VETERANS AS DEFENDANTS
Brockton D. Hunter
Just as PTSD is a natural side effect of war, research also reveals veteran-committed crime waves in the wake of every major American conflict, particularly Vietnam. Even today, 40 years after that war, hundreds of thousands of psychologically injured Vietnam veterans are incarcerated, chronically addicted and/or homeless across our country. This session will explore the history of PTSD and its ties to criminal behavior. It will then explore the ways in which America and its criminal justice system can learn lessons from history and avoid mistakes made with past generations of troubled returning war veterans.
Larson, G. E., & Norman, S. B. (2014). Prospective prediction of functional difficulties among recently separated Veterans. Journal Of Rehabilitation Research & Development, 51(3), 415-427. doi:10.1682/JRRD.2013.06.0135
Reports of functional problems are common among Veterans who served post-9/11 (more than 25% report functional difficulties in at least one domain). However, little prospective work has examined the risk and protective factors for functional difficulties among Veterans. In a sample of recently separated Marines, we used stepwise logistic and multiple regressions to identify predictors of functional impairment, including work-related problems, financial problems, unlawful behavior, activity limitations due to mental health symptoms, and perceived difficulty reintegrating into civilian life. Posttraumatic stress disorder symptoms assessed both before and after military separation significantly predicted functional difficulties across all domains except unlawful behavior. Certain outcomes, such as unlawful behavior and activity limitations due to mental health symptoms, were predicted by other or additional predictors. Although several forms of functioning were examined, the list was not exhaustive. The results highlight a number of areas where targeted interventions may facilitate the reintegration of military servicemembers into civilian life. [ABSTRACT FROM AUTHOR]
Fleming, M., Simpson, M., & Presecan, N. (2013). The Correlation Between PTSD and Criminogenic Behaviors In Incarcerated Veterans. Corrections Forum, 22(6), 37-40.
The article discusses the research study on the characteristics of post-traumatic stress disorder (PTSD) in incarcerated veterans. It highlights the problems associated with the link between PTSD and criminal behaviors, the prevalence of incarcerated veterans, and the link of PTSD with traumatic brain injury. It also explains the treatment options for PTSD.
Renshaw, K. D., & Kiddie, N. S. (2012). Internal anger and external expressions of aggression in OEF/OIF veterans. Military Psychology, 24(3), 221-235. doi:10.1080/08995605.2012.678197
National Guard/Reserve service members (n = 143) deployed to Operations Enduring/Iraqi Freedom completed measures of anger/aggression, coping, and PTSD. Regressions and path analyses revealed that PTSD and avoidant coping both contributed to elevated anger. Furthermore, PTSD exerted indirect effects on verbal and physical aggression via anger, with direct effects only on physical aggression. Younger age was unrelated to anger but directly related to greater verbal and physical aggression. These results contribute to a more comprehensive understanding of risk for aggression in veterans of recent conflicts; however, the generalizability is limited by sample characteristics (all National Guard/Reserve, mostly White, married, religious). (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract)
Elbogen, E. B., Johnson, S. C., Newton, V. M., Straits-Troster, K., Vasterling, J. J., Wagner, H., & Beckham, J. C. (2012). Criminal justice involvement, trauma, and negative affect in Iraq and Afghanistan war era veterans. Journal Of Consulting And Clinical Psychology, 80(6), 1097-1102. doi:10.1037/a0029967
