Juvenile Psychiatry and the Law

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I am not sure when a series of volumes becomes an "institution", this is the fourth annual volume of Critical Issues in American Psychiatry and the Law, and each has been an extraordinary summary of important forensic topics. This book makes the point that the interface of psychiatry and law is not merely a legal one, but has a great deal to do with clinical issues such as diagnosis and treatment. Children and adolescents are not adults. This may come as something of a shock to those who proselytize for equal rights for children, and to those adults (including some psychiatrists, attorneys, and judges) who advocate giving the child adult choices and/or responsibilities. Children differ from adults in many ways. The specialist in child or adoles­ cent psychiatry knows not only that one must attend to special social and family issues for juveniles, but that juveniles are more complex internally as well. They attempt to survive in the world while rapidly growing and learning, usually with physically and emotionally immature resources. They have had few years in which to develop experience, and do not have the psyche with which to integrate that experience in ways one would expect of a mature adult. Sometimes this frightens the patient, as in the case of a physically large teen­ ager whose impulse control is impaired. Sometimes it is frustrating, as in the case of a healthy child unable to escape from a dysfunctioning family. It is always confusing, and usually uncomfortable.