Question
Case Scenario
Background:
The defendant is a forty-year-old, single, black female charged with a first-degree assault. Specifically, she is alleged to have splashed liquid fire, a liquid drain cleaner, onto another woman’s face, thus incidentally splashing five bystanders. Per the court order you received, Ms. Tyler was referred some time after the alleged crime for evaluation of her criminal responsibility. Her competency to stand trial (CST) was also at issue. At the time of the evaluation, Ms. Tyler was being held at the Southern County Detention Center. You met with Ms. Tyler. The defendant was informed that the results of the evaluation will be released to the court and that the results may be used against her in the court. Ms. Tyler gave her written consent to be evaluated.
Psychosocial History:
Only limited information is available regarding Ms. Tyler’s background. She is a lifetime resident of the state. Her mother died of cancer at the age of seventy-nine years. Her father, L. Defendant, is eighty-four years old and is a retired farmer. Ms. Tyler has five living sisters, four living brothers, and two deceased siblings. Three of her sisters have received inpatient psychiatric treatment. One sister lives in Close Town, one in Europe with her husband who is in the military, and one sister died in a drowning accident. One brother committed suicide by hanging himself. There is no history of psychiatric problems among the other brothers.
Ms. Tyler has completed the tenth grade. She is literate. Ms. Tyler has worked on an assembly line for five years until 1988 when the factory closed. She then did an office-cleaning job. Her reasons for leaving this position are vague. She was unemployed for several years and was supported by her family. She lives in rent-free government housing. Her church pastor, A. Reverend, arranged for her to get employment at Helpful Industries through a vocational office at the State Psychiatric Hospital. She was employed at Helpful Industries for approximately two months prior to the incident. Ms. Tyler has never married. She has a thirteen-year-old son who lives with his father.
Psychiatric History:
Ms. Tyler denies any previous psychiatric treatment. Family members and individuals who know Ms. Tyler state that she has a long history of psychiatric symptoms such as loose associations and persecutory delusions. Ms. Tyler’s sister, Ms. Sister, reports that Ms. Tyler has been violent in the past, threatening her niece with a knife. Her emotional difficulties were also apparently common knowledge among her congregation. As stated above, Ms. Tyler has a positive family history for psychiatric illness. Ms. Tyler is currently on haloperidol, an antipsychotic medication.
Ms. Tyler denies any alcohol or substance abuse. She states that she has one previous arrest for prostitution in 1975. She spent six months in jail for this offense.
Report of the Crime:
When asked to report what happened, Ms. Tyler states, “It happened so fast, I just remember, I threw it on her. I didn’t mean to.” She continues, “I threw liquid fire on her. She always caused me trouble . . . She picked with me all the time . . . Sometimes she would step on my feet. I did not mean to do it, it happened so quick I did not understand myself. That morning when I went to church, I was standing by a table and she came over, starting trouble with me . . . Came over and said my name.”
Ms. Tyler was guarded in her responses, and at one point, she asked what the court would do with her if she said, “just didn’t know why I did it.” Her report conflicts with several eyewitness reports. All the eyewitnesses who were interviewed claimed that Ms. Tyler yelled at Ms. Mobly. Mr. Witness 1 states that Ms. Tyler approached Ms. Mobly and said, “I’m getting sick and tired of you picking on me every day at church.” He states that she then started splashing Ms. Mobly with the drain cleaner. Ms. Witness 2’s account is similar. She states, “As soon as Ms. Mobly entered, Ms. Tyler grabbed her purse and started throwing the solution on her saying ‘told you I was gonna get you. I’m tired of you getting me in trouble.'”
Ms. Witness 3’s report of the incident is also similar. Additionally, Ms. Witness 3 states that Ms. Tyler would frequently deny making threats when confronted with an issue, claiming that she did not make such a threat or did not remember making it. Ms. Witness 3 also states that Ms. Tyler reported experiencing auditory hallucinations telling her to get people. However, Ms. Tyler has consistently denied hallucinations.
Tasks:
In a 8- to 10-page report, analyze this case and address the following to the best of your abilities:
What tests or assessments would you recommend to provide a comprehensive diagnostic assessment of Ms. Tyler?
