In June 2005, a movie star sat on a sofa and told the world that my profession was a “pseudoscience”. He called the anchor of the Today Show “glib” for defending the chemical imbalance theory. At the time, as a consultant forensic psychiatrist with the weight of the Royal College and the GMC behind me, I found it offensive. We had the manuals. We had the science. We had the authority. But that was twenty years ago. Today, looking across ...
What This Article Is Actually About Prof Keith Rix, a forensic psychiatrist with fifty years’ experience, has collected the court judgments where these failures were exposed. His 2025 paper in BJPsych Advances shows what happens when diagnostic habits formed in clinics meet the scrutiny of a courtroom. The results are disturbing. And they affect everyone who has ever received a psychiatric diagnosis, instructed an expert, or sat on a tribunal. Consider the following: A man loses his compensation claim because an occupational ...
In the world of physical medicine, there is a concept known as “ground truth.” If a patient presents with chronic abdominal pain, a surgeon does not simply “divine” the presence of appendicitis based on the patient’s personality or the “vibe” of the consultation. There is a verifiable chain of evidence based on physical examination, blood markers, and imaging. If a surgeon operates on a healthy appendix because they “felt” it was diseased without proper diagnostics, they’re courting a malpractice claim. ...
Daniel was 34 years old and on remand, awaiting trial for a serious offence. He had been in custody for six weeks. His history included two previous suicide attempts by hanging in the community three years earlier, a diagnosis of emotionally unstable personality disorder, and a longstanding pattern of alcohol and polysubtstance misuse. He was lost to contact with his mental health team in the community. The prison where he is housed is notorious for ‘drugs’ being readily available. His ...
Bayesian reasoning is not, in this context, a demand for spurious mathematics. It is a disciplined way of thinking under uncertainty. Its value in forensic psychiatry lies in requiring the assessor to distinguish between the baseline picture, the new evidence, the weight of that evidence, and the updated judgement that follows. In ordinary professional language, the question is simple: what was already known, what has now emerged, how much should it change the view, and why? [See also: Applying Bayesian ...
The issue begins with the Summary of Product Characteristics (SmPC). That’s just the manufacturers raw data and licence specifications that few doctors ever read. For methylphenidate (MPD), the list of contraindications is extensive and spans multiple physiological systems. In the UK regulatory framework, this creates a “red line” established by the MHRA through the drug’s Marketing Authorisation. This article should be informative for psychiatrists, medical line managers and non-medical managers. While clinicians often treat “off-label” prescribing as a routine occurrence, ...
While Jimmy Savile and Jeffrey Epstein operated in different decades and across different social strata, their functional methods reveal a striking parallel in how predators can co-opt the machinery of power. If Savile was the ‘Chameleon of Authority’ within the British public sector, Epstein was the ‘Architect of Influence’ within the global private elite. Both men succeeded not merely through stealth, but through a form of aggressive visibility that made them feel like essential nodes in their respective social networks. ...
Savile’s knighthood was the ultimate evidence of a national blindness. Jimmy Savile was not merely a television personality; he was a highly functional predator who turned his own psychopathology—a lethal cocktail of grandiosity, narcissistic entitlement and a chameleon-like ability to mimic authority—into a master key for manipulation of the British establishment. By positioning himself as the state’s indispensable ‘fixer’ and a prolific fundraiser, he successfully mesmerised swathes of people and institutions, buying a decades-long immunity that allowed him to colonise ...
The locum “Assignment Schedule” is often treated by agencies and NHS HR departments as a trivial bit of admin—a template filled with blanks and vague placeholders. It is a lazy habit. For a consultant, an ambiguous contract threatens clinical safety and professional standing. The defence that “I am not a lawyer” is an admission of incompetence in a high-stakes environment. In specialist medical practice, fuzzy arrangements lead to systemic failures. When a contract fails to define start times, shift durations, ...
1. Introduction This article demonstrates my dislike of publishing in journals: no journal will allow such a deep dive into a single case. Is it necessary? Well, put yourself in Dr Garrard’s shoes and think again. You get sacked for two similar incidents with months between them in the absence of any hard evidence. The balance of probability means you did it – you’re sacked! This article may at first glance seem like nothing to do with psychiatry. Some want ...
