Practical Approaches to Forensic Mental Health Testimony

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Psychology, Public Policy, and Law —27, Journal of the American Academy of Psychiatry and Law —, Arkansas Law Review, —, Hanson RK. What do w eknow about sex offender risk assessment? Psychology, Public Policy, and Law —72, Washington v. Strauss, 20 P. Petrila J, Otto RK. Admissibility of expert testimony in sexually violent predator proceedings.

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Wilson JJ. Macallair D. Emerging from darkness: Reinventing San Francisco's juvenile justice system. Stanford Law and Policy Review —39, — Butterfield A. Hard time: A special report: Profits at a juvenile prison come with a chilling cost. Dale MJ.

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Lawsuits and public policy: The role of litigation in correcting conditions in juvenile detention centers. University of San Francisco Law Review —, Comment: Jimmy Ryce involuntary civil commitment for sexually violent predators' treatment and care act: Replacing criminal justice with civil commitment.

Florida State University Law Review , Walker JC, Freedom is to confinement as twilight is to dusk: The unfortunate logic of sexual predator statutes. University of Missouri Law Review —, Kanas v. Crane, US , Research Preview: Reintegrating juvenile offenders into the community: OJJDP's intensive community-based aftercare demonstration program. National Institute of Justice. New York, Guilford, Petrila J. Tyler TR. The psychological consequences of judicial processes: Implications for civil commitment hearings. Southern Methodist Law Review —, Archives of General Psychiatry —, MedSurg and Acute Care Nursing.

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Multiple Sclerosis. Parkinson's Disease and Movement Disorders. Spinal Cord Injury. Women's Health. SpringBoard The Professional Nurse. Use Code SPF In contrast, spontaneous confabulations occur without provocation from other individuals or the situation [ 14 ]. These spontaneous confabulations are difficult to detect and often happen inconsistently over time within an individual [ 15 - 17 ]. Both types of confabulation have the potential to profoundly impact legal processes [ 18 , 19 ].

Regardless of type, it is difficult to discern when confabulation is occurring, as an individual may be recounting a false memory at certain times and presenting accurate memories other times [ 20 ]. A key step in this process is distinguishing confabulation from willful forms of fabrication and symptoms of mental illness. On the topic of willful deception, Kerns differentiates confabulation from other forms of deception using the following characteristics: level of consciousness, goals, memory, content, and sensorium [ 21 ].

In terms of mental illness , there may be similarities between the clinical signs of confabulation and delusions, which can be present in neuropsychiatric populations.

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Generally, confabulation tends to be associated with false memories while delusions tend to be associated with false beliefs. It has also been noted that delusions are firmly held beliefs lasting over longer periods of time, whereas confabulations are dismissed more rapidly and readily [ 22 - 24 ]. Nonetheless, several investigators argue that a common core deficit may exist in both conditions [ 25 , 26 ].

Together, these characteristics describe the psychological state and underlying motives of the individual along with the general nature of the falsified information. Once the occurrence of confabulation is confirmed, discerning its multifaceted and complex causes is the next step to properly managing both the impacted individual and the phenomenon itself [ 27 ]. Although confabulation can occur in relatively healthy individuals, two key factors have been linked to confabulation: physical causes e. In terms of physical causes, traumatic brain injuries involving damage to the frontal lobes may be the most consistent link.

These can result from car crashes, sports collisions, and violent altercations, each of which lead to the stretching and tearing of tissue and blood vessels [ 29 , 30 ]. After experiencing a traumatic brain injury , individuals can go from consistent reporters of accurate information to inconsistent and unreliable reporters of information [ 22 , 31 ].

Conversely, neurological and psychological factors ranging from neurodegenerative diseases to depleted cognitive functioning resulting from extreme stressors and environmental factors can result in confabulation.

Neurodevelopmental disorders and depleted cognitive functioning, which are disproportionately likely in criminal justice settings may include susceptibility to fantasy and confusion along with deficits in executive functioning, short- and long-term memory, autobiographical memory, and reality and source monitoring.

Alternatively, demanding situations can also contribute to the likelihood of confabulation [ 2 , 32 - 34 ]. This could be caused in part by an effort to make sense of a situation or leading questions and repetitive negative feedback. When placed under greater pressure, and accused by an untruthful witness, participants confessed to the accusations and confabulated how they performed the accused activities.

