The approximately 100 judicial opinions designated as landmark cases deal with issues routinely encountered in the practice of forensic psychiatry. Information from these cases has comprised 30-40% of the forensic psychiatry board exam. Thus, it is imperative that forensic psychiatrists read the landmark cases and understand their importance to the field. This article suggests an approach to analyzing a landmark case.
First, note the name of the case (e.g., O'Connor v. Donaldson). Next, notice the court that decided the case. This indicates the extent of the precedential authority of the opinion (e.g., United States Supreme Court, a state supreme court, or a federal district court).
The year of the opinion is important because it gives the reader an indication of the social and political climate in which the case was decided. Note whether the opinion involves civil litigation or a criminal proceeding. Each landmark case belongs to a "line" of cases based on the psychiatric issues involved (e.g., civil commitment, criminal responsibility). Reading all of the opinions in a line of cases in chronological order helps the reader follow how the courts have handled a particular issue in a series of cases.
Most judicial opinions begin with a succinct summary of the case in the form of a syllabus and/or headnotes. Headnotes are topic-focused summary paragraphs about the main points of law in a case. Headnotes are numbered to direct the reader to paragraph numbers in brackets in the body of the opinion. The syllabus and the headnotes are included for the convenience of the reader and constitute no part of the official court opinion.
The body of the case officially begins with the majority opinion. Pay attention to the author and the number of justices voting in favor of the majority opinion. The Chief Justice of a court often writes opinions on cases of the most legal significance. A unanimous vote typically indicates the court's strong consensus on an issue. Opinions decided by a one vote majority with a strong dissent often lead to speculation that the court may rule differently in the future. The first few paragraphs of the majority opinion usually state the facts, the procedural history, and the legal issues raised in the case.
For most forensic psychiatrists, it is not necessary to memorize the specific facts of each case. Instead, one should read the landmark cases to develop an appreciation of what lawyers call the "fact pattern". It is less important to remember the specific facts of a landmark case (e.g., Johnnie Baxstrom was transferred from a New York prison to Dannemora State Hospital) and more important to be able to recognize a similar pattern of facts later in an actual case or a board exam. For example, the fact pattern of Baxstrom v. Herold could be succinctly stated as "A prison inmate at the end of his sentence was committed to a mental hospital without a full hearing."
Take note of the "procedural history" of the case, a term that refers to prior legal rulings on the case and how the case made its way through the lower courts for a decision by the current court. Most of the landmark cases are appeals court decisions, as opposed to trial court decisions; they address legal issues decided by lower courts and appealed to higher courts such as the United States Supreme Court, a United States Court of Appeals, or a state supreme court. Examples of how a case may reach a higher court include appeals of a motion for summary judgment, a writ of habeas corpus, or a trial court jury verdict.
The general rule is that only issues of law, not issues of fact, can be raised on appeal. The reader should be able to pick out the important legal issues because not all of the legal issues raised in each case pertain to forensic psychiatry. Legal issues commonly raised in the landmark cases include denial of Fourteenth Amendment rights (due process and equal protection), cruel and unusual punishment in violation of the Eighth Amendment, and civil rights deprivations under 42 U.S.C. 1983.
The most important part of the landmark case is the court's ruling or "holding". The holding states the court's opinion on the legal issues raised in the case. For example, the U.S. Supreme Court considered in Washington v. Harper the legal issue of whether a judicial hearing is required by the Due Process Clause before a state may treat a mentally ill prisoner with antipsychotic medication against his will. The Supreme Court held that treatment of a mentally ill prisoner with antipsychotic medication against his will without a judicial hearing does not violate due process.
Also of importance in the analysis of a landmark case is the court's reasoning or rationale for its holding. The court may decide the case based on its holding in a prior case (by following the principle of stare decisis) or the court may establish a new judicial precedent. Comments in the opinion which are not part of the official holding are frequently referred to as "dicta", which give the reader further insight into the court's reasoning and may indicate how the court would rule in future cases. The reader should take note of the holdings and dicta in early landmark cases (e.g., Addington v. Texas, Jackson v. Indiana), which are frequently cited as legal precedent for the decision in many subsequent landmark cases.