Objective: Although criminal behavior in veterans has been cited as a growing problem, little is known about why some veterans are at increased risk for arrest. Theories of criminal behavior postulate that people who have been exposed to stressful environments or traumatic events and who report negative affect such as anger and irritability are at increased risk of antisocial conduct. Method: We hypothesized veterans with posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) who report anger/irritability would show higher rates of criminal arrests. To test this, we examined data in a national survey of N = 1,388 Iraq and Afghanistan war era veterans. Results: We found that 9% of respondents reported arrests since returning home from military service. Most arrests were associated with nonviolent criminal behavior resulting in incarceration for less than 2 weeks. Unadjusted bivariate analyses revealed that veterans with probable PTSD or TBI who reported anger/irritability were more likely to be arrested than were other veterans. In multivariate analyses, arrests were found to be significantly related to younger age, male gender, having witnessed family violence, prior history of arrest, alcohol/drug misuse, and PTSD with high anger/irritability but were not significantly related to combat exposure or TBI. Conclusions: Findings show that a subset of veterans with PTSD and negative affect may be at increased risk of criminal arrest. Because arrests were more strongly linked to substance abuse and criminal history, clinicians should also consider non-PTSD factors when evaluating and treating veterans with criminal justice involvement. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
January 24, 2012
Wilson, J., Brodsky, S. L., Neal, T. S., & Cramer, R. J. (2011). Prosecutor pretrial attitudes and plea-bargaining behavior toward veterans with posttraumatic stress disorder. Psychological Services, 8(4), 319-331. doi:10.1037/a0025330
Prosecutors are handling increasing numbers of criminal cases concerning veterans from the wars in Iraq and Afghanistan who suffer from posttraumatic stress disorder (PTSD). How these prosecutors handle such cases may reflect their attitudes toward veterans or offenders with PTSD. In turn, their attitudes may affect perceptions of blameworthiness, as well as negotiations about sentencing during the pretrial stage. The present study investigated the effect of a defendant's military experience and mental health status (i.e., PTSD) on prosecutors' offers at the pretrial stage and their ratings of the defendant's blameworthiness. Prosecutors' offers were more lenient to stress-disordered veterans; specifically, they were offered more diversion programs as compared with veterans without PTSD and to other offenders with PTSD. Prosecutors also perceived veterans and those with PTSD as less criminally culpable; they also empathized and identified more with veterans and those with PTSD than nonveterans and offenders without PTSD. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
Keeping Veterans with PTSD out of the Justice System. (2010). Keeping Veterans with PTSD out of the Justice System, 2. doi:10.1037/e553532011-001
This report discusses how in recent years, programs have been developed to keep war Veterans with mental health problems from being put in jail or prison. The programs aim to assist Veterans who become involved in the justice system to get treatment for mental health problems that may exist. This includes the numbers of Veterans returning from Afghanistan and Iraq. (PsycEXTRA Database Record (c) 2013 APA, all rights reserved)
Tramontin, M. (2010). Exit Wounds: Current Issues Pertaining to Combat-Related PTSD of Relevance to the Legal System.Developments In Mental Health Law, 29(1), 23-47.
Written for those in the mental health and legal communities dealing with war veterans embroiled in the criminal justice system, this Article presents an overview of current issues pertaining to the diagnosis, assessment, and treatment of combat-related post-traumatic stress disorder (PTSD). The objective is to provide information that can assist the legal system when addressing PTSD-related issues of combat veterans charged with crimes, with a specific focus on those returning from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). As part of this discussion, insights from clinical practice for assessing and treating combat veterans are offered and considered in light of state of the art trends from the complex and evolving field of traumatic stress studies. [ABSTRACT FROM AUTHOR]
Hafemeister, Thomas L. and Stockey, Nicole A., Last Stand? The Criminal Responsibility of War Veterans Returning from Iraq and Afghanistan with Post-Traumatic Stress Disorder (March 4, 2010). Indiana Law Journal, Vol. 85, No. 1, p. 87, 2010; Virginia Public Law and Legal Theory Research Paper No. 2009-06.
