.159 --> 00:57:09.239
is that kind of an arena that
because I know you also you also mentor

626
00:57:09.239 --> 00:57:13.400
a lot of folks coming into the
into the field and is this is this

627
00:57:13.440 --> 00:57:15.679
also an area I guess, Like, I think that's a fascinating question to

628
00:57:15.760 --> 00:57:21.079
kind of think about, Like do
we see any shifts like this in psychiatric

629
00:57:21.119 --> 00:57:23.360
training that are trying to find either
I don't know, if it's more connectivity

630
00:57:23.400 --> 00:57:29.840
between you know, neurophysiology and biomarkers
and things like that, you know,

631
00:57:30.280 --> 00:57:31.320
or I guess, or maybe the
other question is like what is what is

632
00:57:31.360 --> 00:57:37.280
your hope to kind of then help
move forward psychiatry thinking to either include some

633
00:57:37.360 --> 00:57:40.280
of these frameworks or deeper frameworks,
like what might it look like? I

634
00:57:40.280 --> 00:57:44.159
guess, because I don't even know, right, I mean, I'm imagining

635
00:57:44.199 --> 00:57:46.280
going back to Freud's couch and psychoanalysis
to start, and then coming forward to

636
00:57:46.360 --> 00:57:49.639
still talking about that, and then
getting some meds as part of that.

637
00:57:49.800 --> 00:57:52.760
You can't get pretcribed cocaine anymore,
you know, but probably for the best,

638
00:57:52.400 --> 00:57:57.880
you know. Yes, an interesting
question about that of like where where

639
00:57:57.880 --> 00:58:00.440
where are we I guess, you
know, if we're in a less kind

640
00:58:00.440 --> 00:58:04.760
of evolved in medical state in this
perspective, like what where could we go?

641
00:58:04.800 --> 00:58:07.400
I guess. I'm curious, like, is it kind of more like

642
00:58:07.440 --> 00:58:08.960
threads in the brain to read the
neurology of what's happening, or like,

643
00:58:09.000 --> 00:58:12.559
what might that look like in your
in your view, well, I think

644
00:58:12.599 --> 00:58:16.360
that there. I think again,
your question is broad and there's several important

645
00:58:16.400 --> 00:58:24.119
different threads in it. One is, yes, there's been an increased medicalization

646
00:58:24.480 --> 00:58:32.119
of psychiatry, which has its benefits
and its disadvantages. Its benefits are that

647
00:58:32.480 --> 00:58:39.639
as the understanding of the brain advances, people who are in training in psychiatry

648
00:58:39.840 --> 00:58:46.519
are learning more about that. What's
bad is they're doing it at the expense

649
00:58:46.760 --> 00:58:54.480
of not learning psychotherapy. Current residents
in psychiatry have about twenty five percent of

650
00:58:54.519 --> 00:59:01.480
the training in psychotherapy that I had, and I became a psychoanalyst because in

651
00:59:01.519 --> 00:59:12.800
those days that was the most advanced
level of psychiatric training. But that had

652
00:59:13.519 --> 00:59:17.320
whether or not that should be the
same today as it was then, it

653
00:59:17.400 --> 00:59:23.679
had advantages to me because I really
learned how to listen, and learning to

654
00:59:23.840 --> 00:59:29.639
listen is such an important part of
all medical practice, you know, at

655
00:59:29.679 --> 00:59:34.159
the bedside manner, whereas and today
it's very hard to find a physician,

656
00:59:34.239 --> 00:59:39.360
forget about the chiatry, who will
spend forty five minutes with you taking a

657
00:59:39.400 --> 00:59:45.239
careful history and listening and going down
those rabbit holes where they're a question.

