The Journal of Psychiatry & Law

Elevated levels of depression and anxiety have consistently been found to be prevalent among law students. Various explanations have been offered to account for these findings, with many commentators pointing to specific features of legal education as causative factors. Law students are confronted with an educational environment that poses many threats to their self-esteem. Responses to this situation have taken many forms; some of these adaptations have been identified as obsessive, paranoid, schizoid, hysterical, and acting out.

An understanding of the critical role of self-esteem in psychological development has been the focus of the work of Heinz Kohut. Applying his ideas to the experience of law students has highlighted their struggle with narcissistic aspirations as well as their efforts to develop a professional sense of self. His constructs of grandiose self and idealized parental imago are not only helpful in illuminating the experiences of law students, but have broad implications for the policies and structures of legal education.

Many of the key concepts in the ongoing dialogue between legal and mental-health professionals have become accepted over the years, while each side continues to define them differently without making explicit the significant differences in definition. Although the differences in meaning are generally clear to their respective advocates, they are often obscure to the decision-makers who are called upon to arbitrate between the two sides. The author discusses a number of such hidden agendas and argues that they need to be brought into the open so that all the issues can be discussed directly.

An analysis of the Veterans Administration interpretation that certain types of alcoholism constitute “willful misconduct” and the opinion of the U.S. Supreme Court in Traynor upholding that position reveals weaknesses in both. The VA's position was based on data accumulated nearly 50 years ago and is inconsistent with the position of the majority of medical and psychiatric practitioners today. The Court consciously chose to ignore the vast amount of evidence before it that argues in favor of the “disease” concept of alcoholism. The struggle between these two opposing ideologies can be resolved only through an act of Congress defining with specificity the critical terms in dispute.

Homosexuals have been excluded from entry into the United States since 1917. The issue of an individual's sexual orientation may also arise in the context of naturalization proceedings. This article examines the statutory and judicial development of these laws and the conflict that exists between their enforcement and current medical and psychological knowledge regarding homosexuality. The author concludes with a proposal for the elimination of the exclusion provision and the establishment of a “uniform rule of naturalization” that does not seek to judge private sexual behavior between consenting adults.

This study examines the admission of emergency certified patients to Chicago's state mental hospitals and the process by which patients decide to sign a voluntary admission form. Involuntary commitment is rarely used to admit Chicago's state mental patients. Patients, staff and court personnel negotiate with a common interest in avoiding commitment court.

Hospital staff use three different strategies to convince emergency certified patients to admit themselves voluntarily and avoid involuntary commitment: persuasion/coercion, bartering and stalling. Similar strategies are employed to discourage voluntary patients’ requests for release. Hospital staff in Chicago are disinclined to commit patients because they feel pressured to discharge the majority of patients as quickly as possible to make room for a steady flow of new admissions. Workers manage their caseload by choosing the most expedient form of admission, which is to obtain their patients’ signatures on a voluntary admission form. In order to accomplish this task, however, hospital staff sometimes circumvent legal standards of voluntariness in the admission process.

This study was aimed at implementing a multiaxial diagnostic system developed for violent delinquent adolescents (VDAs) on a sample of 100 subjects. The results revealed that the most prevalent psychiatric diagnoses were conduct disorder, substance use disorder, specific developmental disorders, and personality disorders. There was a high prevalence of severity of psychosocial stressors, levels of poor and very poor adaptive functioning, low IQ, mental illness and criminality in the family, and a high level of chronicity and severity of delinquency. Additionally, the axes with more informational richness were chronicity of delinquency (age at first offense, recidivism, and number of offenses) and diagnosis of conduct disorder, substance use disorders and specific developmental disorders.