Provide diagnostic impressions based upon the case and the tests you have recommended. Provide an explanation or a rationale for how you arrived at this diagnosis.
What are the psycholegal issues to be assessed? What are the standards used to evaluate these issues (i.e., discuss the relevant court decisions and holdings)?
What tests should be administered and why? What is the empirical support for the tests you have suggested?
What other information do you need to offer an opinion on whether Ms. Tyler is competent to stand trial?
What other information do you need to offer an opinion as to whether Ms. Tyler met the legal criteria for insanity at the time of the offense?
What outcomes do you expect will be reached by the court with regard to these issues and why?
What are the potential ethical issues involved in this case? How would you resolve these issues?
Sample paper
Ms. Tyler Case Study
It is important to Put Ms. Tyler through a number of assessments in order to obtain a comprehensive diagnostic assessment of her mental status. Ms. Witness 3 reports that Ms. Tyler makes threats but later denies making threats. In addition, she reports that Ms. Tyler experiences auditory hallucinations. With this regard, it is important to conduct a test to examine her hallucinatory tendency. The Launay Slade Hallucination Scale (LSHS) is an appropriate tool that can help examine her hallucinatory tendency. The LSHS is a questionnaire comprising of 12 items designed to measure auditory and visual hallucinatory tendency at clinical as well as subclinical levels (Gracie, et al., 2007). The LSHS tool is however applicable to normal individuals only. Reports indicate that Ms. Tyler experiences persecutory delusions. The paranoia scale (PS) can help examine the occurrence of paranoia in an individual. The paranoia scale comprises of 5-points, which rates items from 1 – 5 , ranging from “not at all applicable” to “extremely applicable” (Gracie, et al., 2007, p. 284). The items in the paranoia scale are designed to measure persecutory predisposition, suspiciousness, resentment, and ideas about reference.
The Traumatic Life Events Questionnaire (TLEQ) can help in assessing whether Ms. Tyler had a traumatic childhood, and whether childhood experiences are the result of the current behavior. The TLEQ comprises of 24 –items that examine whether an individual was exposed to traumatic events (Gracie, et al., 2007). Using a yes/no format, the items seek to establish whether an individual has experienced any traumatic event. The questionnaire also prompts individuals to rate their fear on a 3-point scale in the event that one experienced a traumatic occurrence. The questionnaire can help examine whether Ms. Tyler experienced emotional abuse and neglect during childhood, which could be manifested in adulthood in different ways.
Another assessment for Ms. Tyler is the Positive and Negative Syndrome Scale (PANSS), which groups items using three subscales (Wallwork, Fortgang, Hashimoto, Weinberger, & Dickinson, 2012). The first scale examines positive symptoms such as excitement, grandiosity, hallucinatory behavior, and others. The second scale evaluates negative symptoms such as emotional withdrawal, stereotyped thinking, and others. The third scale evaluates general psychopathology factors such as anxiety, tension, poor impulse control, uncooperativeness, and others. Another important tool is the Brief Psychiatric Rating Scale (BPRS), which measures various symptoms such as anxiety, depression, hallucinations, and general unusual behavior.
The diagnostic impressions relating to Ms. Tyler point toward psychosis. Psychosis a range of mental health conditions that cause distortion of reality among those involved. In particular, Ms. Tyler seems to suffer from schizophrenia with paranoia. According to the National Institute of Mental Health (NIH) (n.d), schizophrenia is a mental health condition that affects thoughts, feelings and behavior patterns of individual. The key risk factors associated with schizophrenia are genes and the environment. In this case, Ms. Tyler’s siblings (sisters) have had episodes of psychotic behavior. Paranoid schizophrenia is the most common form of schizophrenia. According to Puri and Treasaden (2009), individuals suffering from paranoid schizophrenia are likely to experience distortions in their perceptions of reality. For instance, they may experience auditory hallucinations, or believe that other people are planning to harm them in some way. Moreover, Puri and Treasaden (2009) observe that people suffering from schizophrenia are likely to become violent to delusions and the hallucinations they experience. Ms. Tyler exhibits most of the behaviors mentioned above, such as violence, auditory hallucinations, persecutory delusions, and others.