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This study highlights the impact of the situation on confabulation. This phenomenon can also happen in the real world. For example, Kassin and Kiechel discuss the case of a former deputy sheriff who was charged with satanic cult crimes and raping his two adult daughters [ 35 , 36 ]. However, when he was accused of an equally disturbing crime by an expert who reviewed his case, he not only confessed but also added details to the story that he believed to be true.

It was later determined that this individual suffered from a dissociative disorder, rendering him more vulnerable to stress and suggestive questioning [ 37 ]. As the above example highlights, confabulation can have extraordinary consequences in criminal justice settings. Confabulation has been linked to everything from inaccurate witness accounts to false confessions and wrongful convictions. In these cases, individuals have incorporated information from a variety of sources into the creation of a false memory, including leading questions from the investigators and overheard conversations [ 38 ].

As such, the potential for confabulation threatens the reliability and validity of testimony provided by witnesses, victims, and defendants and limits the capacity of a defendant to assist her or his legal team in the development of a defense strategy [ 39 ]. In these instances, the confabulator provides inaccurate information without any outward indicators of lying [ 3 ]. Despite the dire consequences of confabulation in criminal justice settings, very few professionals working in these settings understand the intricacies of the topic and even hold many misconceptions about this memory phenomenon [ 4 ].

To begin addressing this need, this article provides an overview of the symptoms and effects associated with confabulation for criminal justice, forensic mental health, and legal professionals. People suffering from confabulation often present a unique challenge in criminal justice settings. Although neurological conditions like Fetal Alcohol Spectrum Disorder FASD and traumatic brain injury TBI can contribute to confabulation, psychological processes and environmental stressors are likely more influential in criminal justice settings [ 42 - 44 ].

The potential for confabulation is exacerbated by the use of close ended i. In some instances, the suspect can incorporate secondhand details into the formulation of detailed confessions via confabulation [ 38 ]. Despite the devastating consequences of confabulation, there are relatively few scientific studies on the phenomenon [ 27 ]. In a replication of Kassin and Kiechel, Horselenberg, Merckelbach, and Josephs, explored whether these findings held up in a different sample of 34 undergraduate psychology students [ 35 , 46 ].

The difference in the percentage of confabulating participants may be ascribed to a slight variation in the experimental procedure introduced in the Horselenberg study [ 46 ]. In their procedure—every participant was informed by a putative witness that the participant was seen to have committed the computer task error.

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In the Kassin and Kiechel procedure, only half of the participants were confronted by an experimental confederate who claimed to see the participant commit the error [ 35 ]. The other half of the participants were not. In a recent review article, Gudjonsson summarizes the existing literature on the role of confabulation in false confessions [ 47 ]. Central to this presentation is the development of a heuristic model or hypothetical example of how someone might falsely confess to murder as a result of confabulation.

Ultimately, the individual partially or fully accepts responsibility for the event and wrongly confesses to a crime not committed by that person. In light of this possibility, it is important for criminal justice professionals to anticipate and recognize the symptoms and risk factors associated with confabulation.

Further, criminal justice practitioners, legal professionals, and forensic mental health specialists should consider a variety of issues regarding confabulation, particularly as it relates to accurate witness accounts, testimonies, and court-ordered forensic evaluations. If confabulation is suspected, professionals should consider the possible presence of mental, neurological, and other medical conditions. The following are key points about confabulation that criminal justice, legal, and forensic mental health professionals should take into consideration.

Practical Approaches to Forensic Mental Health Testimony

The relationship is less than straightforward, but the frontal lobe, executive function, and confabulation have been consistently linked in the scientific literature [ 64 , 65 ]. However, contrary to common law, it is characterized by the codification of legal principles. There is natural overlap between the work of forensic psychiatrists and forensic psychologists. As a consequence, legal measures for the protection of individuals with mental disorders have been created. Strategies and techniques are clearly illustrated and arm readers with exactly what they need to be successful in their testimony. Services on Demand Journal.

Influenced by intelligence, socialization, temperament, and culture American Psychiatric Association this concept is composed of three components. First, the conceptual component relates to equal and simultaneous competence in different academic skills i. Second, the social component primarily involves verbal and non-verbal communication, the capacity to establish and maintain relationships, and empathy. Limitations in adaptive functioning are common in both individuals involved in the criminal justice system and those affected confabulation [ 42 , 50 - 52 ].

Those suffering from frontal lobe impairment, which has been linked to confabulation Moscovitch and Melo, Stuss and Levine, have difficulty with self-monitoring and emotional processing, leading to inappropriate social behavior [ 53 , 54 ]. For example, Beer, John, Scabini, and Knight note that patients with orbitofrontal damage exhibited unusual behaviors such as reacting to strangers in an inappropriately intimate manner, disclosing too much personal information, and teasing others in an unsuitable way [ 55 ].

