科羅拉多特大槍擊案在引起很多人感歎同情和痛恨的同時，大家也實在想不明白為什麽James Holmes 會殺這麽多人，他是不是精神有問題。這就涉及一個法醫精神病鑒定的問題。正好在網上看到一篇用通俗語言對此問題所做的簡單介紹，貼在這裏供有興趣的人參考。考慮到有些人可能既不想看英文也不願意看這麽長的文章，我就把文章的意思用中文簡單歸納一下。有不夠確切的地方，以原文為準。至於James Holmes是不是有精神問題，能不能被判因精神疾患而無罪，這個估計需要最終經過法庭判斷，我就不在這裏猜測了。
法醫精神病鑒定的目的是看嫌疑犯是不是有嚴重的精神疾患從而不能上庭，以及不需要為自己的行為負法律責任。具體到James Holmes，他沒有明確的精神病病史，而且是個受過高等教育的博士生，所以首先要做一些檢查看看有沒有一些軀體疾病比如腦瘤，或者會不會是什麽藥物的作用。然後需要有精神科醫生做一個詳細的問診檢查，包括了解他從小是怎麽長大的，以及在檢查過程中能不能觀察到幻覺或者幻想等等。
一般還需要做那種耗時幾個小時的心理學測試，比如明尼蘇達多相人格測驗。這個明尼蘇達多相人格測驗很著名，是法醫精神病鑒定不可或缺的手段，可以用來看病人是不是在裝病。
通常，這種要求因精神病而不服刑的請求很難成功，絕大多數都會失敗。道理也很簡單，因為陪審團一般不太願意讓一個能夠犯下嚴重罪行的人將來被放出來繼續害人。即使經過法醫精神病鑒定判定病人最終被判決不需要服刑，通常也會被長期留在精神病院進行治療，比如，1981年因為喜歡朱迪福斯特而行刺裏根總統的John Hinckley, Jr，在華盛頓DC的St Elizabeth's Hospital已經住院30多年了。
How James Holmes will be evaluated by psychiatrists
James Holmes, the suspect responsible for the worst mass shooting in U.S. history, has begun a legal journey that will include an extensive psychiatric evaluation and may include a plea that he is not criminally responsible for his acts--an "insanity" plea. As a forensic psychiatrist, I have participated in many such evaluations and then rendered expert testimony about killers in court.
Here's how they work:
First, given the extraordinary change in Holmes' mental status--from brilliant neuroscience Ph.D candidate to a mass killer--all organic (i.e. physical) causes for psychiatric symptoms must be excluded via an extensive medical work-up, including an MRI (to rule out a brain tumor or slow bleed), an EEG (to rule out seizures), a lumbar puncture (to obtain cerebrospinal fluid to rule out a central nervous system infection) and blood work (to rule out toxicity from heavy metals, other physiological abnormalities and any use by Holmes of illicit drugs). Any medication with which Holmes has recently been treated will be considered for its possible psychiatric side effects.
Second, a detailed series of psychiatric interviews will be conducted to create a timeline of Holmes' life story--from birth right through any recent stressors--and to attempt to determine how Holmes thinks, feels and communicates. This will include an analysis of Holmes' personality, as well as a determination of whether he harbors any fixed and false beliefs (delusions)--like being under the control of aliens, being specially selected to save the world, being pursued by the CIA or having thoughts implanted into his head by devices in the walls of his apartment. Pains will be taken to observe whether he acts as though he is hallucinating--hearing voices or seeing visions or experiencing odd bodily sensations (of, for example, his skin peeling away) in the absence of any stimulus to account for them.
Long, written psychological tests--like the Minnesota Multiphasic Personality Inventory--will likely be used, as well, in order to support or refute data gleaned from the clinical interviews, to gain further insight into Holmes' ways of thinking and feeling and to determine whether he is faking or exaggerating symptoms or, conversely, attempting to cover up symptoms. The tests and the way they are analyzed have built-in mechanisms to identify those who are trying to seem crazy when they are not--or trying to seem normal when they are not.
The medical work-up, psychiatric interviews and psychological testing will probably both be used first to determine whether Mr. Holmes is competent to stand trial or too burdened by mental illness. The bar is pretty low. The issue is whether Holmes knows how a courtroom works (that a judge administrates the proceedings and a jury determines guilt or innocence, that his defense attorney will attempt to establish his innocence and a prosecutor will attempt to establish guilt, that he is the one accused of a crime) and that Holmes can assist his attorney in defending him (rather than being too confused to follow along or too distracted by voices or refusing to speak with his attorney, whom he considers, for example, to be an alien or one of the people sent by the devil to make him renounce God).
The medical and psychiatric evaluation(s) will also form the basis of any "insanity" plea Holmes may put forward. The questions at the heart of that matter will be whether a major mental illness so impaired Mr. Holmes as to render him unable to tell right from wrong, or if he still knew right from wrong, and whether an illness so impaired him as to render him unable to conform his behavior to the requirements of the law.
While forensic psychiatrists hired by the state and those hired by the accused often disagree whether a defendant suffers from a mental illness that qualifies him or her as not criminally responsible, sometimes they do agree--and, sometimes, the fact that they are in complete agreement even before trial leads to a trial never taking place. After all, the district attorney in Colorado will need to decide whether to take this case to court or, after receiving information from psychiatrists, whether to agree Holmes should simply have his plea of insanity (if offered) automatically accepted, leading to his hospitalization on a locked psychiatry unit.
It is important to note that while planning a killing is part of the data used to evaluate the mental state of a killer, some people who are psychotic and who kill based on incredibly powerful, unavoidable delusions, do so with a great deal of planning. If, for example, one were to believe that aliens had invaded the Earth and taken the form of one's family, one might plan for a long time how to do away with them and save the universe. Yet, the foundation of one's motivation would be a product of mental illness.
Contrary to popular belief, defendants who are found not criminally responsible by virtue of a mental illness generally remain on locked psychiatry units for several decades--or for life. This has been the case, for example, for John Hinckley, Jr., the man who, in 1981, shot Ronald Reagan to impress actress Jodi Foster. He has remained an inpatient--with some passes to his family home--at St. Elizabeth's Hospital in Washington, D.C. for more than 30 years.
Holmes' journey through the system is just beginning. Insanity pleas are notoriously unsuccessful. The vast, vast majority fail, probably because juries simply don't want to worry over whether a person capable of horrific acts will ever hit the streets. So, if Holmes should offer such a plea and prevail, it will be because he isn't even close to sane and because the culprit who stole 12 lives and shattered dozens more was mental illness, camouflaged by those accomplices who saw it hobbling a man and did nothing--or too little.
Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached at info@keithablow.com
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http://www.foxnews.com/health/2012/07/24/how-james-holmes-will-be-evaluated-by-psychiatrists/
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