re: What happened to that dude who punched the old man in the parking lot a while back?

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Posttraumatic stress disorder (PTSD) has been offered as a basis for criminal defenses, including insanity, unconsciousness, self-defense, diminished capacity, and sentencing mitigation. Examination of case law (e.g., appellate decisions) involving PTSD reveals that when offered as a criminal defense, PTSD has received mixed treatment in the judicial system. Courts have often recognized testimony about PTSD as scientifically reliable. In addition, PTSD has been recognized by appellate courts in U.S. jurisdictions as a valid basis for insanity, unconsciousness, and self-defense. However, the courts have not always found the presentation of PTSD testimony to be relevant, admissible, or compelling in such cases, particularly when expert testimony failed to show how PTSD met the standard for the given defense. In cases that did not meet the standard for one of the complete defenses, PTSD has been presented as a partial defense or mitigating circumstance, again with mixed success.

Even before posttraumatic stress disorder (PTSD) became an official diagnosis, traumatic stress syndromes, such as traumatic neurosis of war, were successfully offered as bases for criminal defenses.1 Soon after its introduction in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III), in 1980,2 the PTSD diagnosis also made its way into the criminal courts as a basis for several types of criminal defenses for both violent and nonviolent crimes.1,3,4 In addition, other trauma-related syndromes not included in the DSM, such as battered-wife syndrome and battered-child syndrome, have been offered as bases for criminal defenses.3,5,6 However, these related syndromes have generally been presented as special types of PTSD.4,5

Initially, the introduction of PTSD raised concern about its potential misuse in the criminal courts.1,3 Skepticism was further heightened by cases in which malingered PTSD was used as a criminal defense.3 In addition, shortly after the introduction of PTSD as a diagnosis, widespread reform of insanity defense statutes took place after the insanity acquittal of John Hinkley in 1984. These trends most likely made the successful use of PTSD as a criminal defense more difficult.1,3 Appelbaum et al.7 examined the frequency and rate of success of the insanity defense based on PTSD in several states and found that defendants had no more success with PTSD than with other mental disorders and that insanity pleas based on PTSD made up a small fraction of all insanity pleas, suggesting that fears about abuse of the diagnosis in the courts were largely unfounded.

Various PTSD phenomena have been presented in courts as bases for criminal defenses, including dissociative flashbacks, hyperarousal symptoms, survivor guilt, and sensation-seeking behaviors.1,3,4,8,–,10 It has been suggested by some that dissociative flashbacks should be the only legitimate basis for insanity and other exculpating defenses and that other PTSD phenomena are insufficient to warrant exculpation. However, there has not been consensus on this proposal in the field.1,3,4 Furthermore, although there has been some psychiatric research examining the role of certain PTSD phenomena in violent and criminal behavior, this body of research is yet to elucidate the relevance of such phenomena to criminal defenses.8,9 Correlations between a diagnosis of PTSD and interpersonal violence, as well as between a diagnosis of PTSD and criminal behavior, have been described in the psychiatric literature, lending some empirical support for the use of PTSD as a criminal defense.11,–,14 However, there has been little empirical research examining the role of specific PTSD symptoms in criminal behavior. The relevance of PTSD and specific PTSD symptoms to criminal defenses may therefore be best understood by examining how the criminal justice system has addressed the question.

In this article, we review United States criminal case law involving PTSD as a criminal defense. Case law is based on published legal decisions, which are typically at the appellate level. The significance of these cases is that they establish precedents for courts to follow in subsequent cases. Verdicts at the trial court level are usually not published, unless they are appealed. In addition, most pretrial decisions, such as whether a criminal defense based on PTSD can be presented at trial, are not published, unless they are appealed. As a result, research on appellate cases preferentially involves cases in which a criminal defense based on PTSD was barred or failed at the trial court level. On the other hand, cases in which a criminal defense based on PTSD was allowed at trial or was successfully presented at trial are largely not included in this review. This review will not address trends at the pretrial or trial court level; however, it will address the precedents that trial judges follow in rendering decisions about the use of PTSD as a basis for criminal defenses.

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