Author Archives: tawfik

Does Prison Work? Questions about the effectiveness of the United Kingdom’s proposed system.

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The United Kingdom has help to reignite the questions about alternative forms of punishment and/or rehabilitation to prison. In the U.K., roughly 60% of those convicted each year are only in prison for less than 12 months, because they are there as a result of small offenses, and drug offenses. Of those who leave prison, roughly 60% of them are convicted again within a year of their release. With a system that such high rates of recidivism it is no wonder the U.K. is struggling to do something to correct it. Justice Secretary, Ken Clarke announced that he thinks there must be a better way to approach the issue as he announced that the inmates should work a 40 hour week getting paid minimum wage and give a part of their wages to pay for their stay at the prison and some of it to the victim’s charities.

The underlying reason for this rapid change in policy was the new spending budget which proposes cutting the Justice Department’s budget by around 25% in the next 5 years. In order to reach those dramatic cuts, dramatic action must be taken in reducing the recidivism of inmates and making sure they leave jail to become productive members of society. Part of the problem with this is that the short term offenders are serving sentences which are just long enough to dramatically effect their life (job, family, etc…), but in many cases, the sentences are not effective at bringing forth a change in behavior. The idea of giving prisoners a 40 hour work week has its disadvantages. According to Mark Johnson, it would be impossible to be able to monitor inmates, many of whom suffer from mental health and addiction problems, during a 40 hour work week if they were able to do any meaningful kind of work other than sorting recycled goods. This brings forth another option brought forward by Ken Clarke, which was that of payment by results; a system where private outfits would be paid in accordance with the reduction of recidivism.

Though all of these reforms may be promising in their own way, I think that a better idea would be to use the tools we have gained with cognitive and behavioral neuroscience to help find new ways of rehabilitating these inmates to keep them from falling back into the cycle of crime. In a BBC report interviewing former inmates and those involved in rehabilitation; it seemed almost unanimous that they believed prisoners should be given some kind of responsibilities and work while they are in prison, but many of the rehabilitation groups argued for the importance of giving the inmates “real” jobs. I agree with this sentiment; I think that by giving inmates both the education and training to be successful in the outside world must come with some real life application of those skills, which could be done through a targeted job. These “rehabilitation jobs” should be customized based on the inmates skills. In fact, in doing so the system might even be able to use the inmates own weaknesses (reason they committed the crime) as a reference point to what skills they should help the individual develop to prevent them from going back to that path. Overall, I think this is a landmark opportunity for the U.K. Justice System to try out more comprehensive rehabilitation strategies, and their success (or the lack thereof) should be followed closely by Judicial Systems around the world, many of whom have the same issues.

Traumatic Brain Injury, Criminal Behavior, and a new preventive face shield for veterans

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Traumatic Brain Injuries (TBI) and the mental health of veterans returning from war has been a very important topic as more veterans are returning from war with TBI than we have had before and the government placing 1.7 billion dollars into research for cures for TBI and PTSD. With increased protection from armored vehicles and better body armor, soldiers are surviving blasts they previously would not have and sadly many of those who survive face problems from the many injuries to both their body and brain. In a previous post on the large amount of juvenile prisoners with TBI, I discussed some of the issues related to mental health and crime when it comes to juveniles. In an article by Sarah Foley, she discussed the many battles veterans face when they come home, with the unemployment rate much higher for them than for the general population. She talks about Cruz De Leon, who spend 18 months in Iraq, who was medically discharged after being diagnosed with Post-Traumatic Stress Disorder (PTSD) as a result of several TBI’s which came about through road side bomb attacks on his convoy. De Leon suffers from some typical side effects of PTSD, which include claustrophobia, paranoia, and short attention span. These problems make it hard for him to be able to find and keep a good job.

Another bigger problem for veterans in this situation is the difficulty to treat TBI. This is because little can be done to reverse the brain damage caused by the trauma so the first months of treatment for TBI are vital. When untreated, TBI and PTSD can lead to undesirable and sometimes criminal behavior as seen when a group of returning veterans, many of whom had PTSD and TBI, went on a crime spree in Colorado Springs. Given that roughly 130,000 U.S. service members who have been deployed in Iraq or Afghanistan have sustained TBI’s, this is a growing worry to the department of veterans affairs as many of the soldiers begin to come home. Even with these numbers, many argue that current screenings are missing around 40% of those with TBI or PTSD. In a study examining discharge from military service after TBI, they found that from the “total discharge population (n = 1,879,724), the relative risk for behavioral discharge was 1.8 times greater for those with mild TBI (n = 1,778).”

