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Published byElvin Harris Modified over 8 years ago
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Mental disorders, clinical evidence and memory problems relevant to IRB proceedings Janet Cleveland, LL.L, M.Sc.,Ph.D. Psychologist and researcher McGill University
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Relevance of psych reports for IRB All divisions 1. Inability to understand proceedings - DR 2. Impaired ability to present one’s case – procedural acccommodations 3. Ability to testify coherently (credibility) RPD 4. Plausibility of alleged trauma 5. Mentally ill persons: members of particular social group? 6. State protection/IFA
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ID & IAD – release & stay of removal 7. Danger to the public - e.g., schizophrenics no more violent than general population - drug or alcohol abuse increases risk of violence 8. Conditions of release/stay of removal - compliance difficulties inherent to certain mental disorders - need for case management & support
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Clinical assessment process Signs observed by clinician - nonverbal signs, tone of voice, incoherence, agitation, tears, facial expressions, etc. Self-reported symptoms - appearance & evolution of symptoms - relevant personal & family antecedents - current psychosocial stressors Assessment vs. treatment Investigation and analysis vs. support
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Psychological tests Limited relevance for IRB proceedings Objective test = structured self report Cross-cultural validation: rare Examples of differences: persecutory beliefs Detecting malingering No specific test for veracity of PTSD or depression claims MMPI-2: not cross-culturally validated
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Detecting malingering Veracity of person’s story Clinicians monitor consistency with clinical indicators Not truth of alleged events Deception detection: psychiatrists, psychologists, judges, police, customs officers, general public… Scarcely better than chance!
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PTSD and depression - prevalence PTSD prevalence - Conflict zones: 13-25% - Western, non-conflict: 1-4% Depression prevalence - Conflict zones: 13-36% - Canada: 4-6% High comorbidity, esp. asylum seekers Functional impairment +++
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PTSD predictors Cumulative exposure to trauma Interpersonal violence – Torture and rape +++ Current stressors (e.g., exile, uncertainty, lack of status, isolation, separation from family) Also predictors of depression (+ loss of loved ones, loss of self-esteem, loss of status) Individual vulnerability/resilience
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PTSD – evolution over time Normal response to abnormal event Recovery rates (no treatment) - By 12 months: 1/3 have recovered - By 3 years: 2/3 have recovered Interpersonal violence (especially sexual assault and torture) + repeated trauma Higher initial PTSD rate More likely to remain chronic Greater impairment
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PTSD & depression - impairment Impairment relevant to IRB proceedings Ability to tell a coherent/consistent story Memory Reluctance to talk about trauma Emotional incongruence (e.g., apparent lack of emotion) Nonverbal behavior Vulnerability (disorganization, suicidal reactions, etc.)
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Memory – general principles Not a video recording! Encoding Limited attention Most information not encoded Focus on what is most important in the moment Interpretation Expectations, stereotypes, knowledge E.g., young man with pistol/cell phone
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Encoding (cont.) Poor memory for time (dates, etc.) Abstract Inferred, not perceived Intense emotions: ‘tunnel vision’ Narrowing of focus on central features Fewer secondary features encoded ‘Weapon focus’ Violence, fear, horror Decreased memory for preceding events
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Storage – recall - narrative Memory is dynamic Gist of events retained, secondary details fade – Even for traumatic memories Recounting events transforms them into a coherent narrative Filling in gaps – ‘scripts’ and inferences Incorporating new information – source confusion Repeated events – consolidation Hypermnesia – increased recall
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Context of recall – impact on memory Intense anxiety at time of recall Increases confusion, omissions, incoherence Especially for individuals who are anxious, depressed or have other psychological difficulties
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PTSD effects: intrusive memories Intrusive memories, nightmares, flashbacks - Involuntary, vivid, distressing - Physical symptoms (e.g., fast heartbeat) - Suppression/avoidance of traumatic memories and triggers - Negative impact on concentration - IRB hearing may trigger traumatic memories
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PTSD effects: memory for events Amnesia? - Traumatic Brain Injury or HIV/AIDS Effect of PTSD on memory School 1. More incoherent, more inconsistencies vs. School 2. No negative impact on memory UNLESS significant dissociative symptoms Determining factor: stress at time of recall
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Consensus on PTSD & recall Factors that negatively impact attention, concentration & memory: -Recall in a high-stress context -Insomnia -Depression -Avoidance of ‘triggers’ -Reluctance to trust following interpersonal violence -Dissociative symptoms
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Depression – effects on recall Moderate/severe depression Concentration and attention problems Slowed response (may be mistaken for dishonesty) Insomnia – negative impact on memory Despair, self-punitive tendencies
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Guideline 8 – Vulnerable persons Why limit to “the more severe ” cases? Procedural accommodations Foster more accurate credibility assessment Decrease interference of stress Questioning vulnerable persons IRB Training Manual on Victims of Torture
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