Recently, I received a phone call from a local homicide detective. He was investigating the death of a child, and the suspect in the case was a 19-year-old woman who was also a caretaker. She had a history of psychiatric problems, and family members implicated her in the death of another child. The detective expressed concern about a potential future risk to other children in the home, and he wanted help with his investigation.
While speaking to a detective can be a routine part of forensic work, this is usually done in the context of a larger pretrial evaluation after someone is charged with a crime. Psychiatry residents looking for a career in forensic psychiatry, as well as some members of the general public, sometimes think of forensic work as being a CSI-type investigator who helps the police catch the "bad guy." In fact, consultation to law enforcement is a tricky business fraught with ethical implications.
Let’s consider what this detective wanted. The first issue he wanted help with involved the design of interrogation questions. He wanted to know what he should ask this young woman to trigger a "tell," or in other words, a reaction indicative of guilt. His second question was to ask for help eliciting information that could be grounds for an involuntary psychiatric admission – an opportunity for "further study" or information-gathering, potentially for incriminating purposes.
There are several ethical imperatives for both general and forensic psychiatrists that apply to this situation. Honesty, nonmalfeasance, and respect for persons would always require a psychiatrist to disclose the purpose and limits of questioning, and to refrain from aiding or participating in deceptive practices. Deception is a standard practice in an interrogation and is legally allowed for police investigators. Identifying points of psychological weakness to elicit a confession, true or otherwise, would violate the principle of nonmalfeasance. The forensic psychiatrist’s duty to strive for objectivity would be violated by accepting the investigator’s implication of guilt. Finally, general medical ethics dictates that a physician should practice competently within the limits of one’s training and experience. Neither general nor forensic training prepares a practitioner to be a qualified lie detector.
Once the investigator failed to get the response he had hoped for to either question, he fell back to the last resort of a risk to public safety. "Think of the children," he told me, thus giving me a firsthand taste of another interrogation tactic – an emotional appeal for empathy and justice. This guy was good.
Psychiatry as a profession bears a duty to exercise police powers in order to protect public safety under certain well-circumscribed conditions. Professionals who consult with law enforcement take the position that this duty must supersede the imperatives I’ve just outlined. My personal view is that this line of justification has been extended far enough; psychiatry is now at risk of being coopted and corrupted in the name of safety and national security. A psychiatrist’s skills should not be usurped and turned against those they were designed to protect and treat.
Dr. Hanson is a forensic psychiatrist and coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work" (Baltimore: The Johns Hopkins University Press, 2011). The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson's employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.