Forensic Psychiatry, Neuroscience, and the Law J. Arturo Silva, MD The rise of modern neuroscience is transforming psychiatry and other behavioral sciences. Neuroscientific progress also has had major impact in forensic neuropsychiatric practice, resulting in the increased use of neuroscientific technologies in cases of a psychiatric-legal nature. This article is focused on the impact of neuroscientific progress in forensic psychiatry in relation to criminal law. Also addressed are some emerging questions involving the practice of forensic neuropsychiatry. These questions will be reframed by providing alternative perspectives consistent with the objectives of forensic neuropsychiatric practice. The last part of the article is a discussion of potential developments that may facilitate the integration of neuroscientific knowledge in forensic neuropsychiatric practice. J Am Acad Psychiatry Law 37:489���502, 2009 Forensic neuropsychiatry is an area of forensic psy- chiatry that addresses the relationship between psy- chopathology and neuropathology and its relevance to the law.1,2 Forensic neuropsychiatric practice makes use of multiple approaches, which include neuropsychological testing, neuroscientifically based technologies such as neuroimaging and electroen- cephalography, and the assessment of physical ab- normalities via neurological examination. It may also involve the use of technologies derived from the field of molecular genetics and computer science and both theoretical and practical approaches derived from fields such as developmental psychology and bioin- formatics. Like other neuroscientific fields,3���5 foren- sic neuropsychiatry faces the fundamental challenge of identifying and integrating the complex relations between brain function, mind, behavior, and social phenomena. This challenge was recognized by 19th century scientists and articulated by the psychologist William James in 1890 when he stated: A science of the mind must reduce complexities (of behav- ior) to their elements. A science of the brain must point out the functions of its elements. A science of the relations of the mind and brain must show how the elementary ingre- dients of the former correspond to the elementary functions of the latter [Ref. 6, p 28]. Since the time of William James, the neurosciences have made impressive progress, a record that includes areas of forensic neuropsychiatric importance.3,7 De- spite these advances, there is substantial concern re- garding the relevance of neuroscientific knowledge to forensic psychiatric assessment, both with its the- oretical underpinnings and practical interven- tions.7���14 This article is focused on forensic neuro- psychiatric topics of potential relevance to criminal law. It has three objectives. First, some important concerns will be delineated involving the use of emerging neuroscientific knowledge in forensic neu- ropsychiatric practice. The second objective is to re- frame these concerns from various alternative per- spectives. The last objective is to provide an overview of various factors and emerging developments that may facilitate the integration of neuroscientific knowledge with forensic psychiatry, such as the in- troduction of evidence-based psychiatry, the adop- tion of emerging neuroscientific paradigms, and neu- ropsychiatric training. The Nature of Causation in Forensic Neuropsychiatry Delineating neuropsychiatric factors in forensic psychiatric settings involves a search for both psycho- logical and brain-related deficits. From this perspec- tive, the origin of criminal behavior is viewed as hav- ing a multiplicity of causes. Furthermore, their psychiatric-legal value must ultimately be linked to their potential evidentiary role in aiding the trier of fact in making judgments about such matters as re- Dr. Silva is in Private Practice, San Jose, CA. Address correspondence to: J. Arturo Silva, MD, P.O. Box 20928, San Jose, CA 95160. E-mail: silvapsych@earthlink.net 489 Volume 37, Number 4, 2009 R E G U L A R A R T I C L E

sponsibility and culpability, in accordance with the law. A major reason that modern psychiatry is becom- ing increasingly relevant to criminal law involves the adoption of an integrative spatiotemporal perspec- tive that has influenced the development of psychia- try during the past few decades. The term integrative spatiotemporal perspective refers to the notion sum- marized by the philosopher Johns Searle���s statement to the effect that, ���All events in the real world occur in physical space and time��� (Ref. 5, p 117). An inte- grative spatiotemporal paradigm is a comprehensive way of integrating information involving human be- ings, their environment, and associated components (i.e., the brain, socioeconomic status) and it must acknowledge their existence in space as a function of time. Furthermore, progress in the psychiatric sciences has increasingly relied on two basic interdisciplinary strategies. The first is strongly informed by the bio- logical sciences and includes ideas and methodolo- gies derived from molecular and cell biology, organ- ismic biology, evolutionary biology, as well as from other branches of medicine. This strategy also merges information and paradigms from behavioral sciences that have had a formative role for psychiatry, and include the fields of psychology and anthropology. The second strategy focuses on human organization as a function of time. This approach is exemplified by studies that require behavioral measurements over short periods, as typified by psychotropic drug trials, by the study of human development at the level of individuals and small groups such as the family,16 and by life-span paradigms that focus on cohort stud- ies involving long-term effects due to large-scale events such as the great depression or major natural catastrophes.17 Given the increasing prominence of these ap- proaches in modern psychiatry, normal behaviors and psychiatric disorders and associated physical cor- relates are conceptualized as originating and being located in three-dimensional space, undergoing real- world changes as a function of highly complex time- dependent contexts. Most important is that the resultant perspective views people and their compo- nents as part of an interconnected organizational framework composed of multiple levels of biopsy- chosociocultural organization.1,3,4,15 These developments are giving psychiatry more societal influence but also more scrutiny. Such scru- tiny is particularly focused on forensic psychiatry due to its intrinsic relation with the legal system and its robust orientation to the social world. Given the so- cial dimension of forensic psychiatry, component ar- eas that are likely to experience considerable growth, such as forensic neuropsychiatry,1,2 are even more likely to be scrutinized. An important critique concerning the use of neu- roscientific knowledge in forensic psychiatry focuses on the nature of causation and rationality. For exam- ple, the legal scholar Stephen Morse is under the impression that forensic psychiatric professionals fre- quently confuse neuropsychiatrically based causation with lack of responsibility, an analytical error that results in mistaken impressions concerning culpabil- ity. He calls the resultant mistake ���the fundamental psychological error��� (Ref. 12, p 180). I agree with the view that the fundamental psycho- logical error is an important analytical error that must be addressed by the neuroscientifically in- formed forensic psychiatrist. However, the nature of the causes surrounding the question of responsibility necessitates at the very least that such a concern be viewed from the perspective of both brain and psy- chosocial levels of organization. Therefore, a forensic neuropsychiatric perspective that takes into account the causes of responsibility also requires that those causes be viewed in relation to the general level of the brain, or otherwise, in relation to one or more areas within the brain. At psychosocial levels of organiza- tion, relevant causes of responsibility also should be clarified with the information that has been made available to the forensic psychiatrist. Also, forensic neuropsychiatry must recognize that while its goal should be to delineate as clearly as possible the potentially legally relevant causes of mental dysfunction directly related to cerebral dys- function, our current level of neuropsychiatric knowledge tends to involve relatively indirect infor- mation derived from correlational studies between brain and psychologically defined factors. However, it is also true that despite these limitations, many neuroscientifically oriented fields have already made impressive progress in areas of practical and theoret- ical value for forensic neuropsychiatric practice.18���21 These advances constitute a trend that is likely to gain momentum in the foreseeable future. Given this situation, we will be better served if we address the fundamental psychological error by inquiring under what conditions, if any, localizing a brain abnormal- Forensic Psychiatry, Neuroscience, and the Law 490 The Journal of the American Academy of Psychiatry and the Law