N R Fff U DEFENDANT-APPELLANT

ILiWNAL

IN THE SUPREME COURT OF OHIO

DENA G. LAIYIBERT,

Appellant, On Appeal from the Summit County Court of Appeals,

V. Ninth Appellate District

STATE OF OHIO, Court of Appeals Case No. 13846 Appellees.

MOTION TO FILE DELAYED APPEAL

Dena Gaye Lambert respectfully moves the Court pursuant to Ohio Supreme Court Rule II,

Section 2(A)(4)(a) for leave to file a Delayed Appeal and a Notice of Appeal. This cases involves a felony and more than 45 days has passed since the Court of Appeals decision was filed in this case. A memorandum in support is attached.

11 0 SEP 2 a tb1? Respectfully submitted, CLERK OF COURT SUPREME CGUR7 OF OHIO Dena G. Lambert, in Pro Se #021684 - Lincoln Ohio Reformatory for Women 1479 Collins Avenue Marysville, Ohio 43040 n r Fff U DEFENDANT-APPELLANT

SEt 2 i? CLERK OF CQURT SUPREME OCUo d 01 CR'C MEMORANDUM IN SUPPORT

On April 26, 1989 the Court of Appeals filed its decision in my case. I have attached a copy of

the Court of Appeals opinion to this motion. I was unable to file a Notice of Appeal to this Court,

and a Memorandum in Support of Jurisdiction within 45 days of the Court of Appeal decision in

my case for the following reasons:

This case arises from my attempt to escape from the violent captivity of James Sprake, who for

approximately 6 months in 1988, traveled across the United States, and Central & South America

forcing me to commit criminal acts of: property and identity theft against businesses and individuals,

pornography, prostitution, drug-trafficking & manufacturing, shop-lifting, fraud, and other criminal

acts, under threats and acts of physical violence, and coercion, while subjecting me to emotional

trauma, mental torture, sexual abuse, and physical bondage.

I have an extended history, since early childhood, of being a victim of violent human-trafficking

and domestic violence, and I have been either hospitalized or left-for-dead on several occasions.

In 1978, at 14 years old,I ran away from an abusive home in Bellevue, Nebraska, only to

eventually be forced into a well-organized, juvenile prostitution ring in California. This prostitution

ring involved grown men who traveled with juvenile females, who were forced to attend "Gentlemen"

parties at various locations across the United States. Upon being transported into the State of Ohio, in

1979, I was spotted by a hotel manager's wife, who suspected something was wrong with a young

teenager with several grown men. Once I was taken into one of the several hotel rooms rented by my

captors, a Sheriffs Deputy arrived and took me from the hotel room, handcuffed me, and sent me to a juvenile facility for holding until I told them who my dad was, so he could come and get me. None of

the other juvenile were rescued because I was the only female one spotted by the hotel manager's wife,

and non of the grown men who ran this illegal, juvenile prostitution ring were arrested.

In 1983 in yet another incident of forced prostitution, at age 19, 1 was prostituted out at Casino's and truck stops by a man named Larry Delozier, whom the F.B.I. knew was a known drug-trafficker,

3hile being prostituted in a truck stop in Catoosa, "bookie", arms-dealer, bigamist, and pimp. V

Oklahoma, I was stalked, abducted, sodomized, tortured, and Ie$ for dead by a serial killer who targeted me as his thirteenth prostitute victim and the only one who lived. He was never caught to my As a result Tailsa, Oklahorna, St. Francis Hospital Medical record (1983). knowledge. See Exhibit A, of this extreme torture, I suffered severe physical trauma, and facial lacerations, in addition to,

(P.T.S.D.) which impaired my ability to function. See undiab osed Post Traumatic Stress Disorder

Description of Post Traumatic Stress Disorder. ExhibitA(1), In December of 1987, as a result of homelessness in Tucson, Arizona, I meet James Sprake of

Scottsdale, Arizona, whom I believed was a legitimate business man who sold insurance for department

store owners. Over the course of several weeks of personal grooming and etiquette training by James

Sprake, unfortunately I learned he was not an honest business man; rather, a well-connected, criminal

mastermind who was unwilling to let me simply walk away.

On approximately the 11"' day of June, 1988, James Sprake brought me to the city of Akron,

Summit County Ohio, and registered at the State Road Inn. Once located in a hotel room, I was not

allowed to make any contact with any individuals and not even the strangers James Sprake would Police occasionally bring to the hotel rooms for various criminal dealings. See Exhibit B, Akron

Report of hotel employee.

Upon arriving at the hotel, James Sprake had in his possession: a large quantity of cocaine in

which he would process into crack: including marijuana, which he would consume over the next three

days. Due to the paranoid tendencies of James Sprake, he would force me to remain awake during the

entire time of his drug-binges. It was during these drug-binges that James Sprake would physically and

sexually abuse me. And once the drugs were gone, James Sprake would make contact with local

individuals to schedule more drug pick-ups after a night-out on the town where he would solicit strange

females for group orgies which always resulted in the physical, escalation of violence against me. This was the regular routine of James Sprake.

On the I4`h day of June, 1988, I was left alone in the hotel room and received a telephone call ordering from the hotel room by James Sprake who had left the hotel earlier. He was at a striper-club where he was attending a party. From pure exhaustion I had laid down in an attempt to sleep, but I knew the consequences of disobeying James Sprake so I got dressed. A cab arrived for me and I was driven to a striper club where James Sprake paid the cab fee and ordered me to make my choice. This choice was in picking which female striper James Sprake would bring back to the hotel. Since I complained the striper's were all ugly, James Sprake called for another cab and re-located to the "Touch of Class", and he told me I'd make a choice there.

As the evening progressed and James Sprake became intoxicated, the verbal abuse and aggressive man-handling by James Sprake toward me increased, so I suggested he go somewhere else so he could shoot some pool while I tried to relax. I made this sugaestionfor the purpose of attempting another escape from James Sprake because there might be safer strangers to turn to for help at a regular bar, rather than seeking customer help from a striper-club. Also, on several previous occasions I attempted to escape from James Sprake only to be found by him through his multiple contacts with the criminal underground.

James Sprake asked about the location of a pool table and was informed one was across the street at the "Temple Tavern", on North Hill in the city of Akron, Summit County, Ohio. As we entered the "Temple Tavern", I became very afraid because the tavern was crowded with motorcycle gang- members, wearing colors. As James Sprake started interacting with biker chicks at the pool table, I began looking for a safe individual to help me escape from James Sprake., After several conversations to request help from the tavern staff to no avail, I eventually approached a stranger, Mr. Harry

Robinson, and asked him to help me get away from a dangerous man who brought me to the tavern.

Mr. Robinson agreed to assist me, but only after he purchased me a drink. Mr. Robinson bought some drinks, but I purposefully spilled the drink for me because James Sprake kept purchasing me double- shots of Jack Daniels Whiskey, and I was already severely intoxicated. Mr. Harry Robinson agreed to take me to my hotel, so we left the tavern together.

Once outside the tavern, I began crying and told Mr. Robinson that I wasn't from Ohio and had nobody to call for help and that I was in a very bad situation. I stated that all I needed was for him to drive me to the hotel room so I could get my belongings, then drop me off at a truck-stop or something and I would pay him in traveler's checks which James Sprake had left at the hotel. Mr. Robinson agreed and helped me into his car where I think I passed-out in the passenger seat because I don't recall the drive. Upon shaking me awake and escorting me up a few stairs, I resisted and expressed my awareness that the hotel I was staying in had no stairs. Mr. Robinson reassured me that I could use his telephone to call the hotel, so I continued to allow Mr. Robinson to assist me inside of his apartment.

While inside Mr. Robinson's apartment, he seated me on his couch and put the telephone and telephone book on the coffee table in front of me. I attempted to locate the hotel I was staying at but was unable to remember the name of the hotel due to intoxication. When I went to grab for my purse, it was not on the coffee table where I had laid it. I felt panicked and a strong need to leave so I tried to find the exit door, but there were several doors in this room, and I was very disoriented. In a state of fear and panic I hid behind a recliner and apparently passed-out. I was abruptly awaken by Mr.

Robinson dragging me across the living room floor by the hair of my head, then he lifts me up by the hair of my head, and without any provocation restrains me physically and holds a steak knife to my throat.

The State of Ohio contended at trial that I was attempting to steal or con Mr. Robinson's wallet or other valuables from him while I was in the apartment even though the evidence did not support this claim. And unfortunately, neither my court-appointed attorney nor the prosecuting attorney inquired anything about why I was trying to get away from James Sprake in the first place. No one simply cared.

A violent struggle ensued after I resisted his attack in the living room which resulted in Mr. Robinson assaulting and cutting me with his knife while still in the living room. With my hand injured

severely and blood profusely flowing from a deep cut between my right thumb and index finger, I

believed I was going to die, so I lunged at Mr. Robinson and we lost our balance, tumbling onto the

floor in the living room, where I began crawling toward the dining room to get away from him. Once

in the dining room, I stood up and turned to find Mr. Robinson coming after me so I opened the china

cabinet door and began throwing various dishes and glasses at him to keep him from catching me.