As more psychologically-scarred troops return from combat in Iraq and Afghanistan, society's focus on and concern for these troops and their psychological disorders has increased. With this increase and with associated studies confirming the validity of the Post-Traumatic Stress Disorder (PTSD) diagnosis and the genuine impact of PTSD on the behavior of war veterans, greater weight may be given to the premise that PTSD is a mental disorder that provides grounds for a "mental status defense", such as insanity, a lack of mens rea, or self-defense. Although considerable impediments remain, given the current political climate, Iraq and Afghanistan War veterans are in a better position to succeed in these defenses than Vietnam War veterans were a generation ago. This Article explores the prevalence and impact of PTSD, particularly in war veterans, the relevance of this disorder to the criminal justice system, and the likely evolution of related mental status defenses as Iraq and Afghanistan War veterans return from combat.
Holbrook, Justin G. (2010). Veterans’ Courts and Criminal Responsibility: A Problem Solving History & Approach to the Liminality of Combat Trauma. Social Science Research Network. Retrieved from http://ssrn.com/abstract=1706829
In September 2010, a federal judge dismissed a criminal case involving a veteran accused of assaulting a federal police officer to allow the case to be heard by the Buffalo Veterans Treatment Court, a division of Buffalo City Court. For those involved in veterans’ advocacy and treatment, the case is significant for a number of reasons. First, it is the first criminal case nationwide to be transferred from federal court to a local veterans treatment court where the goal is to treat - rather than simply punish - those facing the liminal effects of military combat. Second, the case reignites the still unsettled controversy over whether problem-solving courts generally, and veterans courts specifically, unfairly shift the focus of justice away from the retributive interests of victims to the rehabilitative interests of perpetrators. Third, the case serves as a signal reminder to all justice system stakeholders, including parties, judges, attorneys, and treatment professionals, of the potential benefits of sidestepping courtroom adversity in favor of a coordinated effort that seeks to ameliorate victim concerns while advancing treatment opportunities for veterans suffering from combat-related trauma. This chapter explores these issues in light of the history of combat-related trauma and the development of veterans’ treatment courts around the country.
Elbogen, E., Wagner, H., Fuller, S., Calhoun, P., Kinneer, P., & Beckham, J. (2010). Correlates of anger and hostility in Iraq and Afghanistan war veterans. The American Journal Of Psychiatry, 167(9), 1051-1058. doi:10.1176/appi.ajp.2010.09050739
Objective: As troops return from Iraq and Afghanistan to civilian life, clinicians are starting to grapple with how best to detect those at risk of postdeployment adjustment problems. Data reveal the presence of mental health problems in these soldiers, including posttraumatic stress disorder (PTSD), head injury, and alcohol abuse. Each of these conditions has been associated with elevated anger and hostility in veterans from previous conflicts. The authors sought to identify variables empirically related to anger and hostility in Iraq and Afghanistan veterans. Method: A total of 676 veterans who served since September 11, 2001, and who volunteered to participate in research studies were interviewed with instruments designed to collect information on psychiatric symptoms, health, and possible postdeployment adjustment issues. The primary outcome measures were variables measuring aggressive impulses or urges, difficulty managing anger, and perceived problems controlling violent behavior. Results: The three outcome measures were each significantly associated with PTSD hyperarousal symptoms. Other PTSD symptoms were less strongly and less consistently linked to anger and hostility. Traumatic brain injury and alcohol misuse were related to the outcome variables in bivariate but not multivariate analyses. Distinct sets of demographic, historical, and military-related variables were associated with the different facets of anger and hostility measured. Conclusions: The results underscore the need to tailor interventions individually to address anger and hostility effectively and to develop theoretically sophisticated, evidence-based knowledge to identify service members at risk of problematic postdeployment adjustment.
Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010). Antidepressant drug effects and depression severity: A patient-level meta-analysis. JAMA: Journal Of The American Medical Association, 303(1), 47-53. doi:10.1001/jama.2009.1943
Context: Antidepressant medications represent the best established treatment for major depressive disorder, but there is little evidence that they have a specific pharmacological effect relative to pill placebo for patients with less severe depression. Objective: To estimate the relative benefit of medication vs placebo across a wide range of initial symptom severity in patients diagnosed with depression. Data Sources: PubMed, PsycINFO, and the Cochrane Library databases were searched from January 1980 through March 2009, along with references from meta-analyses and reviews. Study Selection: Randomized placebo-controlled trials of antidepressants approved by the Food and Drug Administration in the treatment of major or minor depressive disorder were selected. Studies were included if their authors provided the requisite original data, they comprised adult outpatients, they included a medication vs placebo comparison for at least 6 weeks, they did not exclude patients on the basis of a placebo washout period, and they used the Hamilton Depression Rating Scale (HDRS). Data from 6 studies (718 patients) were included. Data Extraction: Individual patient-level data were obtained from study authors. Results: Medication vs placebo differences varied substantially as a function of baseline severity. Among patients with HDRS scores below 23, Cohen d effect sizes for the difference between medication and placebo were estimated to be less than 0.20 (a standard definition of a small effect). Estimates of the magnitude of the superiority of medication over placebo increased with increases in baseline depression severity and crossed the threshold defined by the National Institute for Clinical Excellence for a clinically significant difference at a baseline HDRS score of 25. Conclusions: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Marcia G. Shein
Greenberg, G., & Rosenheck, R. (2009). Mental health and other risk factors for jail incarceration among male veterans. The Psychiatric Quarterly, 80(1), 41-53. doi:10.1007/s11126-009-9092-8
Data derived from the 2002 Survey of Inmates in Local Jails and the 2000 National Survey of Veterans show that having mental health problems in addition to such sociodemographic characteristics as being a member of a minority group, not being married, having less education, and being younger are risk factors for incarceration among veterans, as they are for the general population. As in previous studies veterans who served during the Vietnam Era and to an even greater extent, those who served in the early years of the All Volunteer Force were at greater risk of incarceration than veterans from the most recent period of the AVF, after controlling for age and other factors.
Anthony E. Giardino
More than 1.5 million Americans have participated in combat operations in Iraq and Afghanistan over the past seven years. Some of these veterans have subsequently committed capital crimes and found themselves in our nation’s criminal justice system. This Essay argues that combat veterans suffering from post-traumatic stress disorder or traumatic brain injury at the time of their offenses should not be subject to the death penalty. Offering mitigating evidence regarding military training, post-traumatic stress disorder, and traumatic brain injury presents one means that combat veterans may use to argue for their lives during the sentencing phase of their trials. Alternatively, Atkins v. Virginia and Roper v. Simmons offer a framework for establishing a legislatively or judicially created categorical exclusion for these offenders, exempting them from the death penalty as a matter of law. By understanding how combat service and service-related injuries affect the personal culpability of these offenders, the legal system can avoid the consequences of sentencing to death America's mentally wounded warriors, ensuring that only the worst offenders are subject to the ultimate punishment.
Friel, A., White, T., & Hull, A. (2008). Posttraumatic stress disorder and criminal responsibility. Journal of Forensic Psychiatry & Psychology, 19(1), 64-85. doi:10.1080/14789940701594736
There has been an increased interest in the relationship between posttraumatic stress disorder (PTSD) and violence, and in the factors that mediate their linkage. PTSD is a common, often underdiagnosed, condition with high levels of psychiatric comorbidity. It often has poor outcomes, with many cases becoming chronic, leading to substantial costs both to the individual and society as a whole. In this paper we report on the literature on PTSD, its diagnosis, assessment, and treatment. The difficulties encountered when assessing PTSD – the subjective nature of the symptoms, the risk of malingering, and the possibility of secondary gain – have been highlighted. Assessment and treatment in forensic settings is further complicated by the possibility of perpetrator PTSD. We have reviewed the prevalence of PTSD with particular reference to offender and forensic populations. The association between PTSD and violence, its relevance across the spectrum of criminal responsibility, and relevant case law are explored.
