The tickle of curiosity. The gasp of discovery. Fingers running across the keyboard.

The tickle of curiosity. The gasp of discovery. Fingers running across a keyboard

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Monday, March 3, 2014

Forensic Psychiatry: Information for Writers An Interview with Olga Miret


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Fiona
Today, I would like to introduce you to Olga Núñez Miret. Olga will you take a moment to tell us about you, explain your fabulous academic background, and what you do for a living?


Olga - 
Thanks so much for having me here as a guest, Fiona. When I was 12 years old or so, I decided I wanted to study Medicine and be a doctor. I went to Medical School at the University of Barcelona (6 years) and obtained a degree that there is called LMS (Licentiate in Medicine and Surgery). I left Barcelona and came to the UK where I carried on my studies to become a psychiatrist. 

I worked as a junior doctor in Psychiatry for a few years and then felt it was time to try something a bit different and went back to University. I studied a BA in American Literature at the University of Sussex (in Brighton). It included a year in the US (I spent it at Mount Holyoke College, a beautiful campus and great courses). I carried on my studies and completed a PhD on American Film (although the title of my PhD is 'The films of David Mamet' the university didn't have a Film Department at the time.)

I went back to work in Psychiatry and got the Membership of the Royal College of Psychiatrists. Whilst working full-time in forensic psychiatry, I became quite interested in the workings of the Criminal Justice System and completed a Masters (MSc) in Criminology and Criminal Justice.I have worked in a variety of specialties in psychiatry: general psychiatry, old-age, substance misuse, but since 2004 I've been working as forensic psychiatrist. I work for the NHS (National Health Service) although I have worked in the private sector in the past.

Fiona - 
...and of course you also write. Your newest book came out in January Escaping Psychiatry. I want to get back to your writing in just a moment. But can you please explain to the readers the difference between forensic psychiatry and forensic psychology?


Olga -
I am a psychiatrist, and we are doctors who then specialize in psychiatry. We have to study medicine first and then spend several years working as psychiatrists. There can be confusion between psychology and psychiatry, although psychologists study psychology, and in England have nothing to do (in general, I know in the US this could change) with prescribing medication or providing specific diagnosis, although they do assessments and provide therapy. As a forensic psychiatrists, our work is not terribly different from other psychiatrists.

Both professions look after people who suffer from mental illnesses. As a forensic psychiatrist most of my cases have been involved with the criminal justice system. They have committed crimes, and in most cases, the courts, instead of sending them to prison, feel that they need to receive treatment in a hospital.

Sometimes we also look after people who have not been charged with any crimes, but are felt to be too risky for standard psychiatric services.

Fiona-
So you're interviewing and making determinations in a hospital setting?

Olga - 
I work in a low-secure unit. Here in the UK (I'm not that familiar with the set-up in the US), we have three types of secure facilities: high (places like Rampton Hospital), medium and low. Normally, if somebody has committed a serious crime, like murder, and it's felt that they might be a serious and immediate risk to others, they would go to High Secure hospital. Once they've received treatment, and it's felt that they are not a major risk to others, they would move to a medium secure facility. Where I work, we aim to discharge people to the community. I mostly work in the hospital setting, but part of our work is also about seeing people in prison to provide reports to the courts, to guide them with regards to the mental health difficulties of prisoners (and help them decide if the prisoner needs to be in a hospital or not).

Fiona - 
In parts of  the US, suicide is considered a criminal act - would people exhibiting suicidal ideation come under your expertise?

Olga - 
They might do. Here suicide is not criminalized, although assisting to suicide is. They would come under our area if they were in prison and are found to be at risk, especially if they required expert treatment. It is more common to see people with suicidal ideation in general psychiatry, but it happens.

Fiona -
Can you give me a general idea of how your diagnosis statistically breakdown? In criminal psych do you see mostly individuals who experience schizophrenia, depressive and anxiety disorders that can be medicated and treated through various therapies or do you find many of your clients to be dealing with personality disorders narcissism, and the like?

Olga - 
In the hospital where I work, our criteria is that people we admit (it's a male only unit) must have a diagnosis of mental illness, not solely personality disorder. The great majority of our patients suffer from psychosis, mostly schizophrenia  (Blog Link) or schizo-affective disorder. We have had some patients diagnosed with bipolar disorder, and some with psychotic depression. (Blog Link) Substance misuse problems are very high within our population. In general, in the prison population, personality disorders, particularly for men antisocial, feature very highly, and one of the problems is how difficult they are to treat. There have been attempts and units specifically created for it (like the DSPD, Dangerous and Severe Personality Disorder unit in Rampton Hospital, where patients would have been diagnosed with at least 2 different types of personality disorders), both in hospitals and prisons, but in general the outcomes aren't very good.

It is a bit of a chicken and an egg situation, as criminality scores highly as one of the criteria for diagnosing somebody with antisocial personality disorder. Psychopathy is not a specific psychiatric diagnosis, but people who score highly in psychopathy ratings (like PCLR, Hare Psychopathy Check List, Revised) are likely to re-offend and be violent again.

Fiona -
Would your training and expertise allow you to be proficient if say if a detective sought you out and said, "We have this terrible case we need to figure out who could be involved in this series of attacks." Could you develop a picture for them like: I think he's uneducated male, about 45 years old, with no familial ties except for a deep and disturbing attachment to his mother...