The recommended tests could also indicate that Ms. Tyler is suffering from schizophrenia with paranoia. According to Gracie et al. (2007), there is a close connection between post-traumatic stress disorder (PTSD) and psychosis. In other words, majority of those with psychotic disorders also show signs of PTSD. The Traumatic Life Events Questionnaire (TLEQ) will help examine the history of Ms. Tyler concerning traumatic events. The Paranoia Scale will help evaluate the level of paranoia, specifically thoughts about persecution, ideas about reference, and resentment. If Ms. Tyler obtains a high score, it would be clear that she is suffering from one or more of the schizophrenic symptoms. The LSHS scale will help examine Ms. Tyler’s hallucinatory predisposition. A common symptom associated with schizophrenia is hallucinations, both auditory and visual. The PANSS helps in measuring the severity level of various symptoms in patients suffering from schizophrenia. Some of the items to be measured include delusions, hallucinations, hyperactivity, hostility, and others. The BPRS scale will also help in measuring various symptoms presented by the patient.
Various psycholegal issues may emerge concerning Ms. Tyler’s case. One of the issues concerns to reviewing the ‘case facts’. Examiners in a case can review various documents relating to the client, such as police reports with an aim to challenge the psychology professional’s opinion. The examiner may review the information prior or during the case. The psychology professional must take into consideration third party opinions in order to corroborate evidence. Another psycholegal issue regards to competency to stand trial (Skeem, Golding, Cohn, Berge, 1998). The psychology professional must establish whether the defendant can understand the nature of the proceedings or the accusations brought against him or her.
Another psycholegal issue relates to the nature of data used. The psychology professional may rely on traditional clinical data or methods of testing, which the courts may fail to recognize as sound methods. Another psycholegal issue involves issuing an opinion on competency to stand trial without basing judgment on sound data analysis (Skeem et al., 1998). The psychologist professional must also address the issue of evaluation and advocacy. As evaluators, the professional provides objectivity, while as an advocate the professional is a guide.
The Dusky Standard is one of the standards used to evaluate the psycholegal issues. In Dusky v. United States, the Federal Court held that the defendant must show competency and understanding in order to stand trial. The defendant must show rationality of proceedings and be able to consult with the attorney. Another standard used to evaluate the issue is the Daubert Standard. This standard examines the nature of the scientific inquiry, for instance, the methods of data collection, the theory applied, the quality of data used, and potential errors that could result (Erickson & Grise, 2013). The Daubert Standard holds that the judge is the ‘gatekeeper’ regarding admissibility of expert testimony. Another standard used to evaluate these issues is based on Ewing v. Goldstein ruling, which regards the need for the psychologist professional to warn any identifiable victims about particular threats.
The Positive and Negative Syndrome Scale (PANSS) is a significant test that is worth considering. The PANSS test is of the most widely applied scales in evaluating psychotic behavior among individuals. The scale comprises of 30 items categorized into three subscales. The PANSS is one of the most useful tools applied in schizophrenia research in the modern world. Since the Ms. Tyler shows schizophrenic symptoms, it is important to apply the PANSS test. The Brief Psychiatric Rating Scale (BPRS) should also be administered. This is because the scale helps in evaluating the general symptomatology of the patient, anxiety levels, hostility, and signs of depression. The BPRS has a high validity, reliability, and sensitivity, which makes it an accurate measure of psychopathological predisposition (Leucht et al., 2006). The last measure is the Paranoia Scale. The Paranoia Scale has a high internal consistency, thus it will be a good measure of various behavioral tendencies.
The empirical backing of the Paranoia Scale relates to its high internal consistency. According to Gracie et al. (2007), the scale has a high internal consistency with a Cronbach’s alpha level of 0.84. In addition, the measure exhibits good test-retest reliability with a correlation value of 0.70 after a 6-month period. The PANSS provides comprehensive evaluation of the symptoms associated with schizophrenia. The entire scale comprises of 30 items. This increases its validity and reliability. A reliability test conducted by Emsley et al. (2003) indicates that the PANSS has over 0.80 inter-rater reliability. This indicates that the scale yields dependable results. There is a strong association between the PANSS and BPRS assessments (Leucht et al., 2006). As such, utilizing the two tests can be a good way of examining client behavioral aspects.
