171526 AAPL April 2017 Newsletter_rev4.qxp_April 2017 5/3/17 9:45 AM Page 1 AAPL Newsletter American Academy of Psychiatry and the Law April 2017 • Vol. 42, No. 2 vulnerable to its grasp may have per- Forensic Psychiatry Review Course: sonal insecurities, perceived injus- tices, psychological deficits, or a his- October 23-25, 2017 tory of delinquency.3 A study from AAPL 48th Annual Meeting: Boston Children’s Hospital regarding mental health of young Somali October 26-29, 2017 refugees in United States and Canada noted that moderate levels of trauma Hyatt Regency Denver and discrimination are associated with support for both non-violent and at the Colorado Convention Center violent activism, but personal and social factors determine which type is Denver, Colorado chosen by an individual. PTSD symp- toms were associated with openness to illegal and violent activism, possi- bly due to cognitive and behavioral changes. They additionally noted a correlation between support for vio- lent activism with social marginaliza- tion and time on the Internet. Mean- while, post-traumatic growth and social bonds to both North American society and their Somali community were protective.4 How do heightened American immigration concerns affect the prac- tice and role of the forensic consul- tant? Forensic psychiatrists can be involved in an asylum application by providing diagnostic information that may support an applicant’s claims, along with how culture and mental Asylum Evaluations in the Terrorism Era health symptoms may relate to Danielle Kushner MD, Human Rights Committee deficits in credibility or delays in an 5 The global refugee crisis has led to heightened concerns regarding application. With today’s heightened reached the highest level since World radical Islamic terrorism developing concern about terrorists entering the War II, primarily due to the ongoing in the United States. The fight against country, forensic evaluations of asy- Syrian conflict. According to United terrorism has inevitably impinged lum seekers will become more scruti- Nations High Commissioner for upon international human rights, nized and key evaluation topics of Refugees (UNHCR) by the end of demonstrated most recently by malingering and cultural issues will 2015, 65.3 million individuals were Trump’s new Executive Order on become even more crucial. forcibly displaced worldwide as a Immigration.2 Asylum seekers and Research outlines three explanato- result of persecution, conflict, gener- refugees have become doubly victim- ry models for malingering in an eval- alized violence, or human rights vio- ized: persecuted at home and margin- uation context: pathogenic, crimino- lations, 5.8 million more than the pre- alized abroad, as they are increasing- logic, and adaptational. Pathogenic vious year. Of the total number of ly unable to enter safe countries due malingering describes an individual displaced persons in 2015, 21.3 mil- to a variety of restrictive measures. who has genuine psychopathology, lion were refugees and 3.2 million More individuals hold radical but whose symptoms are not entirely were asylum seekers.1 views than are willing to engage in consistent with the malingered diag- Simultaneously, recent domestic violent action. The process of radical- nosis. The criminological model terrorism incidents, such as the Orlan- ization is multi-factorial. For exam- involves those with antisocial tenden- do and San Bernardino attacks, have ple, research has shown that those (continued on page 2) American Academy of Psychiatry and the Law Newsletter April 2017 • 1 171526 AAPL April 2017 Newsletter_rev4.qxp_April 2017 5/3/17 9:45 AM Page 2 American COVER STORY Academy of Asylum Evaluations given cultural barriers for testing and little additional documentation or Psychiatry continued from page 1 contacts. and the Law Culture is another important topic cies for secondary gain, while in the to be addressed in asylum assess- adaptational model, the feigner is try- Editor ments, especially as some researchers ing to increase his or her chances to Susan Hatters Friedman, MD have found DSM 5 diagnoses, such succeed in adversarial circumstances.6 as PTSD, not cross-culturally valid. Associate Editors One of the most prevalent diagnoses Consultants may also be asked to dis- Philip Candilis, MD in asylum applications, PTSD, is par- cuss cultural issues related to the Ryan Hall, MD ticularly susceptible to malingering Stephen Herman, MD applicant’s behavior and treatment. due to the high incidence of comorbid Neil S. Kaye, MD Linguistic translation needs to be symptoms, fewer objective findings, Joseph Simpson, MD, PhD examined closely for euphemisms or and high incidence of secondary gain. Renée Sorrentino, MD mechanisms of collective avoidance. Joel