Post-traumatic Stress Disorder and Criminal Behavior
Post-traumatic stress disorder (PTSD) is described as “the development of characteristic symptoms following exposure to an extreme traumatic stressor” (Baker & Alfonso, 2006, p. 1) where a traumatic stressor must involve threatened or actual serious injury or death “or other threat to one’s physical integrity” (Baker & Alfonso, 2006, p. 1). The event can be directly experienced or witnessed, although it can also be about a person learning of a traumatic event that violently or unexpectedly occurred to a close associate or a family member. Examples of such events include growing up in an environment in the inner-city, experiencing a natural disaster, military combat, rape, or other traumatic events.
Aside from surviving the traumatic event, the person must also exhibit symptoms from 3 categories, namely an increased baseline physiological arousal; numbing or avoidance; and reexperiencing.
Reexperiencing symptoms include flashbacks, nightmares, intrusive thoughts about the trauma, and trigger responses, that is, becoming distressed upon encountering a stimuli that reminds the person of the trauma. On the other hand, numbing or avoidance symptoms include a general feeling of emotional numbness; isolation from others; amnesia with regards to some parts of the trauma; and avoidance of situations that remind the person of the trauma. Lastly, arousal symptoms include a general sense of jumpiness, irritability or angry outbursts, and insomnia.
It should be noted, however, that these symptoms don’t always manifest right after the event. Rather, they can take many years to become evident. Moreover, it was found that among Vietnam war veterans, these symptoms were more likely to persist and were more intense “among men whose position in our society makes them least able to cope” (Erlinder, 1984, p. 305), which include the poor, the irregularly employed, the unemployed, blacks and other minority members, as well as those who experienced instability in their families during childhood.
Aside from the establishment of the existence of an extreme traumatic stressor, the diagnosis of PTSD is made by a mental-health professional who makes use of instruments such as the Clinician Administered PTSD Scale for DSM IV (Diagnostic Statistical Manual of the American Psychiatric Association), the Mississippi Scale for PTSD, and some portions of the Multiphasic Personality Inventory. It is, however, possible for lay people to also detect the possibility of PTSD through behaviors such as difficulty in concentrating, irritability, and jumpiness.
An example of PTSD-induced behavior would be a war veteran violently attacking a home, with the belief that he is assaulting enemy troops (Melton, Petrila, & Poythress, 2007). Another is when a rape victim harms someone, thinking she is fighting her assailant.
Someone who willingly talks about the event most likely does not have PTSD. Similarly, it is necessary to establish that the behaviors and symptoms in question did not exist before the trauma and that there was a decline in the person’s level of functioning after the trauma.
As well, it has been found that in a study of male Vietnam veterans, those who sought in-patient treatment for PTSD were significantly more likely to have engaged in violent behavior in the four months prior to hospitalization than other psychiatric in-patients without PTSD (Benedek & Grieger, 2006). Some of the violent acts exhibited included threats of violence with or without a weapon and a likelihood to endorse physical fighting.
There are two ways by which PTSD can be linked to criminal behavior. One is that PTSD symptoms “can incidentally lead to criminal behavior” (Baker & Alfonso, 2006) and another is that the offenses can be connected directly to the specific trauma experienced by the individual.
Many of the PTSD symptoms that a person experiences can lead to a lifestyle that is prone to sudden violent outbursts or criminal behavior. People with PTSD are usually bothered by memories of the trauma and suffer from chronic anxiety, while some attempt to self-medicate with alcohol and drugs. It is also possible for people who experience an emotional numbness to get involved in sensation-seeking behavior for the sake of trying to feel some kind of emotion. In the case of combat veterans, they might try to recreate the adrenaline rush they felt while in combat. In addition, the feeling of having to always be on guard can make these veterans misinterpret simple or trivial situations as something threatening, which can then lead them to act in a self-protective way. Their heightened baseline physiological arousal, on the other hand, can cause violent behavior that is not proportional to the perceived threat. In addition, it is common for people with PSTD to feel guilty, which can in turn cause them to commit crimes that will lead to their punishment, apprehension, serious injury, or even death.