There is other information necessary to prove that Ms. Tyler is competent to stand trial. One of these is rational understanding of the matters at hand. Rationality refers to the mental states of an individual as exemplified by purposeful or coherent beliefs, and the ability to make decisions that weigh costs and benefits. A rational person will act in a way that reduces detriments. Ms. Tyler should have the mental capacity to recognize her presence with regard to time and place. As such, if Ms. Tyler is not able to understand that she is in a court of law and charged for a particular crime, then she may be deemed incompetent to stand trial. From the case study, Ms. Tyler is aware of the consequences that she may face if she is found guilty, and this is the reason she is guarded in her response.
Another information that may help tell whether she is competent to stand trial regards her ability to consult with her lawyer about the alleged offense. If Ms. Tyler is able to talk to her lawyer about the facts surrounding the case, then she may be deemed competent to stand trial. This would show whether the defendant might satisfy the conditions of M’Naghten rule. Other information necessary regards to the ability to recall the events of the day she committed the crime. If Ms. Tyler has sufficient memory to recall the events of the day, she can stand trial. It is clear that Ms. Tyler can articulate the events of the particular day when the offense was committed. As such, it is clear that she is not mentally incapacitated.
It is important to identify relevant third party information with regard to the case. Gathering third party information can provide crucial details regarding whether Ms. Tyler is competent to stand trial (Otto 2006). The examiner may evaluate criminal justice records such as arrest reports in order to gain more information concerning the nature of charges. Other records that may be of great importance are medical records, mental health records, and even school records. The social history of the defendant is also important and may help assess whether Ms. Tyler is competent to stand trial (Otto, 2006). The social history includes family history, substance abuse history, academic history, and other details regarding the life of the defendant.
The general criteria for establishing whether the defendant meets the legal criteria for insanity at the time of the offense regards whether he/she is criminally responsible for their behavior. There are a number of tests used to establish whether the defendant was insane at the time of committing the offense. A common standard applied in this is the M’Naghten rule, which states that insane defendants cannot face conviction of offenses resulting from the mental defect (“Findlaw,” n.d). The focus of this rule is whether the defendant could actually identify wrong or right at the time of the offense. The tests applied include Durham rule, Model Penal Code Test, and the Irresistible Impulse Test. Thus, in order to offer an opinion on whether Ms. Tyler met the legal criteria for insanity, one may need additional information about her mental health state. It is important to establish whether her mental status is solely to attribute for her actions. For instance, was she aware of the fact that she was committing an offense?
The outcome that is most likely to be reached by the court is that Ms. Tyler is competent to stand trial. In addition, the defendant was sane at the time of the crime and clearly understood wrong from right. The Ali Model Penal Code test (ALI Test) assumes that a defendant can be found not guilty by reason of insanity only if he/she suffers from a relevant mental health problem and during the time of committing the offense could not satisfy two requirements. First, he/she is unable to appreciate the wrongfulness or rightness of his conduct, and second, he is unable to “conform his conduct to the requirements of the law” (“Findlaw,” n.d). It is clear that at the time of committing the offense, Ms. Tyler could appreciate the wrongness and rightness of her actions. As Ms. Witness 2 recounts, Ms. Tyler was on a revenge mission since the plaintiff always got her into trouble.
It is clear that while committing the offense, Ms. Tyler understood the criminality of her actions. In addition, Ms. Tyler can conform her actions to the requirements of the law. During trial, Ms. Tyler asks the court what would happen if she said, “just didn’t know why I did it”, meaning she is aware of her criminal conduct. From the eyewitness accounts, it is clear that Ms. Tyler held a grudge with Ms. Mobly. Although it could partly be the result of her psychotic behavior, she understood the nature of her actions, and including the legal consequences. Ms. Tyler tells off the victim that she is “tired of you picking on me every day at church”, meaning she was aware of the issue between her and Ms. Mobly. The fact that Ms. Tyler knew what she was doing indicates she was aware of her actions. As such, she is competent to stand trial in the court of law.
