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Handbook of Forensic Psychiatric Practice in Capital Cases


Communication of diagnostic information in reports should include:


• Te diagnosis that is made • Te manual that has been used in reaching the diagnosis • Te symptoms that are present and the evidence for these symptoms • Consideration of alternative diagnoses and why these have been rejected


• Consideration of the likely validity of the diagnosis made, including by reference to the possibility of feigning or malingering of symptoms, and why this is not considered to be likely


Diagnosis, behaviour and offence


Tere should be careful separation of diagnosis from behaviour or criminal offences. Hence, even where a term is used both in description of a mental condition and a type of offence, it is clearly not the case, for example, that someone who has been convicted of paedophilia is ‘a paedophile’ medically. A child sex-offender might fulfill diagnostic criteria for paedophilia but neither the behaviour nor the conviction makes the diagnosis, and they should not be confused. Similarly, arson is not a clinical diagnosis. Tere is no diagnosis that is directly equivalent to any legal finding, and it is improper to convert an offence into a condition. For example, someone who has committed arson may, legally, be ‘an arsonist’; but they do not exhibit a mental condition called ‘arsonism’.


Te same applies to legal defences. Hence, for example, psychosis might lead to consideration – and a finding – of insanity, but psychosis does not automatically indicate that insanity will apply. Tis represents the problem of ‘translation’ between psychiatry and law described in Chapter 2. Very rarely does the law ‘incorporate’ a medical notion into itself as a legal test or criterion, and perhaps a diagnosis of learning disability (mental retardation) does itself come close to determining illegality of imposition of the death penalty, and may also inhibit legally execution per se.


Specific considerations when making diagnoses in capital cases Intellectual disability


Intellectual disability is synonymous with learning disability or mental retardation, and can be a classification of great importance in capital cases. It is unusual in that the diagnosis itself might be equivalent to the ultimate legal determination: a classification of someone as mentally retarded might automatically excuse them from a capital sentence (see also above). However, a clinical diagnosis will not always be accepted if the basis of that diagnosis is rejected. In the United States, legal definitions of mental retardation differ between states.


Te diagnosis is of significant importance and should be approached carefully. In DSM-IV there are three broad criteria that need to be satisfied: i) sub-average general intelligence; ii) limitations in adaptive functioning; and iii) onset before the age of 18 years. General intelligence is measured in different ways and expressed in the form of an intelligence quotient (IQ) (see Chapter 5).


Te testing of IQ should take into account the individual’s background, their language, their education and any specific impairments. Any assessment of IQ incorporates some possibility of error and so, whilst


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