Why should I learn about forensic psychiatry? I plan to have an outpatient practice." For more than 20 years I have heard this or similar statements expressed by psychiatry residents or clinicians who are just beginning their practice. In the past, it was quite possible that a clinician would never come into contact with the legal system. However, in recent times the fields of medicine and law have become more intertwined, especially in the area of addiction psychiatry. Clinicians who deny this fact are at best ill prepared to assist the patient and at worst personally vulnerable when—not if—legal issues emerge in their practices.
This problem is one of the major general themes repeatedly expressed by Lawrence B. Erlich in A Textbook of Forensic Addiction Medicine and Psychiatry. Erlich, who is certified in both addiction and forensic psychiatry, emphasizes that the rules of conduct in the legal arena are dissimilar to those in medicine. As an example, he compares the difference between "truth" in the legal sense and the definition of truth embodied in medicine. In law, truth is what is logical, or what "makes sense." However, in medicine something that seems to make sense in reality must be proven through a well-designed study before it can be accepted as truth. Throughout his book, Erlich points out how these differences in the meaning of truth represent limitations of each of these disciplines. He defines the roles of the physician, the attorney, and the court in a forensic psychiatric case.
Even more formidable are the challenges that members of each profession confront when presented with a forensic addiction psychiatric case. Much has been written about the issues and questions that present themselves in the field of forensic addiction psychiatry. However, such information is published in numerous resources, which often is burdensome for professionals who use this material in their work.
With this awareness, Erlich has attempted to collect "all of the information relevant to addiction psychiatry and medicine in one place." In the space of 25 chapters, he outlines the dilemmas that face both the legal profession and the medical profession as they confront the issues in a psychiatric addiction case. He concisely and clearly lays a foundation grounded on the definitions of terms commonly used in both disciplines. He then gives a brief historical perspective on the development of each field before addressing, in individual chapters, specific problems that are commonly faced by the forensic psychiatrist as well as options that must be considered as one develops a solution to the problem. The material he uses to illustrate the problems and solutions is often presented in the form of composite patient material.
Overall, Erlich has written a physician-friendly textbook that addresses the challenges facing those who practice forensic addiction psychiatry. I found his chapters on basic legal terms, being an expert witness, the drug-free workplace, and drug courts to be most informative. With its ample references, this book is a good resource text. I recommend it especially for residents and physicians who practice in the area of addiction psychiatry.