There are three ways by which a particular crime can be directly linked to a specific traumatic stressor. One is when the crime symbolically or literally recreates the integral aspects of the trauma. Another is when the environmental conditions resemble those that existed at the time of the trauma. This can induce the same behavior or violent responses that were exhibited when the trauma occurred. The third way is when life events prior to the criminal offense symbolically or realistically forced the person to deal with unresolved conflicts that were related to the trauma. This causes a disturbance in the person’s psychological state, which then results in the otherwise unlikely behavior.
Crimes linked to PTSD often share similar characteristics. One is that the defendant usually has no previous criminal history and has no coherent explanation for their behavior. A study of Vietnam war veterans found that their violent tendencies were explained better by their war experience rather than by any premorbid criminal behavior (Benedek & Grieger, 2006). Similarly, the study suggested that the violence and anger were better considered as reaction stress instead of as another “outburst of a notoriously sociopathic population” (Benedek & Grieger, 2006, p. 52).
Others may also find it hard to provide a motivation for the crime. A seemingly trivial situation may result in violence, and the victim is often chosen in an accidental manner. Amnesia may also surround part or all of the crime, and the defendant might cite a number of stressors that occurred before the crime, and which may be psychologically or literally related to the initial trauma. The crime itself may also have a realistic or symbolic link to the initial trauma, although the person is often unaware of this connection.
In a study conducted by Collins and Bailey (1990) where they examined male felons among whom no one developed PTSD from combat-related experience, it was found that those who were diagnosed with PTSD were considerably more likely to have been incarcerated for assault, rape, or homicide, or have an arrest history for violent behavior within the year prior to the incarceration. It was also found that of those who reported at least 1 PSTD symptom and had at least 1 arrest for assault, rape, or homicide, 85% experienced their first PTSD symptom within the previous year or the same year of the arrest. This implied that PTSD was associated to violence even when the symptoms were not related to combat experience and even when antisocial personality was controlled (Collins & Bailey, 1990).
Court sentencing procedures should consider the presence of PTSD where the defendant’s diagnosis must be introduced as a mitigating factor during the capital case’s penalty phase. The presence of PTSD may cause courts to deviate from mandatory sentencing guidelines, especially in federal cases or in states that have versions of the three strikes law.
It should be considered whether any type of treatment was made available to the defendant either immediately following the event or in the succeeding months, as crisis intervention for trauma survivors is of extreme importance. The age when the trauma occurred should also be considered, as well as its effects on the individual’s personality development. Although a trauma can have more pervasive effects on a person’s functioning when the trauma occurred at an early age, the documentation of personality changes before and after the trauma is easier when the stressors are experienced at a later age.
The role played by an undiagnosed PTSD in the defendant’s behavior should also be considered if the defendant has a record of previous criminal convictions or has been subjected to poor adjustments during previous incarcerations. It should be noted that being in prison would require a person’s constant vigilance against the threat of violence, which can cause the person with PTSD to feel even more traumatized. This can worsen the person’s PTSD symptoms, which can eventually lead the person to act out with violence.
Lastly, the psychiatric prognosis should be considered. Although a chronic condition, PTSD can usually be managed successfully with proper education and treatment. However, the person will unlikely get the treatment they need if incarcerated. In addition, prolonged incarceration will only worsen the PTSD symptoms and will cause a deterioration in the person’s level of functioning.
The enhanced awareness of PTSD and its role in the legal process has been met with a lot of controversy (Erlinder, 1984). There is fear that the use of PTSD in the courtroom will give criminals a clean slate for them to commit antisocial acts or other crimes. There are also concerns that PTSD might be misused by lawyers in attempts “to stretch the diagnosis beyond scientifically justifiable limits” (Erlinder, 1984, p. 307).
