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PTSD AND THE LAW PTSD IS DISORDER OF MEMORY, MEANING, EMOTION, CHEMISTRY, NEURAL CIRCUITS, GENETICS, AND SOCIAL ADAPTATION THE PAST ISNT DEAD, IT ISNT.

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Presentation on theme: "PTSD AND THE LAW PTSD IS DISORDER OF MEMORY, MEANING, EMOTION, CHEMISTRY, NEURAL CIRCUITS, GENETICS, AND SOCIAL ADAPTATION THE PAST ISNT DEAD, IT ISNT."— Presentation transcript:

1 PTSD AND THE LAW PTSD IS DISORDER OF MEMORY, MEANING, EMOTION, CHEMISTRY, NEURAL CIRCUITS, GENETICS, AND SOCIAL ADAPTATION THE PAST ISNT DEAD, IT ISNT EVEN PAST William Faulkner William Faulkner 1

2 2 Click on Forensic PTSD Link Role of PTSD in Litigation PTSD and Immigration Law Attorney as First Responder DSM V Criteria Veterans and the Justice System PTSD Criminal Defenses Dillon v. Legg (68 Cal. 2d 728) Zone of Risk Thing v. La Chusa (48 Cal.3d 644) Zone of Risk People vs. Cortes (CA 6 th Circuit) Alternative Theory Evidence People vs. Bledsoe (California Supreme Court) Rape Trauma Syndrome Paterson vs. Board of Trustees (New Jersey Sup. Ct.) Work Disability New Jersey vs. Kelly (New Jersey Sup. Ct.) Battered Woman Syndrome

3 WHY PTSD LITIGATION? BECAUSE IT IS AN ACTOR IN THE ARENA BECAUSE IT IS AN ACTOR IN THE ARENA SHIFTS FOCUS TO STRESSOR / PERPETRATOR SHIFTS FOCUS TO STRESSOR / PERPETRATOR SUPPORTS CAUSATION AND DAMAGES SUPPORTS CAUSATION AND DAMAGES EXPLAINS, MITIGATES, JUSTIFYS EXPLAINS, MITIGATES, JUSTIFYS HAS EFFECTIVE EVIDENCE BASED TREATMENT HAS EFFECTIVE EVIDENCE BASED TREATMENT 3

4 WHERE IS PTSD IN LEGAL PRACTICE? CASE MANAGEMENT CASE MANAGEMENT CRIMINAL LAW CRIMINAL LAW ACTUS REUS / MENS REA ALTERNATIVE THEORY EVIDENCE 5K2 DOWNWARD DEPARTURE THERAPEUTIC SENTENCING CIVIL LAW TORTS, WORKPLACE LAW IMMIGRATION LAW DISABILITY LAW FITNESS-FOR-DUTY

5 A ROSE BY ANY OTHER NAME … Soldiers Sickness Soldiers Sickness Traumatic Neurosis Traumatic Neurosis Shell Shock Shell Shock Combat Fatigue Combat Fatigue Camp Syndrome Camp Syndrome Identity Diffusion Disorder Identity Diffusion Disorder Gross Stress Reaction Gross Stress Reaction Vietnam Syndrome Vietnam Syndrome Rape Trauma Syndrome Rape Trauma Syndrome Battered Woman Syndrome Battered Woman Syndrome Battered Child Syndrome Battered Child Syndrome Posttraumatic Stress Disorder Posttraumatic Stress Disorder 5

6 PTSD 6 BEFORE-AND-AFTER DISORDER BEFORE-AND-AFTER DISORDER BRAIN BURN FROM A HOT EVENT BRAIN BURN FROM A HOT EVENT MORE THAN SUM OF ITS PARTS MORE THAN SUM OF ITS PARTS HIDES IN PLAIN SIGHT HIDES IN PLAIN SIGHT DOES NOT TRAVEL ALONE DOES NOT TRAVEL ALONE