Since I had initially sustained a knife injury to my hand in the living room, my fingerprints and blood would have been on every single item I threw at Mr. Robinson to keep him away from me as he still was wielding his steak knife. One glass out of dozens of broken dishes was identified and sent to the

Crime Lab for fingerprints and blood analysis, but was never entered into my trial by the state. See

Exhibit C & D, and T.R. Evidence Entry. Out of dozens of pieces of evidence which I used to protect myself from further injury and death, only Mr. Robinson's steak knife which was never identified as belonging to Mr. Robinson, and a tea kettle which I grabbed from off the kitchen counter to make Mr.

Robinson let go of me, was entered into trial as evidence. Evidentially the B.C.I. Lab which the evidence was sent to in Richland, Ohio, came under Federal scrutiny and was shut-down as an illegally operated crime lab with questionable practices.

Once I ran out of items to throw at Mr. Robinson to keep him away me, as he began approaching me, I ran around the dining room table and knocked chairs and a plant stand over to keep him from catching me with the steak knife. When I ran around the dining room table and turned at the doorway of the living room, Mr. Robinson caught me by the arm, so I began swinging and fighting him off of me.

In a blackout, I apparently obtained possession of the knife at that location then stabbed Mr.

Robinson multiple times at the doorway from the living room into the dining room, but I still do not remember stabbing him. I then must have dropped the knife and ran toward the kitchen area. Upon entering the kitchen area, Mr. Robinson caught me from behind by grabbing the back of my dress. See

Exhibit E. As I began to lose my balance and fall backwards, I reached for and grabbed a tea kettle from off the counter and hit NIr. Robinson in the head at least twice to get him to release me. Upon the second head blow, Mr. Robinson fell to the floor where he remained as I stumbled into the living room and got on the telephone to call for help. While shaking and unable to focus my eyes on the punch- numbers, a stranger answered the telephone and when I told him a man tried to rape me that I knocked him out, and I was afraid he was going to come after me again, the stranger asked me for the address to my location. Since I did not know where I was, the stranger instructed me to find something with the address on it so he could send me help. As I looked around quickly, I found a small piece of paper

on a table and attempted to read the address; however, my eyes would not focus in and the writing was

all blurry so I was unable to read the writing on the small piece of paper. When the stranger realized I

couldn't give him the address to my location, he told me to get out now. This stranger was never

subpoenaed to my trial to testify as a primary witness, and since I had no memory of the events, I was

unable to tell anybody about him or our conversation.

On the night of my attack, I was attempting to escape from the captivity of James Sprake. Due

to the trauma of the attack, I was in a fight-or-flight mode and I suffered from undiagnosed P.T.S.D.

Rather than finding a law enforcement, advocacy services, and legal system educated and trained in

identifying the characteristics of modem-day slavery of forced. human-trafficking victims, my 'exigent

circumstances' of violent captivity was not identified; thus, without "Victim-of-Crime" Rights as an

accused defendant, I was in no position to receive a Constitutionally Protected Right to Equal

Protection of the Law and Due Process; therefore, the very foundation on any defense I may have

offered was prejudicially flawed and "structurally" defective.

Niy court-appointed attomey, Kerry O'Brien, spoke regularly with James Sprake, who visited

me at the county jail and threatened my life to remain silent regarding his criminal associates and

activities. And James Sprake informed me that he consulted with my appointed-counsel and was scheduled to testify as the main witness. James Sprake told me that my case was a Capital Offense where the State was seeking the "Death Penalty."

After the second day of a three-day trial, I was offered a plea-bargain amounting to a reduction to a charge of murder. Out of fear of James Sprake whom I believed was manipulating my appointed- counsel, against the struggle I realized that the appointed-counsel was unable to prepare a proper defense given the totality of my situation, I considered the plea bargain, but decided against it because

I knew I was not guilty of murder and I believed Justice would prevail.

A jury returned a verdict of guilty to aggravated murder, aggravated robbery, and grand theft, and I was sentenced without any due process hearing allowing mitigating legal circumstances or expert testimony at my sentencing hearing. At sentencing, I was sentenced to the REMAINDER OF HER

NATURAL LIFE for the punishment of the crime of Aggravated Murder, R.C. 2903.01(B), consecutive with Ten (10) Years to Twenty-Five (25) Years for punishment of the crime of

Aggravated Robbery, R.C. 2911.01(A)(1)/(2), consecutive with two (2) Years for the punishment of

Grand Theft, R.C. 2913.02(A)(1).

On February 17, 1989, my court-appointed trial counsel filed an appeal brief. On April 26,

1989, the Ninth District Court of Appeals rendered it's decision against the appeal and only then was I notified for the first time since trial by my appointed-counsel that my appeal was filed and denied.

For several months, since being transported to prison, I was experiencing much difficultly adjusting due to having black-outs, nightmares, depression, hallucinations, and other symptoms which impaired my ability to function. Upon reading the appeal and denial by the Court of Appeals, I attempted to pursue the appellate process on my own because I had no one to help me. However, in attempting to read my own court records as I was unable to remember even the trial, I suffered a complete nervous break-down and was ultimately reassigned to the prison mental health unit.

After several years of mental health treatment I was eventually diagnosed by the Ohio State

University Hospital as a sufferer of long-term Post Traumatic Stress Disorder (P.T.S.D.) which began at early childhood. As a direct result of the P.T.S.D. symptoms, I have been unable to seek the Justice I have long since been denied. Over these many years of incarceration, I have made several attempts to obtain my psychiatric file only discover many obstacles which hinder the Judicial Process of an alone

ene in my behalf. And as a result of attempting to read citizen with no advocacy of any kind to interv

my court records to pursue the appellate process has repeatedly triggered relapses in P.T.S.D. and

possibly "Stockholm Syndrome" symptoms further hindering the Judicial process in my case. It has

only been since recently that I am now able to cope with the events of 24 years ago without the use of

psychotropic medications. As a Pro Se litigant without an attomey to act in Psychiatric intervention or my behalf, I have been denied by prison officials and prevented from obtaining a copy of either my

prison psychiatric file or my O.S.U. Diagnosis of P.T.S.D., which is the new evidence I need to file a

motion for new trial under Ohio Crim. Rule 52(A) & 33. The direct appeal which was filed in my behalf, was not a Constitutionally Protected fair review

of my conviction because regardless how many trial errors there may have been in the prosecution and

conviction which ultimately sent me to prison, the whole defense and trial was "structurally" defective

because of a lack of statute which protected victims of human-trafficking. The court allowed me to

plead "not guilty" because of self-defense which was not a legal defense in Ohio Law at that time.

And since I pled an affirmative defense, I was entitled to a greater degree of Discovery to establish my

defense "Justifiable Homicide"; however, I was kept from a fair trial due to withheld evidence and the

identity of the stranger I called for help, by the State, which was evidence and testimony in in my favor.

Also, "Duress" did not exist as a defense which was the situation I was in as a victim of involuntary

servitude and human-traffficking at the time. Unfortunately, I was not protected by the very system designed to protect and serve innocent

citizens in harms way. This was common for labeled prostitutes. Over the course of almost my entire

life in captivity, many individuals within the various State Law Enforcement Communities, including

F.B.I. Agents, knew I was being prostituted out; but, nobody ever bothered to learn or ask "why?" Even when my physical appearance was so obviously injured with bruises as a result of violent rapes,

nobody ever helped me when I'd fall back into captivity for a lack of intervention and understanding.

As a direct result of an untrained law enforcement community, regarding the identification of human-

trafficking victims, "Rights" were withheld from me which would have determined "Victim of

Crime" status. Thus, any defense I may have offered was prejudiced severely which rendered the

entire trial proceedings defective and Unconstitutional.

If this Honorable Court would intervene and grant me a Delayed Appeal and appoint me legal

counsel to present my case before your Honorable Justices, I would raise the following issues in my

11'Iemorandum in Support of Jurisdiction:

1. Whether or not the defendant-appellant, a non-resident citizen of the State of Ohio who was

transported into Ohio against her will in 1988, entitled to "Victim of Crime" Rights; and,

2. Whether it is a Civil Rights and Constitutional Rights violation for Peace Officer's to

withhold the "Victim of Crime" Rights from an American citizen who was forced to act in

self-defense; and,

3. Whether withheld "Victim of Crime" Rights could prejudice the criminal trial in a Capital

case against an American citizen in "exigent circumstances" of involuntary servitude, who

was forced to escape, then protect and defend herself; and,

4. Whether not having "Anti-Trafficking Laws" resulted in the "structural" error of the criminal

trial of the defendant-appellant, who unintentionally kills while attempting to escape captivity?

In 1988, the law enforcement communities nor society was educated regarding the horrific

crimes of human-trafficking committed against young Americans, nor the harm caused to families and the public. For almost the entirety of my life, I've been in captivity and under the control of others in one form or another. In no way did I deserve the abused life of the cruel and unusual punishment of sexual exploitation, forced criminal labor, and suffering at the hands of violent criminals with personal for lack of Due Process and a Fair Trial. ^Vhat I am asking for is my Right as a Freeborn, American

citizen to a Constitutionally Guaranteed review of this conviction. And on June 27, 2012, Governor

John Kasich, signed into Law House Bill 262 which now provides the statutory provision and

protection for victim's of human-trafficking. The granting an order for review will result in Justice and

the increased hope for other victims/survivors of human-trafficking with the message all human-

trafiicking victims no Ionger have to be victim's of involuntary servitude in a Nation which now

protects its vulnerable citizens to the benefit of our civilized society.

