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CPA Briefings
The California Psychological Association
Clinical
Theory, Research, and Practice: II
II. The Study of Evil and Depravity:
An Interview with Michael Welner, M.D.
by
Megan Sullaway, Ph.D.
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MS:
What kind of patients do you work with, or, if this is too broad
a question, what kind of patients most interest you?
MW:
As far as my treatment practice: those who want to get well,
and those I feel I can help, given the skills that I can best
apply in my patient care.
As far as
forensic cases, I apply the same philosophy. My approach is
very investigative, intensively hand-on, but very clinically
rooted. I'm a behavioral scientist first and second, and investigator
third. Sure, I have picked up a lot of law along the way, but
I prefer to the leave the law to the lawyers. I always advise
students that it's hard enough just to keep up with psychiatry.
At this
stage in my career, I prefer to get involved in cases in which
there are unanswered questions that leave me feeling that if
I don't probe and uncover, no one else will. I really love the
intellectual-investigative interface, particularly when it involves
multiple disciplines, like pathology, toxicology, and criminalistics,
and general medicine. Basically, the cutting edge. And so, not
surprisingly, I find myself retained in death penalty cases,
involuntary intoxication questions, disputed confessions, retardation
issues, ADA, hate crimes, terrorism, and interesting civil competency
matters.
In a way,
that parallels my enthusiasm for the Depravity Scale effort.
The potential for controversy, confronting closed-minded colleagues,
and even the terrible despair from exposure inherent in defining
evil in the courts provide a real obstacle - so I have come
to appreciate it as worth the challenge of trying to do right
- with help from colleagues.
Given the
emotional pressures of operating in the adversarial system,
I need to feel that I am assisting the side, in criminal or
civil matters, that is right. In fact, I try to warn attorneys
even before I get involved in a case that if they don't believe
in scientific merit of their case, they should hire someone
else. If, for example, someone has a legitimate mental health
issue, I find fleshing that vulnerability out to be quite a
meaningful responsibility, as a defense witness. But I want
no part of someone whose mental and psychological issues are
legally irrelevant, even if they are medically real. And I have
no qualms about working for the prosecution - if the psychological
evidence does not pass muster.
MS:
Have you ever interviewed or examined a prisoner
who genuinely frightened you? If so, what was it about that
person that was particularly frightening?
MW:
I have. A few. What one quickly learns is that most prisoners
are not fearsome - they are merely people who made pathetic
choices. They, like any other people, viscerally connect with
your sincerity towards them, and respond to you if you are not
judgmental and professional. Even the psychopaths, even the
violent.
I remember
treating one unassuming but paranoid and antisocial prisoner
whom I sensed, on that one day, was poised to attack me, and
I was alone in a large interview room. I felt incredibly relieved
to have ended the interview and to have spirited him back to
a more safe environment before he could act. I felt even more
of a sense of sobriety when I learned that he sexually assaulted
a student only three weeks later, the same student I had warned
about her attire around the inmates.
And then, there are the paranoid and violent inmates I have,
as a corrections psychiatrist, confronted about forcing them
to take medicines.
In my experience,
the greatest risks come from those prisoners who carry out instrumental
aggression, that a doctor engages in a personal way. If you
don't make it personal, they won't take it personal. And I learned
that in working the ER, from drug seeking patients - long before
I got into forensics.
Certain
psychotic prisoners can be more scary if they are hallucinating
and you are in the line of fire. In a treatment and assessment
setting, in my experience, delusions won't get you whacked unless
you have developed a deep relationship with the patient, which
is more a predicament for the outpatient setting -- where transference
evolves into a forty headed hydra, even when the patient is
not psychotic.
MS:
How did you become interested in forensic psychiatry?
MW:
Serendipity. During my psychiatry residency at Beth Israel,
I had just wanted to take care of patients in the outpatient
setting. But in a lecture one day, I watched a videotaped interview
of a defendant claiming insanity. The ensuing class discussion
about his criminal responsibility left me so intellectually
juiced up that I quickly concluded that I needed to be doing
this every day. I haven't been disappointed; in fact, I think
I am genetically and temperamentally suited to be doing this
work. So, I stumbled into my calling. That's especially surprising
when you consider that in my free time, I will not watch a gory
movie, and will not read mystery thrillers, etc.
But the
mental calisthenics of thinking through problems on the various
psychiatry/ psychology/ law/ investigative levels is very satisfying.
I am surprised and grateful that I actually get paid to do it.
MS:
Do you think there is an emotional "price" to be paid
for doing this kind of work? Do you think a forensic psychiatrist
or psychologist should have particular characteristics or skill
sets to excel at this work?
MW: You
bet there is an emotional price. This is very, very hard work.
In any discipline, and that includes as a clinical psychiatrist/psychologist,
or a therapist, you can get away with suboptimal work. In medicine,
you learn it takes a lot to kill someone, believe it or not.
And often, no one will ever know. The patient on the operating
table doesn't see who sweats in the operative field.
In forensics, if you do substandard work, someone is watching
at all times. Accountability is the process itself. It attaches
an enormous burden, not only for competence, but for intellectual
and professional rigor. That said, the most important skills
for a psychiatrist or psychologist is to be a strong psychiatrist
or psychologist.
If you are
competitive, you respond to this. But in any athletic endeavor,
one's competitive drive is always challenged after awhile. When
you lose the will to stay up all night to dig through medical
records for the second time looking for a clue you know is there,
with no compensation, it's time to do something else.
The stories,
too, are so dreary. One must guard against yielding to the forces
of despair and cynicism.
r, for identifying
with the stories that we immerse ourselves in, that can eclipse
our appropriate sense of Ozzie and Harriet normality. It's easy
to distance television and movies as fantasy, but when one is
forced to rationally untangle death and destruction, time after
time, it numbs the senses like a traumatic event. What a danger
to risk trivializing the evil that we, as professionals, are
mandated to do anything but ignore.
Reprinted
from:
CPA
Briefings
The California Psychological Association
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