A new possible treatment for the problems of TBI may involve better prevention. In this case, in the form of a new face shield. Findings from a MIT group’s research found that the traditional Advanced Combat Helmet barely mitigates the effects of blasts, while using both the helmet and a face shield does a much better job at mitigating the effects of the blast. An important aside on the face shields is that they are only proven to reduce the effect of impact when the shield is between the blast and the head, but it still does a good enough job in that situation to warrant its use. Preventive treatments such as these will go a great deal in preventing TBI, which is ultimately the best way to combat the illness.

Overall, I think these findings are very significant and they will help in future research in finding more ways to protect our troops. I also think that as TBI cases continue to increase, we should implement programs advocating safety to prevent them from occurring and rehabilitation programs to help keep the injury from progressing. In addition, we many even be able to extend the use of the “face shields” to other areas with high incidence of TBI such as motorcycle and race car drivers.

Further Reading:

http://news.cnet.com/8301-27083_3-20023723-247.html

http://articles.latimes.com/2010/nov/22/health/la-he-military-helmet-20101123

http://www.caller.com/news/2010/nov/13/vets-find-new-battle-at-home/

http://www.ninds.nih.gov/disorders/tbi/tbi.htm

http://www.npr.org/templates/story/story.php?storyId=127402993

http://www.ncbi.nlm.nih.gov/pubmed/8970548

Juveniles, Crime and Traumatic Brain Injury

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Juvenile justice and mental health has been a very important topic as prison reform has been coming up repeatedly. In previous posts on Juvenile sentencing and Low IQ, I discussed the many issues related to mental health and crime when it comes to juveniles. There has been new compelling findings from a recent article by Huy Williams et al on the possible risk for young male offenders may face if they had brain trauma some time in their past. The study shows that show a higher percentage of young offenders suffered a traumatic brain injury (TBI) compared with the rest of society. The study finds this by surveying 197 young male offenders and finding that roughly half reported having had a childhood TBI. This is astounding as the rate is three times higher than in non-offenders. Important to note was that the researchers found brain injury must go along with other factors to increase the chance of offenses by these juveniles. This study was a follow up of another study which found roughly 60% of adult prisoners had TBI in the past. The study also found that those with more than 3 TBI events were linked to more violent crime, showing that they are very big consequences to severe brain trauma.

These findings are important because it is already known that brain injuries lead to many problems with attention, memory, planning and behavior. If these juveniles do not receive the right treatment they stand a much higher risk of getting worse and performing behaviors which may lead to criminal behavior. The solution brought up by Williams is to the set up early recognition and intervention when there is a TBI in childhood. With the many situations that can lead to TBI, such as contact sports (football), it is vital that the many youths get treatment for these injuries.

These findings help the cause for those who advocate for Juvenile mental health courts, by showing the importance of a full medical assessment on juveniles who commit crimes. In fact by catching it earlier as they are juveniles, the system will do itself a favor by helping to rehabilitate the youths before they get caught in the cycle of crime. Another thing officers can begin to do, is to look for examples of TBI in the juvenile criminals, symptoms which include impulse control problems, problems with facial recognition, decision making, speech in general and other easy to see symptoms. Even easier, officers can just ask them “have you been knocked out?”

Overall, I think these findings are very significant and they will help in future research as to why juveniles commit crimes. I also think that as TBI cases continue to increase, we should implement programs advocating safety to prevent them from occurring and rehabilitation programs to help keep the injury from progressing.

Further Reading:

http://www.bbc.co.uk/news/health-11718241

http://www.medicaldaily.com/news/20101110/3582/traumatic-brain-injury-highly-prevalent-among-young-offenders.htm

http://dx.doi.org/10.1080/09602011.2010.519613

http://www.judgejohnfphillips.com/downloads/HCJMHC_Overview.pdf

Juvenile Sentencing: Punishment Versus Behavioral Change

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Juvenile sentencing has been an ongoing topic of discussion. Recently, in the Supreme court ruled that putting juveniles in prison for life without parole is cruel and unusual punishment for non-murderers. In the majority opinion Justice Anthony Kennedy said that “a life without parole sentence improperly denies the juvenile offender a chance to demonstrate growth and maturity.” This means that throughout the country roughly 150 inmates are eligible for lighter sentences. In addition courts across the county have begun to reduce the sentences of prisoners, allowing them to be eligible for parole. In addition attorneys hope to be able to get the supreme court to rule that this should also be the case for juvenile murderers. This is significant progress given that only five years ago, the court struck down capital punishment for juveniles.