658
00:59:45.039 --> 00:59:50.880
It will be much closer to you
know, maybe putting a stethoscope on your

659
00:59:51.000 --> 00:59:55.079
shirt and you know, and not
even feeling your abdomen or looking in your

660
00:59:55.119 --> 01:00:00.960
ears or your mouth and saying,
well, let's go order tests. And

661
01:00:01.360 --> 01:00:07.679
that's also complicated because there are medical
legal reasons for that too. People are

662
01:00:07.679 --> 01:00:14.960
worried about being sued and they want
but it's often not a brain MRI that's

663
01:00:15.039 --> 01:00:22.000
needed. It's actually a sympathetic fear
that can help the person find their way

664
01:00:22.039 --> 01:00:25.039
through the forest they're stuck in at
the moment. And that is an important

665
01:00:25.079 --> 01:00:30.199
part of being a physician and certainly
important part of being a behavioral physician a

666
01:00:30.239 --> 01:00:34.920
psychiatrist. So but you know,
both are happening. The former head of

667
01:00:34.920 --> 01:00:40.519
the National Studentmental Health was a big
advocate for changing the nosology a diagnosis,

668
01:00:40.599 --> 01:00:47.719
to a biologically driven system the problem. And there are some very good researchers

669
01:00:47.760 --> 01:00:54.880
now at leading medical institutions in psychiatry
working on biomarkers, meaning what can we

670
01:00:55.000 --> 01:01:00.960
learn from things that we can test
for biologically that says this person is going

671
01:01:00.000 --> 01:01:05.639
to respond to prozac and this person
is not. They both have symptoms of

672
01:01:05.719 --> 01:01:12.840
depression. What's different in their chemistry, in their circuitry that makes one person

673
01:01:12.960 --> 01:01:17.079
respond and another So that we can
target our medicine to work better and ultimately

674
01:01:17.079 --> 01:01:21.840
so that we can understand what's going
on on a circuit level. You know,

675
01:01:22.199 --> 01:01:25.320
back in the one hundred years ago, it was areas of the brain.

676
01:01:25.440 --> 01:01:30.599
This area is involved with hearing.
In this area is that you know,

677
01:01:30.679 --> 01:01:37.840
a right or left brain with you
know, abstract in verbal things or

678
01:01:37.880 --> 01:01:44.440
with visual things, et cetera.
And the brain has been divided into sort

679
01:01:44.440 --> 01:01:49.079
of gross anatomy, but that's not
really the level in which things happen because

680
01:01:49.079 --> 01:01:53.960
all these parts connect and it's the
circuitary understanding that they're the key. That's

681
01:01:54.000 --> 01:01:57.559
a that's super fascinated I think for
walking through that too, because I think

682
01:01:57.559 --> 01:02:00.960
that that's a such an interesting point
that you know, I get also as

683
01:02:00.000 --> 01:02:05.519
a as a you know, as
a as a corollary that we often see

684
01:02:05.599 --> 01:02:08.360
in business that when we want to
do things like consumer research and understand you

685
01:02:08.360 --> 01:02:13.760
know, human behavior, in human
psychology and cognition, even if it's around

686
01:02:13.760 --> 01:02:16.800
the marketplace too, that there's a
kind of distrust of the ethnographic method,

687
01:02:16.840 --> 01:02:20.400
which you know comes from anthropology because
it takes a long time, because it's

688
01:02:20.480 --> 01:02:24.079
it's disciplined listening, right, and
it's a it's long engagement and sympathetic listening

689
01:02:24.199 --> 01:02:29.199
and kind of getting to know somebody's
worldview through engaging with them, versus like,

690
01:02:29.960 --> 01:02:30.719
you know, on an NPS,
you know, one out of ten

691
01:02:30.760 --> 01:02:35.679
score, how would you rate this
experience? You know, because it's like,

692
01:02:35.719 --> 01:02:37.559
how would you like if your wedding
was then like, oh yeah,

693
01:02:37.599 --> 01:02:38.960
well on a score from one to
ten, how was your wedding? You're

694
01:02:39.000 --> 01:02:43.760
like, uh, you know,
versus like let me, let's talk about

695
01:02:43.800 --> 01:02:45.079
that experience. You know. So
there is that interesting kind of back and

696
01:02:45.079 --> 01:02:49.639
forth as we think about the desire
for data right and and to your point,

697
01:02:49.679 --> 01:02:52.960
I think you also wisely said that
oftentimes, like organizations don't want to

698
01:02:52.960 --> 01:02:54.920
get sued, right, and so
having data saying well, we had this

699
01:02:55.039 --> 01:02:58.440
MRI that pointed this thing out.
Therefore we did the best we could in