7 CO-OCCURRING CONDITIONS DEPRESSION DEPRESSION ANXIETY ANXIETY SUBSTANCE ABUSE SUBSTANCE ABUSE MALADAPTATIVE SOCIAL BEHAVIOR MALADAPTATIVE SOCIAL BEHAVIOR 7

8 EPIDEMIOLOGY 4-7% OF POPULATION 4-7% OF POPULATION SIGNIFICANT SOCIAL COSTS SIGNIFICANT SOCIAL COSTS PTSD OVER REPRESENTED IN LEGAL SYSTEM PTSD OVER REPRESENTED IN LEGAL SYSTEM 25-30% OF W.O.T. VETERANS RETURNING WITH PTSD 25-30% OF W.O.T. VETERANS RETURNING WITH PTSD LOOMING NATIONAL DISASTER LOOMING NATIONAL DISASTER 8

9 VETERANS COURTS CA PENAL CODE SEC VET ALLEGES OFFENSE RESULT OF SERVICE IN COMBAT THEATER OF OPERATIONS VET ALLEGES OFFENSE RESULT OF SERVICE IN COMBAT THEATER OF OPERATIONS COURT SHALL CONDUCT HEARING COURT SHALL CONDUCT HEARING IF EVIDENCE CONFIRMS AND VET ELIGIBLE FOR PROBATION, COURT MAY ORDER TREATMENT FOR PTSD, SUBSTANCE ABUSE, OTHER SERVICE- RELATED PSYCHOLOGICAL DISORDERS IF EVIDENCE CONFIRMS AND VET ELIGIBLE FOR PROBATION, COURT MAY ORDER TREATMENT FOR PTSD, SUBSTANCE ABUSE, OTHER SERVICE- RELATED PSYCHOLOGICAL DISORDERS 9

10 TRAUMA SEQUENCE TRAUMATIC EVENT TRAUMATIC EVENT PSYCHOLOGICAL & NEUROBIOLOGICAL CASACADE PSYCHOLOGICAL & NEUROBIOLOGICAL CASACADE SYNDROMAL SYMPTOMS APPEAR SYNDROMAL SYMPTOMS APPEAR RESOLUTION AND RETURN TO BASELINE OR RESOLUTION AND RETURN TO BASELINE OR SYMPTOMS WORSEN, BECOME CONTINUOUS SYMPTOMS WORSEN, BECOME CONTINUOUS FUNCTION DETERIORATES FUNCTION DETERIORATES MALADATIVE COPING EMERGES MALADATIVE COPING EMERGES CO-OCCURRING DISORDERS APPEAR CO-OCCURRING DISORDERS APPEAR CONDITION BECOMES CHRONIC CONDITION BECOMES CHRONIC 10

11 HIPPOCAMPUSCOOLMARRATIVE IMPAIRED BY TRAUMA AMYGDALA AMYGDALA HOTSOMATOSENSORY SENSITIZED BY TRAUMA PRE-FRONTAL CORTEX REGULATORY FUNCTION 11 STRESS HORMONE DAMAGE TO H-P-A SYSTEM

12 PTSD DSM V CRITERIA 1.TRAUMATIC EVENT 2.INTRUSIVE SYMPTOMS 3.AVOIDANT SYMPTOMS 4.PERSISTENT HYPERAROUSAL 5.CHANGES IN THOUGHT, FEELING, SENSE OF SELF 6.DURATION OF B, C, & D MORE THAN ONE MONTH 7.CLINICALLY SIGNIFICANT DISTRESS / IMPAIRMENT 12

13 A. EXPOSED TO DEATH / THREATENED DEATH, SERIOUS INJURY, SEXUAL VIOLATION; 1OR MORE OF FOLLOWING WAYS: 1. 1.PERSONALLY EXPERIENCED THE EVENT 2. 2.WITNESSED THE EVENT AS IT OCCURRED 3. 3.LEARNED EVENT HAPPENDED TO CLOSE RELATIVE OR FRIEND; VIOLENT OR ACCIDENTAL 4. 4.INTENSE EXPOSURE TO DETAILS; DOES NOT APPLY TO EXPOSURE THROUGH MEDIA UNLESS EXPOSURE WORK RELATED. 13