However there are some who are against this new “leniency.” Scott Burns, head of the National District attorneys association says that “there are millions of young kids who do not commit outrageous crimes. To say we can excuse a small percentage who do just because their frontal lobe hasn’t developed is not persuasive.” However, as Neuroscience research shows, the Supreme Court says that juveniles are less able to control their behavior and more likely to be rehabilitated. Nonetheless, there are some states which are not easing up on Juvenile sentencing. New Mexico’s Supreme Court ruled 4-1 that it is constitutional to give a juvenile to get a 25 year sentence in an adult prison without a jury trial. In the case, juvenile probation officers stated that rehabilitation programs for older juvenile offenders were unavailable. This played an important role in determining his sentencing.

Overall, I think that the Supreme Court has taken the right step in making sure that juvenile defendants for non-murder cases are able to get parole. Juveniles are different from the rest of the prison population, in that their frontal lobes are not fully developed, meaning that they are not able to make the same decisions as those who are older. I think that the Justice system should do a much better job with rehabilitation programs for these youths, because they are the part of the prison population which would benefit the most from rehabilitation programs. A great example is John Daly, who recently has begun a set of classes called The Key Class, where he teaches juvenile inmates in California about social etiquette for success in both personal and professional situations. The classes are very basic and teach skills ranging from conversations on a phone to eating a meal, to body language. His classes many times are held in local restaurants and clothing stores, where he gives the students on the job training, and shows them how the can change to make life better for themselves. In addition, for many of these young people he is showing them that he cares, that he believes that they can succeed, which is something many of the juvenile criminals have never heard before. This comes back to the central argument of the criminal justice system; should prison be for rehabilitation or retribution? The answer lies in a kind of scale, one in which we still have to decide where we draw the line.

Further Reading:

http://news.yahoo.com/s/yblog_upshot/20101029/us_yblog_upshot/shifting-attitudes-on-tough-sentencing-for-juveniles

http://online.wsj.com/article/SB10001424052702303443904575578444151929822.html?mod=WSJ_WSJ_US_News_5

http://www.independent.com/news/2010/nov/07/working-juvenile-offenders-personal-and-business-s/

http://www.correctionsone.com/arrests-and-sentencing/articles/2866891-NM-Supreme-Court-Juvenile-can-be-sentenced-as-adult/

Low IQ: Should measures be taken to institute activities that raise IQ.

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Low IQ and prison sentencing has been a large topic as of late. From cases ranging to  a youth in Tel Aviv who stabbed attorney Anat Pliner to death to that of Ricky Aldridge who  attempted to arrange a murder for hire, many criminals may not reach the threshold of mental retardation, but they are very close. The youth in Tel Aviv was ruled to have enough cognitive capacity to have to stand trial, and be convicted for the murder charges. Ricky Aldridge was also ruled to have enough cognitive capacity with an IQ of 76, to be able to stand trail, and he was convicted to arranging for killing his neighbor. As a side note, Ricky previously was convicted for manslaughter and spent a year in jail while a juvenile. In both cases, the criminal, may not have reached the threshold for mental incapacitation, but it can be seen that to some extent their mental capacity had something to do with their impair decision making.

This leads to the important findings of several research articles regarding Iron deficiency and low IQ from the past few years. In their research on iron deficiency, Dr. Wolf and his colleagues found that children who had anemia as infants had lower scores on mental and motor functioning tests that other comparative students. In most cases, the children came from homes with lower socioeconomic status, but even that was not significant. Another research study by Dr. Lozoff and her colleagues found similar results, and after following them long term they found that the infants who had chronic iron deficiency when they were infants never caught up with the control group when it came to cognitive function.

The importance of these studies is that it is clear that certain deficiencies in infants can cause lower IQ in them when they grow up. This leads to the question, “should there be laws mandating tests for vitamin and mineral deficiencies in infants and enforcing treatment of the issues.” From the outside this seems like a great idea, because it not only will help the infant long term, but it was also help society which will not have to deal with many of the problems related to their loss of IQ. However, there are still problems with balancing personal freedoms, with enforcing medical treatment. Nonetheless, since the treatment can be proven to be safe and beneficial to the infant, it should be made mandatory.

