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Today’s Palo Alto Daily Post“Suspect’s father said he “saw this coming”.

Homeless Iraq vet with TBI and PTSD

Four attempts at suicide past 2 years.

Told father suicidal again . Father said go to VA.

“Kidnapped” women, forcing her to drive him around.

She escaped. He was arrested.

Trauma and the Law

The view from both sides

HARVEY DONDERSHINE, MD, JDADJUNCT CLINICAL PROFESSORSTANFORD SCHOOL OF MEDICINEHDONDER@STANFORD.EDU

Brain StuffDissociationAmnesiaPTSDCase-in-ChiefSentence MitigationExpert WitnessPeople v. Cortes

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Brain Stress• Impact on neurodevelopment

• Fast system and slow system

• Impact of sudden threat on executive functions

• “Weak” executive functions can’t control “hot” amygdala

• Shift from top-down to bottom-up behavior regulation• Disinhibition of reactive aggression / reactive

submission

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Dissociation• State, trait, or disorder

• Horizontal or vertical

• Acute stress dissociation• Phase 1 (over modulation)

• Phase 2 (under modulation)

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Amnesia• Credible or convenient?

• Impaired encoding vs. impaired retrieval?

• Was person “dissociated” at the time, or only after?

• Were actions while amnesic legally culpable?

• Is it indicative of high stress, or more?

• Is expert testimony admissible ?

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PTSD• Hides in plain site.

• Arousal, cognition, threat perception, impulsivity, dissociation

• Is the stressor corroborated

• Did symptoms begin after?

• Is there a more plausible explanation?

• DSM V and the Law: the good, the bad, and the “so-what”

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BREAK

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Criminal Law: Case-in-Chief• A crime requires union of actus reus and mens rea

• Mens rea - general intent

• Mens rea - specific intent

• Admissibility of expert testimony • CST - focus on trial skills

• NGRI - focus on cognition

• Mental state defense - Penal Code Sections 25, 28, and 29

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Criminal Law: Sentence Mitigation

• Ethical issues

• Post –conviction state court

• Federal court – “5k2 departure”

• Treatment Court

Defendant

LawSociety

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Role of Expert Witness• Evidence must be relevant, probative, reliable

• Judge decides admissibility - Jury decides weight given

• Does jury need to know it?

• Does jury need expert to understand it?

• Is the witness an expert? Are his or her opinions reliable?

• Standards for “qualifying”: before jury, 402 hearing

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People v. Cortez• The crime

• The forensic assessment

• The 402 hearing

• Appellate reversal

• How this changed the law?

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Light Reading

• http://forensicpsychiatry.stanford.edu/PAU

• http://forensicpsychiatry.stanford.edu/Forensic PTSD/