Dr. Usman Amin Hotiana
Associate Professor at Mayo Hospital Lahore was invited for a guest lecture at the Institute of Psychiatry, BBH Rawalpindi.
Forensic Psychiatry & Law
A Tale of Torrid Love Affair
Introduction
The Institute of Psychiatry, Benazir Bhutto Hospital, hosted a seminar on the theme, “Forensic Psychiatry & Law: A Tale of Torrid Love Affair”. Dr. Usman Hotiana, who is an Assistant Professor of Psychiatry at King Edward University & Mayo Hospital delivered the seminar. Professor Malik H. Mubbashar, Founder of the Institute of Psychiatry and Professor Emeritus, was the chief guest at the occasion. In attendance were consultants, residents & house officers from psychiatry and neurology, and psychologists.
Opening
Prof. Fareed A. Minhas, Professor of Psychiatry and Head of the Institute, started the proceedings by introducing the subject and the respected speaker. He highlighted that these academic endeavors are in line with his vision as the Dean of the Faculty of Psychiatry. Providing such opportunities to younger, talented supervisors and to replicate these across the country is the concrete fulfillment of his vision. He said that it honors us to have Prof. Mubbashar, the father of the institute, in our midst. He spoke about the concerns of senior psychiatrists that a lot of work gets done in mental health, but there’s a gap in the next generation taking that work. With this realization we give the opportunities, he said, to the budding psychiatrists so we can give them timely guidance regarding the ditches and peaks in mental health.
My responsibility extends across 350 trainees and forty-eight supervisors across the country, he said. Prof. Fareed narrated the struggles of Prof. Mubbashar and others in trying to get the mental health ordinance to be implemented in Pakistan. He lamented the failures in that path. He spoke about the talent he noted in Dr. Usman Hotiana to take the struggle forward.
Introduction
Dr. Usman Hotiana began his talk by extending his gratitude to Prof. Fareed for the opportunity. Dr. Usman opened the floor for an interactive session from the very beginning. He began the discussion speaking of the affair between law and psychiatry being symbolized in the brain with the amygdala having a unique quality for assessing the feelings of the others allowing us to empathize, the frontal cortex; its orbital part allows for an understanding of right and wrong, and the jury lives in the anterior cingulate gyrus, which does the risk assessment.
Brain's courtroom | |
|---|---|
| Amygdala | Recognition of feelings of others |
| Orbitofrontal Cortex | Right versus wrong |
| Anterior cingulate | Risk assessment |
| For details on these functions, check out the module on frontal lobe | |
He alluded to the importance of having an insight into the historical evolution of a subject to comprehend it. He spoke about Dr. Hodgkin who was called as an expert witness, with King George III, which was an unprecedented event, made a historical statement saying:
"I can tell as I deal with people of unsound mind all the time." When asked the limits of human responsibility, he responded, "I’m sorry that it is outside of my field."
Forensic means going to the public; forensic psychiatry has involved all of us; taking consents, authoring a report, etc. It is an area that no medical practitioner can avoid and augment his point he quoted Isaac Ray as having prophesied said that "in the future times all the hospitals will be fated into forensic hospitals." True enough, Dr. Usman said, if you look around the world with the threat of lawsuits hanging over overall medical practitioners, the prophecy has found fulfillment.
He traced the history and origin of forensic psychiatry to antiquity, even though the appellation may not have been born reminding the attendees of the trial of Socrates, and for corrupting the youth he had to take the poison. He mentioned that in the year 1738; the king had some problems, and nobody could help him. So, they called Francis Willis, who saw the florid psychosis in the king. Frances would gather all the mentally ill on a farmhouse and coerce them into heavy physical work.
This resulted in the king getting relieved. And Frances thus guaranteed himself a regular paycheck from the royalty. In the year 1800, they passed the Criminal Lunacy Act. A person called Hadfield in the middle of a theatrical drama stood up and started firing shots. He was apprehended, this led to the development of the criminal lunacy act, and they cast him into a facility specially developed for the mentally ill. In 1843, Daniel McNaughton’s attempt at assassinating the Prime Minister (accidentally killing his secretary) marked the birth of forensic psychiatry. He attempted the feat because of paranoia; however, the public was incensed at his acquittal. In 1984 in Revisiting McNaughton the law was further revised considering John Hinckley’s attempt at assassinating President Ronald Reagan driven by his erotomania towards Jodie Foster.