“Caffeine, how far does murder defense go?”

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Can the intake of caffeinated substances really cause temporary insanity? If so, was that the case for Woody Will Smith from Newport, Kentucky? Woody’s defense team plans to argue that he had ingested excessive amounts of caffeine (over 400 mg) from five or six energy and soft drinks daily in addition to diet pills, which rendered him temporarily insane and they argue that given that fact he could not have consciously strangled his wife to death. The Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association defines a caffeine overdose as more than 300 mg. During the day of the incident, Woody claims to remember little about the events that occurred and that he was unable to understand his actions. Known effects of high caffeine intake range from irregular heartbeat and nervousness to temporary insanity and skeletal muscle breakdown when taken in large amounts.

The defense also plans to use the testimony of the expert witness Dr. Robert Noelker, a psychologist from Williamstown, who determined Woody was suffering from “brief psychosis” brought on by sleep deprivation caused by the ingestion of caffeine and diet pills. This case plans to build on the precedent set by the case of Daniel Noble, who drank two coffee’s from Starbucks and during his drive home, lost control of his car hitting pedestrians and driving away. However, this case was different in that Noble was diagnosed with a rare form of bipolar disorder that could have been aggravated by heavy caffeine consumption. Also there was no one killed in the case, and as a result the judge let Noble off, but with the understanding he would not be allowed to consume caffeine again.

Given all of the information from this case, I believe that Woody Smith should still face conviction for murder by the jury for three reasons. The first is that unlike the Noble case Woody actively murdered someone, he did not just loose control of a car. Also unlike the Noble case, Woody does not have any other psychiatric diseases that could have affected his judgment. The final reason is that voluntarily subjecting oneself to caffeine intoxication should not be treated very differently from subjecting oneself to another potentially toxic substance such as alcohol. Overall, though the intake of caffeine may have had some effect on Woody’s judgment, it is not conclusive enough to show that it alone caused his actions. If this were the case we would see a lot more aggressive behavior coming from the many college students and working professionals who use caffeine to get through their daily routines. Rather, his actions must be in coordination with a specific criminal decision he made or influenced by some unknown mental illness he was suffering from. Another thing for the judge to consider in this case is the precedent it may set.

Barrouquere, Brett. “Kentucky Man Kills Wife, Blames Caffeine.” Salon.com. Associated Press, 20 Sept. 2010. Web. 04 Oct. 2010. <http://www.salon.com/news/feature/2010/09/20/us_caffeine_defense>.

Black, Rosemary. “Buzz Killer: Could Caffeine Overload Cause Temporary Insanity?” NY Daily News. NY Daily News, 21 Sept. 2010. Web. 04 Oct. 2010. <http://www.nydailynews.com/lifestyle/health/2010/09/21/2010-09-21_buzz_killer_could_caffeine_overload_cause_temporary_insanity.html>.

Drummond, Katie. “Any Truth to the Caffeine Intoxication Insanity Defense?” Aolnews.com. Aol News, 20 Sept. 2010. Web. 04 Oct. 2010. <http://www.aolnews.com/surge-desk/article/caffeine-intoxication-insanity-as-legal-defense-strategy/19640561>.

Simon, Mallory. “Murder Defense: Too Much Caffeine.” This Just In – CNN.com Blogs. CNN.com, 20 Sept. 2010. Web. 04 Oct. 2010. <http://news.blogs.cnn.com/2010/09/20/murder-defense-too-much-caffeine/>.

Proposition 19: Will drug legalization, help or hurt the people of California?

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Later this week, Californians will vote on whether or not to legalize all marijuana production and consumption. The exact terms of proposition 19, would allow those over 21 to possess up to one ounce of marijuana and grow up to 25 square feet of cannabis plants. Proponents of the referendum say that it will decrease the millions spent on drug enforcement, allow the state to gain tax revenue from its sale, and allow police to focus on violent crime. However, that does not change the U.S. Attorney General Eric Holder, and the U.S. Drug Enforcement Administration from speaking out against the legalization of the drug. They say that the cost both economically and socially of approving the practice would be detrimental to us as a society, and would push back against the progress they and the Mexican Government have achieved in cutting down drug abuse not to mention causing unwanted mental and other healthcare issues for years to come.

