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PTSD AND THE LAW “THE PAST ISN’T DEAD, IT ISN’T EVEN PAST”

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Presentation on theme: "PTSD AND THE LAW “THE PAST ISN’T DEAD, IT ISN’T EVEN PAST”"— Presentation transcript:

1 PTSD AND THE LAW “THE PAST ISN’T DEAD, IT ISN’T EVEN PAST”
PTSD IS DISORDER OF MEMORY, MEANING, EMOTION, CHEMISTRY, NEURAL CIRCUITS, GENETICS, AND SOCIAL ADAPTATION “THE PAST ISN’T DEAD, IT ISN’T EVEN PAST” William Faulkner

2 Click on Forensic PTSD Link
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 6th 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
SHIFTS FOCUS TO STRESSOR / PERPETRATOR SUPPORTS CAUSATION AND DAMAGES EXPLAINS, MITIGATES, JUSTIFYS HAS EFFECTIVE EVIDENCE BASED TREATMENT

4 WHERE IS PTSD IN LEGAL PRACTICE?
CASE MANAGEMENT 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 …
Soldier’s Sickness Traumatic Neurosis Shell Shock Combat Fatigue Camp Syndrome Identity Diffusion Disorder Gross Stress Reaction Vietnam Syndrome Rape Trauma Syndrome Battered Woman Syndrome Battered Child Syndrome Posttraumatic Stress Disorder

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

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

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

9 VETERANS COURTS ca penal Code Sec. 1170.9
VET ALLEGES OFFENSE RESULT OF SERVICE IN COMBAT THEATER OF OPERATIONS 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

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

11 STRESS HORMONE DAMAGE TO H-P-A SYSTEM
PRE-FRONTAL CORTEX REGULATORY FUNCTION HIPPOCAMPUS COOL MARRATIVE IMPAIRED BY TRAUMA AMYGDALA HOT SOMATOSENSORY SENSITIZED BY TRAUMA NARRATIVE MEMORY: INTEGRATED, ANCHORED IN TIME, SEEN AS PART OF THE SELF RATHER THAN AS “FOREIGN BODY.” COMES FROM DIGESTION OF EVENT BY PRE-EXISTING SCHEMA. EVOLVES. EMOTIONAL MEMORY IS THE OPPOSITE. WHEN SUPERSENSITIVE AND DISSOCIATED (DISCONNECTED) FROM NARRATIVE MEMORY (HIPPOCAMPUS) AND FROM SUPPRESSIVE CIRCUITS (PREFRONTAL CORTEX) , IS REFERRED TO AS TRAUMA MEMORY. INTERVIEW BEHAVIOR: LOOK FOR MICRODISPLAYS OUTSIDE AWARENESS, SHIFT LANGUAGE, GET PERMISSION, EXPLORE, PUT NARRATIVE AROUND FRAGMENTS, RE-DISCUSS, RE-ORIENT. STRESS HORMONE DAMAGE TO H-P-A SYSTEM

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

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

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

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

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

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

18 EVIDENCE-BASED TREATMENT
STABILIZE EDUCATE EMOTIONS MANAGEMENT SKILL TRAINING TREATMENT OF CO-OCCURRING DISORDERS TRAUMA-FOCUSED THERAPY FOR CORE SYMPTOMS PSYCH MEDS REINTEGRATION AND RELAPSE PREVENTION Prevent social breakdown / substance abuse Coping skills: breathing, relaxation, emotional grounding, anger management, communication, expression of loving feelings. Conflict resolution, friends-work-relatives Education, demonstration, rehearsal, feedback, real-world practice, diary. Structural family therapy

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

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

21 EXPERT WITNESS DON’T LOOK FOR EXPERT TO FIT YOUR THEORY
DOES EXPERT KNOW PTSD, TREATMENT, SCIENCE ENCOURAGE PROCESS OF MUTUAL EDUCATION ASK THE RIGHT QUESTIONS PROVIDE EXPERT ALL RELEVANT RECORDS IS THERE CORROBORATION OF THE TRAUMA? ARE THERE THIRD-PARTY REPORTS OF SYMPTOMS? WILL TREATMENT PROTECT THE COMMUNITY? WILL EXPERT PASS FRYE AND/OR DAUBERT TESTS?

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

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

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


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