I swear that all of the above facts are true and that I seek the Ohio Supreme Court Justices to

grant an order of "exigent circumstances" in my particular case, so that I might have this conviction

and sentence reviewed for "structural" error outside the scope of the assignments of errors in the

original direct appeal. And in conclusion, this Court should grant me leave to file a Delayed Appeal

and a Notice of Appeal.

Dena 0. Lambert, In Pro Se

Sworn to and subscribed in my presence this .0- day of _^)TifZIIL __

SEAL

Expiration

CERTIFICATE OF SERVICE

I certify a copy of the foregoing MOTION TO FILE A DELAYED APPEAL has been sent by regular U.S. Nlail to the office of the Summit County Prosecutor, Appellate Division, Summit Counry

Safety Building, 53 Universiy Bidg, 6" Floor, Akron, Ohio 44303-:630, this 1-3 day of

, 2012.

Respectfully submitted,

Dnae G. Lambert, In Pro Se

DEFENDANT-APPELLANT P,^

IN THE COURT OF APPEALS STATE OF OHIO ).. ''9s: NINTH JUDICIAL DIS2RICT. COUNTY OF SUMMIT )

C.A. N0. 13846 STATE OF OHIO Plaintiff-Appellee APPEAL FROM JUDGMENT v. ENTERED IN THE DEENA GAYE LAMBERT, aka COMMON PLEAS COURT COUNTY OF SUMMITr.0610 SPRAGUE CASE NO. CR 88 06 0857 Defendant-Appellant

DECISION AND JOURNAL ENTRY

Dated: April 26, 1989 This cause was heard upon the record in '.he trial court. Each error assigned has been reviewed and the

following disposition is made:

REECEi J. Appellant, Deena Lambert, met Henry Robinson at the

Temple Tavern, in the City of Akron. Mr. Robinson bought. some drinks for the appellant and they left the tavern`

together. Mr. Robinson drove the two of them to his apert-i

ment. A struggle ensued and the appellant ran from Mt. Robirsson°s apartment out to the street. Jeffery Wolfe was driving by and stopped to appellent. Mc. Wolfe saw that the appellant

and took her to St. Thomay Mospital. At the hoapitalo Mr. y61[e got out of his appellant. into the hospital to asak h elp for the y ^ ^aa^at ^rt A0p44e4o9 ®ibq. N14-!++ A®neI eaPt INArwWt -z-

point, without Mr. Wolfe's permission, the appellant aped

away in his car.

Mr. Wolfe's car was found several hours later, abandoned

in the Margaret Park area of Akron. several items of personal property belonging to Mr. Robinson were found in or

around the car. Police searched the area and found appel-

lant hiding in some bushes.

Subsequently, the police went to Mr. Robinson's np.art-

ment where they found him dead. The appellant was charged with aggravated murder and

aggravated robbery. The case was tried to a jury. The jury

returned a verdict of guilty on both counts and she was

sentenced accordingly. Appe.l.lant timely appeals.

ASSIGNMENT OF ERROR I

•Due process is denied an accused where the conviction has been obtained upon evidence insufficient as a matter of 1aN. Appellant contends that there was insufficient evidence

to warrant the convictions of aggravated murder and aggra-

vated burglary.

This court will not reverse a jury verdict where there

is substantial evidence upon which a jury could reasonably conclude that all the elements of the offense have been

proven beyond a reasonable doubt. State V. Bley tI9781, 56 jottlo St. 2d 149, syllabus. in the instant case, Dr. Ruiz, a medical examiner !or ^the Summit County Coroner's ofEice, tastified that thirty-

^ teeu 0323 wounds were found on the body of Mr. Robinson. mo

^Cbtucw 6t muM aas aa 1^!ri!f.. ^^aia 4moF~^aatr; fJe^*q^ct -3-

that the cause of death was hypovolemic shock; Ftestified (loss of blood). He stated that seventeen (17) wounds were,

defense marks. _ Defense wounds are usually cuts to the fore-

arms or hands that are produced when the person is defending

himself from an attacker. Jeffery Wolfe testified that he saw appellant, covered

with blood, trying to enter Mr. Robinson's automobile. Re'

ask:ed the appellant if she needed to go to the hospital.

The appellant got into Mr. Wolfe's car and they proceeded to

gt. Thomas Hospital. On the way there, the appellant stated

to Mr. Wolfe that he couldn't take her to the hosp3tal

because 'they would put her away forever.' Mr. Wolfe asked

her what she meant and the appellant stated to him °I killed

the M:...P..., I cut him up.` An officer testified that a flashlight and watch were

found by the stolen car that the appellant abandoned. Mr. Robinson's son-in-law testified that the watch and fIash-

light belonged to Mr. Robinson. i Upon rev i ew o f the entire record , there is sufficient

evidence in support of the jury's verdict. Appellant's first. assignment of error is overruled.

lSSSSCNMENT OP ERRdR 11 °The trial court abused its discretion by not per- mitting full inquiry of the witness 8rydon i.aebert.' discretion ot Eroidentiary rulings are within the broad the trial court and will be the basis tor reversal on apptaT

use of that diacretion which aacunts ti

667ua ! Ai AF9N%m91/& 61m6, MYM10 A4dita 49A ®r4a piY.':F -4.-

prejudicial error. State v. Graham (1978), 58 Ohio St.aa 350, 352.

The appellant claims the court erred in limiting the

testimony of Brad Lambert. Mr. Lambert was married,to tiie

appellant from 1980 to 1992. The court allowed limited

testimony on the issue of appel.lant's blackouts. 9owever

the court did not allow Kr. Lambert to discuss the medical .condition of the appellant while they were married. The court based its decision on the relevancy of the evidence

and that Mr. Lambert was not qualified to testify as to tie,r medical condition.

Upon review of the record, the court properly exerclsed

its discretion in limiting Mr. Lambert's testimony.

Appellant's second assignment of error is overruled.

The decision of the trial court i.s affirmed.

The Court finds that there were reasonable grounds fo:r this appeal.

We order that a special nandate issue out of this cour't^

directing the county of Summit Common Pleas Court to carry

this Judgment into execution. A certified copy of th!®

journal entry shall constitute the mandate, pursuant to App:

R. 27.

I.mmediately upon the filing hereof, this document shall 1constitute the journal entry of ju3gment, and it shall bo ftle stamped by the Cleck of the Court of Appeals at ahioti

m;d CtdAKi@ :,k! 1^6f6'A89 73M o0q^1;: (dtlN1p 0{r ..Pt6q4l. ml9PME6`7 , _ . . . W. REECE THE COURT

MABONEY, P. J. QUILLIN, J. COtiCUR

APPEARARCESs

.RC R. WOLFF, A88t. ?roeecutor, City-County Sa,oty Bigg., Akron' OH 44308 for Piainesif:f. RER O BR2EN, Attorney at Laa, 423 Soc ety B g., 06 44306for Defendant.

f7P dtftAG^.Y ^ OofiF%. (b^1'N pO6^E.`:CAP@, C1PN'f(frl:l C®PY IN THE COURT OF COMMON PLEAS n.!+ _ ^ : ^ ! COUNTY OF SUMMIT S^t LG SU!',_ .. ^ SEPTEMBER T@Ri11J 88 THE S%4^kiO9"OH10 No. CR 88 06 0857 vs. DEENA GAYE LAMB ExT aka SPRAGUE JOURNAL ENTRY ,rn'..1^60 e+.c^ ^30 THIS DAY, to-wit: The 22nd day of September, A.D., 1988, now comes the Prosecuting

Attorney on behalf of the State of Ohio, the Defendant, DEENA GAYE LAMBERT aka SPRAGUE,

being in Court with counsel, KERRY 0'BRIEN, for trial herein. Heretofore on September 15,

1988, a Jury wasduly empaneled and sworn, and the trial commenced and not being completed,

adjourned from day to day until September 21, 1988 at 5:45 O'Clock P.M., at which time

the Jury having heard the testimony adduced by both parties hereto, the arguments of

counsel, and the charge of the Court, retired to their room for deliberation. _

And thereafter, to-wit: On September 22, 1988 at 11:15 O'Clock A.M., said Jury came again into the Court and returned their verdict in writing finding said Defendant

GUILTY of AGGRAVATED MURDER, as contained in Count One (1) of the Indictment, AGGRAVATED

ROBBERY, as contained in Count Two (2) of the Indictment, and GRAND THEFT, as contained

in Count Three (3) of the Indictment.

Thereupon, the Court inquired of the said Defendant if she had anything to say why

judgment should not be pronounced against her; and having nothing but what she had already

said and showing no good and sufficient cause why judgment should not be pronounced:

IT IS, THEREFORE, ORDERED AND ADJUDGED BY THIS COURT that the Defendant, DEENA GAYE

LAMBERT aka SPRAGUE, be imprisoned and confined in the OHIO STATE REFORMATORY FOR WOMEN

at Marysville, Ohio for the REMAINDER OF HER NATURAL LIFE for punishment of the crime of

AGGRAVATED MURDER, Ohio Revised Code Section 2903.01(B), a special felony, for an indeterminate

period of not less than Ten (10) Years and not more than the maximum of Twenty Five (25)

Years for punishment of the crime of AGGRAVATED ROBBERY, Ohio Revised Code Section 2911.01(A)(1)/(2), an aggravated felony of the first (1st) degree, and for a definite period of Two (2) Years for punishment of the crime of GRAND THEFT, Ohio Revised Code

Section 2913.02(A)(1), a felony of the third (3rd) degree, and that the said Defendant Y9'^.tîâW=^tiTBAaât' t0

^ys^s€iit^her aPPolaCs

^yp^^^e af a{spesl. :` COPY

,IN THE COURT OF COMMON PLEA^ , . COUNTY OF SUMMIT, OHIO

^e 6Y 2 N :^I! L INDICTMENT TYPE: SECRET CR. CASE NO. 88-06-0857

INDICTMENT FOR: AGGRAVATED M^RDER (1) 2903.01(B); AGGRAVATED ROBBERY (1) 2911.01(A)(1)/(A)(2); GRAND THEFT (1) 2913.02(A)(1)

In the Common Pleas Court of Summit County, Ohio, of the term of MAY in the year of our Lord, One Thousand Nine Hundred and EIGHTY-EIGHT.