The National Institute on Drug Abuse says that long term Marijuana use causes the brain to have some changes in circuity similar to that of other drugs. This begins with changes in dopamine neurons, which are involved in the regulation of motivation and reward, which increase in the receptors for Marijuana, causing possible addiction, “which leads to compulsive drug seeking and abuse despite the known harmful effects upon social functioning in the context of family, school, work, and recreational activities.” In Dr. Eaglemans article on Why Neuroscience and a Rational Drug Policy, he discusses the many others problems drug addicts face, and the many kinds of rehabilitation they have to go through to have an effective recovery. In light of the problems of recovering from an addiction, the use of Marijuana should be considered a much more dangerous activity than the proponents of proposition 19 make it out to be.

Given all of the debate about the issue from all sides, I think that the issue comes down to a few main points. On the one hand, Law Enforcement has approached the problem in a non sustainable way, as they have spent billions on enforcement and have watched prisons fill with addicted drug users, who have a high recidivism rate. Then on the other hand repeated Marijuana use has been repeatedly shown to lead to many problems to the brain, the lungs, the heart, not to mention the drastic social problems caused by its use. While proponents may compare its use to that of tobacco, even tobacco has brought almost half a million people die from problems related to tobacco use. Whatever supposed benefits Marijuana may have just does not seem to match up with the many problems which will be caused by its legalization and widespread use. A better approach would be to find ways to decrease marijuana use, not by incarceration only, but rather by a scientific approach based on neuroscience as advocated by Dr. Eagleman in his paper on Rational Drug Policy.

Sources:

http://www.google.com/hostednews/afp/article/ALeqM5h6lFWWaBqcVUY53oI504fBHYZc9g?docId=CNG.90fcc3fb8fe0939f953755a219011833.1f1

http://www.csmonitor.com/USA/Election-2010/2010/1015/Marijuana-in-California-Prop.-19-won-t-stop-federal-drug-enforcement

http://www.justice.gov/dea/ongoing/legalization.html

http://www.justice.gov/dea/ongoing/marijuana.html

http://www.justice.gov/dea/demand/speakout/speak_out_101210.pdf

http://www.drugabuse.gov/infofacts/marijuana.html

http://yeson19.com/about

http://eaglemanlab.net/papers/EaglemanCorreroSingh_Neuroscience%20and%20Drug%20Policy.pdf

http://www.ncjrs.gov/pdffiles1/201229.pdf

http://www.cdc.gov/chronicdisease/resources/publications/aag/osh.htm

Punishment Effectiveness: Ben Roethlisberger

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In a previous post, I discussed whether brain injury could alter one’s behavior and whether or not that can be a grounds of reducing their sentence. In that post, I used Pittsburgh Steeler quarterback Ben Roethlisberger as an example as he had been through many occasions of head trauma in his career, and he was then serving a suspension for alleged misconduct in a Georgia nightclub. Now Ben Roethlisberger is in the news again as he has finished serving his suspension and is now back to playing. The NFL hoped that through his time away from the sport and the money he would have made, he would have learned a lesson.

From reports so far, it seems as though most of what was ailing Roethlisberger was not due to any kind of brain damage, but was just due to his own pride. This is the only reasonable way to explain his change in behavior, unless he is just putting on a show. From the little seen so far the punishment seems to have been effective. Roethlisberger seems to have learned that despite his achievements and fame, he is not any different than others. Another article about his conduct during his first game back said that Roethlisberger has become more social with his teammates, talking to as many of them as he could find while on the sidelines, and giving encouraging words to even those who he previously (prior to his suspension) would not have approached. The response from players on his team resoundingly said that his actions have improved and that he is a much more humble individual.

It still goes to say what does that mean about the effectiveness of punishment? In a 2003 paper by Dr. Stewart Henry, he talked about how punishment alone may not be the most effective deterrent to recidivism. He advocated the use of literacy programs, skills training, higher level education, and overall working on helping the individual change their behavior rather than just institutionalizing them, as he put it. This is in fact what was done in Roethlisberger’s case, though he was suspended from playing, he was mentored by Merril Hoge, he spent time talking to psychiatrists and other counselors, and he distanced himself from his old persona and some other things which he previously had problems with. What do the (preliminary) results of this situation mean for other cases regarding neuroscience and law? First, it helps us to understand that the legal system should not be too fast to claim ones actions were due to a neurobiological problem, as Roethlisberger seemed to respond very well to the sentenced punishment. Second, it stresses the importance of effective punishment. In this case, Roethlisberger’s punishment targeted what effected him most; his reputation (and the money that came with the 4 games), as well as requiring him to seek counseling and alter his behavior. Finally, this case should also serve to help increase the discussion as to why people break the law (Roethlisberger was never charged) and how to find ways to rehabilitate them before they ever go far enough to commit an offense.