14 B. INTRUSIVE SYMPTOMS ASSOCIATED WITH TRAUMATIC EVENT; 1 OR MORE OF FOLLOWING: 1. 1.INVOLUNTARY MEMORIES 2. 2.DISTRESSING RELATED DREAMS 3. 3.DISSOCIATION (E.G., FLASHBACKS, OTHER) 4. 4.DISTRESS ON EXPOSURE TO CUES THAT SYMBOLIZE OR RESEMBLE ASPECT(S) OF EVENT 5. 5.MARKED PHYSIOLOGICAL REACTION TO REMINDERS 14

15 C. AVOIDANCE OF STIMULI ASSOCIATED WITH EVENT; 1 OR MORE OF FOLLOWING : C. AVOIDANCE OF STIMULI ASSOCIATED WITH EVENT; 1 OR MORE OF FOLLOWING : 1.AVOIDS INTERNAL REMINDERS 2.AVOIDS EXTERNAL REMINDERS 15

16 D. NEGATIVE ALTERATIONS IN COGNITION OR MOOD; 3 OR MORE OF FOLLOWING: 1. 1.AMNESIA FOR IMPORTANT ASPECTS OF EVENT 2. 2.NEGATIVE EXPECTATIONS SELF, OTHERS, OR WORLD 3. 3.BLAMES SELF / OTHERS- CAUSE OR CONSEQUENCS 4. 4.PERVASIVE FEAR, ANGER, GUILT, OR SHAME 5. 5.DIMINISHED INTEREST /PARTICIPATION IN ACTIVITIES 6. 6.DETACHED OR ESTRANGED FROM SELF, OTHERS 7. 7.INABILITY TO EXPERIENCE POSITIVE EMOTIONS 16

17 E. ALTERATIONS IN AROUSAL AND REACTIVITY; 3 OR MORE OF THE FOLLOWING: 1. 1.IRRITABLE OR AGGRESSIVE 2. 2.RECKLESS OR SELF-DESTRUCTIVE 3. 3.PROBLEMS CONCENTRATING 4. 4.SLEEP DISTURBANCE 5. 5.HYPERVIGILANCE 6. 6.EXAGGERATED STARTLE RESPONSE 17

18 EVIDENCE-BASED TREATMENT STABILIZE STABILIZE EDUCATE EDUCATE EMOTIONS MANAGEMENT SKILL TRAINING EMOTIONS MANAGEMENT SKILL TRAINING TREATMENT OF CO-OCCURRING DISORDERS TREATMENT OF CO-OCCURRING DISORDERS TRAUMA-FOCUSED THERAPY FOR CORE SYMPTOMS TRAUMA-FOCUSED THERAPY FOR CORE SYMPTOMS PSYCH MEDS PSYCH MEDS REINTEGRATION AND RELAPSE PREVENTION REINTEGRATION AND RELAPSE PREVENTION 18

19 ATTORNEY-CLIENT ISSUES CLIENT ISSUES CLIENT ISSUES TRUST, TEMPER, SENSITIVITY, REACTIVITY, ALCOHOL TRUST, TEMPER, SENSITIVITY, REACTIVITY, ALCOHOL CASE-RELATED RETRAUMTIZATION CASE-RELATED RETRAUMTIZATION ATTORNEY ISSUES ATTORNEY ISSUES MEET FIRST-RESPONDER RESPONSIBILITY MEET FIRST-RESPONDER RESPONSIBILITY EMPOWER WITH RESPECT AND EMPATHY EMPOWER WITH RESPECT AND EMPATHY CONDUCT GOOD INTERVIEW CONDUCT GOOD INTERVIEW DO BRIEF SCREEN FOR PTSD WHEN INDICATED DO BRIEF SCREEN FOR PTSD WHEN INDICATED CONSIDER NEED FOR EXPERT CONSULTATATION CONSIDER NEED FOR EXPERT CONSULTATATION 19