The Jurors of the Grand Jury of the State of Ohio, within and for the body of the County aforesaid, being duly impanelled and sworn and charged to inquire of and present all offenses whatever committed within the limits of said County, on their oaths, IN THE NAME AND BY THE AUTHORITY OF THE STATE OF OHIO,

COUNT ONE

DO FIND AND PRESENT, That DEENA GAYE LAMBERT AKA SPRAGUE on or about the 14th day of June, 1988, in the County of Summit and State of Ohio, aforesaid, did commit the crime of AGGRAVATED MURDER, in that she did purposely cause the death of Harry V. Robinson while said DEENA GAYE LAMBERT AKA SPRAGUE was committing or attempting to commit, or fleeing immediately after committing or attempting to commit Aggravated Robbery, in violation of Section 2903.01(13) of the Ohio Revised Code, A SPECIAL FELONY, contrary to the form of the statute in such case made and provided and against the peace and dignity of the State of Ohio.

COUNT TWO

And the Grand Jurors of the State of Ohio, within and for the body of the County of Summit aforesaid, on their oaths in the name and by the authority of the State of Ohio, DO FURTHER FIND AND PRESENT that DEENA GAYE LAMBERT AKA SPRAGUE, on or about the 14th day of June, 1988, in the County of Summit and State of Ohio, did commit the crime of AGGRAVATED ROBBERY, in that she did, in attempting or committing the offense of Theft in violation of Revised Code 2913.02, or in fleeing immediately after such attempt or offense, have a deadly weapon, to-wit: a knife, as defined in Section 2923.11 of the Revised Code, on or about her person or under her control, or did, in attempting or committing the offense of theft, in violation of Revised Code 2913.02, or in fleeing immediately after such attempt or offense, inflict or attempt to inflict serious physical harm on Harry V. Robinson, in violation of Section 2911.01(A)(1)/(2) of the Ohio Revised Code, AN AGGRAVATED FELONY OF THE 1ST DEGREE, contrary to the form of the statute in such case made and provided and against the peace and dignity of the State of Ohio.

l^ COPY

COUNT THREE

And the Grand Jurors of the State of Ohio, within and for the body of the County of Summit aforesaid, on their oaths in the name and by the authority of the State of Ohio, DO FURTHER FIND AND PRESENT that DEENA GAYE LAMBERT AKA SPRAGUE, on or about the 14th or 15th day of June, 1988, in the County of Summit and State of Ohio, did commit the crime of GRAND THEFT, in that she did, with purpose to deprive the owner, Jeffery G. Wolfe, of property to-wit: 1977 Chevrolet Impala, knowingly obtain or exert control over said property without the consent of Jeffery G. Wolfe, or a person authorized to give consent, said property being a motor vehicle as defined in Section 4501.01 of the Revised Code, in violation of Section 2913.02(A)(1) of the Ohio Revised Code, A FELONY OF THE 3RD DEGREE, contrary to the form of the statute in such case made and provided and against the peace and dignity of the State of Ohio. s/ L L- S^ LYNN C. SLABY, Prosecu or County of Summit, Ohio

Prosecutor, County of Summit, by

S/ QRLt Assistant osecuting A torney

ei anu^ 01LL v PAULETTE RHINEHART Acting Foreperson of the Grand Jury CC,F'Y

ORDER

TO: DAVID W. TROUTMAN, Sheriff County of Summit, Ohio

DEENA GAYE LAMBERT AKA SPRAGUE

THAT she has been indicted by the Grand Jury of the County

of Summit and that each person named in the indictment is hereby ordered to .M. personally appear for the purpose of arraignment at _ on the day of , 198 before the

Honorable , Judge of the Court of Common Pleas

in Courtroom No. in the County of Summit Court House at 209 South

High Street, Akron, Ohio: and THAT FAILURE TO APPEAR WILL RESULT IN A

FORFEITURE OF BOND, IF ANY, OR ADDITIONAL CRIMINAL WARRANT FOR ARREST,

CHARGES FOR FAILURE TO APPEAR UNDER O.R.C. SEC. 2937.99.

I certify that this is a true copy of the original indictment on file

in this office.

JAMES B. McCARTHY, Clerk Court of Common Pleas

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This 18 year old lady was found in a ditch near Catoosa wearing only a blouse. She was confused at that time and was brought to the SFH ER.

On examination she was somewhat lethargic, oriented only to year. Palpation over her chest revealed no pain; breath sounds were symmetrical, her color was good. Vital signs revealed blood pressure of 90 and a pulse of 116.

Abdomen was soft. There was some tenderness with minimal guarding in the epigastrium. Bowel sounds were normal. Palpation over the pelvis was not painful. Exam of the perineum revealed a superficial laceration in. the left labia majora and bilateral labia minora hematomas. Internal exam was not performed by this examiner. Lower extremities were normal. There was minimal pain to palpation over the cervical spine. The left upper extremity initially was not as strong as the right but under observation the two seemed to have equal strength. Deep tendon reflexes were symmetrical bilaterally.

The patient had 2-3 facial lacerations and at least a couple of scalp lacerations. Her pupils were PERLA. TMs were injected bilaterally but there did not appear to be hemotympanum. Teeth were normal. Mandible was tender on the right side with some induration.

LABORATORY AND COURSE IN THE EMERGENCY DEPARTMENT: Chest x-ray, skull films, cervical spine and mandible were all normal. WBC 30,000, amylase elevated above 500.

DISPOSITION: The patient was seen in consultation by the OB-GYN resident and a formal rape examination was performed by him. Dr. Mesko was the GYN resident. See his note regarding that examination.

Because of the elevated amylase and white count, the General Surgery Service Doctors Decker and C. T. Thompson were consulted. They elected to admit the patient for observation and assumed responsibility for the facial lacerations. The neurosurgeons were not consulted. The GYN resident made note that he was unable to advise the patient regarding pregnancy prophylaxis because of her mental status and advised that this be done when her mentation cleared.

DIAGNOSIS: 1. Concussion. 2. Multiple facial and scalp acerTMot\s 3. Alleged rape with perinealra 4. Hematuria. C THOMAS HEADLEE, Y. - TH:mjd

HISTORY & nuv^nni E: fl ^,oint ffcrr,^5 ' rtal TULSA, OKLAHOMA 2-27/2-28-83 SFH-12O.A ^OCTOR OMITTEO HOSPITAL NO NAME ROOM NO. LAMBERT, DEE 4221A C T THOMPSON M.D. 1 2-27-83 183058.405-6P G. DECKER,M.D. Resident 844168-5

CC: Multiple trauma.

HPI Dee Lambert is an 18 year old white female who was found early this morning lying in a ditch along the side of the road with no clothes on her lower extremities. She states she was beat up but doesn't remember anything about the assault. She did request a raoe exam when she came to the ER. Other circu_mstances surrounding the incident are unknown at this time.

PAST MEDICAL HISTORY: SURGERY: None. GENERAL HEALTH: The patient stated that her general health was excellent and denied any heard, lung or kidney problems. SHe denies hypertensic or diabetes. ALLERGIES: No known allercTies. CURRENT MEDICATIONS: None. But the Datient did state she does take "speed".

FAMILY HISTORY & SOCIAL HISTORY: Not taken completely at this time due to the patient's condition The patient was somewhat lethargic and sleepy. She responded appropriately to most questions but was slow to respond.