In addition to these deficits in social behavior , individuals with orbitofrontal damage are at an increased risk for confabulation. In turn, negative social consequences may be associated with an increase the likelihood of confabulation, particularly in response to negative feedback [ 27 ]. Finally, the risk of confabulation increases with age and in the presence of uncertain social settings and expectations such as during interrogations in criminal justice settings [ 27 ].

To protect against the consequences of adaptive functioning deficits in criminal justice settings, a reliable and valid assessment of adaptive functioning is essential. Once completed, the assessment should be used to inform important legal decisions like competency to stand trial or make other legal decisions e. Executive functioning refers to the higher-order cognitive processes including information processing, attention, impulse control, and memory that are necessary for complex thoughts [ 57 , 58 ].

As a result, individuals with executive functioning issues are prone to feeling overwhelmed, affective dysregulation e.

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As regards to the current concern, compromised executive functioning has been linked to memory impairments including confabulation [ 61 - 63 ]. The relationship is less than straightforward, but the frontal lobe, executive function, and confabulation have been consistently linked in the scientific literature [ 64 , 65 ]. Specifically, damage or disorders impacting the frontal lobe often co-occur with executive functioning deficits [ 64 ]. In a meta-analysis of 27 lesion and neuroimaging studies and 1, participants, Alvarez and Emory found mixed evidence on the relationships between frontal lobe activity and executive functioning.

Although these findings do not reveal a simple causal relationship, there may be a more nuanced relationship between frontal lobe impairments and executive function than originally posited. Similarly, the research on the relationship between executive function and confabulation is just as strife with inconsistencies. For example, an MRI case study of an individual recovering from a stroke reported that the level of executive function impairment in the paramedian arteries of the thalami was related to confabulation [ 67 ].

Despite these inconsistencies, mental health professionals should be familiar with the symptoms of executive dysfunction and its possible relationship with confabulation until research clarifies the nature of the relationship between these constructs [ 65 ]. Not only does substance abuse increase risk of criminal justice involvement, but it has a negative influence on executive functioning [ 68 ]. In fact, alcohol, cannabis, and heroin are substances that have been shown to influence cognitive impairments and increase the likelihood of confabulation [ 69 , 70 ].

The deleterious influences of cannabis on working and declarative memory have been well established for decades [ 69 ]. In their recent literature review, Barcels and colleagues explore new research to gain a clearer understanding of the relationship between cannabis and confabulation [ 69 ]. The authors summarize that cannabis use renders a susceptibility to confabulation in both current and former users. This susceptibility may be linked to alterations in the cognitive functioning abilities of the lateral and temporal lobes of the frontal cortex.

In light of long-term impact of heroin abuse on cerebral structures, Mitrovic and colleagues explored the impact of longterm heroin use on neurophysiological functioning and memory in a sample of 90 participants with a history of heroin addiction [ 70 ]. Here, the 90 participants were split into three groups of 30 participants: participants who abused heroin up to one year, between one and five years, and longer than five years. Findings indicate that heroin abuse for a period of longer than one year was associated with impairments in short-term and delayed verbal memory.

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In other words, the length of heroin abuse is positively correlated with the number of confabulations. As such, long-term heroin abuse could increase the risk of confabulation. Given that substance abuse has exceedingly high prevalence rates in the criminal justice system, practitioners should be prepared to identify the co-occurrence of confabulation and substance abuse.

Individuals with frontal lobe injuries and subsequent executive function deficiencies are not only at risk for confabulate but are also more susceptible to suggestibility and manipulation [ 9 , 58 ]. For example, in a study of 32 psychiatric patients, Smith and Gudjonsson found that confabulation was correlated with suggestibility and anxiety. Because these relationships were not strong in magnitude, there is a possibility that other social and situational factors may influence the likelihood of confabulation [ 58 ]. Interestingly, Smith and Gudjonsson found that confabulation was not associated with compliance or selfesteem, suggesting that the tendency to simply go along with requests or obey instructions has little impact on this behavior [ 58 ].

Specifically, these participants were more prone to suggestibility and confabulation relative to a comparison group with average intellectual abilities. The findings reported above provide evidence that executive function, or in general, I.

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These relationships have been empirically investigated and have been shown to be statistically valid [ 19 ]. Nonetheless, other research by Gudjonsson and Young found that confabulation was not correlated with suggestibility or acquiescence [ 73 ].