Thursday, October 29, 2009

What I Learned Part 1

Here's a brief summary of tidbits from the first day of the American
Academy of Psychiatry and Law conference.

First, there was an interesting keynote by Dr. Pat Recupero regarding
how to incorporate questions about the use of the Internet into the
mental status examination and the ethics of googling patients. (Shrink
Rap reader?)

The Indiana v Edwards case is a popular topic for presentation.
Defendants who represent themselves at trial are more likely to be
convicted of misdemeanors than felonies. Lots of discussion about how
pro se competence should be assessed and what the standard should be.

Got to meet and listen to Dr. Steve Morse, doing some of the most
fascinating research in forensic neuroscience. He stated functional
MRI will likely never be determinative of any legal issue. Favorite
quote: "Brains don't kill people, people kill people." Followed by:
"The only thing we know for sure about the mind and the brain is that
when the brain is dead, the mind is gone."

Six Federal jurisdictions have case law to bar third party observers
(ie lawyers) from forensic evaluations.

There are still people writing books about ritual cult abuse. They are
still not acknowledging that some claims may not be true, not even
after multimillion dollar malpractice actions for implantation of
false memories and exoneration of alleged perpetrators.

There was a presentation about expert witnesses' transference
reactions to attorneys and defendants. I think this is a pretty broad
stretch of the term.

Interesting historical overview of multiple personality disorder. The
patient Sybil had her sessions recorded. Her psychiatrist, Dr. Wilbur,
can be heard invoking and assigning names to her alters. The patient
Eve, Chris Sizemore, later wrote an autobiography repudiating her
diagnosis. Fifty-seven percent of audience (forensic psychiatrists)
did not believe in the disorder. Fifteen percent of surveyed general
psychiatrists think dissociative identity disorder should be removed
from the DSM. There was discussion of the role of the media and the
book Courage to Heal in precipitating the DID epidemic. DID experts
themselves disagree about the literal reality of satanic ritual abuse.
Some say this is a metaphor for severe psychological trauma. The FBI
division for offenses against children has never found evidence of
such cults.

Burgus v Braun is a landmark case for anyone working with trauma
patients. It resulted in a 10.3 million dollar settlement against
therapists for malpractice and Dr. Braun was expelled from the APA.


moviedoc said...

Did anyone challenge Recupero for her repeated mislabeling of practice Web sites as "advertising?"

"Transference reaction" is redundant at best. The reactions may be real. Calling it "transference" invokes a psychoanalytic treatment concept that has no place or relevance in a forensic evaluation.

Nice summary for those of us who couldn't make it to the mtg! Keep up the good work.

Dinah said...

Are we more chipper today?

Anonymous said...

Interesting about Dr. Wilbur and Sybil. I remember reading, about 3or 4 years back, that one day Sybil saw a covering psychoanalyst while the doctor was away. She told this covering doctor, "Dr. Wilbur says I should call myself 'Peggy' when I'm feeling this way. That sort of skews the whole presentation, doesn't it?

Anonymous said...

As someone with DDNOS (call it "DID lite") I can say that dissociation is real and distressing, and that learning about the diagnosis allowed me to make sense of some confusing and distressing experiences well prior to the dx.

This is not to say that DID cannot be an iatrogenic effect of treatment. I think it can. (I'm also appalled at some of the message/support boards for DID, to be frank.) But I strongly suspect it comes from making a less severe traumatic spectrum disorder worse. For what it takes to cause DID, you cannot cause that in someone with no trauma history, not in the typical psychotherapeutic context.

The real difficulty may lie in recognizing the less severe disorders. If trauma disorders do fall on a spectrum, one would expect more severe diagnoses to be rarer. Yet I would bet that DID is diagnosed more often than DDNOS. Heck, even PTSD is often misdiagnosed as something else.

Sarebear said...

Sybil really said that to the covering doc?

That's just wrong, of Dr. Wilbur, to have done that, if that's what he did.

I've disassociated (is that the word?) and there are instances when I was being hit that I cannot remember what was happening during - I remember the before and after but not the during.

There's also a wierd episode from earlier in my marriage, a Thanksgiving at my in-laws house, and I, well, there was no . . . . . I. From what I can remember. I was a person with no I, just wandering around aimlessly but bothered like that was something faintly tugging at the back of this non-self somewhere . . .. vision settled on a cup and I woke up from this wierd state I was in by, er, borrowing the will of the cup, the purpose of it, which was to get back to the Thanksgiving table, and sit down.

It sort of snapped into place whatever that botherdness was that was taking up my brain and identity and was keeping the I, the Me, out.

It was Wierd with a capital W.

My psychologist says I ws dissociated (sp?). Anyway. It was VERY not something I EVER want to experience again, and for the life of me I can't remember what triggered it, nor the moments just before I went into that state.

Oh, and not that I want to prove or any proof that satanic cults exist, but once in high school, I had a friend who said she had gotten tangled up with some people in one, and this put the fear of God in me because I had been told if you ever get a hint of that, that people, satanic cult people, go after associates of associates of associates of etc. ad nauseum, and to not associate with anyone that you even think has any involvement like that.

So, being a teenager not knowing what to do, I mean, do I just cruelly cut off friendship with my friend based on something she may have made up to sound, er, bad-ass, or what do I do, I called my Bishop (leader of our congregation) and set an appt. to talk to him.

His counsel was to stay friends with her at school, but to not do things with her outside of that, which was pretty much how our friendship was already; so things were find and I didn't do anything stupid and my friend never said anything like that again, altho she also said she was singer Bryan Adams' cousin, or something.

So perhaps she had a problem with grandiose lying, or perhaps it was true, who knows. She struck me as the troubled type, which is why I didn't want to just dump her (as if I had that many friends myself).