Transformation: Embracing Change — Psychiatry & Behavioral Science, January 2016

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AAFS President Weedn’s theme for this coming year is Transformation: Embracing Change. This is particularly relevant for psychiatry and behavioral science and presents a challenge that is, perhaps, unique to the behavioral sciences when compared to some of the other “hard sciences” involved in the AAFS. To borrow from the terminology of Dr. Henry Nasrallah, a neurobiology and schizophrenia researcher, psychiatry has moved over the years from “Bedlam to biomarkers.” What was once considered demonic possession or bad “bile” is now understood to be the result of neurocircuitry and molecular neurobiology.

However, the complex nature of human emotions, decision-making, and behaviors is still far from easy categorization. Much of our modern understanding is just now coming to light. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has recently been published. Even this standard in mental health diagnosis has been subject to controversy. The National Institute for Mental Health expressed a standpoint that they would move away from the “consensus-based” and symptom-based diagnostic criteria of the DSM to an etiological- and genetic-based framework in their Research Domain Criterias. The approach has its detractors as well as its supporters. The move to evidence-based medicine in the last decade has challenged psychiatry, as with other fields of medicine.

If the foundations of our understanding of behavioral science have been shaken, how much more so the application of this understanding to forensic mental health endeavors. Numerous articles have been published in an attempt to establish standardization of protocols in forensic mental health assessment using empirically demonstrated assessment instruments, ethical guidelines, and evolving judicial demands. Various organizations, including the Academy, have led this path of change in publishing standard guidelines with recommendations for evidence-based practice. “Reliability” and “best scientific evidence” are the catchwords for the future of the forensic sciences, including forensic behavioral science. An abundance of research, particularly with regard to suicide and violence risk, challenges the still-existent, idiosyncratic inconsistencies in clinical practice.

Forensic psychology, psychiatry, and other behavioral science continues to expand its empirical evidence base. Publications that review relevant evidence are proliferating, as are texts which compile these findings, such as Dr. Richard Rosner’s (AAFS Past President and forensic psychiatry pioneer), Principles and Practice of Forensic Psychiatry. The members of our section are contributing to this change as well by presenting new data in our 2016 Annual Scientific Meeting Scientific Sessions. Topics such as proposed models for assessing sadistic offending, evolving ethics of capital punishment, new genetic links to behavior, DSM-5 challenges for forensic science, new perspectives on the role of forensic science and sexual disorders, and assessing treatment efficacy for probation and prison treatment programs will be explored. As individual clinicians, ultimately, we are tasked with incorporating this growing evidence into our practices for the benefit of our patients, society, and our field.