Sleep disorders and criminal behavior.

Behaviors that would otherwise be considered criminal acts, but occur in the context of a sleep disorder, pose challenges to the traditional application of legal principles of criminal responsibility. Determining the degree to which consciousness is present during such behaviors becomes a necessary step in assigning criminal culpability. Historically, legal defense theories of unconsciousness, automatism, and insanity have been raised to negate culpability for parasomnia related behaviors. Accordingly, proper assessment of sleep disorders in the context of criminal charges becomes critical in assisting the functions of the justice system. This article reviews principles related to the legal tradition, expert assessment, and elements of expert testimony related to criminal behaviors and sleep disorders.

Criminal Justice Outcomes of Suicide by Cop Survivors.

The concept of suicide by cop (SbC) is of interest to psychiatrists, law enforcement professionals, lawyers, and citizens. It is a form of provoked homicide arising from a wish to die. Those who attempt SbC experience more mental illness, substance use, and recent trauma than the general population. This article examines those who attempt SbC and survive the encounters. SbC survivors who threaten or harm police or others may be charged with crimes such as weapons possession, aggravated assault, murder or attempted murder of an officer. The formulation of a provocative act, however, frustrates attempts at defenses based on mental state, resulting in few requests for expert testimony. Few data exist on how these individuals fare in court. Appellate cases in which defendants attempted to introduce evidence of SbC illustrate great variability in adjudication. Psychiatric defenses, such as diminished capacity and insanity, are usually inapplicable or unsuccessful because intent and knowledge of wrongfulness are implied in the provocative act. Diversion of SbC defendants into mental health courts is rare because of firearms use against police. The author argues that criminal justice ignores SbC survivors' mental health and recommends application of therapeutic jurisprudence to give full expression of SbC dynamics.

The Case Against "Excited Delirium".

ABSTRACT: Citizens' deaths in police custody are sometimes attributed to "excited delirium syndrome" (ExDS). This terminology is rejected by the American Medical Association and the American Psychiatric Association. ExDS has no demonstrable pathology but has been proposed as predisposing to sudden death, thus exonerating police. Ketamine use during arrests complicates manner of death. ExDS deaths trigger lawsuits claiming police misconduct and excessive force. Defendant officers and municipalities have used ExDS to distance themselves from liability, using expert testimony from nonpsychiatrists. This argument is expressed despite lack of autopsy findings, the false idea that mental illness itself can lead to sudden death, and the absence of consistent diagnostic criteria. This article traces the history of ExDS and reviews the arguments for and against its use in psychiatry and law enforcement. The authors conclude that the label is medically unreliable, has eroded confidence in police-citizen interactions, and obscures dynamics of deaths in custody.

Suicide by Cop and Civil Liability for Police.

Suicide by cop (SbC) is a variant of victim-precipitated homicide. In SbC, a citizen intent on dying provokes police, often with credible threats of violence. A fatality results in ambiguity about manner of death (homicide versus suicide). Decedents' families may raise claims of civil-rights violations, asserting insufficient restraint by officers. Police officers, when questioned, may justify their actions as reasonable and necessary force. Defendant officers and municipalities are concerned about police safety and adverse economic and public-perception consequences of litigation. This article explores the history and evolution of the SbC phenomenon, examines related civil case law, and reviews the contours of police-citizen interactions in SbC cases. There is potential liability for officers whose actions must be objectively reasonable to prevail in court. Since SbC can be admitted as evidence, there may be an expanded role for forensic psychiatry in distinguishing manner of death. Expert testimony can also aid fact finders in appreciating the decisions of officers faced with ambiguous and threatening situations. The author recommends collaboration between law enforcement and mental health professionals to improve recognition and handling of difficult situations involving persons with mental illness.

Preserving Immunity for Reporters of Medical Child Abuse.

All American jurisdictions have laws protecting children from abuse and neglect. Mandated reporters, including health professionals, whether their suspicions ultimately are substantiated or unfounded, are entitled to immunity when their reports are entered in good faith. When harm takes the form of medical child abuse (MCA, also known as Munchausen syndrome by proxy or factitious disorder imposed on another), its origin is ambiguous, at least initially. Questions arise as to whether the caregiver intended to deceive medical professionals and if the condition improved when the child was separated from the caregiver. Clinicians may have an obligation to report MCA in difficult-to-diagnose cases or those where parents press for hospitalizations and procedures. Substantiated cases may lead to removal of children from homes and criminal prosecution of parents. This can result in backlash against the reporter by the parents, with claims of malpractice, official misconduct, intentional harm, fraud or conspiracy to commit fraud, defamation (libel or slander), or all of the above. This article examines case law regarding alleged departures from good-faith reporting of MCA and explores potential limitations to immunity provided to mandated reporters. The findings include no significant instances in which the immunity shield for good-faith reporting was pierced.