Watts, MD Memory difficulty in trauma is anoth- Yet, other researchers have argued er controversial topic, but research AAPL Photographer that using cultural formulations in continues to grow regarding validity Eugene Lee, MD forensic psychiatry can emphasize of memory in trauma. The dual repre- stereotypes and stigmatization of eth- Former Editors sentation model shows that involun- nic groups.5 Evaluators must remem- Charles Dike, MD, MPH (2008 – 2016) tary memories, such as flashbacks or ber their own objectivity especially in Victoria Harris, MD, MPH (2003-2008) nightmares, occur spontaneously, this heated political climate. Michael A. Norko, MD (1996-2003) while verbally accessible voluntary Robert Miller, MD PhD (1994-1996) Traditional risk assessments for memories are more difficult to Alan R. Felthous, MD (1988-1993) violence, such as the HCR-20 and retrieve.7 As with any challenging Robert M. Wettstein, MD (1983-1988) SAVRY, are appropriate for psychi- diagnosis, additional collateral of pre- Phillip J. Resnick, MD (1979-1983) atric patients, but have not been Loren H. Roth, MD, MPH (1976-1979) morbid functioning, collateral reports, found to be helpful for evaluating or testing data are important to help radicalization. Psychometric scales Officers support the evaluator’s opinion. Yet, and assessment tools currently used President for some asylum seekers, collateral Michael A. Norko, MD information may be non-existent (continued on page 32) President-elect Christopher R. Thompson, MD Vice President Philip J. Candilis, MD CALL FOR AWARD NOMINATIONS Vice President Jagannathan Srinivasaraghavan, MD Secretary Isaac Ray Award Jessica Ferranti, MD Treasurer The Isaac Ray Award, established in 1951, recognizes a person who has made Douglas Mossman, MD outstanding contributions to forensic psychiatry or to the psychiatric aspects Immediate Past President of jurisprudence. It is a joint award of the APA and the American Academy of Emily Keram, MD Psychiatry and the Law that honors Isaac Ray, M.D., one of the original founders and the fourth president of the American Psychiatric Association. The AAPL Newsletter is published by Deadline for Nominations: June 1 AAPL, One Regency Drive, PO Box 30, Bloomfield, CT 06002. Opinions expressed in bylined articles and Manfred S. Guttmacher Award columns in the Newsletter are solely those of the authors and do not neces- The Manfred S. Guttmacher Award, established in 1975, recognizes an sarily represent the official position outstanding contribution to the literature of forensic psychiatry in the form of a of AAPL or Newsletter editors. book, monograph, paper, or other work published or presented at a professional Manuscripts are invited for publication meeting between May 1 and April 30 of the award year cycle. in the Newsletter. They should be sub- Deadline for Nominations: June 1 mitted to the editor via email to [email protected] The Newsletter is published in January (deadline for submission is November 15), April (deadline Febru- Learn more about how to make ary 1), and September (deadline July 1). a nomination at: psychiatry.org/awards www.aapl.org © 2017 AAPL. ALL RIGHTS RESERVED. 2 • April 2017 American Academy of Psychiatry and the Law Newsletter 171526 AAPL April 2017 Newsletter_rev4.qxp_April 2017 5/3/17 9:45 AM Page 3 EDITOR’S COLUMN “The More You Tighten Your Grip… summer, providing possibilities for cross-pollination of ideas, not only The More Star Systems Will Slip with others at the intersection of men- tal health and the law (forensic psy- Through Your Fingers” chologists and attorneys) but also cross-pollination with our internation- Susan Hatters Friedman MD al counterparts. Looking forward to Welcome to to her urn shaped like a large Prozac this, we will read about (and see pho- the April pill (reportedly her favorite posses- tographic evidence of) the recent newsletter. This sion), nothing about Carrie Fisher Asia-Pacific IALMH Chapter meet- year has seen a was conventional. Despite the fraught ing. You will also find ideas for men- lot of changes in relationships with her parents torship in research. An in-depth our world. While throughout her life, she emerged an review of Neurolaw from AAPL’s working over- outspoken, brave, and witty advocate 2016 course and an update from seas, new immi- for mental health. For many, she AAPL’s representative to the APA gration policies humanized mental illness and addic- round out this issue. Hope to see you in the United tion in women, despite facing stigma all at the APA Guttmacher Lecture States are the primary topic people herself. Her story, not just of Axis I next month! have raised with me. I hear frequent disorders, but also of overcoming dif- tales of colleagues rebooking their ficult developmental