Philosophy

Forensic Psychiatry...
My Personal Philosophy

...psychiatry has changed its image from an analytic cult to arguably the most intellectual and scientific medical specialty. 
 

To paraphrase Freud, Dr. Sostowski believes that the primary task of the psychiatrist is to make the distinction between “a psychiatric disorder and normal human unhappiness.”

His colleagues describe him as exhibiting “the 5 Cs of competency, candor, compassion, clarity and credibility.”

An attorney at a national firm said that “Dr. Sostowski treats everyone with the same respect whether you are the managing partner or happen to be on the office cleaning staff. Once he is retained, he will do everything possible to make your job easier. I was pleasantly surprised when he volunteered to do an examination at 6am because the plaintiff had to catch a plane later that day. Don’t get me wrong. Although, he is flexible and accommodating, he is not one to be bullied. I’ve seen him get tough when it is called for.”

Dr. Sostowski believes that the best preparation for excellence in forensic work is excellence in clinical work. Forensic psychiatrists frequently forget that those interview skills and powers of observation, developed over years of clinical work, are also useful in the forensic arena.

When performing a forensic evaluation, he pays close attention to his interaction with the interviewee. He notes the thoughts and feelings stirred up in him as well as his impact on the litigant. Dr. Sostowski takes this same approach when interacting with attorneys, the judge and the jury. “During depositions and court testimony, I pay close attention to what has just been said, what is being said at this very moment and what I anticipate is about to be said.” Dr. Sostowski believes that this is the reason why several attorneys have told him that he was “a quick read” of their strategy.

His clinical experience has made him effective in the diagnosis of Post Traumatic Stress Disorder (PTSD) which is usually an issue in personal injury cases. He believes that PTSD is diagnosed all too frequently in the forensic arena especially by the plaintiff’s psychiatric expert. According to Dr. Sostowski, “the DSM-IV has limitations in the diagnosis of PTSD which is based mostly on the endorsement of symptoms by the plaintiff. It is a diagnosis with built in causation. The best way to even the playing field is healthy skepticism, a thorough interview, staying current with the literature and knowing more about the presentation of PTSD than your adversary can learn from textbooks and the internet. Ask him to elaborate on his symptoms. You may be surprised when his response is shock!”

Dr. Sostowski believes that the diagnosis of malingering must also be given serious consideration in every forensic examination. The malingerer is consciously exaggerating or downplaying symptoms, omitting key facts or outright lying, all for the purpose of clear secondary gain. Since the label of malingering is essentially “character assassination”, the psychiatrist must be prepared to provide extensive documentation to support his opinion. Malingering must be differentiated from Somatoform, Factitious, and Conversion Disorders which are legitimate psychiatric diagnoses.

The forensic expert should never forget that “normal human unhappiness” is not the same as a documented psychiatric disorder. The former is part of day to day life of humankind and is not compensable. On the other hand, the person who has sustained emotional damages warrants compensation. Dr. Sostowski says that “I have found that attorneys have a tendency to equate the two. The psychiatric expert must not allow himself to be pushed into agreeing with this position. One way to avoid this trap is through the process of empathy. I ask myself, if I was the litigant, would I experience my damages as an inevitable life lesson or as the result of negligence? I believe that, ultimately, this approach is good for both the plaintiff and the defendant.”