700
01:02:58.559 --> 01:03:01.920
terms of having scientific data. Right. So it's actually we face a very

701
01:03:01.920 --> 01:03:07.880
similar challenge in terms of continuing to
promote the efficacy, you know, and

702
01:03:08.000 --> 01:03:13.880
value of sympathetic listening, right of
engaged conversation and getting to know someone and

703
01:03:13.960 --> 01:03:19.000
like listening to their history and their
associations as an important part of the subjective

704
01:03:19.039 --> 01:03:22.719
experience, right, But then also
it makes it adds I think some levels

705
01:03:22.719 --> 01:03:27.079
of important reality to also the objective
experience is weird? Does that that sounds

706
01:03:27.159 --> 01:03:29.360
right? Like? There is an
objective reality that the sky is a certain

707
01:03:29.599 --> 01:03:31.920
color, even though we might perceive
it all a little bit differently different state

708
01:03:31.920 --> 01:03:35.800
of blue right now, But there's
a chemical composition that does up there,

709
01:03:35.840 --> 01:03:37.079
right, And there may be some
chemicals in my brain or my eyes that

710
01:03:37.119 --> 01:03:42.440
make me see a certain shade versus
you. But you know, we can

711
01:03:42.920 --> 01:03:45.239
agree that the sky is blue,
you know, But then you know,

712
01:03:45.000 --> 01:03:49.800
being able to spend time talking about
what the blue sky might mean to somebody

713
01:03:49.920 --> 01:03:52.480
that might shape the way I'm perceiving
the world right now. It's an important

714
01:03:52.480 --> 01:03:55.119
part of what that is like.
So it's never just do I see,

715
01:03:55.559 --> 01:03:58.719
you know, this shade of blue, and you see that shade of blue,

716
01:03:58.719 --> 01:04:00.519
But it's also like, you know, what is what the sky or

717
01:04:00.519 --> 01:04:02.199
the stayer I mean to us in
a certain point. And I always find

718
01:04:02.360 --> 01:04:06.880
find that interesting to kind of,
uh, you know, think about what

719
01:04:06.920 --> 01:04:11.679
does this mean, as we need
in the science advances, as medicine advances,

720
01:04:11.719 --> 01:04:13.960
you know, how do we also
keep the human right, keep the

721
01:04:14.119 --> 01:04:16.559
the We're looking at human behavior to
keep that, keep that human right.

722
01:04:17.000 --> 01:04:19.000
It's one of those that maybe it's
just my just comfort of you know,

723
01:04:19.000 --> 01:04:21.199
I don't I don't. I don't
think we can be but also don't want

724
01:04:21.199 --> 01:04:25.320
to see us all reduced to like
you know, a circuit board, right,

725
01:04:26.760 --> 01:04:28.679
like turn the switch on, turn
that switch off, and then these

726
01:04:28.719 --> 01:04:30.800
genes on, those genes off,
and then you can either make me tall

727
01:04:30.880 --> 01:04:32.320
or shorter or what you know,
whatever it is, will be more likely

728
01:04:32.400 --> 01:04:38.000
to go be a policeman versus anthropologist
or something. But you know, there's

729
01:04:38.039 --> 01:04:40.000
there's more see that, there's more
to the box, I guess than that.

730
01:04:40.000 --> 01:04:43.719
But I think it's an interesting question
in this regardoons. So I'm getting

731
01:04:43.760 --> 01:04:47.239
us off into philosophy here, but
you know, I think there's good he

732
01:04:47.320 --> 01:04:49.760
is good. You know, yeah, that's some good good overlap in our

733
01:04:49.800 --> 01:04:54.320
thinking process. But I appreciate the
conversation so far, and I think just

734
01:04:54.360 --> 01:04:57.320
as as a kind of a wrap
wrap up point. You know, so

735
01:04:57.440 --> 01:05:01.639
you mentioned that there's you know,
sub tooth thousand certified forensic psychiatrists. But

736
01:05:01.639 --> 01:05:04.159
I think it's really it seems a
really interesting field. So I'd be curious

737
01:05:04.159 --> 01:05:06.280
just to hear a little bit about, you know, your organization and how

738
01:05:06.280 --> 01:05:09.639
you help folks kind of move into
that into that field, right so that

739
01:05:09.639 --> 01:05:11.920
they now I want to be a
psychiarist. But I didn't even realize that

740
01:05:11.960 --> 01:05:14.400
this is a career option. Some
folks might be saying, Hey, this

741
01:05:14.480 --> 01:05:16.039
sex year, this will be a
very cool blend that I'd love to see.