Litz, B. T. (2008), Early intervention for trauma: Where are we and where do we need to go? A commentary. Journal of Traumatic Stress, 21: 503–506. doi: 10.1002/jts.20373
In this commentary, the author underscores the importance of early intervention for trauma and describes the challenges that lie ahead for researchers, decision makers, and care providers. The author also provides a review of where things stand, briefly reviews psychological first aid strategies, and underscores where we need to go from here. Although the field has advanced considerably in the last decade or so, and there are compelling trials underway, there is much work that needs to be done, especially in terms of effectiveness and the task of integrating early intervention into various work cultures, such as the military.
Noonan, M. E., & Mumola, C. J. (2007). Veterans in State and Federal Prison, 2004. Veterans In State And Federal Prison, 2004, 1-16. doi:10.1037/e640312007-001
Reports on veterans who are inmates in state and federal prisons. Demographic characteristics, offense types, co-occurring substance use and mental health problems are addressed. Data in this report were based on personal interviews with prisoners, conducted through the Survey of Inmates in State and Federal Correctional Facilities, 2004. Conducted every 5 or 6 years since 1974 (Federal facilities were added for the first time in 1991), the inmate surveys are the only national source of detailed information on criminal offenders, including special populations such as military veterans. (PsycEXTRA Database Record (c) 2013 APA, all rights reserved)
Bureau of Justice Statistics Special Report
Dr. Peter Breggin
September 13, 2009
Daniel, D. L. (2008). Post-traumatic Stress Disorder and the Casual Link to Crime: A Looming National Tragedy. US Army, US Army Combined Arms Center. doi:10.1037/e614642009-001
The purpose of this paper is to investigate if there is a correlation between PTSD and criminal behavior in soldiers that have been incarcerated after returning from the GWOT and to determine the obligations of the U.S. government/DoD to prevent, treat, and/or mitigate the problem. This study includes data collected, examined and analyzed from three primary sources. First, an existing study on PTSD and criminal behavior by James J. Collins and Susan L. Bailey which examines the correlation between PTSD and criminal behavior primarily in 1140 nonveteran North Carolina inmates. This study is included to establish whether a general causal link exists between PTSD and an incidence of violent criminal behavior. Next, statistical data compiled by the Bureau of Justice Statistics (BJS) section of the Office of Justice Programs, U.S. Department of Justice (DoJ) is analyzed for trends in incarceration rates among veterans in Federal and State correctional facilities. The BJS data is included to examine whether the incarceration rates of veterans for violent criminal offenses has peaked during and after periods of war. Finally, this study will look closely at aggregate exempt inmate data recently compiled by the administrative and mental health staff of the United States Disciplinary Barracks, Fort Leavenworth, Kansas (USDB). The data from the USDB is part of an ongoing survey of the inmates (n=440) to determine the incidence of PTSD and mental health disorders within the prisoner population for treatment purposes and program analysis. This paper explores the history of PTSD in previous conflicts, the characteristics of the disorder and briefly discusses current treatment approaches. The data presented, particularly the initial results of the current USDB survey, strongly supports the current hypothesis that there is a correlation between PTSD and criminal behavior in soldiers that have been incarcerated after returning from the GWOT. As such the final contribution of this paper is to offer some brief recommendations on what our national leaders should do to prevent or mitigate the impending problem in our society of more veterans involved in violent criminal behavior. (PsycEXTRA Database Record (c) 2013 APA, all rights reserved)
Captain Evan R. Seamone
Captain Evan R. Seamone
Aggression Among Combat Veterans: Relationships With Combat Exposure and Symptoms of Posttraumatic Stress Disorder, Dysphoria, and Anxiety Severity of Posttraumatic Stress Disorder and Involvement with the Criminal Justice System
Taft, C., Vogt, D., Marshall, A., Panuzio, J., & Niles, B. (2007). Aggression among combat veterans: relationships with combat exposure and symptoms of posttraumatic stress disorder, dysphoria, and anxiety. Journal Of Traumatic Stress, 20(2), 135-145.
