58: A Forensic Psychiatrist Takes the Stand

[Note: this is the second half of the Psych Pearls interview with James L. Knoll IV, MD. In the first half of the conversation, Knoll discussed the challenges of treating patients with traits like psychopathy or anti-social personality disorders. – Ed]

Forensic psychiatrists have emotionally taxing jobs: They spend countless hours studying acts of violence and the individuals who commit them. How could anyone endure this job for more than a few years?
James L. Knoll IV, MD, has survived decades in the field. In this edition of Psych Pearls, Knoll talks about how he maintains his mental well-being. He also reveals the childhood obsession that set him on his career path, reflects on how forensic psychiatry has changed over time, and looks forward to how it might change for the better in the future.

In this conversation, Psychiatric Times and Knoll cover:

1. His childhood fascination with the Jonestown murder-suicide. 2. How he got interested in forensic psychiatry. 3. The risk of burnout in forensic psychiatry (or any other psychiatric specialty). 4. How the arts and other creative endeavors can help psychiatrists stay mentally and physically well. 5. The tension at the heart of the forensic psychiatrist’s identity: are they primarily treaters of mental illnesses, or expert witnesses? 6. The new importance of social media for forensic investigations. 7. Why it’s important not to judge patients—no matter how difficult they may be.


Dr Knoll is professor of psychiatry and director of forensic psychiatry at SUNY Upstate Medical University in Syracuse, New York, and clinical director of Central New York Psychiatric Center in Marcy, New York. He is Emeritus Editor-in-Chief of the Psychiatric Times and President-elect of the American Academy of Psychiatry and the Law (2022-23).