742
01:05:16.039 --> 01:05:18.840
So how does that work with your
with your organization? Yeah, thank

743
01:05:18.840 --> 01:05:25.559
you for asking that, because I'd
like to say a little bit about how

744
01:05:25.599 --> 01:05:28.960
we are organizing and what we do
and what my role is in that.

745
01:05:30.320 --> 01:05:34.679
We are one of as far as
I know, only two forensic psychiatric groups

746
01:05:34.719 --> 01:05:42.159
in the country, and I'm not
sure the ultimate the ultimate reasons for that,

747
01:05:42.280 --> 01:05:49.119
but they're Originally medicine general practice was
solo practice. It's all been consolidated

748
01:05:49.199 --> 01:05:56.800
now into group practice, multi specialty
practice, insurance company owned practices, hospital

749
01:05:56.840 --> 01:06:02.800
owned practices. That's been an evolution
of medical economics over of the course of

750
01:06:02.800 --> 01:06:14.079
my career. A last bastion of
solo practice for many years was clinical psychiatric

751
01:06:14.199 --> 01:06:20.519
and psychological practice. You know what's
now done by quote unquote therapists and even

752
01:06:20.679 --> 01:06:27.800
psychiatrists have moved into working in larger
groups, being employees and larger groups.

753
01:06:29.239 --> 01:06:35.920
Forensic psychiatry is a much younger subspecialty. The boards were only offered in the

754
01:06:36.000 --> 01:06:44.400
late nineties in forensic psychiatry, and
so those were psychiatrists who were interested in

755
01:06:44.440 --> 01:06:48.639
the interface of law and psychiatry and
got and made that gift, such as

756
01:06:48.639 --> 01:06:59.800
myself me, And so that was
a solo practice, solo practitioner profession and

757
01:07:00.280 --> 01:07:08.400
I just had the you know,
I don't know, perhaps entrepreneurial thought.

758
01:07:08.719 --> 01:07:15.199
When I was I had been on
the volunteer faculty at University California, San

759
01:07:15.199 --> 01:07:25.079
Francisco and now more recently also Stanford, and I was working teaching the fellows

760
01:07:25.119 --> 01:07:30.199
taking this one year fellowship in forensic
psychiatry. And I realized that I was,

761
01:07:30.440 --> 01:07:36.639
at that time, probably twenty five
years into my clinical practice. My

762
01:07:38.239 --> 01:07:43.519
brain was already slowing down, and
I had these really bright, really interesting

763
01:07:43.880 --> 01:07:49.000
young fellows, and I had an
abundance of referral So I thought, well,

764
01:07:49.039 --> 01:07:55.599
why not form a group with them
and share that? And I didn't

765
01:07:55.679 --> 01:08:00.519
at any to any extent then know
what I know now, which is excuse

766
01:08:00.599 --> 01:08:08.119
me. It's very difficult to get
started in forensic psychiatry. You don't generally

767
01:08:08.159 --> 01:08:15.319
yet have gray hair. The attorneys
are looking for gravitas in their experts.

768
01:08:15.760 --> 01:08:23.479
It's because of the theatrics as well
as whatever that may represent, and so

769
01:08:24.640 --> 01:08:29.319
by what has evolved now into actually
a whole system in our group. We

770
01:08:30.680 --> 01:08:34.119
have built our group to about thirty
two experts now, ten of whom are

771
01:08:34.279 --> 01:08:43.560
forensic neuropsychologists who do all the testing, and twenty two our Boorchuer divide forensic

772
01:08:43.560 --> 01:08:50.079
psychiatrists. But we build it primarily
by finding really the very best graduates of

773
01:08:50.199 --> 01:08:56.319
fellowships. You know, we have
a relationship with the directors of those fellowships,

774
01:08:56.880 --> 01:09:03.079
and they come in and very well
trained. They have been psychiatrists usually

