Opinions, Veracity and Drug Abuse 1

Opinions, Veracity and Drug Abuse

PSY 8360

Current Issues and Trends in Forensic Psychology

Part 1: Diagnosis and Opinions

Diagnosis
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During the evaluation in regards to sanity at the time of offense on January 1st by Mr.

John Smith, he presented with a history of chronic substance abuse and a history of mental

illnesses that led to various inpatient hospitalizations at Bedrock Behavioral Health and the

county hospital. Although he denied any substance abuse the week prior to the offense

committed he did admit to drug use in the weeks leading up to the event, which makes his denial

of recent use of illicit substances unlikely based on his history. The defendant’s substance abuse

may have exacerbated his schizophrenia diagnosis which was received years prior to the

incident.

During this evaluation, the defendant stated that at the time of the offense, it should again

be noted that he denied any drug use during this time, that he believed that the victim was going

to “eat him” and that he/she had “Fanged teeth and elongated ears”, he had been admitted to

county hospital the day of the offense because of hallucinations of vampires and people that were

not there. Given the detail and the complexity of the symptoms presented at the time of the

offense, as well as the history of his mental illnesses it is unlikely that he is exaggerating or

malingering the psychotic symptoms presented, therefore based on the data presented my

diagnostic considerations at the time of the offense are:

Alcohol use disorder

Schizophrenia- Paranoid, hallucinations

Marijuana use disorder (experienced withdrawal symptoms)

Stimulant use disorder (Cocaine and Methamphetamine)

Opinions
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Based on the accessible data provided in the sanity report of Mr. John Smith, sufficient

subjective evidence has been provided to conclude a schizophrenic episode during the time of the

offense on January 1st 2016. Mr. Smith demonstrated symptoms of a psychotic disorder, paranoia

and hallucinations. As the main considerations regarding Mr. Smith’s sanity are that the

explanation given to the reason of the offense was not reality based and that he was not under the

influence of any illicit drugs, with regards to his sanity at the time of the event, in my opinion,

was not sane. The defendant mentions that at the time he committed the offense he did not

believe that he was doing anything wrong although he is aware that felonious assault is a crime.

Under the assumption that the victim was out to eat him, Mr. Smith attempted to protect himself

from the “vampires” which resulted in the injury of the victim.

His actions due to his hallucinations presents substantial danger to those around him, as

his prior history has indicated as well as the events on January 1st. There is no evidence that the

defendant was in fact sane when the offense occurred. Though the defendant presented behavior

that was not only coherent but he also understanding of what was going on during this interview

there is no guarantee that the opposite was the case during the time of the assault. This would

need to be determined after completing the third party interviews of the police responders and

the nurse who intervened. As he has been able to maintain this condition before it would be wise

to look into psychotropic drug therapy and rehab in order to maintain his mental illnesses and

drug abuse.

Part 2: Verifying Veracity

Like many instances regarding criminal activity, obtaining accurate facts regarding an

event is crucial. Many times defendants or even those who were around at the time can change

facts that benefit them in the particular situation even if there are consequences to lying.

Detecting deception or rather verifying veracity in the cases of a sanity issue can not only be

crucial to the outcome of the case but also be crucial to correctly diagnose the defendant as sane

or not sane at the time of the offense committed. There are many ways to detect deception and

gain the most accurate information that ranges from simply reviewing records and documents

such as medical records, therapist reports, criminal records etc. to conducting collateral

interviews of people who are familiar with the defendant (Glancy, 2015).

During collateral interviews, a third party such as employers, police, or mental health

professional can aid in making sure that the accounts given are in fact accurate. In the case of

Mr. John Smith, the nurse who intervened in the incident as well as the friend who provided

transportation to the county hospital are capable of providing information the confirm the

veracity of the defendants own account. By using people who were there before and after the

incident not only can we confirm that the defendant was in fact exhibiting symptoms prior to the

admittance to the hospital but we can also confirm the behavior shown during the offense and

immediately afterwards. Although it would be best to conduct these interviews right after the

incident occurs that luxury is often not afforded when conducting court appointed evaluations

(Yohananoff, 2016).

Another technique to verify veracity is by conducting psychological test, two of the most

commonly used test are the Test of Memory Malingering (TOMM) and the Computerized

Assessment of Response Bias. The TOMM is a visual recognition test that aids in distinguishing
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between malingered and true memory impairments, it can be completed in 15 to 20 minutes and

consist of two learning trial and a memory retention trial. During an evaluation malingering can

be detected if the defendant scores higher than 45, this indicated that the defendant is

intentionally exaggerating the memory deficiencies present ( Teichner, 2004). The

Computerized Assessment of Response Bias is a tool that helps assess possible malingering, poor

effort, or exaggeration of deficit (Allen, 2003). Each of these test have a threshold where the

majority of people with and without a mental illness fall within, however if the scores are

significantly different than the norm the likelihood of deception is high which makes these two

assessments highly useful when confirming the veracity of a defendant in regards to sanity

defense.

