Mental State at Offense: role of Neuropsychology

1. Mental State at Offense: role of Neuropsychology Jason Gravano, M.S. 7/21/14

2. Larrabbe, 2012

3. McSherry, 2003

4. Components: • Mental disease or defect • Causation- Causes the events directly, or indirectly through dysfunction that in turn impairs the individuals appreciation or control of the acts constituting the offense • Cognitive impairment (delusion?) • Volitional impairment (irresistible impulse) • Policeman at elbow Melton, 1997

5. Not all Mental Illness created equal… • a pervasive inability to engage reality: as a failure of ‘reality testing’ • why psychotic disorders are generally distinguished from neurotic and personality disorders McSherry, 2003

6. Disorders to consider • Major Psychosis • Epilepsy (varied levels of unconsciousness, post ictal confusion, etc.) • Hypoglycemic syndrome • Dissociative states • Posttraumatic Stress disorder • Genetic Aberrations: XYY syndrome • Impulse disorders (pyromania, kleptomania, pathological gambling) Melton, 1997

7. Epilepsy • Confirm previous epileptic activities • Confirm that these are similar to the crime • Confirm that loss of awareness is consistent with previous episodes • Confirm that loss of awareness is consistent with type of episode claimed • Compatible with EEG findings • Confirm that lack of awareness was probable/possible (lack of motive, senseless, no evidence of premeditation, no escape) Melton, 1997

8. PTSD

9. The complexities of the current legal situation in relation to mental disorder and criminal responsibility stem from the admissibility of evidence of mental disorder to negate voluntariness and intention. • dividing conditions into sane and insane automatism. • Modern psychological theories view behavior as on a continuum such that actions performed in altered states of consciousness may be goal directed • challenges the legal assumption that conduct is either voluntary or involuntary or intentional or unintentional. McSherry, 2003

10. Criminal Responsibility Assessment Tools • Rogers Criminal Responsibility Assessment Scale (Rogers, 1984) • Reliability • Organicity • Psychopathology • Cognitive Control • Behavioral Control Larrabbe, 2012

11. Diminished Capacity • A mens rea defense • Lesser culpability because of lesser intent • Intoxication, neurological condition, extreme emotional disturbance • Automatism • Seizure, sleepwalking, dissociation, brain injury Larrabbe, 2012

12. Amnesia & dissociation • Experiencing a dissociative state can decrease an individual’s capacity to control his or her actions and therefore diminish criminal responsibility. • Dissociation • Dissociative Amnesia • Due to a psychotic episode • Due to sleep disorders • In clinical practice, there is a need to distinguish between different types of claimed memory impairment, including amnesia caused by organic disease, dissociative amnesia, amnesia due to a psychotic episode, and feigned or malingered amnesia. Bourget & Whitehurst, 2007

13. Assessment of Amnesia • Difficult to diagnose only on one interview • Repeated interviews • Verbal and nonverbal behaviors • Self report measures (structured inventory of malingered symptomology) • Dissociative experiences scale/ Dissociate disorders interview schedule • Clinical history, collateral info, past and present behavior • Alcohol or substance use • Pattern and characteristics of the amnesia • Triggers? Bourget & Whitehurst, 2007

14. Sleepwalking defenses • unconscious defense, People v. Sedeno • automatism defense, McClain v. Indiana • insanity defense, Bradley v. State • involuntary mental incapacity (unconsciousness), physical incapacity (automatism), or insanity Bourget & Whitehurst, 2007

15. Impulsive vs. Premeditated Aggression • Aggressive acts can be measured many ways including • (i)frequency; • (ii) intensity; • (iii) target; • (iv) mode (e.g., verbal versus physical); • (v) type (e.g., impulsive, premeditated, or secondary to a medical disorder); • (vi) pattern(e.g., cycles of intensity). • applicable to the unconsciousness defense, the insanity defense, the extreme emotional disturbance defense, and specific elements of mens rea. Barratt & Felthous, 2003

16. MSO investigations • Third party info • Defendant Interview • Orientation • Developmental, sociocultural history • Current mental status • Crime info • Testing, hypnosis, and other special procedures Melton, 1997

17. Third party info Melton, 1997

18. Offense Info Melton, 1997

19. Summary

21. Neuropathology and Potential for Violence • Prefrontal cortex, temporal poles, frontal-subcortical systems. • “pseudopsychopathy” • Impulsively aggressive- evidence of neurocognitive compromise? Responsive to anti seizure meds. • ineffective behavioral control Larrabbe, 2012

22. Brain Disorders • Redding (2006) provides an overview of how CNS dysfunction integrates into understandings of culpability

23. Q’s • Where do you stand on the free will debate? • Does that matter for MSO? • Free will vs. Free won’t • What are the necessary/sufficient functional neural correlates that subserve control? How is this info processed? • What cultural or personal learning history variables would you look for that might moderate your MSO eval?