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Kenneth Gray, an attorney as well as a psychiatrist, was the leader in the development of law and psychiatry in Canada prior to his death in 1970. He lived during the post WWII years which saw a phenomenal growth of psychiatry as well as the beginnings of the modern era of a renewed concern for human rights. This later concern has caused the belegalment of many areas of psychiatric practice.Kenneth Gray would have to learn a new set of rules for commitment, the use of ECT and informed consent. He would discover that a patient has a right to treatment that must be buttressed by an individual treatment plan. He would discover that a committed patient has a right to refuse treatment and that some courts in the United States have said that anti-psychotic medications are mind-altering and thus an invasion of the patients 1st amendment rights. He would see untreated refusing patients languishing in the hospital or the homeless mentally ill on the streets because of restrictive commitment laws. As an attorney he would also be concerned about the proposed solution to the homeless, outpatient commitment.He certainly would have been impressed with some of the recent decisions in the United States on our duty to warn or protect known and unknown victims. Seeing patients’ advocates on the hospital wards would be a real surprise to him. These controls on the practice of psychiatry for the protection of our patients cut both ways. Dr. Gray's medical/legal education would be tested to its full.

Participating in a medical/legal situation is quite different from the ordinary office or hospital experience and requires the expert to see that all of the new parameters are clarified. A thorough and complete evaluation with a review of all the pertinent records and interviews with ancillary individuals is necessary, as is good preparation by way of a pre-trial conference with the attorney. Review of all notes and records prior to deposition or testimony can put the expert at ease. Once under oath, the expert is expected to tell the truth and not advocate for the retaining party. On the other hand, the expert must advocate for his opinion. When the answer is not known, or when one is proven wrong because new data is presented, then the expert must readily admit this. The expert should take the necessary time, pausing, listening to the question, reflecting upon the answer, giving time to the attorney to object. This trip through the vagaries of the legal system should assist psychiatrists in feeling more at ease when participating in forensic matters.

Psychological therapies as described by Marshall are but one means of reducing the rapist's and child molester's sexual aggressive urges and behaviors. Various organic therapies have been recommended, including psychosurgery and surgical castration. Spodak, Falck, and Rappeport review a newer and more reversible form of castration, chemical castration by the use of the female hormone medroxyprogesterone acetate and the new antiandrogen, cyproterone acetate. These drugs are used to decrease the functioning level of the male hormone, testosterone. Reduction of testosterone appears to decrease overall sexual drive and rather rapidly allows the rapist or child molester to gain greater control (in some cases complete control) of his aggressive sexual urges.Spodak, Falck, and Rappeport describe the use of these hormonal agents, their effects and side effects, and give therapists some guidelines to follow when using these chemical interventions. Although not seen as a panacea, these agents do appear rapidly to assist the deviant in gaining control of his urges, and when coupled with psychotherapy they serve a valuable adjunct to the therapist armamentarium.

Explores the present and future status of forensic psychiatry. Population of psychiatrists in the U.S. as of June 2005; Forensic activities learned by psychiatrists; Factors that will lead to changes in the developments of forensic psychiatry; Possible changes in the treatment of offenders.