One of the difficulties encountered by forensic examiners in these types of cases is the establishment of the diagnosis’ validity, considering that most of the measures used for the assessment of PTSD are self-reported (Melton et al., 2007). It can therefore be manipulated, especially since it is based on the defendant’s interpretation of the event instead of on its objective impact. In addition, it would be difficult to tease out the effects of secondary disasters such as the financial issues encountered after an earthquake.
Another difficulty is the ability to retrospectively establish that a reliving flashback occurred, considering that flashbacks are supposed to be unconscious occurrences. Although the identification of the triggering stimuli may be helpful, “because such stimuli in theory need only be symbolic of the original trauma,” (Melton et al., 2007, p. 241) mental professionals may be tempted to find non-existent triggering stimuli. Still another difficulty is the interaction of PTSD with drugs. For example, alcohol, which is usually an unacceptable basis for an insanity defense, may have largely influenced the defendant’s flashback.
As such, Erlinder (1984) proposed that a thorough education for lawyers and mental health professionals about the nature of PTSD and its effects on the defendant’s behavior should be provided to prevent the abuse and misapplication of PTSD. In addition, lawyers should understand that PTSD can affect virtually every aspect of the defendant’s behavior, which can have legal implications with regards to employment problems, marital difficulties, substance abuse, and high suicide rates.
In addition, the effects of PTSD may be subtle. The symptoms may also resemble those of substance or alcohol abuse and are episodic in nature. As such, the defendant’s abnormal behavior characteristics may not be readily evident and the presence of PTSD may be overlooked. It should also be kept in mind that “PTSD is a psychological condition brought about by factors external to the person who experiences symptoms” (Erlinder, 1984, p. 312), that is, unlike other psychological disorders, it is possible with PTSD to point to the specific events that caused the defendant’s behavior. As such, PTSD can be presented in a more concrete way in court cases unlike other psychological disorders where a leap of faith may be necessary based on expert opinion. It is then possible to explain a defendant’s behavior in a certain setting as a reaction to specific conditions without having to conclude that the defendant cannot be treated and that the behavior will necessarily recur.
In conclusion, it is important to note that PTSD is a mental condition that is caused by external stressors such as combat, rape, natural disasters, and other tragic events. Symptoms include the reexperiencing of the traumatic event; the avoidance of stimuli that’s associated to the event; a general numbing effect; and a heightened arousal. Without proper and prompt treatment, these symptoms can lead to violent and even criminal behavior.
It is then important for lawyers, the judicial system, and mental-health professionals to be equipped with adequate knowledge on how to deal with and properly diagnose PTSD. The violent behavior exhibited by people with PTSD are merely their reactions to perceived stressors, and unduly punishing them while providing them with poor treatment conditions can only worsen their illness and result in more violence.
References
Baker, C., & Alfonso, C. (2006). National Center for PTSD fact sheet: PTSD and criminal
behavior. Retrieved from http://www.ncptsd.va.gov/ncmain/ncdocs/
fact_sheet_fs_legal.html
Benedek, D. M., & Grieger, T. A. (2006). Post-deployment violence and antisocial behavior: The
influence of pre-deployment factors, warzone experience, and posttraumatic stress
disorder. Primary Psychiatry, 13 (3), 51-56
Collins, J. J., & Bailey, S. L. (1990). Traumatic stress disorder and violent behavior. J Trauma
Stress, 3 (2), 203-220
Erlinder, C. P. (1984, March 1). Paying the price for Vietnam: Post-traumatic stress disorder and
criminal behavior. Boston College Law Review, 25 (2), 305-347. Retrieved from
http://lawdigitalcommons.bc.edu/bclr/vol25/iss2/2
Melton, G. B., Petrila, J, & Poythress, N. G. (2007, September 18). Psychological evaluations
for the courts: A handbook for mental health professionals and lawyers. New York, NY:
Guilford Press