Prior research has revealed heightened aggressive behavior among veterans with PTSD. This study tested a model examining the interrelationships among combat exposure, posttraumatic stress disorder (PTSD) symptoms, dysphoric symptoms, and anxiety symptoms in predicting aggressive behavior in a sample of 265 male combat veterans seeking diagnostic assessment of PTSD. Combat exposure was indirectly associated with aggression primarily through its relationship with PTSD symptoms. Symptoms of PTSD were directly related to aggression, and indirectly related to aggression through dysphoric symptoms. Results highlight the role of PTSD symptoms and dysphoric symptoms with respect to aggressive behavior among this population, and suggest the relevance of aggression theory to the study of combat veterans.
Calhoun, P. S., Malesky Jr., L., Bosworth, H. B., & Beckham, J. C. (2004). Severity of Posttraumatic Stress Disorder and Involvement with the Criminal Justice System. Journal Of Trauma Practice, 3(3), 1-16. doi:10.1300/J189v03n03_01
Two hundred and forty-one Vietnam combat veterans with chronic posttraumatic stress disorder (PTSD) completed measures of PTSD symptom severity, combat exposure, depression, hostility, interpersonal violence, substance abuse, and arrest history. The majority of veterans with PTSD (63%) reported being arrested at least once after returning from Vietnam. Logistic regression analyses indicated that PTSD severity was positively correlated with arrest history even when other variables associated with criminal behavior were taken into account. Recommendations for evaluation and treatment of individuals with PTSD who are at risk of becoming involved with the criminal justice system are discussed. [ABSTRACT FROM AUTHOR]
Lasko, N.B., Guruits, T.V., Kuhne, A.A., Orr, S.P., & Pitman, R.K. (1994). Aggression and its correlates in Vietnam veterans with and without chronic post-traumatic stress disorder. Comprehensive Psychiatry, 35, 373-381.
This study measured self-reported aggression, hostility, and anger in Vietnam combat veterans with (n = 27) and without (n = 15) posttraumatic stress disorder (PTSD). On the Buss-Durkee Hostility Inventory, Past Feelings and Acts of Violence Scale, Episodic Dyscontrol Scale, and State-Trait Anger Expression Inventory (STAXI), PTSD subjects scored significantly higher than non-PTSD subjects, whose scores fell in the range reported for normative, noncombat populations. The PTSD versus non-PTSD group differences were not explained by combat exposure, which did not correlate significantly with the psychometric aggression measures. These findings suggest that increased aggression in war veterans is more appropriately regarded as a property of PTSD, rather than a direct consequence of military combat. The association between compromised neurologic and neuropsychologic status and the psychometric measures was modest and explained little of the group differences.
Samuel Pyeatt Menefee
Erlinder, C. P. (1984). Paying the price for Vietnam: Post-traumatic Stress Disorder and criminal behavior. Boston College Law Review, 25(2). 305-347.
Wilson, J. P., & Zigelbaum, S. D. (1983). The Vietnam Veteran on Trial: The Relation of Post-Traumatic Stress Disorder to Criminal Behavior. Behavioral Sciences & The Law, 1(3), 69-83.
The purpose of this paper is to conceptualize the relationship of Post-Traumatic Stress Disorder (PTSD) in Vietnam veterans to criminal behavior. A conceptual framework is discussed which proposes that the disposition to criminal behavior is determined by whether or not the veteran enters into the survivor mode of functioning as a behavioral defense mechanism against the disorder. It is hypothesized that there exists a relationship between the severity of PTSD and the tendency to commit illegal acts. The Vietnam Era Stress Inventory (Wilson and Krauss, 1980) was used to assess PTSD among a volunteer national sample of Vietnam combat veterans (N = 114) participating in the Veterans Administration's counseling program known as Operation Outreach. The results strongly supported the hypothesis and indicated that combat role variables, exposure to stressors in Vietnam and the severity of PTSD were significantly correlated with criminal acts. [ABSTRACT FROM AUTHOR]