A group of 30 AAPL members, spouses and friends enjoyed spending the first ten days of October in Budapest, Vienna, and Prague. We spent a splendid dinner evening in a round tower room at the Gellert Hotel in Budapest with five Hungarian colleagues led by Dr. Istvan Bitter. In addition to the live music and colorful folk dancing, we enjoyed informal conversation over a superb feast.
Dr. Kroll had lectured earlier in the day to the Psychiatry Department at Budapest University and introduced Dr. Bitter, who opened with a question about American training in forensic psychiatry. Dr. Michals described his experiences running a program and answered several questions. Dr. Kern added an explanation about multiple jurisdictions.
Everyone warmed up for some reflections on managed care, including personal experiences shared by Drs. Dvoskin and Regan along with speculations by Drs. White, Daum and Michals about the impact of managed care on the number of individuals becoming involved in forensic psychiatry. We compared notes on experiences with payment systems and heard that in practice the Hungarian system was government-funded with an apparent agenda to promote privatization — at least until the most recent election. With spouses joining freely, the conversation turned naturally to impressions of both clinical and political import, continuing until we were the only party remaining in the restaurant.
On the bus ride to Vienna there was time for Dr. Young’s talk on marriage tribunals in the Roman Catholic Church and the contributions that forensic psychiatric experts can make to tribunal work. He began with a brief history of the canon law and explained the roles of the various parties in a typical case. The judge acts for the local bishop, working to coordinate all parties in a search for the truth. The petitioner is the party making the request for an annulment, and the respondent, now ex-spouse, may or may not agree and cooperate. There is an instructor or auditor who gathers and presents the data, while the defender of the bond speaks against the requested annulment.
The process first requires a civil divorce and any efforts towards reconciliation that seem appropriate. Parties have full rights to inspect the gathered evidence, including experts’ reports, and to comment on what they see. Various appeals are available, and a case can be reopened should new evidence come to light. Finally, the three principal grounds for an annulment were briefly described: lacking sufficient use of reason, suffering from a grave lack of discretion of judgment concerning essential matrimonial rights and duties, and not being capable of assuming the essential obligations of matrimony. The less commonly used grounds having to do with such issues as fraud, force and error were also covered. Discussion focused on a number of clarifications and some substantive issues such as concern about the expert appearing to facilitate unfairness based on social rank.
The bus ride to Prague featured Dr. John Lion’s talk on a topic that has recently piqued his curiosity, that of happiness. He shared personal experiences that had led him to recognize the importance of considering exploring with patients how they pursue happiness and the results they experience. He gave some examples of answers to these questions from various sources and of how thinking about them made him want to find out more. He suggested that training should include fostering the ability to ask patients about how happily they fare after recovery. He mused on how deeply the struggle for happiness can be veiled and acknowledged the disputes over humor in the therapy literature. Following a case example illustrating several of the points he had raised, Dr. Lion engaged his colleagues in a very lively discussion that clearly served to show how much the subject means to all of us, in contrast to how little it is discussed.
From Prague there was a day’s excursion to Karlsbad, providing time for a third presentation. Dr. Kern shared an engaging civil case from his recent work. It involved an employee who alleged discrimination causing emotional harm. The situation gradually progressed, reaching an acute level after the plaintiff was passed over for a promotion. Matters temporarily seemed to resolve somewhat, then worsened again, and progressed to an impasse after the employee returned from a brief absence due to injuries from an accident. Rather than allowing somewhat for the resulting physical impairments, the employer seemed to make the work even more difficult.
Next, the plaintiff was accused of petty theft and denied it vehemently. Communications between employer and employee went from bad to worse, resulting eventually in termination. The plaintiff’s side called in Dr. Kern. He found the employee significantly anxious and depressed, exquisitely sensitive for cultural reasons to the accusation of stealing. The examinee was also over-controlled in both appearance and affect. The lawyer was particularly interested in knowing why his client was so markedly depressed: was it due to being terminated from employment or to the accusation of theft?
Dr. Kern summarized the results of his evaluation, which did not lead to a clear answer to the lawyer’s question. He recounted puzzling over it with a close collaborator who asked a surprising question: was the examinee in fact guilty of the alleged theft? This struck Dr. Kern as an intriguing issue, the forensic psychiatrist functioning as detective. Although this role might ordinarily be outside the expert’s appropriate scope in a civil case, the issue of guilt or innocence could sometimes have significant impact on the expert’s primary opinion.
Discussion covered further interesting issues. Dr. Chaudhary asked whether the employee’s union had something to contribute to the case, and Dr. Kern’s impression was that little help was expected from the union’s involvement. Dr. Michals stated that judges often ask him about his opinion on plaintiffs’ veracity, and that he typically responds by trying to avoid taking a position. Dr. Kern sagely commented that such judges were trying to get their own job done by the expert. The absence of sufficient information to evaluate veracity was recognized as a problem, with Dr. Daum pointing out that police records might help to decide whether a delusional disorder might be present. Dr. Chaudhary wondered about malingering as a possibility. Further tests were suggested, an MMPI by Dr. Michals and a reading test (especially if an MMPI were to be done) by Dr. Recupero. Further exchanges covered the general value of using the MMPI, the importance of sensitivity to cultural issues in forensic evaulations, and various experiences with different classes of defendants in discrimination cases.
The tradition of quality academic discussion on AAPL trips thus continues, with every expectation that the same will prove true next year in Ireland.