Involuntary Administration of Long-Acting Injectable Antipsychotics for Competency Restoration.

In implementing the decisions in the landmark case Sell v. United States, jurisdictions have adopted mechanisms for the involuntary medication of defendants to restore competency to stand trial. These procedures attempt to balance the liberty and privacy rights of the accused against the government's responsibility to ensure timely prosecution and fair trial. The question of which medications are most appropriate for this goal, however, remains open. This article reviews the legal status of the administration of long-acting injectable (LAI) antipsychotics for sustained competency restoration. We explore case law and discuss the theoretical and empirical benefits and drawbacks to this practice, considering recent technological advancements in LAI development. Some courts have regarded LAI use pursuant to Sell as equivalent or superior to immediate-acting medications, whereas others have regarded LAIs as either more intrusive or medically riskier. We conclude that the use of LAIs may be carefully integrated into treatment plans to restore and maintain trial competency amid competing interests.

What Ever Happened to Nostalgia (the Diagnosis)?

ABSTRACT: Nostalgia and homesickness are not currently regarded as mental disorders. The psychic pain associated with longing to return home had been considered a mental disorder for centuries, especially in Europe, where it was a sign of moral weakness between nations. Nostalgia's effects on American Civil War soldiers-anxiety, depression, and sleep and appetite disturbances, for example-were described by clinicians and linked to significant morbidity and mortality. Since then, although these effects of combat have been of interest, focus has shifted to psychic trauma, relegating the concept of nostalgia to an unclassified but commonly encountered condition. Besides wartime trauma, symptomatic conditions related to nostalgia have been described among displaced persons and refugees living in the diaspora longing for their homelands (e.g., social displacement syndrome). More recently, nostalgia has pervaded culture as a benign pastime, with no implications for psychopathology. Finally, the longing for return to an idyllic or imagined lifestyle has returned amid worldwide quarantining and isolation during the COVID-19 pandemic. In this new sense, nostalgia has become a remedy rather than a disease. We identify four major iterations of nostalgia: the medical condition of homesickness, the condition studied in wartime, the application to migration and social displacement, and as a remedy for existential anxiety. We conclude that nostalgia per se is neither pathological nor normative, but a consistent phenomenon in human existence that should not be overlooked in cultural assessment and psychotherapy.

Arsenic, Familicide, and Female Physiology in Nineteenth-Century America.

Sarah Jane Whiteling was accused of fatally poisoning her husband and two children in Philadelphia in 1888. The case prompted public outrage over the appearance that Ms. Whiteling's motive was to collect life insurance. It was evident, however, that she was disturbed, raising a question of culpability. Dr. Alice Bennett, the first female physician in charge of an asylum, provided the defense with expert testimony on the defendant's mental state. Dr. Bennett, who had little forensic but much clinical experience, proposed a physiological theory of insanity among women with reproduction-related derangements. At that time, cultural ideas about "female poisoners" colored popular and journalistic perceptions of Ms. Whiteling. Familicide was considered unconscionable because a mother's duty was to nurture and protect her family. When Ms. Whiteling was convicted and sentenced to death, Dr. Bennett undertook a campaign for commutation. Her unsuccessful efforts to reduce culpability were followed by Ms. Whiteling's hanging in 1889, the first execution of a woman in Philadelphia since colonial times. This article recounts the Whiteling case, Dr. Bennett's involvement in it, and how it relates to what is known about familicide. It is argued here that Dr. Bennett was a pioneer in applying medical expert testimony to effect individualized mitigation.

Insanity: A Legal and Cinematic Diagnosis.

The term "insanity" has been retired from medical nomenclature for about 100 years. Formerly interchangeable with the legal term, implying unsoundness of mind, it persists as a legal determination, mainly in criminal matters. However, the most prevalent uses of "insanity" are in colloquial speech and media. We track "insanity" in medical and legal parlance, reasons for its disappearance from psychiatry, and its persistence in popular culture. During the 19th century, specific types of legal insanity fell out of favor, especially "moral insanity," referring to irresistible impulses. The term persisted, for example, in some civil cases and in criminal cases, both denoting lack of capacity. In America, early 20th century focus on disease classification and nomenclature shifted from catchall terms (such as insanity, dementia, mania, and idiocy) to medical labels (psychosis and neurosis). Psychiatrist William Alanson White led the movement to change nomenclature. In 1921, the American Journal of Insanity became the American Journal of Psychiatry. By the time White was the American Psychiatric Association president in 1925, the medical use of "insanity" had been replaced in textbooks by progressive terminology. However, variations on "insane," suggesting loss of reason without diagnostic specificity, have become a staple among film tropes.