He quoted one of the earlier presidents of the American Academy of Psychiatry and Law, Alan Stone, as saying that psychiatrists need to not comment on who is insane and not and that there is a possibility that a psychiatrist may be biased towards the patient or the government. His student-developed appropriate guidelines for psychiatrists in forensic situations.
He warned that in this torrid affair, as in any other relationship between foreigners, we need a common ground of compromised language for the legal experts and the psychiatrists to effectively communicate. They need to understand some aspects of our area of expertise, and we must understand theirs.
He then spoke about several cases of serial killers and their mental illnesses. He spoke about Ted Kaczynski, a graduate of Harvard with an IQ of 160-170 and possible autistic traits. Ted, aka Unabomber, severely against modern technology and mailed homemade bombs killing three people and injuring several others, was pursued by the FBI and over fifty million dollars were spent in trying to apprehend him. He spoke about a woman who killed 5 of her children in 1992 because of a psychotic episode, and her case led to a revision in the definition of insanity. He alluded to the case of the infamous Javed Iqbal killing one hundred kids, at which Prof. Mubbashar reminisced about having seen him. The youngest serial killer was Amarjeet, 8 years of age, who killed three infants before being apprehended.
Dr. Usman Hotiana reminisced about how his own inclinations towards forensic psychiatry developed with Prof. Haroon’s talk about his achievements in this area. He spoke about his efforts in collaboration with Barrister Sarah Bilal for the legal rights of the mentally ill.
He reminded the audience that the focus in the court is something vastly different. They scrutinize no one more than a forensic psychiatrist. Even if we eradicate the violence caused by the mentally ill, contrary to the popular perception he said, it will only reduce 3-4% of the total violence in the society.
Psychiatry, he said, now takes the help of statistics for forensic cases in particular; actuarial assessment tools have been developed in which risk factors will lead to a few questions and then responses to those will determine the assessment of the patient via a computer program. He alluded to how a psychopathy checklist that would give a score of 5 in the general population gives an average score of 22 in jails. Dr. Usman also reminded the attendees that no psychiatrist can give an opinion on a patient that he had been previously seeing.
Prof. Fareed concluded the session by speaking about his experiences in court. He says it is remarkably interesting to evaluate what goes through the mind of the judge. We ensure that we make a minimum statement (as opposed to foreign countries), he said, so as not to confuse the legal team with medical jargon which may complicate matters further for them. The system doesn’t exist in our setup for the legal experts to have a foundational understanding of our field. He reminisced about the challenges and threats that are associated with this field. With that, he thanked Dr. Usman for an informative talk and invited Prof. Mubbashar for the concluding address. Prof. Fareed recommended that Dr. Usman Hotiana should work towards gathering a group of academicians that can further the case of forensic psychiatry from all over the country, like how child psychiatry was brought up.
Prof. Mubbashar lamented how people don’t value history and commended Dr. Usman Hotiana for doing a wonderful job in that area. However, he said, the area that should also have been covered is what to do under the current circumstances. He remembered the liaison psychiatry cases during his career and how that had led to four attempts on his life because of these cases. He appreciated Prof. Fareed’s support through some of those. He appreciated Prof. Fareed in the way he developed the institute with no infrastructural support from WHO, contrary to the understanding of some groups. He concluded with a poetic reminder to the younger audience to keep the flame burning, realizing that the carriers of the lamps will inevitably pass on.
Report by Dr. Yousaf Raza & photography by Dr. Omar Murtaza, Post-Graduate Residents at the Institute of Psychiatry, Benazir Bhutto Hospital.
Malik Hussain Mubbashar
Professor Emeritus and founder of the Institute of Psychiatry
He lamented how people don’t value history and commended Dr. Usman Hotiana for doing a wonderful job in that area. He recommended the lecture should have shed light on the current strategies.
Professor Farid Aslam Minhas
Hosting the Lecture at the Institute of Psychiatry
He concluded the session by speaking about his experiences in court. He says it is remarkably interesting to evaluate what goes through the mind of the judge. “We must ensure making a minimum statement to avoid confusing the legal team with medical jargon.” Reminiscing about the challenges and threats that are associated with this field, he thanked Dr. Usman recommended him working towards gathering academicians who can further the case of forensic psychiatry in Pakistan.
Guest Presenter
September 6, 2016
Associate Professor
Usman Amin Hotiana
MBBS, FCPS (Psych)
Department of Academic Psychiatry.
King Edward Medical University & Mayo Hospital Lahore
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