Interview with Forensic Psychiatrist Dr. Michael Welner, M.D.: Part Three

Renowned Forensic Psychiatrist Dr. Michael Welner Shares Insights on the Elizabeth Smart Kidnapping Case and What It Takes to Succeed in Psychiatry, Forensic Psychiatry, Psychopharmacology, and Disaster Medicine

Michael Welner, M.D. is a renowned forensic psychiatrist and the founder and chairman of The Forensic Panel. Criminal Justice Degree Schools provides more background on Dr. Welner's distinguished career in the first installment of our interview.

What was your role in the case against Brian David Mitchell (the fundamentalist accused of kidnapping Elizabeth Smart from her Utah home in 2002)?

Many people do not realize how close Brian David Mitchell came to getting away with kidnapping Elizabeth Smart. Federal prosecutors came to me in 2008 after Mitchell had been repeatedly found incompetent, ready to dismiss charges and release Mitchell to a hospital. As I had been asked in the Andrea Yates case and in others, I was asked to take a definitive look at Mitchell and to advise whether he was incompetent to stand trial.

One of the many points that came to be pivotal was the need to sort out the difference between fundamentalist schismatic offshoots of the Mormon Church and their core beliefs from delusional ideas. Earlier courts had pigeonholed Mitchell’s thinking as delusional. I studied what I could about Mormonism, the core tenets of breakaway fundamentalist sects, the significance of polygamy, the significance of sex with children, and the trajectory of others who fashion themselves as sect leaders of divine providence.

My study led me to consider the histories of over 50 sect leaders. Their writings and journeys, and core ideas, bore important resemblance to Mitchell on his most grandiose points. My closer study of Mitchell revealed a completely ignored history of pedophilia and sociopathic behavior. I was fortunate enough to find and to interview 58 people who knew him across his life. The robe-costumed, singing, and elusive Mitchell came alive for me through the people he let his guard down with – including Elizabeth Smart. Smart and others helped me to appreciate what a core pervert he was, to the end that his lust invariably trumped his “faith.”

The case was quite complex, and made more difficult still by the court’s difficulty relating to the fundamentalist ideology. Then, late before the competency hearing, one of the sources I had long been seeking became available to me. The notes of the defense’s key psychologist revealed her to have lied on the witness stand during earlier proceedings, when she claimed that Mitchell did not inform her of plea negotiations and why they broke down. As it happened, they had extensive and rational discussions about Mitchell’s plea strategy. When the doctor hid this from a court she testified to in 2005, the court was left to assume that Mitchell was sick and disengaged from plea negotiations.

All of the new data and the defense psychologist’s shocking perfidy came out in the competency proceeding in December 2009. The court wrote a detailed opinion that quoted extensively from the 205 page report I had written, and from my testimony. Mitchell, once on the cusp of having his charges dropped, was found competent and proceeded to trial.

At trial, the defense contended that he had delusional disorder. Evidence from prosecutors, including my testimony, gave emphasis to his pedophilia and the absence of his psychotic symptoms. The jury convicted Mitchell after only several hours of deliberations. That case, for me, was the most dramatic swing from the cusp of getting away with a crime to being held accountable that I have ever seen. I was proud to have been trusted to find the truth. Mitchell was not the hardest case I have ever had; but it was the hardest I have ever worked on a case.

You are board certified in four disciplines – Psychiatry, Forensic Psychiatry, Psychopharmacology, and Disaster Medicine. What does it take to enter these fields and be successful?

I am a strong believer in a career in medicine as a privilege. There is no greater satisfaction than saving a life. Doctors and caregivers, like emergency service workers, firemen, police, and military, have the opportunity to save lives every day. Imagine if this value was cultivated in the alienated we spoke about earlier.

Each of these disciplines delivers a different reward. Psychiatry poses the inscrutable challenge of restoring health to emotions and the most personal and meaningful of maladies. The brain, emotions, the dynamics of sensitive relationships, and the experience of listening to others and giving respect to their dreams is an awesome but gratifying responsibility. The level of pain one encounters is a personal test. The futility of watching some patients flounder in bad choices or interventions that do not click is painful itself. But the goal of being a healthy engine that can feed constructively into a patient’s recovery is a humbling privilege. Psychiatry is not for everyone. There are those who are well suited who nevertheless cannot survive the drama of visceral human suffering without themselves losing their color and vitality. But when the patient walks out of your office, improving, and you are party to that, it feels so satisfying. It takes a good soul to be a psychiatrist – is that emotional intelligence, sensitivity, empathy, or all of the above? Suffice to say that successful psychiatry involves the skill of applied humanity.

Psychopharmacology is the discipline of psychiatry that concentrates on medication and other biological treatments. Patients improve faster and improve more reliably from severe mental illness. Psychopharmacology uses the frontier of our understandings of brain biology to reset and restore chemical balance to that associated with mental health. It is much more than medicine but much less like psychiatry. The best psychopharmacologists, however, have a bit of Mario Battali to them – the influence of a feel for people that one acquires from patient care, that sorts out the chemistry imbalance that would respond to treatment, what treatment, and how much of it. Psychopharmacologists can definitely hear the same story from the same patient and arrive at markedly different treatment strategies. Psychiatrists, by contrast, hear different things from the same patient when each one listens.

Disaster Medicine is a growing discipline. Disasters are not new, obviously, but the unique medical care needs are better understood. In addition, the effects of biological and chemical weapons, radiation, and less frightening industrial toxins are part of the consciousness of early intervention to limit the scope of loss. Pandemic and epidemic fears and the movements of populations expand what we have to know of like never before. The shrinking world also enables us to help other peoples who once were too far to reach. Haiti now seems like it’s “in the South.” Once it was just a faraway place we could never relate to.

Mental health professionals, pediatricians, infectious disease specialists and emergency and family physicians come to disaster medicine out of the desire to help when chaos makes health delivery fragmented. Disaster medicine is the medical community’s response to delivery of health in the setting where it is most acutely needed, yet most inaccessible.

Forensics is very different from all of the above. In my daily life, I am presented with an array of challenges that force me to think on the medical, psychological, legal, investigative, and tactical planes – simultaneously. Nothing, nothing, is as intellectually stimulating. Every story is different.

One has to have an exceptional eye for detail in forensics. Your work is under great scrutiny and you are held accountable in a way that one does not find in clinical medicine. It requires an athlete’s temperament because there is tremendous pressure to refine one’s findings. Temperamentally, that suits me. I’m always thinking about how to improve my work. I absolutely think the same pressures do not exist in clinical medicine. So I guess you can say that forensics helps me improve as a clinician.

Forensics also reflects society at large. For this reason, forensics is inherently inviting to enter. My advice to the next generation is always to spot the next trend within the science-law interface and to become expert in it, and to help to shape that discipline. Or, to spot the trend that excites you and identify the science-law aspect of it. There is a limitless supply of niches within forensic science to engage and inhabit. In medicine, the body is your universe, and a huge universe at that. Forensics brings you to a universe of how science relates to the world around you. That’s a far greater universe of possibilities.

Read Part 1 of Dr. Welner's Interview
Read Part 2 of Dr. Welner's Interview