Colorado Shooting-psychiatrist testifying

[psych md jd]

Isn't Dr. Gur from UPenn?

“I am not forensically trained and never wish to be,” Gur responded ...

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[whopper]

Don't know where she's from.

A phenomenon I see in state systems is a newbie doc that actually is very good but is fresh out of residency. Those docs either leave very very soon (they're good so why stay in a state system), or they get locked into the state system because they're so heavily ridden in debt and state jobs pay off loans, or they just happen to like working for the state.

There is a doctor by that name from U Penn. Don't know if it's the same one.
Anyways, people could likely tell I'm not following this case closely. I got too many things going on right now to invest myself more in it.

 

[heyjack70]

Looks like she's an academic doc not in the state system.

 

[heyjack70]

http://www.thedenverchannel.com/new...nman-james-holmes-illness-led-to-the-shooting

Still no mention of wrongfulness by defense expert. She seems to be leaning on a product test of inanity. And also using brain scanning to explain his mental illness which as far as I know is worthless, unless you want to make money at an Amen clinic.

 

[smalltownpsych]

http://www.thedenverchannel.com/new...nman-james-holmes-illness-led-to-the-shooting

Still no mention of wrongfulness by defense expert. She seems to be leaning on a product test of inanity. And also using brain scanning to explain his mental illness which as far as I know is worthless, unless you want to make money at an Amen clinic.

It seemed to me that she just testified that he had a mental illness. I doubt that anyone would contest that and it doesn't meet the legal definition of insanity unless they are able to go for the "irresistible urge" that was used in the famous twinkie defense case. Not familiar with Colorado law on this though and that other case was California, I believe.

What concerns me more is the brain scan testimony. What exactly is a volumetric analysis and what is the diagnostic sensitivity and specificity and most importantly how much does it correlate with other measures of neurological functioning? Two to three standard deviations below the mean on an intellectual assessment would be intellectually disabled so what does that mean in an volumetric analysis of an MRI?

 

[psych md jd]

She seems to be leaning on a product test of inanity.

I agree, total inanity.

Brain scanning? Volumetric analysis?

COLORADO RULE OF EVIDENCE 703 Bases of Opinion Testimony by Experts:

The facts or data in the particular case upon which an expert bases an opinion or inference may be those perceived by or made known to him at or before the hearing. If of a type reasonably relied upon by experts in the particular field in forming opinions or inferences upon the subject, the facts or data need not be admissible in evidence in order for the opinion or inference to be admitted. Facts or data that are otherwise inadmissible shall not be disclosed to the jury by the proponent of the opinion or inference unless the court determines that their probative value in assisting the jury to evaluate the expert¹s opinion substantially outweighs their prejudicial effect.

 

[EatSleepForensics]

As I learned the hard way helping with a national-profile case during fellowship, attorneys trying and/or contesting insanity before a jury need not concern themselves with the facts and whether the standard at hand is technically met. This technique of going all-in on convincing people about mental illness is a commonly used one and for good reason, particularly in a state like Colorado with a pre-Hinckley arrangement where the prosecutor bears the burden of proof. There is plenty of research indicating that jurors do not accurately learn nor do they adhere to the specific insanity test. Instead, they revert to their own preconceived notions of what constitutes an "insane" defendant.

 

[nancysinatra]

Resnick in forensic conferences emphasizes that "a building crescendo of paranoia" in and of itself is grounds to have someone held in a psych facility for further evaluation and cites several cases where people were new in their first-break psychosis, had a building crescendo of paranoia, and the clinician discharged the patient only to have that patient kill someone within the next few days.
...

Based on what Resnick stated I have placed people in the hospital when detecting this building crescendo of paranoia and have often times quoted him in court when these cases graduated from the hold phase to the involuntary commitment phase.

IMHO suspected psychosis and homicidal thinking is enough for a hold and from there it should be considered. A building crescendo of paranoia too should be in and of itself grounds for at least a hold. The risk is hurting the therapeutic alliance.

Whopper - thanks so much for your informative post! I'm just responding - not disagreeing. I've seen Resnick talk about mounting paranoia. But do you think there are actually any US states where "a building crescendo of paranoia" is grounds for more than say, a 72 hour hold? A 72 hour hold sounds great until you realize that, unlike Resnick, you actually treat lots of general psychiatry patients, and those patients are yours even after the 72 hour hold expires. (Or else you've just passed the liability onto someone else - an inpatient doc, or a judge somewhere - ok fine. Is psychiatry about passing on liability? Is that all we do? We put people on holds even though we don't have cures for their problems?)

Is it even helpful to put people on 72 hour holds on the basis of a single diagnostic feature, i.e. paranoia? Psychiatry is not Beethoven, after all. A crescendo is not naturally followed by anything in psychiatry. None of us knows when or where a crescendo of paranoia will peak. And people can be paranoid over all manner of things, including neighborhood disputes, marital infidelity, politics, etc.

If you compare paranoia to chest pain, you can see the problem. Many if not most fatal MIs are preceded by mounting chest pain. The diagnosis is aided if there are related quantifiable features such as elevated BP, cholesterol levels, a family or smoking history, etc. But certainly not all mounting chest pain is indicative of a coming MI. Chest pain can be musculoskeletal, or a PE, or GI related. If everyone with mounting chest pain were subjected to catheterization, many people would be harmed unnecessarily. The parallel in Resnick's paranoia model is that many people will be unnecessarily detained (which damages their personal and family lives and professional reputations even if we tend to ignore this ugly fact about 72 hour holds.) See my point? What would Resnick say about that basic problem of predictive probability which exists throughout all medicine? Does he accept that it's ok for us in psychiatry to have a lower level of predictive probability? Because I'm pretty sure we do.

As far as quoting him in court - I'm impressed that you do that. In my opinion, he is not the standard of care in general psychiatry - he is the standard of excellence in the forensic world. Most probate court judges I've encountered wouldn't even know who he is!

 

[EatSleepForensics]

As far as quoting him in court - I'm impressed that you do that. In my opinion, he is not the standard of care in general psychiatry - he is the standard of excellence in the forensic world. Most probate court judges I've encountered wouldn't even know who he is!

I would not quote him in court. As for addressing escalating paranoia, it is fairly easy to persuade the court to hospitalize someone focusing on behavioral manifestations of paranoia, particularly if the paranoia appears focused on particular individuals. This need not -and rarely will - amount to actual homicidal ideation or expressed threats of serious violence.

 

[heyjack70]

As I learned the hard way helping with a national-profile case during fellowship, attorneys trying and/or contesting insanity before a jury need not concern themselves with the facts and whether the standard at hand is technically met. This technique of going all-in on convincing people about mental illness is a commonly used one and for good reason, particularly in a state like Colorado with a pre-Hinckley arrangement where the prosecutor bears the burden of proof. There is plenty of research indicating that jurors do not accurately learn nor do they adhere to the specific insanity test. Instead, they revert to their own preconceived notions of what constitutes an "insane" defendant.

This makes sense. I think though if the standard was clearly met the defense would be highlighting exactly how it was met. The fact they aren't makes me think the insanity standard probably was not met in this case from their perspective.