Second, for many patients (though not all), severe suicide risk is a relatively transient condition. That does not mean that most patients can be discharged from the hospital as soon as they say they feel better or show signs of lessened risk. It means that if the psychiatrist, psychologist, other clinician, and treatment team can help such patients survive the days and (often) weeks of acute suicidal danger, and provide good reason to believe that their improvement is stable, they are more likely to return to safe and effective functioning once discharged, and not to relapse (given adequate follow-up treatment and monitoring).
Finally, a word about a common "fix" for lack of psychiatrist access: Primary care physicians often work with nonmedical mental health professionals, such as psychologists and counselors, to try to meet both the medication and psychotherapeutic needs of their patients. Those professional relationships are often useful and important, but it is equally important to point out that the combination of general physician and psychologist or counselor does not equal a competent psychiatrist. Depending on the situation, either or both clinician(s) (the physician and the mental health professional) has/have a duty to reasonably recognize needs for specialty referral when they arise.
The outpatient psychiatrist should have assessed Mr. Perez regularly during treatment, and should have performed regular suicide risk assessments. That deficit led, among other things, to a lack of regularly- and/or frequently scheduled visits which was unacceptable for care of a person with Mr. Perez's known condition, leaving him " alone and without the benefit of a therapeutic relationship with anyone regarding his psychiatric care—all while his psychological status foreseeably deteriorated."
Good discussion of the pros and cons of the two major theories, "innateness" (kids naturally know how to speak) and "behavioralist" (positive reinforcement tells them what's what.) Also discusses the psychological uniqueness of language learning, and relation between child usages and evolution of languages.
Recent publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association (APA) creates an opportunity to remind folks of its "Cautionary Statement for Forensic Use." DSM-5, like its predecessors, was designed and intended for use by clinicians and mental health researchers, not lawyers or courts. Nevertheless, as the APA nomenclature has become standard in U.S. mental health professions, its vocabulary has spread into our news media, social culture, and common conversation. In the process, the words are frequently misused and clinical/scientific intent definitions get lost in the shuffle. Perhaps more important for forensic purposes, the original intent of the DSM is often forgotten, or at least set aside.
There are many different clinical and administrative scenarios that involve assessing the risks associated with potential danger to oneself or others. Many psychiatrists, psychologists, and other clinical evaluators erroneously believe that some rule or law precludes their asking for, or reasonably sharing, risk-related information that can be vital to adequate diagnosis, treatment, protection from self-harm (such as suicide), or reducing danger to others. Further, some evaluators even fail to understand the very basic importance of collateral information in such situations, and make important admission, detention, commitment, discharge, and level-of-care recommendations or decisions without it.
Second (and more broadly important), Pennsylvania's apparent separation of psychiatric/psychological specialists from non-specialists often does not apply in other matters and jurisdictions. As Dr. Zonana points out in his article, a great deal of psychiatric and psychological assessment, diagnosis and treatment is carried out by primary care physicians. In my view – and several courts have held – when a physician represents to a patient that he or she can deal with a psychiatric matter and/or fails to refer the patient to a specialist, the patient is usually entitled to assume that he or she will receive care that meets the relevant psychiatric standard, not some lesser "GP" standard.
Ryan and Richard C.W. Hall recently published a stellar summary and re-examination of the concept of "compensation neurosis." The syndrome refers to psychological interference with assessment and treatment of general medical injury or illness, or to exaggerated Post-Traumatic Stress Disorder (PTSD) or other trauma responses. It involves various aspects of "secondary gain," including symptoms and defenses related to protracted (or simply pending) lawsuits, other litigation, or administrative disability investigations.
Howard Zonana, M.D., Medical Director of the American Academy of Psychiatry and the Law (AAPL), wrote a thought-provoking editorial on "consensual" clinician-patient sex in the January, 2013, issue of the AAPL Newsletter. (I use the term "patient"; some therapists prefer "client." Please don't say "consumer" or "recipient.") His example is narrow (a Pennsylvania case largely limited to general practitioners and decided for Pennsylvania alone), but it brings up at least three important topics: (1) the ethics of such behavior, (2) whether or not it is (or should be) actionable as a tort involving medical negligence (referring to the legal definition of malpractice), and (3) whether or not general practioners who treat psychiatric symptoms and disorders should be held to the same standard of care as mental health specialists.
Following a detailed examination of the basic psychology of human spacing behavior, considers the closely related fields of territorality and crowding and discusses the application of proxemics to social problems (e.g., through environmental psychology).
Lawyers, and some plaintiffs, also know that PTSD is easy to fake. Malingering doesn't always occur, of course, but when it does, it's hard to detect. The PTSD symptoms and diagnostic criteria listed in the American Psychiatric Association's DSM-5 are widely known and notoriously subjective. There are no reliable "tests" for PTSD. Psychological testing instruments that purport to reveal the presence or absence of the diagnosis are predicated on the patient's honesty, and on the premise that the person is seeking treatment, not compensation. Most are simply self-report checklists that easily guide any unscrupulous test-taker to create the result he or she wishes to convey.
The term paper includes a general overview of disability in America; a review of the literature on the psychology of disability, considering the "stages of acceptance" through which the disabled person is said to progress and considering factors involved in the disabled person's adjustment to disability; and a review of the major theories which seek to explain the psychology of people with disability.