20 ATTORNEY BRIEF SCREEN 1.SOMETHING VERY UPSETTING HAPPEN TO YOU? IF YES, IN PAST MONTH, DID YOU EXPERIENCE: 2.BAD DREAMS or UNWANTED THOUGHTS OF IT? 3.AVOIDED OR TRIED NOT TO THINK OF IT? 4.FELT HYPER ALERT OR WERE EASILY STARTLED? 5.FELT NUMB, DETACHED IF YES TO Q#1 PLUS YES TO 2 OTHER QS, PTSD IS LIKELY CONSIDER HIRING AN EXPERT 20

21 EXPERT WITNESS DONT LOOK FOR EXPERT TO FIT YOUR THEORY DONT LOOK FOR EXPERT TO FIT YOUR THEORY DOES EXPERT KNOW PTSD, TREATMENT, SCIENCE DOES EXPERT KNOW PTSD, TREATMENT, SCIENCE ENCOURAGE PROCESS OF MUTUAL EDUCATION ENCOURAGE PROCESS OF MUTUAL EDUCATION ASK THE RIGHT QUESTIONS ASK THE RIGHT QUESTIONS PROVIDE EXPERT ALL RELEVANT RECORDS PROVIDE EXPERT ALL RELEVANT RECORDS IS THERE CORROBORATION OF THE TRAUMA? IS THERE CORROBORATION OF THE TRAUMA? ARE THERE THIRD-PARTY REPORTS OF SYMPTOMS? ARE THERE THIRD-PARTY REPORTS OF SYMPTOMS? WILL TREATMENT PROTECT THE COMMUNITY? WILL TREATMENT PROTECT THE COMMUNITY? WILL EXPERT PASS FRYE AND/OR DAUBERT TESTS? WILL EXPERT PASS FRYE AND/OR DAUBERT TESTS? 21

22 LINK PTSD TO LEGAL ISSUES FLASHBACKS FLASHBACKS SCENARIO REENACTMENTS SCENARIO REENACTMENTS DISSOCIATION DISSOCIATION RECKLESS, SELF-DESTRUCTIVE BEHAVIOR RECKLESS, SELF-DESTRUCTIVE BEHAVIOR MISPERCEPTION OF THREAT MISPERCEPTION OF THREAT HYPER STARTLE BEHAVIOR HYPER STARTLE BEHAVIOR MALADAPTIVE COPING CAUSED BY PTSD MALADAPTIVE COPING CAUSED BY PTSD 22

23 MY OWN RECENT CASES MALPRACTICE MALPRACTICE BURGLARY BURGLARY SELF-DEFENSE SELF-DEFENSE INCOMPETENT ASSISTANCE OF COUNSEL INCOMPETENT ASSISTANCE OF COUNSEL FEDERAL 5K2 DOWNLOAD DEPARTURE FEDERAL 5K2 DOWNLOAD DEPARTURE MENTAL HEALTH COURT ASESSMENT MENTAL HEALTH COURT ASESSMENT 23

24 REVIEW PTSD IS A DISORDER THAT HIDES IN PLAIN SIGHT PTSD IS A DISORDER THAT HIDES IN PLAIN SIGHT HAS IMPORTANT SOCIAL-LEGAL IMPACT HAS IMPORTANT SOCIAL-LEGAL IMPACT ATTORNEY HAS FIRST RESPONDER RESPONSIBILITY ATTORNEY HAS FIRST RESPONDER RESPONSIBILITY KNOW WHEN/HOW TO USE CONSULTANT KNOW WHEN/HOW TO USE CONSULTANT 24


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