The Measure of Madness:. Katherine Ramsland
evaluation by a team of psychiatrists, who pronounced him cured, he had the head of one victim in the trunk of his car outside. Such stories sully the mental health profession, and people on juries remember them. So it’s important to contrast the normal course of an evaluation and its consequences against these aberrant cases.
To be effective, forensic psychologists must know the operations and expectations of the court. As expert witnesses, they must be credible, confident, competent, and prepared. They should understand that the court prefers clear decisions, jargon-free evaluations, and objective information that directly address the issues at hand. While they must offer information that can assist those who will decide on guilt or innocence, they should refrain from making this decision themselves. They must also resist an attorney’s attempt to persuade them about what to say.
In addition to competency and insanity evaluations, forensic psychologists appraise behaviors such as malingering (faking an illness), confessing, and threatening suicide. As consultants, psychologists may assist a forensic artist with behavioral factors for a facial reconstruction, or they may help an attorney select a jury. They might defuse a potentially violent situation with negotiation, offer a threat assessment, or assist a coroner with an ambiguous death determination. Some psychologists are employed at police departments to determine fitness for duty or perform trauma counseling. Many others work in prisons or hospitals for the criminally insane. Psychologists may also participate in forensic work outside the courtroom, including consulting for a cold-case team or a serial killer task force.
In this compelling collection of stories from a twenty-five year career, Dr. Cheryl Paradis offers a window into the world of a clinical psychologist who has made many assessments for the courts. Whether for the prosecution or defense, her job is to remain neutral as she offers the results of her interviews, assessment instruments, and observations of a range of disturbed people—and those who merely pretend they’re disturbed. She’s been hired to evaluate a person’s present mental ability to stand trial, to waive rights, or to confess, and she’s evaluated whether certain offenders appreciated the difference between right and wrong while committing their crimes. Her clients in the following chapters include an angry juvenile, a battered woman, a psychotic arsonist, a clever con man, a range of liars, and even an accused cannibal. What keeps you reading is that, while the issues from one case to another are similar, each case is also unique. Many are surprising.
In the end, forensic psychology is really about the defendants, and Dr. Paradis wisely recalls one of her earliest lessons: “Don’t believe everything your patients tell you.” In other words, listen with your third ear: Gather the facts as they know them, but be wise to their agendas and/or illnesses. This advice covers not just the delusional, but also connivers, psychopaths, and people with poor or distorted memories. While Dr. Paradis explains the steps of her clinical evaluations, the manifestations of mental illness (or its faux counterpart) take center stage, framed within important legal precedents. It’s clear that these tales are not about therapy sessions and that the forensic psychologist is not a defendant’s advocate. She’s an essential player in a complex and difficult legal proceeding.
Psychologists who testify must be prepared for anything—aggressive attorneys, confused jurors, canceled sessions, and even uncooperative defendants. They do not make moral judgments or apportion blame. They simply make an assessment to the best of their ability and let the chips fall where they may. They may not know the outcome of a case unless they make an effort to find out. What makes these stories most compelling is Dr. Paradis’s compassion. Once her part is over, she still wants to know what happened to the people she evaluated, so we get the end of the story. There’s little doubt that this work is challenging, even risky at times, and it can be both depressing and satisfying. One thing is for sure: Each case offers something to make us ponder what it means to be human. Whether it’s a demented mother with fatal religious delusions, a scheming psychopath hoping to slip his bonds, a person who cooks the flesh off his former friend, or a frightened victim acting out, each and every person’s behavior teaches us about the human condition.
—Katherine Ramsland, Ph.D.
Chair, Department of Social Sciences at DeSales University
Associate professor of forensic psychology
Author of The Criminal Mind: A Writers’ Guide to
Forensic Psychology
INTRODUCTION
It was humid, I was sweating, and it was only eight o’clock in the morning. I realized how nervous I was walking past the old hospital buildings to find “the Annex,” a dilapidated brick building housing the psychology department. It was July 1, 1985, the first day of my internship.
I sat down in the lobby with the other six interns and started filling out employment forms. We had to choose the department where we wanted to work for our first three-month clinical rotation. The only air-conditioned area in the old “G Building” of the psychiatric hospital was the jail ward. I quickly raised my hand to volunteer.
It wasn’t that I was particularly interested in working with mentally ill defendants, but I hated the heat. To this day I am amazed that my entire career hinged on that minor decision. I became a forensic psychologist simply because it was hot that day.
Before my internship I had vague plans to develop a psychotherapy practice. That’s what I thought most psychologists did. I expected I would spend the next forty years sitting in an office, treating patients—most, the “worried well”—one per hour.
That all changed after a few weeks on the psychiatric jail ward. I recall one of my first patients was a withdrawn man charged with violating an order of protection against his neighbor. He did not seem especially interesting, until he started to describe how his neighbors installed listening devices in his apartment and “someone” was sending messages through his television. I can’t remember what message was being sent to his television, but I know the one I got—“these forensic patients are much more interesting than anxious neurotics.” Many were driven by hallucinations and delusions to hurt or kill people they loved. Their violent acts made me question my beliefs about free will, responsibility, and punishment.
It’s been a long time since I completed my internship. Over the past twenty-five years I have evaluated thousands of disturbed and disturbing defendants. As a forensic psychologist my responsibilities are different than those of other psychologists. I must put away my “treatment” hat to think more like a detective. I often remember the advice of my first supervisor on the jail unit. He’d grin while warning me, “Don’t believe everything your patients tell you.”
Perhaps the most important lesson I have learned is not to accept a defendant’s version of a crime. Instead I search for clues in their past—in court, school, and hospital records. I came to appreciate the advice of another supervisor who often said, “History is gold.”
In the following chapters I include eighteen of my most intriguing, puzzling, and challenging cases. The first part includes cases of defendants raising a variety of psychiatric defenses at trial, such as insanity and extreme emotional disturbance. In the second part I describe a series of cases of defendants undergoing two types of evaluations: competency to stand trial and competency to waive Miranda rights. Competency to stand trial is the legal term indicating a defendant can work with his attorney and assist in his defense. Competency to waive Miranda rights refers to whether a defendant understands his legal protections against self-incrimination when he confesses to a crime. In the third part I include cases concerning juveniles and the justice system and the assessment of dangerousness and malingering or faking symptoms.
All cases are real and much of the dialogue is taken verbatim from my notes. Some of the dialogue and court testimony are based on my best recollections. At the beginning of each interview I inform each defendant that our conversations are not confidential. However, I still use pseudonyms and disguise most defendants’ identities by changing or eliminating biographical or legal information.
I spend between ten to twenty hours with most defendants, and in this small window of time I try to see the world as they do. My job is not to pronounce guilt or innocence,