Dr. Renee Sorrentino expressed the feelings evoked by her first day of travel as a forensic psychiatrist fellow to evaluate a child murderer. From my vantage point as her supervisor, Dr. Sorrentino’s experience raises three academic issues: 1) the transition from the role of psychiatric healer to forensic evaluator; 2) coping with feelings when trainees first evaluate murderers; and 3) opportunities to mentor while traveling.
Fellows in forensic psychiatry experience a major transition from being psychiatric healers to forensic psychiatric evaluators. Unlike the treating psychiatrist, the forensic evaluator does not take the evaluee’s statements at face value. Instead, the forensic evaluator must maintain a high degree of skepticism. Santayana observed that, "Skepticism is the chastity of the intellect, and it is shameful to surrender it too soon" (George Santayana, www.quotationspage.com). The forensic psychiatrist must always consider the possibility of malingering. For example, a criminal defendant, such as Dr. Sorrentino’s child-murderer, could fake insanity to avoid the possibility of a death penalty. The forensic psychiatric examiner must consequently gather extensive collateral data to corroborate what the defendant reports.
The new fellow in forensic psychiatry must learn that she is serving justice rather than the best interest of the evaluee. Physicians are taught above all to do no harm. However, an evaluation by a forensic psychiatrist may debunk a malingered insanity defense which results in an execution. The forensic psychiatrist is guided by different ethical guidelines, the ethics of truth required to serve justice.
Dr. Sorrentino’s essay illustrates the fact that fellows often do not contemporaneously share their full emotional distress with their supervisor. It is easy for experienced forensic psychiatrists to forget the novice’s intense countertransference feelings when she first sits with a mother who has murdered her children. Dr. Sorrentino experienced "suffocating sadness" and "exhaustion" in the interview. Society expects mothers to always behave in a loving and protective way toward their children. Murdering mothers can be seen as monsters. On the other hand, the fledgling forensic psychiatrist may develop strong empathic feelings upon hearing a murderer’s early life traumas. A forensic fellow’s ability to prevent her feelings from interfering in an evaluation is enhanced by a supervised opportunity to process her feelings.
Dr. Sorrentino wrote about a day of travel with her fellowship director. Travel days provide unusual opportunities for mentoring. Informal talk about career aspirations and personal struggles may occur while on an airplane. In this case, I had the opportunity to model interviewing a murderer and gathering information from her spouse. Dr. Sorrentino also had the chance to participate in a meeting between the retaining attorneys and me. Although it did not occur in this case, a forensic psychiatrist may also demonstrate how to resist efforts by attorneys to improperly alter a forensic opinion. A day of mentoring is always a day of learning for the supervisor.
Dr. Sorrentino is affiliated with Case Western Reserve University, Cleveland, OH. Dr. Resnick is affiliated with University Hospitals of Cleveland, Cleveland, OH.