“Case” Studies

From time to time, various attorneys have wondered how I as a forensic psychiatrist can help them. On many occasions, I have been retained to assess a case about one issue, only to discover an unexpected, unanticipated area for exploration, which then led to understanding the case from a new perspective. My following “reflections” will remain a work in progress. It is worth mentioning at this point that many of these cases were litigated or settled. Because of privacy concerns and confidentiality issues, I have disguised the identities of individuals and particular cases. In instances where I gave testimony in open court, I am less constrained by privacy issues.

Background. I’ve worked on over 100 murder cases, probably 40 of them involving death penalty charges (capital offenses).  I’ve worked both for defense and for prosecution.  The jurisdictions were in California, Alaska and Federal.  The scope of the assessment has been competency to stand trial, ability to cooperate with defense and mental state (mens rea) at the time of the commission of the offense.  I have taught at a CEB level about the elements of malice of forethought, premeditation, deliberation and the distinction between Murder 1, Murder 2 and Manslaughter.
My evaluations have been conducted at some of the better penitentiaries including Folsom, San Quentin (on Appellate matters), at various County jails, as well as at my offices when the accused is out on bail.

One memorable case which didn’t begin as a murder case, was my examination of David Carpenter (later known as “The Trailside Killer”)

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Since I was a kid, the Abbott and Costello routine of “Who’s on First” has always cracked me up. The humor of the confusion, chaos, frustration and the angry impotence of miscommunication is something most people understand and relate to. Chaos, confusion, accusation and confrontations at the workplace are not funny, though.

At the workplace, an employee may develop a belief a co-worker, supervisor, or all of management, is “out to get me” because the employee sees events or understands meanings of communication differently than do

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I was asked by a defendant to evaluate a man who was struck in the head while riding a motorcycle.  The question asked was had he suffered any emotional distress as a result of his depressed skull fracture, and how much neuropsychological function had he recovered from his usual level of functioning.  This last question was a challenge since the attorney for the defense already knew that this individual had done poorly in school all of his life and had a sketchy employment history for the preceding 20 years.  There already was an index of suspicion he suffered from a learning disorder prior to the head injury and his reported difficulties coping with the aftermath of the head injury was due, at least in part, to a pre-existing

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Some years ago I received an enquiry about the strange behavior of an executive at a large employer. The executive had a history of being somewhat aloof from others and odd. In the preceding week, he came to work and posted, on a bulletin board above his desk, a picture of an AK-47 assault rifle.

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My second year psychiatric residency occurred at Letterman Army Hospital in San Francisco in 1968-1969. The Vietnam War was raging and so the injured soldiers were returning there and elsewhere for treatment both medical and psychiatric. The army’s basic attitude about emotional traumas was to treat traumatized soldiers as close to the front lines as possible and to return them to duty as quickly as possible with the hope/expectation that most of the soldiers would recover.

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In October 1989 immediately following the Loma Prieta earthquake, several employers in Oakland had to deal with the death of employees after the collapse of the Cypress Freeway. The deaths of several employees from these companies had a ripple effect throughout the companies in addition to the overall sense of catastrophe from the earthquake. The day after the earthquake, I telephoned the medical director of one company and the human resources director of another company offering to meet with human resources to discuss the psychological consequences of catastrophic occurrences. Given the magnitude of the disaster

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Several years ago, I was called by a defense attorney about a case where a man was alleging emotional distress as a result of a brain injury following a fall while on a ship. The general facts are the man was standing on a hatch cover of an historic ship when he fell backwards striking the back of his head, which resulted in a coup-contrecoup injury and skull fracture. He was unconscious for many minutes, initially had a Glasgow Coma Score (GCS) of 7, and was hospitalized. While in the hospital, he had a grand mal seizure. Thereafter, he suffered difficulty organizing his thoughts and there was evidence about some problems with memory and organizational ability.

As an element of his claim for damages, the gentleman alleged emotional distress since his injury caused him to lose his high-paying executive job

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