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A Practitioner's Guide to Defending Capital Clients Who Have Mental

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A Practitioner's Guide to Defending Capital Clients Who Have Mental A Practitioner’s Guide to Defending Capital Clients Who Have Mental Disorders and Impairments Compiled By: Contributing Authors Anne James (Executive Director) & Matthew Cross Dick Burr The International Justice Project Matthew Cross www.internationaljusticeproject.org David Freedman Anne James Russell Stetler Kathy Wayland All Rights Reserved ACKNOWLEDGEMENTS Illustrations from The Human Brain in Photographs and Diagrams, Nolte, J., & Angevine, J.B., Jr., 2 Ed., Mosby (St. Louis, 2000), reproduced with permission of Elsevier (Mosby) © Illustrations from Neurology of Cognitive and Behavioral Disorders, Devinsky, O., & D’Esposito, M., OUP (New York), 2003, reproduced with permission of Oxford University Press © Other illustration reproduced with permission from Environmental Health Perspectives. Recommendation and Report on the Death Penalty and Persons with Mental Disabilities reproduced in full by kind permission of the American Bar Association. All other rights reserved. CONTENTS Preface...........................................................................................................................1 Chapter 1: Death is Different: Mental Health Issues in Capital Cases .......................3 Mental illness in the capital client population...........................................................4 Roles of mental health experts in capital cases.........................................................7 Mental disorders and client relationships................................................................11 Mental disorders and capital jurors.........................................................................12 Observing clients over a long, stressful time ..........................................................14 Chapter 2: Social History Investigation ....................................................................17 Capital client demographics....................................................................................17 Methodology of social history investigation...........................................................21 Social history interviewing .....................................................................................23 Counsel’s duty to investigate social history in capital cases...................................26 Chapter 3: The Impact of Trauma on Capital Clients...............................................33 Trauma and traumatic exposures ............................................................................34 Prevalence of traumatic events................................................................................35 Conditional risk (non-random nature) of traumatic events.....................................37 Cumulative risk of traumatic events .......................................................................38 Trauma and its effects .............................................................................................39 Post Traumatic Stress Disorder (PTSD) .................................................................39 The disabling effects of PTSD ................................................................................44 PTSD and other psychiatric disorders.....................................................................44 Consequences of trauma: beyond PTSD.................................................................46 Context of interpersonal violence ...........................................................................49 Coercive control......................................................................................................51 Traumatic bonding ..................................................................................................53 Implications for social history investigation...........................................................55 Barriers to disclosure of traumatic experiences ......................................................55 Interviewing for traumatic experiences...................................................................58 The great irony of trauma investigation..................................................................59 Chapter 4: The Brain and its Relationship to Behavior ............................................61 Biology of the brain ................................................................................................62 Overview of brain structure ....................................................................................65 Some key neurochemicals.......................................................................................66 Some key regions of the brain.................................................................................69 Sources of brain damage relevant to social history investigation...........................71 Chapter 5: Broken Brains and Neurological Disorders.............................................73 Fetal Alcohol Spectrum Disorders (FASD) ............................................................73 Pesticide exposure...................................................................................................75 Metal exposure ........................................................................................................79 Organic solvents ......................................................................................................82 Learning disabilities/language deficits ....................................................................85 Traumatic Brain Injury............................................................................................86 Temporal Lobe Epilepsy .........................................................................................89 Degenerative Basal Ganglia Disorders....................................................................90 Autism-spectrum disorders......................................................................................92 Chapter 6: The History of the DSM: A Key to Multi-generational Investigation.....95 The Diagnostic and Statistical Manual of Mental Disorders (DSM) ......................95 Dates and defining features of the DSMs................................................................96 Relevance of historical information about diagnostic schemes to death penalty litigation...................................................................................................................97 Changing conceptions and the emergence of the multiaxial diagnostic scheme.....99 The multiaxial system beginning with DSM-III....................................................100 The fourth (and current) edition of the DSM ........................................................102 Changes in the DSM-IV ........................................................................................104 Chapter 7: Beyond the DSM’s Diagnostic Categories ............................................107 Conceptual issues in diagnostic nomenclature: normality versus abnormality.....107 Consistency of diagnostic conclusions: the concept of reliability.........................108 The relationship of diagnosis to reality: the concept of validity ...........................109 Symptom constellation or disease entity? .............................................................110 Categorical versus dimensional approaches..........................................................110 Dimensionality in mitigation.................................................................................114 Chapter 8: An Overview of Clinical Disorders Common to Capital Clients ..........119 Schizophrenia and other psychotic disorders ........................................................119 Development of schizophrenia ..............................................................................120 Mood disorders......................................................................................................128 Anxiety disorders...................................................................................................133 Dissociative disorders............................................................................................135 Substance-related disorders ...................................................................................136 Dual diagnosis (substance use and psychiatric disorders).....................................145 Chapter 9: Psychological Testing............................................................................147 Types of psychological and neurological tests......................................................147 Neuropsychological batteries ................................................................................151 Neurological examinations....................................................................................152 Academic tests.......................................................................................................153 Intelligence tests ....................................................................................................153 Objective personality tests.....................................................................................154 Projective personality tests ....................................................................................155 Malingering tests ...................................................................................................156 Brain imaging technologies...................................................................................157 Summary of testing issues .....................................................................................158
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