Interview techniques are extremely useful in determining veracity especially when there

is the addition of the defendants back ground. As it takes more energy to actually invent a story

that fits the offense, it is much easier in face to face interviews to simply tell the truth. Asking

various questions that can increase the defendants cognitive load can help in either facilitating

the veracity of the statements or it can confuse the defendant to the point where they can no

longer keep up with the lie (Masip, 2016). In a way, an interview of an defendant that is using

the sanity defense is kind of like a maze with land mines, even when they have the route mapped

out in their head there is no guarantee that it is the correct route or that they couldn’t easily be led

astray. Using strategies that are similar to the clinical setting such as asking questions, rephrasing

and reflections can push the defendant into explaining the state of mind that they were in which

would ultimately give the evaluator sufficient information that can be compared to other

accounts of the incident.

Part 3: Substance Abuse:

Substance use whether short term or chronic can alter the brain in ways that leads to

many different health issues that range from depression to paranoia and hallucinations. In a

sanity evaluation the key goal is to determine whether or not the defendant’s mental condition at

the time of the offense was impaired due to an mental illnesses. As substance use typically cause

symptoms similar to that of a mental illness, distinguishing between an actually illness and an

illness created by a narcotic can get confusing. Substance use is also often directly linked to

malingering or deception, individuals will often volitionally underreport or deny illicit or

prohibitive substance use when facing punitive sanctions (Pizitz, 2014). Substance use has been

connected to criminal behavior in many different instances throughout many time periods, mind

altering drugs can alter the sanity evaluation but only in that the diagnosis will change.

Diminished capacity to understand the nature and the quality of the crime at the time of

the offense whether by use of illicit substance use or a mental illness meets the criteria of the

M’Naughten standard for a successful insanity defense ( Feix, 2007). Based on this fact, it would

be initially hard to confirm the accurate diagnosis of the defendant, however obtaining the

accurate information on the defendants substance use history and the medical records can help

determine whether or not the patient did in fact use at the time of the offense. Using the sanity

report of John Smith this statement is under the assumption that the patient was drug tested upon

admitting himself into the county hospital. However, it should be noted that each state is

different on what is considered acceptable as a sanity defense. In regards to substance use

affecting forensic opinion, depending on the onset of psychotic symptoms and the persistence of
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such symptoms beyond detoxification, most likely in a sanity issue my opinion would stand.

(Feix, 2007).
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References

Allen, L. M., Iverson, G. L., & Green, P. (2003). Computerized Assessment of Response Bias in

Forensic Neuropsychology. Journal of Forensic Neuropsychology, 3(1-2), 205-225.

doi:10.1300/j151v03n01_02

Felix, N. and Wolbert, R. (2007) Intoxication and Settled Insanity: A Finding of Not Guilty by

Reason of Insanity. J. Am. Acad. Psychiatry Law, 35, 172–182

Glancy GD, Ash P, Bath EP, et al. (2015). AAPL practice guidelines for the forensic assessment.

J Am. Acad Psychiatry Law 43, 3–53

Masip, J., Blandón-Gitlin, I., Martínez, C., Herrero, C., & Ibabe, I. (2016). Strategic Interviewing

to Detect Deception: Cues to Deception across Repeated Interviews. Frontiers in

Psychology, 7. doi:10.3389/fpsyg.2016.01702

Pizitz, T. D., Mccullaugh, J., Blue, P., Vacaro, J., Mealing, D., & Fernandez, K. (2014).

Measuring the Veracity of Alcohol and Drug Users’ Self-Report of Sobriety.

International Journal of Clinical Psychiatry and Mental Health, 2(1), 70-76.

doi:10.12970/2310-8231.2014.02.01.7

Teichner, G., Wagner, M.T., (2004). The test of memory malingering (TOMM): normative

data from cognitively intact, cognitively impaired, and elderly patients with

dementia. Arch. Clin. Neuropsychol. 19 (3), 455–464. http://dx.doi.org/10.1016/S0887-

6177(03)00078-715033228.

Yohananoff, A. (2016). The Use of Collateral Sources in Forensic Evaluations: Part I |.

Retrieved from http://www.nycforensics.com/2016/04/the-use-of-collateral-sources-in-

forensic-evaluations-part-i/
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