775
01:09:03.079 --> 01:09:10.840
for five years or more, and
they've seen patients, but they have this

776
01:09:11.000 --> 01:09:14.960
threshold to cross in getting retained.
If they just go out on their own,

777
01:09:15.600 --> 01:09:17.640
it's very difficult because in the initial
interview, the attorney can say,

778
01:09:17.640 --> 01:09:24.960
well, how many cases have you
seen and been an expert in where a

779
01:09:25.079 --> 01:09:31.159
woman has been harassed by her boss
and sexually propositioned, and their answer is

780
01:09:31.199 --> 01:09:36.880
invariably no, not that that's a
rare phenomena, but they haven't been practicing

781
01:09:36.960 --> 01:09:45.039
long enough to acquire this. So
in addition to mentoring, just because I've

782
01:09:45.079 --> 01:09:49.439
been down the road more than they
have, I often get on that phone

783
01:09:49.479 --> 01:09:57.680
call with them in the background and
can convey to the attorney that they're a

784
01:09:57.720 --> 01:10:00.439
member of a team. In the
team, we have, you know,

785
01:10:00.800 --> 01:10:08.640
hundreds of years of experience and sub
sub specialty experts. We have you know,

786
01:10:10.159 --> 01:10:14.720
now half a dozen people who also
have boards in psychiatry, forensic psychiatry

787
01:10:14.760 --> 01:10:19.079
and child adolescents psychiatry, or boards
in substance abuse and addiction medicine, or

788
01:10:19.159 --> 01:10:24.840
boards in neuropsychiatry, whatever. So
if they have any questions, there are

789
01:10:24.840 --> 01:10:28.720
people they can call upon. I'll
be in the background, and that usually

790
01:10:28.720 --> 01:10:34.680
reassures I didn't know it would,
but it usually reassures the attorney that they

791
01:10:34.680 --> 01:10:40.439
don't just have this young wet behind
the ear as a person they're relying on.

792
01:10:41.079 --> 01:10:46.319
But they come with a lot of
backing up, and that's been very

793
01:10:46.359 --> 01:10:49.880
helpful because then they get the two
or three cases under their belt and they're

794
01:10:49.880 --> 01:10:54.560
off to the rage. Just because
they're smart and they're great communicators. Our

795
01:10:55.479 --> 01:11:00.399
profession, what we sell is the
ability to communicate. You know, it's

796
01:11:00.439 --> 01:11:04.960
important to have the training, but
you know, a CV curriculum VITI that

797
01:11:05.079 --> 01:11:11.079
looks like an old fashioned telephone book
doesn't do it if you're a pompous jerk

798
01:11:11.560 --> 01:11:14.880
when you're communicating with a jury or
whatever. You need to be able to

799
01:11:15.560 --> 01:11:20.039
use simple, understandable language and talk
about abstract phenomena in concrete ways and lots

800
01:11:20.079 --> 01:11:26.960
of stuff like that. Because where
a team, we have the ability to

801
01:11:27.079 --> 01:11:32.359
handle multi plaintiff cases, and that's
been really evolving as especialty for our group.

802
01:11:33.079 --> 01:11:42.079
So we get retained when there's been
a say, an industrial explosion,

803
01:11:42.279 --> 01:11:48.319
and there are many plaintiffs who have
been in subsequent lawsuits. We get retained

804
01:11:48.399 --> 01:11:53.800
if there's been someone's quote unquote gone
postal and there's been a shooting in a

805
01:11:53.840 --> 01:12:00.439
workplace and people have been killed and
other people traumatized by this, and there's

806
01:12:00.520 --> 01:12:08.840
civil litigation after that, so that
say, the widows and family members children

807
01:12:08.880 --> 01:12:14.680
of the decedents may be suing for
a loss of spoused, loss of parent,

808
01:12:14.880 --> 01:12:20.199
emotional damages, and others who were
in the scene of the of the

809
01:12:20.279 --> 01:12:27.800
accident or of the shooting are also
suing for the emotional damages and being traumatized

810
01:12:27.800 --> 01:12:34.680
by that, and that's a whole
different I call that. It's like it's

811
01:12:35.000 --> 01:12:40.399
the logistics are very complicated. It's
like turning you know, an aircraft carrier.