Insanity by Proxy

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Can one claim insanity by proxy? That and many other questions come up in the analysis of the horrible crimes committed by Maj. Nidal Malik Hasan, a psychiatrist in the U.S. Army, who killed 12 unarmed soldiers and 1 civilian and wounded 32 others.

Here is a little bit of background on the situation from Ron Zimmerman’s article in Medscape Today. On November 5, 2009, Hasan went to the Soldier Readiness Center at Fort Hood, Texas. He prayed at a table and then began to shoot the soldiers and staff there. Within 10 minutes Hasan killed 12 soldiers (1 pregnant), a physician assistant, and he wounded 32 other individuals. Hasan was shot down, ending his rampage, and he endured 4 bullet wounds. Hasan was transported to a hospital, where he recovered, but was left paralyzed.

In the news there were many suspected motives, which were passed around. These included mentions of his anti-American rants and possible anger at his superiors for refusal to prosecute some of his patients for war crimes, based on what they told him.

Hasan’s defense, led by Col. John Galligan, claims that the stories Hasan heard from his patients may have led to his breaking point. Though Hasan cannot have primary posttraumatic stress  disorder (PTSD) because he did not directly experience those situations on the battlefield, he may have secondary PTSD. This secondary trauma is well described in a 2003 report. In some cases it has been called “compassion fatigue” and “vicarious dramatization.” The 2003 report discusses how the patient’s description of the trauma given to the clinician may result in the same symptoms of PTSD. According to the report, there are several factors, which help to prevent these symptoms including sufficient training, support in the workplace with accessible supervision, sufficient family support, while identification with victims increases the chance of PTSD. From what we know about Dr. Hasan’s life, it seems that many of these factors were significant in determining his susceptibility to PTSD.

Zimmerman’s article also includes opinions from many experts on the topic, including Psychiatrists Anthony Ng, MD and Eric Anderson, MD. Dr. Anderson discusses the dangers of professionals personally identifying with their patients. One important legal question that may come up in the discussion is that of patient confidentiality, which Dr. Anderson answered that those in the military do not have the same aspect of privacy as civilians because they have to take the military oath of loyalty, which means that their superiors must be able to know what their mental condition is to make sure that their soldiers are in their optimal mental ability.

Given all that we know about this situation, this raises a few important questions. First, what findings did the medical review board have when they evaluated Hasan’s mental health? Second, going with the first question, why was their no action taken based on some of the suspect behaviors and red flags which were observed by his colleagues in conversations with him or in his actions? The biggest question going forward is if one can get secondary PTSD, do they then get the same treatment under the legal system as those who have primary PTSD?

From what I have read about the case, I believe that in hindsight the medical review board should have taken action to give more counseling to Dr. Hasan before a horrible event such as this could have occurred. As for his sentence, even if he is shown to have secondary PTSD, I think that it should only reduce his sentence from possibly the death penalty to life in prison without parole with counseling for his mental instability.

It is important to realize that no matter whether Dr. Hasan is proven to have PTSD or not, the results of his actions were devastating. He killed many defenseless American heroes who risked their lives for our country abroad and were back home receiving help for the mental difficulties they sustained from their tours of duty.

This is a very important case because it sets the precedent for cases involving secondary PTSD. PTSD is a controversial issue in the American legal system and will continue to be so as the number of soldiers coming back from war with PTSD continues to increase. This case may demonstrate the horrible consequences of secondary PTSD when untreated and the risks it brings to all involved including those clinicians who help others get over PTSD on a daily basis. If Dr. Hasan’s legal defense team wins their case, this will be one of the most important cases of “insanity by proxy.”

Further Reading:

Oppy, Graham, and David Dowe. “The Turing Test (Stanford Encyclopedia of Philosophy).” Stanford Encyclopedia of Philosophy. Stanford University, 13 May 2008. Web. 16 Sept. 2010. http://plato.stanford.edu/entries/turing-test/.