The landmark cases often contain concurring opinions. A concurrence is usually written when a judge agrees with the holding of the majority opinion but wants to explain their reasoning in a separate opinion. Concurring opinions carry no precedential authority, but are frequently cited in later judicial opinions.
A dissenting opinion explains the reasoning of a judge who voted with the minority. Dissents are often strongly worded and critical of the majority opinion. Dissenting opinions carry no precedential authority, but often stimulate the reader to think critically about the reasoning of the majority opinion. Like concurring opinions, dissents are frequently cited in later cases.
The disposition of a case is stated at the end of the opinion. Appeals court opinions typically affirm, reverse, vacate, or modify the opinion of the lower court. The appeals court may remand the case to the lower court if further proceedings are required.
After analyzing the entire opinion, the reader should reflect on the opinion as a whole. Consider the social and political policy issues involved and how the case affected the law in the line of cases to which it belongs. Note whether the court applied a particular legal "test" (e.g., the rational relationship test) or established a new legal precedent or duty (e.g., Tarasoff duty to protect).
Consider the impact of the court's holding on psychiatry. Why is the court's opinion important enough to psychiatry to be a landmark case? Is the decision a good one or a bad one? Also note the court's attitude toward psychiatry and mental health issues. See Paul Appelbaum's thought-provoking comments on how courts alternate between idealization and devaluation of psychiatry to fit the court's purposes.¹
A judicial opinion by an appeals court is often not the last event in the life of a court case. Following an opinion by an appellate court, cases often settle out of court or are retried based on legal rulings by the appellate court. The legal research task of determining the subsequent history of a judicial opinion is known as "Shepardizing," so named because all citations to a court opinion can be researched in a series of reference books known as "Shepard's Citations." The landmark cases and their citations are available online through commercial legal services such as Westlaw and Lexis. To get the most out of a landmark case, the reader should have available a legal dictionary to look up unfamiliar terms.
For board exam preparation, self-prepared flash cards are a valuable study tool. At a minimum, a flash card should contain the name and date of the case, the court that decided the case, the fact pattern, the holding, the court's rationale for the decision, and any legal test or legal duty mentioned in the case.
The landmark cases deal with issues of national interest. Persons practicing forensic psychiatry in some jurisdictions may need to be familiar with certain "local" landmark cases. The landmark cases may be purchased in three bound volumes from the AAPL office. For those who desire a study guide, landmark case summaries are available in the AAPL Forensic Psychiatry Review Course syllabus and Dr. Richard Rosner's forensic psychiatry text.²
1. Applebaum, P.: The Supreme Court Looks at Psychiatry, Am J Psychiatry, 141: 827-835, 1984.
2. Rosner, R. (ed): Landmark Cases in Forensic Psychiatry, in Principles and Practice of Forensic Psychiatry. Chapman & Hall, New York, 1994 (pp 583-620).
3. Merideth, P.: The Landmark Cases: How to Master Them. American Academy of Psychiatry and the Law Newsletter, 22: 55-56, January, 1998
4. Landmark Cases in Psychiatry and the Law, contained in Dr. James Hooper's Forensic Home Page at http://bama.ua.edu/jhooper/landmark.html
5. Landmark Cases, Volumes 1-3. American Academyof Psychiatry and the Law, Bloomfield, CT 1993. [Contains the full text of 92 landmark cases. Available for purchase from AAPL.]
6. Landmark case summaries and study questions contained in the AAPL Forensic Psychiatry Review Course Syllabus. [Available for purchase from AAPL].
7. Black's Law Dictionary. St. Paul, Minnesota, West Publishing Company, 1979.
8. Melton, G., et al. Psychological Evaluations for the Courts. The Guilford Press, New York, 1997.
9. Keram, E.: Preparing for the Forensic Psychiatry Board Examination. American Academy of Psychiatry and the Law Newsletter, 23: 8-9, September,1998.
10. Audio recordings of U.S. Supreme Court oral arguments for some landmark cases are available on-line by way of Dr. James Hooper's Forensic Home Page at the internet address listed in reference #4 above.
Edís Note: This online version of the article contains additional material added by Dr. Meredith, including additional references, not contained in the originally published version.]