Nonsymptom Factors Suggesting Mental Illness Otherwise Not Obvious

TASA ID: 3640

Mental illness of great enough significance to be a factor in criminal proceedings is most likely to be the product of a genetic disorder or brain damage. It is not uncommon for someone to be experiencing, and to be influenced by, significant mental illness, though he or she may show little or no outward sign of bizarre thinking or behavior. The few or subtle symptoms which may be identified either by defense staff, or by mental health professionals, should not be allowed to be discounted. Rather, in most cases, they will represent the "tip of the iceberg" regarding the presence of severe disturbance in an individual.

In cases where symptoms of mental illness are not evident prior to initiation of a mental health examination, other signs (not specifically symptoms of mental illness, but commonly associated with it) may be a clue to the presence of significant but hidden mental illness. Many defendants will admit to some of the factors below, which may signal the presence of mental illness, when they will not display or admit to more obvious or direct symptoms of mental illness. Some of these people are so reluctant to admit to mental illness that they will risk facing the death penalty before they will admit to symptoms of the mental illness that they have genuinely experienced. A defendant who is manipulative can also be psychotic simultaneously.

The list below of "nonsymptom" signs of possible mental illness should not be considered exhaustive. It focuses heavily on personal history factors. Any one of these signs does not guarantee the presence of significant mental illness. The presence of one or more of these factors, however, is frequently associated with this kind mental illness. This presence indicates that further investigation by means of a thorough mental health evaluation is warranted.

A.  A genetic history of mental illness: blood relatives who -

  1. Have been hospitalized for mental illness
  2. Have been under psychiatric care
  3. Attempted or committed suicide
  4. Had severe, prolonged, intractable drug and/or alcohol problems
  5. Were incapacitated, unable to work, and had to be cared for by family
  6. Suffered episodes of depression.

The apple often does not fall far from the tree.

B. The defendant comes to every meeting with his or her attorney carrying a sheaf of legal papers. S/he may also seem over-involved in filing motions or researching legal strategies.

C. The defendant admits to -

  1.  A history of psychiatric care
  2.  Hospitalization for mental illness, "nerves," or a "mental breakdown"
  3.  Chronic and severe alcohol and/or drug abuse problems
  4.  A chronic and severe history of fighting
  5.  A history of depression, suicidal thinking or gestures
  6.  A history of many (5,6, or more) marriages

D.  A violent or major crime with no prior criminal history.

E.  Any historical events which may have produced or which may be related to brain damage. Brain injury may result from head trauma, oxygen deprivation, and/or damage from chemical exposure. Brain damaging events may include -

  1. History of head trauma from such things as falls from buildings, auto accidents, blows to the head with boards or baseball bats in fights, severe child abuse involving head beating, violent movements of the body (and head), which might create "brain slosh" even though there was no actual blow to the head, or even no unconsciousness.
  2. Prenatal accident or serious illness experienced by the mother during the pregnancy
  3. Prenatal drug or alcohol exposure
  4. Birth complications - e.g., cord around neck, cord squeezed, or forceps
  5. Prematurity and/or very low birth weight
  6. Surgery with anesthesia as an infant (especially during first month of life)
  7. Poor health at birth, low Apgar
  8. Extreme high fever (104 degrees or more for a long time), especially at a young age, e.g., scarlet fever
  9. Near drowning with resuscitation
  10. High blood pressure, hypertension
  11. Poorly controlled diabetes with chronically elevated blood sugar
  12. Asthma or emphysema
  13. Pneumonia
  14. Infantile measles
  15. Heart condition (congenital, or later, like heart attack)
  16. Complications of major surgery
  17. Swallowed gas while siphoning, and sick for extended time from it
  18. Attempted hanging of himself or herself
  19. Electrocution (shocked badly enough to be burned or to be knocked unconscious)
  20. Sickle cell (especially with stroke)
  21. Smoke inhalation
  22. Carbon monoxide poisoning
  23. Transfusion for excessive blood loss
  24. Amphetamine abuse (chronic) - generally, at least for 6 months, 5 days a week, or more (e.g.   
    ecstasy, black beauties or yellow jackets, meth, Prelude)
  25. Hydrocarbons (volatile) - fumes inhaled, or liquids absorbed through the skin, e.g., huffing glue, paint thinner, gasoline, lantern fluid, cleaning solvents, or industrial solvents (toluene, xylene, carbon tetrachloride)
  26. Freon abuse
  27. Lead exposure (prenatal, postnatal, in adulthood)
  28. Neurodegenerative disease - ALS, Parkinson's, multiple sclerosis, or porphyria
  29. Toxic chemical exposure - worked in a plastics factory, paint factory, chemical factory, auto   
    paint spray booth (with enamels or lacquers, and no breathing gear).  Exposure to liquid pesticides, liquid fertilizers, crop dusting fog, or mosquito spraying fog.  Work with dry cleaning fluids, installing cabinetry below decks on boats (glue).
  30. Stroke or TIA
  31. Steroid use (prescribed or otherwise) for long periods, e.g., prednisone abuse
  32. Extreme dehydration
  33. Chemotherapy - especially prolonged or high dose (sometimes called "chemo brain")
  34. Seizures (historical or current)

 F.  A sudden onset of criminal and/or drug abuse activity late in adolescence, or in the 20s, after a benign
      prior history.

 G.  An odd reluctance to divulge even seemingly harmless information about themselves.

 H.  An unwillingness to consider a plea offer under circumstances where conviction appears to be almost 
      inevitable (e.g., fingerprint evidence, eyewitness testimony, confessions, etc.), and where sentencing
      for conviction is likely to be harsh. Note an inability to account with rational reasons for the
      unwillingness to consider the plea offer.

 I.  A consistently hostile, argumentative, or angry defendant under circumstances where there is no 
     apparent reason for this reaction.

 J.  A defendant who seems unwilling to contribute information to defense planning, who seems
     uninvolved and disinterested, particularly with serious charges. Often, these defendants are consumed
     with issues that they have been told repeatedly by their attorneys are irrelevant. Similarly, consider
     mental illness with defendants who are vague and inattentive in their responses to questions seeking
     information for defense planning, or who are persistently unable or unwilling to account for significant
     evidence against them. At least some of these defendants may seemingly be entertaining the  
     "magical" belief that this evidence is unimportant, or will somehow (in an unspecified manner) be 

As this list makes clear, severe mental illness which can affect one's view of reality is not always easy to detect. Contrary to what those who do not work with mentally ill people frequently in the criminal justice system often think, malingering, or faking symptoms of mental illness, is nowhere near as great a problem as may be thought by many. Rather, it has been observed that some people are ready to receive the death penalty before they will admit they are mentally ill. Hiding genuine disturbance is a greater problem in the criminal justice system than malingering, or faking symptoms of mental illness that really do not exist. It is therefore necessary to use as many means as possible to detect mental illness in criminal defendants.

This article discusses issues of general interest and does not give any specific legal or business advice pertaining to any specific circumstances. Before acting upon any of its information, you should obtain appropriate advice from a lawyer or other qualified professional.

This article may not be duplicated, altered, distributed, saved, incorporated into another document or website, or otherwise modified without the permission of TASA.

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