PHYSICAL EXAMINATION: VS: Temp. 36.6, pulse 116, respirations 16. BP 98/60. GENERAL INSPECTION: A sleepy and somewhat lethargic 18 year old white female. She was oriented to person and place but not to time. She was a bit slow to respond but stated that she had been taking some drugs but denied the use of alcohol. HEAD: The head was normocenhalic. There were multiple lacerations aboi the head. There was a laceration of the right lower lip. There was a laceration of the mid fokehead. There was a laceration of the left temporal area. There were 3-4 lacerations on the top of the head in the hairline. EYES: The pupils were equal, round, reactive to light. EOM's were intact. The visual fields were grossly normal. The funduscopic exam was benign. The eyes were swollen and showed signs of bruising. EARS: The TM's were clear bilaterally and the right reflex was present bilaterally. There was no blood noted behind the.tympanic membranes. Auditor_y acuity was grossly normal. NOSE: There was no blood noted. The mucous membranes were moist. MOUTH: The tongue was quite swollen and the posterior pharynx could not be examined properly. There was a laceration on the right lower lip that was not through and through. To examination there were no lacerations felt within the mouth. The patient stated she was having mild difficulty swallowing but denies any shortness of breath. NECK: The neck was ecchymotic and had mild swelling. There were ar oect thaY alntlwPn aora o marizG

HISTORY & 5D.int i rcrc^5 I -kzptal TULSA, OKLAHOMA SFH-I2O-A OATEAOMITTEO HOSPITAL NO. NAME ROOM NO. DOCTOR LAMBERT, DEE -2-

The carotid pulses were +2/+4 and symmetrical. The trachea was midline. BACK: Normal curvature with no scoliosis, lordosis or kyphosis noted. There were no areas of bruising or lacerations noted on the back. LUNGS: The lungs were clear to auscultation and percussion. HEART: The heart showed a Grade 2/6 systolic murmur that was heard most prominently along the left sternal border. There was no S4 or S5 noted. ABDOMEN: Inspection revealed a scaphoid abdomen with no abrasions or brui: noted. Auscultation revealed infrequent bowel sounds. Palpatioi revealed a soft abdomen and the patient complained of mild generalized tenderness upon palpation, but there4a.s no point. tenderness noted. There was no rebound or guarding. The femoral pulses were +2/+4 and symmetrical. PELVIC: The patient was initiall_y seen in the ER by the Ob-Gyn resident and a rape exam was done at that time. There findings included ecchymosis in the perineal area along with a laceration. There was quite a bit of edema. EXTREMITIES: The natient complained of some numbness of the left hand associat ed with weakness but this was very hard to document due to the patient's.,noncooperation. The exam changed somewhat during the stay in the ER and the weakness and numbness subsided. The patient could differentiate pin point and dullness on both upper extremities throughout. The patient could move all upper extremities and lower extremities well. There was no weakness objectively documented. NEUROLOGIC: The patient was somewhat sleepy and responded slow to questions. She was oriented to person and place but not to time. THe fundu- scoDic exam was within normal limits. DTR's were within normal limits.

LABORATORY: ABG's revealed pH of 7.34, Pco2 39, Po2 89. HC03 of 20.6, with 93.9% saturation. Serum alcohol was negative. A Serum amylase revealed 512. WBC's were 31.9 with 79 polys, 6 bands,9 lymphs. The urine was positive for blood with 5-10 rbc's per HPF, however an IVP was negative.

ASSESSMENT: 1. MULTIPLE TRAUMA WITH; a. Probable concussion. b. Multiple lacerations. c. Alleged rape. d. Hematuria.

PLAN: Will admit for observation, will sew lacerations in the ER. Will get an Ob-Gyn consult for pregnancy prophylaxis. /

GD:bs GARY DECKER M.D. C. T. OMP ON,I^.D. ATTENDING CC: . Dec er,M.D. G C3ecy^r lyk

HISTORY & puvelrp 5oint ffancis I-a)otal 61615CUMYµEAYCMIf 1115ACqA'KkAAIdOE SFH 568-272E ( Rev. J177) 2-28/3-1-83 NAME ROOM NO. DATE OF REQUEST HOSPITAL NO. LAMBERT, DEE ) 4221 2-28-83 83058.405-6 844168-5 TO: DAVID FELL . (CONSULTING PHY5ICIAN) CONSULTATION REQUESTEO REGARDING:

SIGNATURE OF ATTENDING PHYSICIAN

C. T. THOMPSON, M.D.

CONSULTATION REPORT:

CC: Amnesia and impaired sensorium after having been beaten.

PI: This 18 year old female was admitted to the hospital in trans- fer from Catoosa today after reportedly having been beaten and raped. In the hospital this morning she was noted to have some weakness of the right arm and persisting amnesia so neurosurgical consultation was requested.

The patient is lethargic but arousable to speak and answer questic well. She said she was in the hospital but thought it was located in Catoosa. She knew it was February, 1983. She however wanted to cover her face and not cooperate very well for examination.

EXAMINATION: HEENT: There are multiple sutured lacerations of the scalp on the left frontotemporal region, right forehead region and right parietal area. External auditory canals are clear. Tympanic membranes are intact and free of blood. Nose, mouth and pharynx are clear. She has difficulty opening her mouth fully. NECK: Supple. NEURO: Visual fields are full to gross confrontation. Extraocular movemen are conjugate and full. She has no nystagmus. Facial expression is grossly intact. Perception to pin prick is intact in both sides of the face. Hearing seems to be good for soft conversational speech. The uvula elevates in the midline. Phonation is normal. Sternomastoid is strong. Tongue protrudes in the midline and deviates well to both sides.

On examination of the extremities she has an I.V. in the left wrist and is reluctant to cooperate to resistive testing with the left arm. However, she has reasonably good strength of the triceps and wrist extensors. We could not get her to exert with the biceps. In the right arm she had good strength of the biceps, triceps, wrist extensors, grips and hand intrinsics.

She has good ability to lift either leg off the bed against gravity and has good hamstring and quadriceps strength. Her

SIGNATURE OF CONSULTM1NT DATE OF REPORT

CONSULTATION ^int 5rcx-cis I--k_^PtGl : TULSA, OKLAHOMA E SFlf-272-1 A NAMC DATE OF NEGVEST LAMBERTy DEE -2- HOSPITwL NO.

CONSULTATION REPORT: (continued)

biceps, triceps, brachioradialis, patellar and Achilles reflexes are all brisk and symmetrically active. Plantar reflexes are flexor. She has good pin prick perception in the hands, arms, feet and legs.

We reviewed her cervical spine and skull x-rays and they are normal. -Lumbar spine x-rays are normal.

IMPRESSION: Probable cerebral concussion.

PLAN: Continued observation.

DF:mjd

SIGNATURE OF CONSULTANT. DATE OF REPORT

CONSULTATION 7ni 0 post-trauEnatic stress disorder Definition

post-traumatic stress disorder (PTSD) is a complex anxiety disorder that may occur when a person experiences or witnesses an event perceived as a threat and in which he or she experiences fear, terror, or helplessness. PTSD is sometimes summarized as "a normal reaction to abnormal events." It was first defined as a distinctive disorder in 1980. Originally diagnosed in veterans of the Vietnam War, it is now recognized in civilian survivors of rape or other criminal assaults; natural disasters; plane crashes, train collisions, or industrial explosions; acts of terrorism; child abuse; or war.

Demographics PTSD can develop in almost anyone in any age group exposed to a sufficiently terrifying event or chain of events. The National Institute of Mental Health (NIMH) estimated in 2007 that about 7.7 mil- lion adults in the United States have PTSD. One study found that 3.7 percent of a sample of teenage boys and 6.3 percent of ^dolescent girls had PTSD. It is estimated that a person's risk of developing PTSD over the course of their life is between 8 and 10 percent. On average, 30 percent of soldiers who have been in a war zone develop PTSD. Women are at greater risk of PTSD following sexual assault or domestic violence, while men are at greater risk of developing PTSD following military combat. Traumatic experiences are surprisingly common in the general North American population. More than 10% of the men and 6% of the women in one survey reported experiencing four or more types of trauma in their lives. The most frequently mentioned traumas are: • witnessing someone being badly hurt or killed • involvement in a fire, flood, earthquake, severe hurricane, or other natural disaster • involvement in a life-threatening accident (work- place explosion or transportation accident) • military combat PTSD is more likely to develop in response to an intentional human act of violence or cruelty such as a rape or mugging than as a reaction to an impersonal catastrophe like a flood or hurricane. It is not surpris- ing that the traumatic events most frequently mentioned by men diagnosed with PTSD are rape, combat exposure, childhood neglect, and childhood

3507 N E : fl O) HIGH-RISK POPULATIONS. Some subpopulations physical abuse. For women diagnosed with PTSD, the in the United States are at greater risk of developing most conunon traumas are rape, sexual molestation, PTSD. The lifetime prevalence of PTSD among per- physical attack, being threatened with a weapon, and sons living in depressed urban areas or on Native childhood physical abuse. American reservations is estimated at 23%. For vic- PTSD can also develop in therapists, rescue work- tims of violent crimes, the estimated rate is 58%. ers, or witnesses of a frightening event as well as in PTSD also appears to be more common in seniors those who were directly involved. This process is called than in younger people. Thirteen percent of the senior vicarious traumatization. population reports they are affected by PTSD in com- parison to 7-10% of the entire population. Reports of Descriptfioor elder abuse crimes have gone up by 200% since 1986. Also, the incidence of PTSD is known to be higher in The experience of PTSD has sometimes been Holocaust survivors, war veterans, and cancer or described as like being in a horror film that keeps heart surgery survivors, which accounts for a signifi- replaying and can't be shut off. It is common for cant portion of older Americans. Of those seniors who people with PTSD to feel intense fear and helplessness, are military veterans, there is an increasing number and to relive the frightening event in nightmares or in who are isolated and/or in poor health as a result of their waking hours. Sometimes the memory is triggered by a sound, smell, or image that reminds the PTSD. sufferer of the traumatic event. These reexperiences of Children are also susceptible to PTSD and their the event are called flashbacks. A person with PTSD is risk is increased exponentially as their exposure to the also likely to be jumpy and easily startled or to go event increases. Children experiencing abuse, the numb emotionally and lose interest in activities they death of a parent, or those located in a community used to enjoy. They may have problems with memory suffering a traumatic event can develop PTSD. Two and with getting enough sleep. In some cases they may years after the Oklahoma City bombing of 1995, 16% feel disconnected from the real world or have moments of children within a 100-mile radius of Oklahoma City in which their own bodies seem unreal; these symp- with no direct exposure to the bombing had increased toms are indications of dissociation, a process in which symptoms of PTSD. Weak parental response to the the mind splits off certain memories or thoughts from event, having a parent suffering from PTSD symp- conscious awareness. Many people with PTSD turn to toms, and intensified,exposure to the event via the alcohol or drugs in order to escape the flashbacks and media all increase the possibility of a child's develop- other symptoms of the disorder, even if only for a few ing PTSD symptoms. In addition, a developmentally minutes. inappropriate sexual experience for a child may be considered a traumatic event, even though it may not have actually involved violence or physical injury. Risk factors Factors that influence the likelihood of a person's MILITARY VETERANS. Studies conducted between 2004 and 2006 with veteran participants from Opera- developing PTSD include: tion Iraqi Freedom and Operation Enduring Freedom . The nature, intensity, and duration of the traumatic (Afghanistan) found a strong correlation between experience. For example, someone who just barely duration of combat exposure and PTSD. Veterans of escaped from the World Trade Center before the combat in Iraq reported a higher rate of PTSD than towers collapsed is at greater risk of PTSD than those deployed to Afghanistan because of longer someone who saw the collapse from a distance or exposure to warfare. on television. : The person's previous history. People who were Information about PTSD in veterans of the Viet- nam era is derived from the National Vietnamo Veterans abused as children, who were separated from their dncted parents at an early age, or who have a previous Readjustment Survey (NVVRS), history of anxiety or depression are at increased between1986 and 1988. The estimated lifetime prevalence of PTSD among American veterans of this war is risk of PTSD. 30.9% for men and 26.9% for women. An add tional • Genetic factors. Vulnerability to PTSD is known to 22.5% of the men and 21.2% of the women have been run in famifles. diagnosedwithpartialPTSDatsomepointine erana of • The availability of social support after the event. The lifetime prevalence of PTSD among People who have no family or friends are more likely World War II and the Korean War is estimated at 20"/0. to develop PTSD than those who do.