America's First M'Naghten Defense and the Origin of the Black Rage Syndrome.

The 1843 M'Naghten verdict led to reformulation of the British criminal insanity standard, which American jurisdictions noted. In 1846, New York State tried William Freeman for slaying several members of the Van Nest family at their home near Auburn, New York. Mr. Freeman had been obsessed with false imprisonment for horse theft. His defense attorney, former governor William Seward, sought an insanity verdict, citing reaction to racist maltreatment as the cause. Though Mr. Freeman was impaired, a jury found him competent to stand trial. The competency adjudication created confusion in the trial court about the admissibility of medical testimony on criminal responsibility, resulting in exclusion of key psychiatric findings. Meanwhile, the interracial killings caused a sensation in the press, which vilified the defendant. Again, the defense argued that maltreatment created mental illness. A second jury convicted Mr. Freeman and the judge sentenced him to death. Seward filed a Writ of Error, and the New York State Supreme Court reversed the conviction, clarifying competency versus criminal responsibility and proclaiming the M'Naghten Rule as the standard in New York. A century later, attorneys cited Mr. Freeman's dynamics to explain and mitigate the violent actions of some African-Americans. We examine the insanity defense during the 1840s and explore twentieth-century "black rage" reverberations of the Freeman case.

Consent for Intimacy Among Persons With Neurocognitive Impairment.

The right to bodily self-determination has a firm foothold in American jurisprudence and legislation. Since the early 20th century, courts have consistently upheld individuals' rights to govern their bodies, citing the constitutional right to privacy and importance of individual autonomy. After these decisions, the advance directive has become an essential way to express personal preferences after incapacity for decision-making, especially in end-of-life scenarios. Can sexual preferences survive cognitive incapacity as well? When individuals lose the capacity to voice sexual needs and preferences, there is no mechanism to protect sexual expression. Dementia's ability to render individuals legally incapable of consenting to sexual activity was the focus of the case of Iowa legislator Henry Rayhons. The state charged Mr. Rayhons with assault for alleged sexual interactions with his wife, who had Alzheimer's disease. The prosecution failed to prove its case. We propose a hypothetical sexual advance directive as a theoretical mechanism to assert sexual desire past incapacity, grounded in claims regarding the possible importance of sex for individuals with neurocognitive disorders. Forensic psychiatrists can play a unique role in the creation and implementation of such a tool.

Assignment of culpability to animals as a form of abuse: Historical and cultural perspectives.

How the law regards animals reflects cultural trends that have varied widely from antiquity to the present. This article argues that cultural views of animals have shaped laws, attitudes, and practices worldwide. Whereas ancient (biblical and Mesopotamian) practices turned on economics, medieval concepts of animal culpability aligned with Christian beliefs of the primacy of humans. In medieval Europe, pets, farm animals, vermin, and insects could be held accountable for damage to persons and property. Considered entitled to due process, they were represented, tried, and punished - sometimes in public executions. Centuries of regarding animals as property subordinated to humans gave way to animal cruelty laws. It was not until the 19th century that respect for animal welfare, apart from economics, assumed legal significance. Presently, animals are not considered capable of criminal intent but can be "executed" for dangerousness. However, they may possess legal standing as civil complainants in animal rights cases. Contemporary trends include animal rights activism and courts conferring legal personhood to animals. The discussion concludes that there will be disparate approaches worldwide, based on prevailing views of animal sentience, spiritually based concepts and values, litigation arguing property and environmental law, and economics.

Liability for Diagnosing Malingering.

Malingering is a medical diagnosis, but not a psychiatric disorder. The label imputes that an evaluee has intentionally engaged in false behavior or statements. By diagnosing malingering, psychiatrists pass judgment on truthfulness. Evaluees taking exception to the label may claim that the professional has committed defamation of character (libel or slander) when the diagnosis is wrong and costs the claimant money or benefits. Clinicians may counter by claiming immunity or that the diagnosis was made in good faith. This problem has come into focus in military and veterans' contexts, where diagnoses become thresholds for benefits. Through historical and literary examples, case law, and military/veterans' claims of disability and entitlement, the authors examine the potency of the malingering label and the potential liability for professionals and institutions of making this diagnosis.