How does one go about evaluating criminal defendants in order to determine their state of mind, dangerousness, or competency, or-in the case of a sexual murderer-to simply understand the criminal act? In Chapter 1, the Cain-Abel murder case was used to illustrate the distinctions between a clinical assessment (as routinely performed in hospitals, mental health centers, and private offices) and a forensic evaluation. In this chapter, a more detailed comparison of the two types of evaluations will be presented as this is critical in understanding the sexual murderer.
Mental health practitioners such as psychiatrists and psychologists are generally taught to evaluate their patients by first interviewing them, perhaps utilizing additional psychological or neurodiagnostic testing, and sometimes requesting supplementary interviews with family members. Hospital and school records or perhaps reports from prior therapists are also frequently reviewed. Following the evaluation, a diagnosis is made and a treatment plan developed. Clinicians are taught to listen to their patients. If a patient says that he feels depressed, anxious, or agitated, or that he is has suicidal thoughts, the mental health professional usually accepts the patient's symptom description as valid unless there is a good reason not to believe him. Lying, deceit, exaggeration, and malingering do occur and may be explored in clinical practice, but generally the main emphasis is on diagnosis and treatment.