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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PTSD AND THE LAWPTSD 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

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http://forensicpsychiatry.stanford.edu/

Click on Forensic PTSD Link

Role of PTSD in Litigation PTSD and Immigration Law Attorney as First ResponderDSM V Criteria Veterans and the Justice SystemPTSD Criminal Defenses Dillon v. Legg (68 Cal. 2d 728) Zone of Risk Thing v. La Chusa (48 Cal.3d 644) Zone of RiskPeople 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

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

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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

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

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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

CO-OCCURRING CONDITIONS

DEPRESSION ANXIETY SUBSTANCE ABUSE MALADAPTATIVE SOCIAL BEHAVIOR

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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”

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VETERANS COURTSCA 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

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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

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HIPPOCAMPUS

COOLMARRATIVE

IMPAIRED BY TRAUMA

AMYGDALA HOT

SOMATOSENSORYSENSITIZED BY TRAUMA

PRE-FRONTAL CORTEX REGULATORY FUNCTION

STRESS HORMONE DAMAGE TO H-P-A SYSTEM

PTSD DSM V CRITERIA

1. TRAUMATIC EVENT 2. INTRUSIVE SYMPTOMS3. AVOIDANT SYMPTOMS4. PERSISTENT HYPERAROUSAL5. CHANGES IN THOUGHT, FEELING, SENSE OF SELF6. DURATION OF B, C, & D MORE THAN ONE MONTH7. CLINICALLY SIGNIFICANT DISTRESS / IMPAIRMENT

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A. EXPOSED TO DEATH / THREATENED DEATH, SERIOUS INJURY, SEXUAL VIOLATION; 1OR MORE OF FOLLOWING WAYS:

1. PERSONALLY EXPERIENCED THE EVENT2. WITNESSED THE EVENT AS IT OCCURRED 3. LEARNED EVENT HAPPENDED TO CLOSE RELATIVE

OR FRIEND; VIOLENT OR ACCIDENTAL4. INTENSE EXPOSURE TO DETAILS; DOES NOT APPLY

TO EXPOSURE THROUGH MEDIA UNLESS EXPOSURE WORK RELATED.

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B. INTRUSIVE SYMPTOMS ASSOCIATED WITH TRAUMATIC EVENT; 1 OR MORE OF FOLLOWING:

1. INVOLUNTARY MEMORIES 2. DISTRESSING RELATED DREAMS3. DISSOCIATION (E.G., FLASHBACKS, OTHER)4. DISTRESS ON EXPOSURE TO CUES THAT SYMBOLIZE

OR RESEMBLE ASPECT(S) OF EVENT5. MARKED PHYSIOLOGICAL REACTION TO REMINDERS

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C. AVOIDANCE OF STIMULI ASSOCIATED WITH EVENT; 1 OR MORE OF FOLLOWING:

1. AVOIDS INTERNAL REMINDERS 2. AVOIDS EXTERNAL REMINDERS

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D. NEGATIVE ALTERATIONS IN COGNITION OR MOOD; 3 OR MORE OF FOLLOWING:

1. AMNESIA FOR IMPORTANT ASPECTS OF EVENT 2. NEGATIVE EXPECTATIONS SELF, OTHERS, OR WORLD3. BLAMES SELF / OTHERS- CAUSE OR CONSEQUENCS4. PERVASIVE FEAR, ANGER, GUILT, OR SHAME 5. DIMINISHED INTEREST /PARTICIPATION IN ACTIVITIES6. DETACHED OR ESTRANGED FROM SELF, OTHERS7. INABILITY TO EXPERIENCE POSITIVE EMOTIONS

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E. ALTERATIONS IN AROUSAL AND REACTIVITY; 3 OR MORE OF THE FOLLOWING:

1. IRRITABLE OR AGGRESSIVE 2. RECKLESS OR SELF-DESTRUCTIVE 3. PROBLEMS CONCENTRATING4. SLEEP DISTURBANCE5. HYPERVIGILANCE6. EXAGGERATED STARTLE RESPONSE

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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

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ATTORNEY-CLIENT ISSUES

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

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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 Q’S, PTSD IS LIKELYCONSIDER HIRING AN EXPERT

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?

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LINK PTSD TO LEGAL ISSUES

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

MY OWN RECENT CASES

MALPRACTICE BURGLARY SELF-DEFENSE INCOMPETENT ASSISTANCE OF COUNSEL FEDERAL 5K2 DOWNLOAD DEPARTURE MENTAL HEALTH COURT ASESSMENT

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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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