GALE ENCYCLOPEDIA OF MEDICINE !'" EDITION 3508 E: RU)

SOCIOCULTURAL CAUSES. Studies of specific pop- Further research needs CROSS-CULTURAL ISSUES. ulations of PTSD patients (combat veterans, survivors to be done on the effects of ethnicity and culture on of rape or genocide, former political hostages or pris- post-trautnatic symptoms. As of the early 2000s, most oners, etc.) have shed light on the social and cultural PTSD research has been done by Western clinicians causes of PTSD. In general, societies that are highly working with patients from a similar background. authoritarian, glorify violence, or sexualize violence Researchers do not yet know whether persons from have high rates of PTSD even among civilians. 11o11-Western societies have the satne psychological reactions to specific traumas or whether they develop OCCUPATIONAL FACTORS. Persons whose work exposes them to traumatic events or who treat trauma the same symptoin patterns. survivors may develop secondary PTSD (also known as cotnpassion fatigue or burnout). These occupations cau se..s and syrcupta;rrus include specialists in etnergency medicine, police offi- The causes of PTSD are not completely under- cers, firefighters, search-and-rescue personnel, psycho- stood. One tnajor question that has not been answered therapists, disaster investigators, etc. The degree of risk as of 2009 is why soine people involved in a major for PTSD is related to three factors: the amount and disaster develop PTSD and other survivors of the intensity of exposure to the suffering of trauma victims, same event do not. For example, a survey of 988 adults the worker's degree of empathy and sensitivity, and living close to the World Trade Center conducted in unresolved issues from the worker's personal history. November 2001 found that only 7 percent had been PERSONAL VARIABLES. Although the most impor- diagnosed with PTSD following the events of Septem- tant causal factor in PTSD is the trautnatic event itself, ber 11; the other 93 percent were anxious and upset, individuals differ in the intensity of their cognitive and but they did not develop PTSD. Research into this emotional responses to trautna; some persons appear question is ongoing. to be niore vulnerable than others. In some cases, this greater vulnerability is related to temperalnent or nat- Causes ural disposition, with shy or introverted people being at greater risk. In other cases, the person's vulnerabil- When PTSD was first suggested as a diagnostic ity results from chronic illness, a physical disability, or in 1980, it was controversial category for DSM-I77 previous traumatization-particularly abuse in child- precisely because of the central role of outside stres- hood. As of 2009, researchers have not found any sors as causes of the disorder. Psychiatry has genet-ally correlation between race or ethnicity and biological emphasized the internal abnormalities of individuals vulnerability to PTSD. as the source of mental disorders; prior to the 1970s, war veterans, rape victims, and other trautna survivors were often blatned for their symptoms and regarded as Symptoms cowards, inoral weaklings, or masochists. The high DSM-IV-TR specifies six diagnostic criteria for rate of psychiatric casualties among Vietnam veterans, PTSD: however, led to studies conducted by the Veterans Trautnatic stressor: The patient has been exposed to Administration. These studies helped to establish a catastrophic event involving actual or threatened PTSD as a legitimate diagnostic entity with a complex death or injury, or a threat to the physical integrity of set of causes. the self or others. During exposure to the trauma, the BIOCHEMICAL/PHYSIOLOGICAL CAUSES. Present person's emotional response was marked by intense neurobiological research indicates that traumatic events fear, feelings of helplessness, or horror. In general, cause lasting changes in the human nervous system, stressors caused intentioinally by hmnan beings (gen- including abnonnal levels of secretion of stress hor- ocide, rape, torture, abuse, etc.) are experienced as mones. In addition, in PTSD patients, researchers have more traumatic than accidents, natural disasters, or found changes in the amygdala and the hippocampus- "acts of God." the parts of the brain that form links between fear and Intrusive symptotns: The patient experiences flash- memory. Experiments with ketamine, a drug that inacti- backs, traumatic daydreams, or nightmares, in which vates one of the neurotransmitters in the central nervous he or she relives the trauma as if it were recurring in system, suggest that trauma works in a sitnilar way to the present. Intrusive symptoms result from an Positron damage associative pathways in the brain. abnormal process of memory fotmation. Traumatic emission tomography (PET) scans of PTSD patients memories have two distinctive characteristics: 1) they suggest that trauma affects the parts of the brain that can be triggered by stimuli that remind the patient of govern speech and language. 3509 GALE ENCYCLOPEDIA OF MEDICINE 4 rH EDITION Er : RU) word- the traumatic event; 2) they have aesf andnsensations ^ E E less quality, consisting of imag class of drugs that have a rather than verbal descriptions. ts to reduce Benzodiazepines-A hypnotic and sedative action, used mainly as tran- Avoidant symptoms: The patient attemp the possibility of exposure to anything that might quilizers to control symptoms of anxiety. therapy-A type of psycho- trigger memories of the trauma, and to minimize his Cognitive-behavioral or her reactions to such memories. This cluster of therapy used to treat anxiety disorders (including symptoms includes feehng disconnected from other PTSD) that emphasizes behavioral change as well people, psychic numbing, and avoidance of places, as alteration of negative thought patterns. persons, or things associated with the trauma. Patients Cortisol-A hormone produced by the adrenal with PTSD are at increased risk of substance n m moriess glands near the kidneys in response to stress. a form of self-medication to numb p splitting off of certain mental Dissociation-The Hyperarousal: Hyperarousal is a condition in which alert" processes from conscious awareness. Many PTSD the patient's nervous system is This symptomdCluster patients have dissociative symptoms. for the return of danger. temporary reliving of a traumatic includes hypervigilance, insomnia, difficulty concen- Flashback-A trating, general irri tabiliity, and an extreme startle event. state of increased emotional ten- Flyperarousal-A response. Some clinicians thinketthae mostcharacterycharacter- sion and anxiety, often including jitteriness and intense startle response may b istic symptom of PTSD. ersist being easily startled. condition of abnormally • Duration of symptoms: The symptoms must p Flypervigilance-A intense watchfulness or wariness. Hypervigilance for at least one month. • Significance: The patient suffers from significant is one of the most common symptoms of PTSD. percentage of a population that is social, interpersonal, or work-related problems as a Prevalence-The result of the PTSD symptoms. A common social affected by a specific disease at a given time. (SSRIs)-A symptom of PTSD is a feeling of disconnection Selective serotonin reuptake inhibitors from other people (including loved ones), from the class of antidepressants that work by blocking the larger society, and from spiritual, religious, or other brain, isi Prozac, significant sources of meaning. levelsotSSRIs of serotonin. ininclude Zoloft, and Paxil. severe injury or shock to a person's Diagnosis Trauma-A The diagnosis of PTSD is based on the patient's body or mind. history, including the timing of the traumatic event and the duration of the patient's symptoms. considered the best way to make a valid diagnosis Examination because it can gauge under-reporting or over-reporting Consultation with a mental health professional for of symptoms. The two primary forms are structured diagnosis and a plan of treatment is always advised. interviews and self-report questionnaires. Spouses, part- ners and other family members may also be interviewed. Many of the responses to trauma, such as shock, terror, reminders irritability, blame, guilt, grief, sadness, emotional Because the evaluation may involve st reactions, reac- numbing, and feelings of helplessness, are natural the trauma in order to gauge a patent viduals should ask for a full description tions. For most people, resilience is an overriding factor results can be and trauma effects diminish within six to sixteen tion process beforehand. Asking months. It is when these responses continue or become expected from the evaluation is also advised. debilitating that PTSD is often diagnosed. A number of structured interview forms have been As outlined in DSM-IV, the exposure to a trau- devised to facilitate the diagnosis of post traumatic matic stressor means that an individual experienced, stress disorder: ni,tered witnessed or was confronted by an event or events ScaleTSD(CAPS) • The Clinician involving death or threat of death, serious injury or the t e National Cen^tiesfor P threat of bodily harm to oneself or others. The individ- developed by SCID) ual's response must involve intense ato evaluation is • The Structured Clinical Interview for DSM ( horror. A two-pronged approach GALE ENCYCLOPEDIA OF MEDICINE 4TH En1-tlON