There are a number of ethical issues surrounding this case. The concept of ‘not guilty by reason of insanity’ raises many ethical issues in the legal field. The first ethical issue is the usefulness of the psychology professional’s testimony in court. The professional may arrive at the wrong decision by relying on wrong facts or using outdated methods. In such a scenario, it would be difficult to ascertain whether the defendant is not guilty by reason of insanity. Another ethical issue involved in this case regards the responsibility of the criminal act. If the court holds that Ms. Tyler is not guilty by reason of insanity, this will allow her to evade taking responsibility of her actions.
The not guilty by reason of insanity standard requires that at the time of committing crime, the defendant must have been suffering from a mental disorder, which significantly impairs judgement. In addition, there must be a causative link between the impaired function and the mental health issue. A causative link shows the cause of or the result of something. As Smith (2012) notes, establishing the causative link is a difficult and complex process. Thus, establishing a causative link between the mental defect and the impairment resulting can bring complexities in practical application. This gives rise to ethical dilemmas since it is difficult to establish the causative link with regard to the defendant’s actions.
While making the insanity claims, the prosecutors may evaluate the decision on whether to categorize the impairment as either volitional or cognitive. If cognitive impairments are present, this simply means that at the time of committing the offense, the defendant could not be able to tell right or wrong. On the other hand, volitional impairment relates to the defendant’s inability to keep control of their actions. According to smith (2012), these functional categories are ambiguous. As such, it is often difficult for judges and prosecutors to prove any of them. This gives rise to ethical issues since it is difficult to prove volitional and cognitive impairment, yet courts still rely on these measures.
References
Emsley, R., Rabinowitz, J., Torreman, M., & RIS-INT-35 Early Psychosis Global Working Group. (2003). The factor structure for the positive and negative syndrome scale (PANSS) in recent-onset psychosis. Schizophrenia Research, 61(1), 47-57. doi:10.1016/S0920-9964(02)00302-X
Erickson, D. R., & Grise, L. R. (2013). Best practices – working with experts. ABA. Retrieved from http://www.americanbar.org/content/dam/aba/administrative/litigation/materials/sac2013/ sac_2013/52_%20best_practices_for_working_events.authcheckdam.pdf
Findlaw. (n.d). The M’Naghten Rule. Retrieved from http://criminal.findlaw.com/criminal- procedure/the-m-naghten-rule.html
Gracie, A., Freeman, D., Green, S., Garety, P. A., Kuipers, E., Hardy, A., . . . Fowler, D. (2007). The association between traumatic experience, paranoia and hallucinations: A test of the predictions of psychological models. Acta Psychiatrica Scandinavica, 116(4), 280-289. doi:10.1111/j.1600-0447.2007.01011.x
Leucht, S., Kane, J. M., Etschel, E., Kissling, W., Hamann, J., & Engel, R. R. (2006). Linking the PANSS, BPRS, and CGI: Clinical implications. Neuropsychopharmacology, 31(10).
National Institute of Mental Health (NIH). (n.d). Schizophrenia. Retrieved from https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
Otto, R. K. (2006). Competency to stand trial. Applied Psychology in Criminal Justice, 2(3): 1- 32. Retrieved from http://www.apcj.org/documents/2_3_Competence.pdf
Puri, B., & Treasaden, I. (2009). Psychiatry: An evidence-based text. Boca Raton: CRC Press.
Skeem, J. L., Golding, S. L., Cohn, N. B., Berge, G. (1998). Logic and reliability of evaluations of competence to stand trial. Law and Human Behavior, 22(5): 519 – 547.
Smith, S. R. (2012). Neuroscience, ethics and legal responsibility: The problem of the insanity defense. Science and Engineering Ethics, 18(3), 475-81.
Wallwork, R. S., Fortgang, R., Hashimoto, R., Weinberger, D. R., & Dickinson, D. (2012). Searching for a consensus five-factor model of the positive and negative syndrome scale for schizophrenia. Schizophrenia Research, 137(1-3), 246-250. doi:10.1016/j.schres.2012.01.031
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