“Post-traumatic Stress Disorder (PTSD).” Mayo Clinic Medical Information and Tools for Healthy Living – MayoClinic.com. Mayo Clinic, 10 Apr. 2009. Web. 20 Sept. 2010. http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246.

Zimering, Rose, James Munroe, and Suzy B. Gulliver. “Secondary Traumatization in Mental Health Care Providers.” Psychiatric Times 20.4 (2003). Print.

“Its his fault”: Can you blame the brain for your irresponsible behavior?

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In 2006, Pittsburgh Steelers quarterback Ben Roethlisberger was in an almost-fatal motorcycle crash where he hit a car’s windshield and collided with the pavement head first. The damage from the incident was serious enough for him to require facial reconstruction surgery. Throughout his football career he suffered numerous concussions, three of which were very serious and required medical attention include tests such as the ImPACT test given to NFL players after a concussion.

In more recent months, as seen in several news sources, Roethlisberger has gotten into trouble for incidents ranging from accusations of sexually assaulting a young woman in a Georgia nightclub to a lawsuit for an alleged sexual assault of a casino employee in 2008. These behaviors seem to have begun after Roethlisberger began playing in the NFL. The question remains, whether his unacceptable actions are caused by traumatic brain injury versus poor decisions regarding his personal conduct. Put in another way, did Roethlisberger have lasting frontal lobe brain trauma and if so, how much has that affected his behavior?

This question applies to many more situations than just the one Roethlisberger has found himself in. In a larger sense professional athletes from many sports are many times seen exhibiting immature, inappropriate social behaviors. In many of these sports brain trauma is a regular occurrence. So should the current law system adept to take brain trauma in sports into account, and if so then how should it go about doing so?

The guidelines we have so far include those from the National Institutes of Health, which states that people who suffer repeated head injuries tend to show signs of aggression, immature behavior, impaired self-control, inappropriate sexual behavior and alcohol abuse.

One of the possible views on the issue comes from neuroscience, which states brain damage would show the same signs consistently. If the abnormal behavior is just not evident any other time different then the time in question then their behavior cannot be attributed to any kind of brain damage.

All of these are hypothetical questions which must be supported by objective data like fMRI, EEG, and other neurophysiological testing. However, these tests may turn out negative especially when the extent of the brain damage is mild. In these cases the it has to be determined whether or not the symptoms of frontal lobe injury are evident only in certain situations. Examples of situations which may exacerbate the symptoms might include taking substances such as alcohol and other drugs. This may help explain why athletes who have had previous head trauma many times react very inappropriately during nights at the bar. More specifically this may help explain the situation Roethlisberger put himself in during those nights after he drank alcoholic beverages those nights. However, this last point will be very hard to prove.

Another very poignant topic is chronic traumatic encephalopathy (CTE), which is a degenerative brain condition that affects players cognition and conduct and has been found to lead to dementia. It effects the emotional circuitry of the brain. CTE has become significant enough that the NFL gave $1 million to help study it. How widespread and common it is among NFL player will be hard to know because the main examination of the brain occurs during the post-mortem autopsy. If scientists were able to set more standard guidelines regarding these topics we would be able to better diagnose problems such as this.

Overall, this is a controversial topic which is still a key concern of the NFL players association and law enforcement. No matter what conclusion they may come to from this topic. One of the important things to take out of this discussion is that to some extent brain damage may affect you as a person and it is much better to keep the players away from situations which may lead to the damage. Another important thing to take from this as a player is that no matter how much brain damage you may have, the only way (currently) you can avoid doing things you may regret would be to keep yourself from getting into those kinds of situations in the first place.

Works Cited

Epstein, David. “Head Injuries May Offer Insight into Roethlisberger’s Recent Behavior.” Sports Illustrated. CNN, 5 May 2010. Web. <http://sportsillustrated.cnn.com/2010/writers/david_epstein/05/05/ben.roethlisberger/index.html>.

Prine, Carl. “Is Roethlisberger’s Brain Trauma at Fault for Recent Behavior?” PITTSBURGH TRIBUNE-REVIEW. Trib Total Media, Inc., 25 Apr. 2010. Web. <http://www.pittsburghlive.com/x/pittsburghtrib/sports/steelers/s_678091.html>.