812
01:12:40.600 --> 01:12:44.199
You don't do it on a dime. There are so many moving parts.

813
01:12:44.239 --> 01:12:46.359
But we've been down that road a
lot of times and have a fair

814
01:12:46.359 --> 01:12:50.520
amount of experience and it so that's
a whole other interesting dimension that has evolved

815
01:12:51.560 --> 01:12:58.960
accidentally from becoming a group. Are
also this I'm very proud of exceedingly diverse,

816
01:13:00.159 --> 01:13:05.199
not just gender but ethnic race.
And we didn't in any way consciously

817
01:13:05.239 --> 01:13:10.760
build that, but it came from
looking for really good people and they brought

818
01:13:10.760 --> 01:13:16.039
with them different ethnicities. So I
really, really I'm proud of that aspect

819
01:13:16.119 --> 01:13:19.119
of our group. Yeah, that's
great. I think that that's such a

820
01:13:19.159 --> 01:13:26.800
fascinating arena. And I appreciate the
idea too that a lot of this work

821
01:13:27.199 --> 01:13:31.279
on one level is translation, right, It's like translating the requirements to legal

822
01:13:31.279 --> 01:13:33.800
worlds, but how to communicate that
and be a good communicator, And it's

823
01:13:33.800 --> 01:13:36.439
like it's a fundamental skill that the
world needs. And then it's like then

824
01:13:36.479 --> 01:13:42.079
you add the extra layer there in
terms of subspecialties in psychiatry and legal practice,

825
01:13:42.119 --> 01:13:45.119
and it's like you got to you
gotta a wizbang combo there right that

826
01:13:45.119 --> 01:13:48.760
that we need in terms of how
do we actually bring those conversations to bear.

827
01:13:48.840 --> 01:13:53.680
So really excited and enthused by by
the work and excited to have folks

828
01:13:53.760 --> 01:13:56.520
check out the organization and all the
other good stuff that you are doing.

829
01:13:56.520 --> 01:13:59.159
And of course I doubt people are
listening to this to necessarily saying, hey,

830
01:13:59.199 --> 01:14:01.560
I need to go find one,
go find a forensic psychiatist. But

831
01:14:01.640 --> 01:14:05.359
if you need to, we got
the guy for you right here, sir,

832
01:14:05.439 --> 01:14:08.000
that could be the way. But
thank you so much for joining me

833
01:14:08.039 --> 01:14:10.520
on the podcast today, Mark and
sharing your thoughts has been been a great

834
01:14:10.520 --> 01:14:14.479
conversation. It's a pleasure, Adam. I've really enjoyed talking with you.

835
01:14:14.600 --> 01:14:17.359
And that's a wrap on today's deep
dive into the nuances and intricacies of forensic

836
01:14:17.359 --> 01:14:20.560
psychiatry with doctor Mark Levy. A
huge thank you once again to Mark.

837
01:14:20.600 --> 01:14:23.880
We're joining me on the podcast.
You know, it's clear there's a whole

838
01:14:23.880 --> 01:14:27.560
world where the mind meets the law, and that's filled with stories of challenge

839
01:14:27.600 --> 01:14:30.039
and transformation and the pursuit of truth. And whether you're thinking about the ethics

840
01:14:30.039 --> 01:14:34.640
of medicalization, what it means to
work as or with a forensic psychiatrist or

841
01:14:34.640 --> 01:14:39.560
expert in the courtroom, or you're
just simply intrigued by the human stories that

842
01:14:39.600 --> 01:14:43.359
are behind the cases. Remember the
importance of communication and the role that we

843
01:14:43.439 --> 01:14:46.000
all play in understanding each other's realities. As always, I'd love to hear

844
01:14:46.039 --> 01:14:49.159
from you your thoughts, comments,
questions from this episodes. You can get

845
01:14:49.159 --> 01:14:53.600
in touch on social media or over
email. And thank you as always for

846
01:14:53.640 --> 01:14:57.279
tuning in and until next time,
keep thinking deeply and look beyond the surface.

847
01:14:57.720 --> 01:15:00.760
I'm Adam Gamwell and this is this
Anthra life. We'll see you next time.