Articles

Toronto Star, “Is Russell Williams Still Grasping for Control?” By Jim Rankin, April 18, 2010

[Background: Col. Russell Williams in the Canadian Forces and a former Base Commander is accused in a string of murders, rapes, now 82 counts of breaking and entering and an unfolding story of escalating violent behavior. Toronto Star reporter Jim Rankin interviewed Stephen Raffle, M.D., and other forensic mental health experts to gain insight into Col. Williams' recent behavior in jail: a hunger strike, what appear to be suicide attempts and their meaning]

“…the major thing is loss of control and trying to remain in control of an out-of-control situation,” says Raffle, who has interviewed serial killers and gives expert testimony in criminal cases…Hypothetically, assuming that he did these things, there may be a sense of shame, and he sees (suicide) as an honourable way out,” says Raffle. “I think this is a man trying to regain control. It’s his only possible escape at this point….”   

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A hostile work environment arises when a worker experiences physical threats, unwelcome sexual advances, humiliation, or other unspecified egregious behavior on the job. The effect of the experience must affect the employee’s psychological well-being and the way in which the employee works. If the employee does not experience the “hostile” acts as abusive, then the conduct has not actually altered the work environment and the workplace is not considered hostile for legal purposes, i.e., no offense has occurred. Thus, a particular act may cause one person to experience a hostile work environment because a particular conduct has altered the work environment for that person whereas another person may remain unfazed.

The definition of unwelcomeness I use is “behavior not incited or solicited.” This definition is directly linked to attitudes and expectations by the aggrieved party and becomes part of the basis of my evaluation. If I am evaluating an employee for fitness for duty and he/she is said by others to have engaged in threatening, bullying, sexual touching, or other unwanted or unsolicited behavior, then I may have a person who is creating a potentially hostile work environment. If the examinee denies the behavior, then I must examine him/her for underlying psychopathology to assess the level of reality he/she is operating in (reality testing). The person may feel justified in the behavior due to a belief the object of attention wants it, e.g. a sexual relationship. Also I must consider the idiosyncrasy of the person I’m examining, especially in civil litigation, but also in fitness for duty exams. For example, one person may claim a hostile work environment and harassment because a co-worker chews and cracks gum. Such hypersensitivity doesn’t create an abusive work environment. To determine “idiosyncrasy,” I try to apply a “reasonable person” test to the alleged wrongdoing and complaint.

One “take away” from all of these parameters and perspectives is that too often employers who seek a fitness-for-duty exam for an employee vis-a-vis the employee’s ability to work, fail to consider that his/her identified behavior may be creating a hostile work environment for co-workers or supervisors.

There are distinctions to be drawn when evaluating individuals for occupational problems, psychopathology, disability, creation of a hostile work environment, workplace stress, retaliation, discrimination, risk of violence, and fitness for duty.

The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is more than 900 pages long and describes in detail most of the psychiatric disorders which exist and their characteristics. It describes psychopathology, which is to say psychiatric malfunctioning. The DSM also categorizes “other conditions or problems which may be the focus of clinical attention,” but which is not the result of a mental disorder,

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Presentation by Stephen M. Raffle, M.D.
Fitness for Duty Psychiatric Examinations
Kaiser Permanente
Employee/Labor Relations Consultants and Disability Managers for Northern California
December 11, 2009

Thank you for inviting me to present on the psychiatric aspects of fitness for duty exams in conjunction with your in house attorneys and the guest attorney from the firm of ReedSmith.  [Transcription of Presentation Follows]…

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What are the indicators which may point to a caregiver raiding a patient’s assets?  As a psychiatric consultant to Hospice by the Bay, I have been asked this question.  This involves assessing elder abuse, Alzheimer’s, other dementias, “senility,” mental confusion, drug effects, and indicators of undue influence and theft.  Exploitation can occur

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Most lay people, and for that matter quite a few physicians, don’t think about psychiatrists having expertise in other areas of medicine.

In my own practice, I was not only Assistant Clinical Professor of Psychiatry at UCSF Medical School but also Assistant Clinical Professor or Orthopedic Surgery albeit as a psychiatrist. There is considerable overlap in the different subspecialties and often the mental and physical converge in the same patient. From the beginning of my practice, I had an abiding interest in neurological processes and psychiatric dysfunction. One of my earliest consulting positions was to the Department of Neurological Rehabilitation at Herrick Hospital in Berkeley, California (5 years), and even after I stopped those consultations, I continued to treat brain damaged patients who suffered from concurrent psychiatric difficulties.

Both clinical experience and systematic investigations have shown that psychiatric problems can magnify or distort the presentation of neurological injury. For that reason, the evaluation of brain injury is best carried out by a team of experts, including a neurosurgeon or neurologist, neuropsychologist (for testing) and a psychiatrist who is adept at evaluating brain injuries and psychopathology.

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Reasons the Treating Psychotherapist
Should Not Be the Expert Witness

In civil cases where emotional distress is alleged, it often occurs that the plaintiff’s attorney designates the treater as his expert. Usually the argument is that the plaintiff’s own therapist has spent many more hours with the plaintiff than the defense expert and therefore “knows” the plaintiff better.  The treater often agrees with this reasoning.

I believe a number of fallacies exist in this conclusion:

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All psychiatric reports evaluate something, but not always the same thing. For example, eligibility for benefits, or fitness to do a job (e.g., in HR arenas, as well as wrongful termination and discrimination lawsuits). To make sense of the report, the reader must determine what is being evaluated and how it is being done. Psychiatric reports are not created equal. To be meaningful, the diagnoses and conclusions in a psychiatric report must be supported by data contained in the report.

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My teacher and mentor, Dr. Bernard Diamond, pondered the question about the role of the psychiatric expert and other experts in the courtroom. My first public presentation was to the American Criminology Society on this topic, and it has continued to occupy my attention to the present. I believe the courtroom is a special place with special rules that must be understood in order for the most effective presentation of the clinical data to occur. The process is adversarial, which is generally contrary to the experience of clinicians or academicians. Clinicians are used to being trusted and believed without having to explain in detail the basis for their opinions. The courtroom is different; there must be a sound scientific basis for the expression of an opinion (the Daubert or Kelly-Fry cases, for example) and most clinicians are not used to having to defend their opinions in this fashion.

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