In insanity cases, leave decision in juries' hands
STEPHEN BERGMAN (“The farce of dueling psychiatrists,’’ Op-ed, July 13) asserts that testimony by mental health professionals to determine legal insanity can be reduced to farce. Despite testimony in the “Clark Rockefeller’’ case that Dr. Bergman considers flawed, legitimate differences of opinion occur frequently. Juries have proved capable of deliberating and arriving at just decisions in such cases. As Bergman points out, cases involving the relationship of mental illness to legal concepts such as insanity are complex and require careful assessment by forensic experts. A mental illness diagnosis may be vague, or even irrelevant to a legal concept such as insanity.
Even in more concrete situations, such as the collapse of a bridge, structural engineers may differ regarding negligence. The jury’s job is to listen to controversial testimony and, after thorough deliberation, to reach a fair decision. Bergman’s suggestion that a panel of experts make the decision on insanity removes a significant function of the judicial system.
While some might argue that the use of such a panel could reduce farce and embarrassment, it would also remove from the jury the right and responsibility to fully hear all the evidence through direct and cross-examination of the forensic mental health experts. The trade-off would not serve the cause of justice.
PAUL D. LIPSITT
Marion
The writer is a diplomate in forensic psychology with the American Board of Professional Psychology.
When diagnoses are picked for their monetary value
DR. STEPHEN Bergman's op-ed "The farce of dueling psychiatrists" has implications that go beyond the courtroom and spill over into everyday practice. Therapists often select the diagnosis that suits them whether it is in a courtroom or their own offices. And what suits them is often related to what pays the most.Many diagnoses from the "Diagnostic and Statistical Manual of Mental Disorders" are either not reimbursed by third-party insurance or are reimbursed at a lower level than conditions that have a clear biological base. For example, a marital problem is not necessarily a mental health problem at all. Most parity laws that mandate treating mental health on a par with other medical conditions will cover more sessions for schizophrenia or major depression, for example, than for an adjustment disorder. Just about all of us are adjusting to something. Are all these adjustments true disorders?
Yet many psychotherapists believe and often state that the "Diagnostic and Statistical Manual" is a crock. They therefore see no problem in selecting the diagnosis that will pay the most or longer. This up-coding is openly discussed and often condoned on therapists' social networks. But the consequences of patients having an erroneous diagnosis or the costs to society are rarely considered.
JOHN A. RIOLO
Hilton Head Island, S.C.
The writer is a retired mental health practitioner.
The same-sex cure
DR. STEPHEN Bergman (Op-ed, July 13) writes that the "Diagnostic and Statistical Manual of Mental Disorders" "is flawed, one example being its listing 'homosexuality' as a psychiatric disease long after society had not." Which society might that be and where?While the American Psychiatric Association's removal of homosexuality as a mental disorder in 1973 was groundbreaking, the Defense of Marriage Act was passed by Congress in 1996 (with huge majorities in both houses), and I have stopped counting how many states in just the past few years have passed constitutional amendments outlawing same-sex marriage. This will change only when American society accepts homosexuality as normal.
DANIEL GADISH
Boston