3510 E : MU)

Psychodynamic psychotherapy. This approach helps • Anxiety Disorders Interview Schedule-Revised (ADIS) the patient recover a sense of self and learn new • PTSD-Interview coping strategies and ways to deal with intense emo- • structured Interview for PTSD (SI-PTSD) tions related to the trauma. Typically, it consists of • PTSD Symptom Scale Interview (PSS-I) three phases: 1) establishing a sense of safety for the patient; 2) exploring the trauma itself in depth; 3) Self-reporting checklists provide scores to repre- i helping the patient re-establish connections with sent the level of stress experienced. Some of the most family, friends, the wider society, and other sources conunonly used checklists are: of meaning. . The PTSD Checklist (PCL), which has one list for Discussion groups or peer-counseling groups. These civilians and one for military personnel and veterans groups are usually formed for survivors of specific • Impact of Event Scale-Revised (IES-R) traumas, such as combat, rape/incest, and natural or . Keane PTSD Scale of the MMPI-2 transportation disasters. They help patients to rec- • The Mississippi Scale for Combat Related PTSD and ognize that other survivors of the shared experience the Mississippi Scale for Civilians have had the same emotions and reacted to the • The Post Traumatic Diagnostic Scale (PDS) trauma in similar ways. They appear to be especially beneficial for patients with guilt issues about their • The Penn Inventory for Post-Traumatic Stress behavior during the trauma (e.g., submitting to rape • Los Angeles Symptom Checklist (LASC) to save one's life, or surviving the event when others did not). Tests Family therapy. This form of treatment is recom- There are no laboratory or imaging tests that can mended for PTSD patients whose family life has detect PTSD, although the doctor may order imaging been affected by the PTSD symptoms. studies of the brain to rule out head injuries or other physical causes of the patient's symptoms. Drugs In general, medications are used most often in Treatntettt patients with severe PTSD to treat the intrusive symptoms of the disorder as well as feelings of anxiety and Traditional depression. These drugs are usually given as one part Treatment for PTSD usually involves a combina- of a treatment plan that includes psychotherapy or tion of medications and psychotherapy. If the patient group therapy. As of 2009, there is no single medica- has started to abuse alcohol or drugs, they must be tion that appears to be a "magic bullet" for PTSD. The treated for the substance abuse before being treated selective serotonin reuptake inhibitors (SSRIs) for PTSD. If the patient is diagnosed with coexisting appear to help the core symptoms when given in depression, treatment should focus on the PTSD higher doses for five to eight weeks, while the tricychc because its course, biology, and treatment response antidepressants (TCAs) or the monoamine oxidase are different from those associated with major depres- inhibitors (MAOIs) are most useful in treating anxiety sion. Patients with the disorder are usually treated and depression. as outpatients; they are not hospitahzed unless they Sleep problems can be lessened with brief treat- or harm other are tlueatening to commit suicide ment with an anti-anxiety drug, such as a benzodiaze- people. pine like alprazolam (Xanax), but long-term usage can Mainstream forms of psychotherapy used to lead to disturbing side effects, such as increased anger, treat patients who have already developed PTSD drug tolerance, dependency, and abuse. Benzodiaze- iuclude: pines are also not given to PTSD patients diagnosed Cognitive-behavioral therapy. There are two treat- with coexisting drug or alcohol abuse. ment approaches to PTSD included under this head- ing: exposure therapy, which seeks to desensitize Alternative the patient to reminders of the trauma; and anxiety Relaxation training, which is sometimes called management training, which teaches the patient anxiety management training, includes breathing exer- strategies for reducing anxiety. These strategies cises and' similar techniques intended to help the may include relaxation training, biofeedback, social patient prevent hyperventilation and relieve the skills training, distraction techniques, or cognitive muscle tension associated with the fight-or-flight restructuring. 3511 GALE ENCYCLOPEDIA OF MEDICINE 4TH EDITION E : ACU (TAT). TAT was Tapas Acupressure Technique reaction of anxiety. Yoga, aikido,t'ai chi, and dance developed in 1993 by a licensed acupuncturist therapy help patients work with the physical as well as named Tapas Fleming. It is derived from traditional TCM), and its practitioners main- the emotional tensions that either promote anxiety or Chinese medicine ( tain that a large number of acupuncture meridians are created by the anxiety. enter the brain at certain points on the face, espe- pther alternative or complementary therapies are cially around the eyes. Pressure on these pointsis based on physiological and/or energetic understanding of how the trauma is imprinted in the body. These thought to release traumatic stress. combines the therapies affect a release of stored emotions and reso- Thought Field Therapy. This therapy lution of them by working with the body rather than acupuncture meridians of Tho e. The therapist then patient's voice over the telep merely talking through the experience. One example provides an individualized treatment for the patient. such a therapy is Somatic Experiencing (SE), developed Traumatic Incident Reduction. This is a technique in by Dr. Peter Levine. SE is a short-term, biological, which the patient treats thewith the the^app t body-oriented approach to PTSD or other trauma. tedly This approach heals by emphasizing physiological and and "runs through" it repea emotional responses, without re-traumatizing the per- until all negative emotions have been dis is aim- Emotional Freedom Techniques (EFT). EFT son, without placing the person on medication, and in that it uses the body's acupuncture without the long hours of conventional therapy. ilar to TAT meridians, but it emphasizes the body's entire When used in conjunction with therapies that "energy field" rather than just the face. address the underlying cause of PTSD, such relaxation by a physician, tlus and aro- Count ng Technique. Developed therapies as hydrotherapy, massage therapy, treatment consists of a preparation phase, a counting are useful to some patients in easing PTSD matherapy phase in which the therapist counts from 1 to 100 symptoms. Essential oils of lavender, chamomile, ner- while the patient reimagines the trauma, and a review ctionsaL it is oli, sweet marjoram, and ylang-ylang are commonly phase. Like Traumatic Incident Redu erarou recommended by aromatherapists for stress relief and intended to reduce the patient's hyp anxiety reduction. ts benefit from spiritual or religious Some patren Prognosis counseling. Because traumatic experiences often affect The prognosis of PTSD is difficult to determine patients' spiritual views and beliefs, counseling with a nts' personahties and the experiences trusted religious or spiritual advisor may be part of a because patie they undergo vary widely. A majority of patients get treatment plan. A growing number of pastoral coun- selors in the major Christian and Jewish bodies in better, including some who do not receive rof PTSD North America have advanced credentials in trauma One study reported that the treatment is 32 months, symptoms in patients who get therapy. Native Americans are often helped to recover compared to 64 months in patients who are not treated. from PTSD by participating in traditional tribal rit- Factors that improve a patient's chances for fnll uals for cleansing memories of war and other trau- recovery include prompt treatment, early and ongoing support from family and friends, a high level of func- prayers and chants, or con ultation with a shaman or tioning before the frightening event, and an absence of tribal healer. alcohol or substance abuse with PTSD never Several controversial methods of treatment for PTSD have been introduced since the mid-1980s. Some About 30 percent of people e have been developed by mainstream medical researchers recover completely, however. A fewo seorrml rt`than while others are derived from various forms of altema- because their symptoms get tive medicine. These methods are controversial because improving. they do not offer any scientificallyvalidated explana- tions for their effectiveness. They include: Heait9t care team ro'es embers to Eye Movement Desensitization and Reprocessing It is essential for all treatment teor l y through- (EMDR). This is a technique in which the patient know their roles and execute themhm Ps of this disorder. reimagines the trauma while focusing visually on out the treatment and recovery p arient treat- movements of the therapist's finger. It is claimed Depending on whether team leaders may include that the movements of the patient's eyes reprogram ment is being provided, the the brain and allow emotional healing. TH E GALE ENCYCLOPEDIA OF MEDiCINE 4r^1TION 3512 ^ OTHER ° Post-Trau- psychiatrists, psychologists, nursing staff, behavior National Alliance on Mental Illness (NAMI). Templa- specialists, physical therapists, and other tnedical/ matic Stress Disorder. http://www.nami.orgJ behavioral staff. In some cases it may be appropriate te.cfm?Section=ByIlhiess&Template=/TaggedPage/ ° to include the patient's religious or spiritual advisor as TaggedPageDisplay.cfm&TPLID=54&_ d a metnber of the teanz. ContentID = 23045 National Center for Posttraurnatic Stress Disorder.Hope for Recovery: Understanding PTSD. [10-minute video] o P'L`et./ent@m¢6 http://www.ncptsd.va.gov/ncmain/ncdocs/videos/ ^ PTSD is impossible to prevent completely because emvhoperecovery_gpv.htnil aa National Center for Posttraumatic Stress Disorder Fact natural disasters and hutnan acts of violence will con- PTSD?http://www.ncptsd.va.gov/ Sheet. What Is tinue to occur. In addition, it is not possible to tell ncmain/ncdocs/fact_slits/fs_what_is-ptsd. html beforehand how any given individual will react to a Helping National Institute of Mental Health (NIMH). Violence and Disasters: Wliat specific type of trauma. Prompt treatment after a Children Cope with http://www.nimh.nih.gov/health/pub- traumatic event may lower the survivor's risk of devel- Parents Can Do. oping severe symptoms. lications/helping-children-and-adolescents-cope-with- violence-and-disasters-what-parents-can-do/ Resources index.shtn'tl. BOOKS Diagnostic and Statistfcal ORGANIZATIONS American Psychiatric Associatiou. Atneican Psychiatric Association, 1000 Wilson Boulevard, Manual of Mental Disorders. 4th ed., text rev. Waslt- Suite 1825, Arlington, VA, 22209-3901, 703-907-7300, ington, D.C.: American Psychiatric Association, 2000. [email protected], http://www.PsYch-0"9- Oxford Antony, Martin M., and Murray B. Stein, eds. Alixiety Disorders Association of Ainerica (ADAA), 8730 and Related Disorders. New York: Handbook ofAnxiety Georgia Ave., Suite 600, Silver Spring, MD, 20910, 240- Oxford University Press, 2009. 485-1001, 240-485-1035, [email protected], Traumati=ed Claildren: A Brohl, Kathryn. Working with VA: CWLA http://www.adaa.org- Handbook for Healing, rev. ed. Arlington, International Society for Traumatic Stress Studies (ISTSS), Press, 2007. 111 Deer Lake Road, Suite 100, DeerfieldIL, United Therapyfor Trau- Grey, Nick, ed. A Casebook of Cognitive States, 60015, 847-480-9028, 847-480-9282, istss@i5t55. niatic Stress Reactions. New York: Routledge, 2009. After the War org, http://www.istss-Org- Slone, Lamie B., and Matthew J. Friedman. Natioiial Alliance on Mental Illness (NAMI), 2107 Wilson Zone: A Practical Guide for Returning Troops and Their Blvd., Suite 300, Arlington, VA, 22201-3042, 703-524- Lifelong, 2008. Families. Cambridge, MA: Da Capo 7600, Hotline: 800-950-NAMI (6264), 703-524-9094, http://www.nanii.org/Hometemplate.cfni. PERIODICALS Cohen, J. A., and M. S. Scheeringa. "Post-traumatic Stress National Center for Posttrauniatic Stress Disorder Disorder Diagnosis in Children: Challenges and Prom- (NCPTSD), Information line: 802-296-6300, 11 (2009): [email protected], http://www.ncptsd.va.gov/ncmain/ ises." Dialogues in Clinical Neuroscience 91-99. index.jsp. Evans, S., et al. "DisabIlity and Posttramnatic Stress Disorder National Institute of Mental Health (NIMH), 6001 Execu- in Disaster Relief Workers Responding to September 11, tive Boulevard, Room 8184, MSC 9663, Bethesda, MD, Center Disaster." Journal of Clinical 20892-9663,301-443-4513,866-615-6464,301-443- 2001 World Trade 4279, [email protected], http://www.nin4i.nih.gov/ Psychology 65 (Apri122, 2009): 684-694. Grinage, Bradley D. "Diagnosis and Management of index.shtml. Family Post-trautnatic Stress Disorder." Anierican Rebecca J. Frey, PhD Physician 68 (Deceniber 15, 2003): 2401-09. Industry." Neia Groopman, Jerome, MD. "The Grief Yorker, January 26, 2004. Available online at http:// www.newyorker.com/archive/2004/01/26/ 040126fafact?currentPage = all Hamblen, J. L., et al. "Cognitive Behavioral Therapy for Postdisaster Distress: A Conimmiiity-Based Treatment Program for Survivors of Hurricane Katrina." 36 (May Adn2inistration and Policy in Mental Health 2009): 206-14. Smith, T. C., et al. "PTSD Prevalence, Associated Expo- sures, and Functional Health Dutconies in a Large, Population-Based Military Cohort." Public Health Reports 124 (January-February 2009): 90-102.