Olga -
No. We don't really do profiling. We do assessments of risk of the people who are under our care using specific rating scales, but even with that, psychiatrist are only marginally more accurate in assessing risk than other people.There are certain symptoms we know are more likely to result in crimes - command hallucinations, paranoia, and definitely substance use, both drugs and alcohol. As mentioned, somebody who scores highly in psychopathy rating scale is more likely to be violent and aggressive, but these people would be unknown until they get caught.

Fiona - 
Are you ever called into court to explain the psychology of your client and offer expertise as to whether you believe they would be a repeat offender, or escalate in criminal activity?

Olga -
If one of our patients (or somebody we have seen for a report) goes to court, we would provide a report to court. Our area of expertise is mental health, so we would comment on their mental state, on our opinion about their likelihood to respond to treatment, etc. Normally, a probation officer (now called Offender Management Officer) would asses the person and provide a report. They look at their statistics and use a rating system to provide a likelihood of repeated offending. It tends to be fairly accurate.On the other hand we get patients that because they have committed a serious crime and are seen as dangerous, end up detained and with a 'restriction order'. That means that the Ministry of Justice keeps track of them, and they cannot be discharge without their agreement. We are asked to provide reports regarding their response to treatment and likelihood that they might destabilize mentally and be violent again.

Fiona -
Olga, with your background if you wanted to become a profiler could you do that?

Olga - 
I'm not sure there are profilers as such here. With regards to looking into something like forensic psychology, even doing something like a masters in Psychology requires having a degree in psychology and being a member of the Psychological Society.I have worked with forensic psychologists and none of them were profilers either.

Fiona - 
The reason I ask is that I have read books where a detective is frustrated and frightened for his community and has sought out the help of a forensic psychiatrist who has rallied to save the day. Is this possible? Probable? Or would they need to have received specialized training to be effective in helping the law enforcement community.

Olga - 
I don't think what we see on the TV and movies is false. But these would be people who apart from studying psychology or psychiatry would have been specifically trained and would need to have a good understanding of the whole process. It is not part of the standard training. As forensic psychiatrists, we can comment on the mental health of people who are suspected or have committed a crime, but we would not be called to try and analyse a crime-scene, for example.

Fiona - 
Thank you so much for that clarification.

Olga - 
We can provide a formulation of how somebody's behavior might be related to previous experiences, to their mental state, to their life, but that would not be the same as the profiles we see in 'Criminal Minds' for example

Fiona - 
Olga your native language is Spanish, when you are doing your creative work, coming up with plots for your writing do you tend to do that in English or Spanish?

Olga - 
It varies. Normally these days in English, as I am surrounded by it. But I was recently visiting my parents and wrote a short story there in Spanish.

Fiona - 
And your books seem very different. Can you give us a quick peek at The Man Who Never Was?


Amazon Link


Olga - 
The Man Who Never Was started as a 45 pages story quite a few years back (I was 16 or 17) when I was reading plenty of books in the Magic Realism genre. I had the idea for a novel where the main character, Jesús, is born so ugly that everybody expects him to be bad or special in some way. Funnily enough everybody around him is pretty unique, but he... is a fairly nice guy. It is a family saga with bizarre goings on. Mystery, politics, cinema, banks, child prodigy...








Amazon Link



My next book published (I have quite a few unpublished) is 'Twin Evils?' that is a novella. I've described it as YA although quite a few people have told me that it also reads as an adult book. 













Fiona - 

Your next book - Click Me Happy - gives readers the choice between three possible outcomes - and it's a romance... That's quite a shift don't you think?

Amazon Link

Olga - 
The three endings thing was because some people had queried the ending of  The Man Who Never Was, and I decided to give them a choice there. I'm usually more of an open ending author, but I knew people would expect a happy ending for a romance.

Fiona - 
So now you're back to dark writing. Tell us about your newest - Congratulations, by the way! Is this the perfect marriage of your two interests - writing and psychiatry?




Olga - 
I wrote the first story of  Escaping Psychiatry called 'Cannon Fodder' many years back (1998 or 99), and I
showed it to some people (including the teacher at a short story writing course I was attending), and they liked it, but it was too short for a novel and too long for a short story. They suggested I write a couple of other stories with the same protagonist, Mary, a psychiatrist, and writer, and publish them together. I did that eventually and after publishing them initially as novellas I've now published them in a single volume with an epilogue. Mary is a psychiatrist who'd like to dedicate herself to writing, but for one reason or another she keeps getting dragged into dealing with cases that require her expertise as psychiatrist.She gets involved in cases dealing with abuse, religion, police corruption, murders, serial killers... A bit of all.



Amazon Link
Fiona -
Yipes! I see I'm over my hour - so sorry! I was having so much fun - let me ask you the question I ask everyone in my interviews - can you please tell me about your favorite scar?

Olga - 
I'm not sure it would count as a scar, but one of  the most spectacular things I remember seeing, when I was still a medical student, was a woman of a certain age (probably early sixties) with a young child in one hand, and in the other holding one of these big mixers (the ones that are a single implement that you hold by hand) stacked on her breast (on top of her clothes. She was wearing a house dress). She explained that she was preparing some food, had taking the mixer out of the bowl and her grandson make a gesture to touch the blades and she instinctively moved it towards her pressing the button. Although it looked very impressive, luckily she'd stopped pressing the button as it touched her and there were only two small cuts. But you should have seen it!

Fiona - 
Thank you so much for spending time with us today. I wish you the very best of luck in all you pursue. 


Thank you so much for stopping by. And thank you for your support. When you buy my books, you make it possible for me to continue to bring you helpful articles and keep ThrillWriting free and accessible to all.


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