Kaustubh G. Joshi

Implications of Pseudologia Fantastica in Criminal Forensic Evaluations: A Review and Case Report

Pseudologia fantastica, a psychological phenomenon that has been described in the literature for at least a century, is an understudied and poorly understood entity. Sometimes referred to as pathological lying, pseudologia fantastica involves disproportionate fabrication that may be present for many years or a lifetime. In a forensic context, it can significantly complicate the evaluation of capacity to stand trial and, in certain jurisdictions, criminal responsibility. We review the current literature regarding pseudologia fantastica and present a case to highlight the clinical and forensic challenges it may create. We specifically discuss the complications that pseudologia fantastica may have on the assessment of a defendants rational ability to consult with an attorney, a required element of capacity to stand trial. In addition, we discuss the implications of pseudologia fantastica in the evaluation of criminal responsibility.

Rehabilitative Potential as a Basis for Involuntary Commitment

In the Matter of the Mental Commitment of J.W.J. , 895 N.W.2d 783 (Wis. 2017), Mr. J. challenged the extension of his involuntary commitment and treatment, in part, on the basis that further involuntary commitment and treatment would not rehabilitate him, thus he was not a proper subject for

Chronicles from the Cradle of Civilization

Military mental health involves traditional mental health approaches coupled with exposure to specific treatment issues and regulations that are unique to service members. A deployed environment creates challenges to treatment not commonly encountered stateside and requires the mental health provider to shift paradigms. Flexibility in approaching treatment issues is necessary to successfully navigating warzone mental health.

Why would I smile

“Why won’t you smile?” I asked my patient after several weeks of treating his psychotic symptoms. Although he reported an improvement in his mood and feeling more upbeat compared with when he was admitted, he never smiled. His answer was profound: “Look at my teeth. I barely have any left, and whatever is left looks gross. Why would I smile?” Dental …

The flame is almost extinguished

“I can’t take it anymore.” “I don’t know how I can go on.” “I don’t want to go to work.” “I think I’m done.” These words could represent a patient’s distress, but they were uttered by a physician colleague and friend. My friend didn’t have clinical depression; he was experiencing burnout. Physician burnout has become ubiquitous. It is …

Eating and huddling with patients

“Hey Doc, thanks for fitting me in today. I’m going outside the wire next week. Can we have our next appointment in the dining hall?” Many providers would consider conducting a therapy session while eating dinner together a boundary crossing. I considered it being flexible in a war zone. I was a military psychiatrist and deployed …

This is my house – respect it

My first day working in the prison was an eye opening experience. I had never previously worked in an environment that was enclosed by high barbed wire fences, surrounded by watchtowers, and patrolled by armed officers. As I entered the medical clinic, I stepped in an unknown fluid, uttered an expletive, and said, “This place sucks.” In the hallway, sitting on a chair, …

I can’t stand him (or her)

It was another busy night in the emergency department. As I was about to interview the next patient, the nurse came over and said, “He’s back.” I didn’t even have to ask who was back. I felt my blood pressure rise, I muttered an expletive, and then I said, “My night is ruined.” This patient is an example of patients …

Why does she (or he) hate me

As we were wrapping up our therapy session, I said, “I wanted to let you know that I will be going on vacation for a week at the end of the month. Can we move our usual appointment time slot to the following week?” She angrily replied, “I hate you” and stormed out of my office. …