GALE ENCYCLOPEDIA OF MEDICINE 4 rH EDITION ^•

Stockholm syndrotne Deflnitimn Stockholm syndrome refers to a group of psychological symptoms that occur in some persons in a cap- tive or hostage situation. It has received considerable media publicity in recent years because it has been used to explain the behavior of such well-known kidnapping victims as Patty Hearst (1974) and Elizabeth Smart (2002). The term takes its name from a bank robbery in Stockholm, Sweden, in August 1973. The robber took four employees of the bank (three women and one man) into the vault with him and kept them hostage for 131 hours. After the employees were finally released, they appeared to have formed a paradoxical emotional bond with their captor; they told reporters that they saw the pohce as their enemy rather than the bank robber and that they had positive feelings toward the criminal. The syndrome was first named by Nils Bejerot (1921-1988), a medical professor who specialized in addiction research and served as a psychiatric consultant to the Swedish police during the standoff at the bank. Stockholm syndrome is also known as Survival Identification Syridrome.

Description Stockhohn syndrome is considered a complex reaction to a frightening situation and experts do not agree completely on aII of its characteristic features or on the factors that make some people more susceptible than others to developing it. One reason for the disagreement is that it would be unethical to test theories about the syndrome by experimenting on human beings. The data for understanding the syndrome are derived from actual hostage situations since 1973 that differ considerably from one another in terms of location, number of people involved, and time frame. Another source of disagreement concerns the extent to which the syndrome can be used to explain other historical phenomena or more commonplace types of abusive relationships. Many researchers believe that Stockhohn syndrome helps to explain certain behaviors of survivors of World War II concentration camps; members of refigous cults; bat- tered wives; incest survivors; and physically or emotionally abused children as well as persons taken hostage by criminals or terrorists. Most experts, however, agree that Stockholm syndrome has three central characteristics: • The hostages have negative feelings about the police or other authorities. • The hostages have positive feelings toward the'r captor(s).

GALE ENCYCLOPEDIA OF MEDICINE 4TH EDITION ae feelings toward the The captors develop pos that refers to a per- hostages. Coping-In psychology, a term rns son's patterns of response to stress. Some patte Causes & syrnpt®rns of coping may lower a person's risk of developing Stockholm syndrome does not affect Stockholm syndrome in a hostage situation, fachoa Fed- f traum^t (or persons in comparable situations); ln Flashback--The re-emergence o a gesd eral Bureau of Investigation (FBI) study of over 1200 ory as a vivid recollection of sounds, The person hostage-taking incidents found that 92% of the hos- sensations associated with tfeels as if they are tages did not develop Stockholm syndrome: FBI having the flashback typicallY researchers then interviewed flight attendants reliving the event. Flashbacks were first described e hijackings, had been taken hostage during plan for the by doctors treating combat veterans of World War I and concluded that three factors are necessary (1914-1918). rossor-In psychology, syndrome to develop: Identification n which a person adopts `^itroc ss^g • The crisis situation lasts for several days or longer. an unconscious p atterns of a captor • The hostage takers remain in contact with the hostages; the perspective or behaviorconsider it p a anialP that is, the hostages are not placed in a separate room. abuser. Some researchers the explanation of Stockholm syndrome. . The hostage takers show some kindness ^ mr Ho return to earlier, usu- psychology, hostages or at least refrain from harminganger toward Regression-In antile, patterns of thought or tages abused by captors typ Y feel ally childish or inf them and do not usually develop the syndrome. behavior. set of symptoms that occur together. In addition, people who often feel helpless Syndrome-A stressful life situations or are willing to do anything order to survive seem to be more susceptible to developing Stockholm syndrome if they are taken hostage. People with Stockholm syndrome report the nature of the hostage situation; the length of time the post-traumatic same symptoms as those diagnosed with crisis lasted, and the individual patient's general cop (PTSD): insomnia, nightmares, general stress disorder ing style and previous experience(s) of tranma. irritability, difficulty concentrating, being easily startled, feelings of unreality or c°riencesnincreased dis enjoy previously pleasurable exp prevent'sern trust of others, and flashbacks. Prevention of Stockholm syndrome at the level of the larger society includes further development of crisis intervention skills on the part of law enforcement as Diagnosis well as strateg es to prevent kidnapping or hostage Stockholm syndrome is a descriptive term for a taking incidents in the first place. Pre2000sbecause pattern of coping with a traumatic situation rather individual level is difficult as of the early all than a diagnostic category. Most psych atrists would been able to identiy for acute stress disor dero r researcherssome have persons not at greater the risk fac- than use the diagnostic criteria P a Per-posttraumatic stress disorder when evaluating tors that may place they disagree on the specific psy- others; in addition, Stockholm syn- son with Stockholm syndrome. - of chological mechanisms invol ldr me asof a form drome. Some regard the sy thought or Treatment regression (return to ch ldish patterns action) while others explain it in terms of e Wott^° he Treatment of Stockhohn^ adon of m dica paralysis ("frozen fright") or identification for PTSD, most commonly a om s cho- tions for short-term sleep disturbances s and p y aggressor. therapy for the longer-term symp o Resources

PY1Dgn€EsES BOOKS Ratio006Maiit^, & Cm'^sis- Ledwig, Marion. Enlotions ' TlteLr 2 The prognosis for recoverythe Stockholat ent New York: Peter Lang, drome is generally good, but tency. needed depends on several variables. These include the 4135

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