The Journal of Psychiatry & Law

A conceptual frame of reference is presented to explain why individuals with clear legal bases for filing civil lawsuits choose not to sue. Eight dimensions are posited within this explanatory framework: psychological contexts, clarity of negligence, physical impairment, sense of injustice, legal history, risks–benefits, time and energy, and inertia. These dimensions are examined in four case studies. The role of workers compensation in deterring such litigation is also explored.

Factitious disorder by proxy (also referred to as Munchausen's syndrome by proxy) is a controversial diagnosis that generally involves the induction, falsification or exaggeration of medical symptoms in a victim by a caretaker. The syndrome is recognized as generally, but not exclusively, involving a mother and child. The author suggests that syndromatic terms for this type of child abuse are outmoded and should be abandoned in favor of an exact description of the suspected abusive behaviors in child dependency courts. Should there be a finding of abuse, the offending parent should be evaluated in terms of the major dynamics of her medically abusive behavior. Such evaluations should be utilized in the dispositional phase of child abuse proceedings and not employed for the proof of the matter.

This is the first of two articles for mandated child maltreatment reporters on issues surrounding the definitions, origins, and effects of child maltreatment. The present article considers physical abuse, sexual abuse, and neglect (abuse by omission). The second article considers emotional abuse and secondary child abuse, which occurs when caretakers allow children to observe other family members engaging in aggressive behavior.

In this clinical article, the author examines the effects of the widely abused drug phencyclidine (PCP, “wet”) in relation to claims of intoxication, diminished capacity or insanity in criminal cases. It is widely accepted that voluntary intoxication is not a defense to a crime, although some states permit such evidence in determining mens rea. Involuntary or pathological intoxication is a permissible defense. A third scenario, persistent or “settled” insanity due to drug effect, is a defense in some jurisdictions. The author notes the prevalence of violent crimes committed under the influence of PCP or in persons with PCP-induced psychosis. The paper presents several cases from the author's practice in which PCP intoxication and/or psychosis was raised as an issue at trial. There is a discussion of how persistent PCP psychosis is different from intoxication and why it might be used in the service of an insanity defense.