Courts do not let offenders with multiple personality disorder, which has imperceptibly morphed into dissociative identity disorder, get off the hook

Dissociative Identity Disorder and the Law: Guilty or Not Guilty? Stefane M. Kabene, Nazli Balkir Neftci and Efthymios Papatzikis. Front. Psychol., August 9 2022. https://doi.org/10.3389/fpsyg.2022.891941

Abstract: Dissociative identity disorder (DID) is a dissociative disorder that gained a significant rise in the past few decades. There has been less than 50 DID cases recorded between 1922 and 1972, while 20,000 cases are recorded by 1990. Therefore, it becomes of great significant to assess the various concepts related to DID to further understand the disorder. The current review has a goal of understanding whether an individual suffering from DID is legally responsible for the committed crime, and whether or not he or she can be considered competent to stand trial. These two questions are to be raised in understanding DID, by first shedding a light on the nature of the disorder and second by examining the past legal case examples. Despite the very nature of the disorder is characterized by dissociative amnesia and the fact that the host personality may have limited or no contact with the alters, there is no consensus within the legal system whether the DID patients should be responsible for their actions. Further to that, courts generally deny the insanity claims for DID suffering patients. In conclusion, more studies in the field are suggested to incorporate primary data into research, as the extensive reliance on secondary data forces us to believe the conclusions that were previously made, and no opportunity to verify those conclusions is present.

Discussion and Analysis

The literature review suggests a general tendency from the courts’ side not to accept the DID propositions and hence exempt the person from the responsibility on the basis of NGRI-DID. The major reasons for the tendency were lack of reliability of scientific methods in diagnosing DID, the possibility of a suspect to malinger DID in such a way that certain specialists will give the desired diagnosis (Ms. Orndorff’s case), the social response to the successful defense based on NGRI-DID, and the immaterial fact of DID, as related to the legal responsibility (the alter in control being sane and competent to stand the trial). Moreover, the case of Maxwell clearly showed that the person can commit the crime again when the society will hardly accept the decision of non-guiltiness. Therefore, the prosecutors tend to find criminals responsible due to the past experience and research done on DID.

The complexity of DID is also supported through the differences in the opinions on the reliability of the tests administered with the purpose of diagnosing DID. It has been suggested by Steinberg that the introduction of Structured Clinical Interview for DSM-III-R (SCID) and the Schedule for Schizophrenia for Affective Disorders and Schizophrenia (SADS) has increased the reliability in diagnosing disorders such as DID (Steinberg et al., 1993). The case of Ms. Orndorff, however, has happened in 2000 and suggests that the diagnostic capabilities in terms of DID were still lacking and hence insufficient to accurately diagnose DID.

As was mentioned before, the courts do have a tendency to deny the NGRI-DID claims for the DID patients that commit crimes. However, it becomes interesting to check on whether similar illnesses, such as epileptic seizures, face the same level of denials in the courts. Epileptic seizures resemble DID in terms of legal responsibility in a way that during a seizure, a person may engage in “actions such as picking at the clothes, trying to remove them, walking about aimlessly, picking up things, or mumbling” (Farrell, 2011b). Of greater importance is the fact that “following the seizure, there will be no memory of it” (Farrell, 2011a). As the actions performed during a seizure are involuntary, the person is unable to appreciate the actions or the consequences that follow, and has no memory of the events, not explained by the regular forgetfulness, the court should consider the person insane at the moment of committing a crime. Farrell elaborates on three cases of successful defenses on the basis of “non-insane automatism” (the definition under which courts nowadays classify epileptic seizures). In all cases, the courts have declared the defendants not guilty of the crimes, as their actions were involuntary, and the defendants had no memory of the events.

It is interesting in the light of above-mentioned cases to see the drastic difference in the courts’ opinions about the similar illnesses in terms of legal responsibility. In both cases, the defendants have no memory of the actions committed. However, it must also be presented that DID patients generally have an identity within them that was aware of the wrongdoing and also carries the memory of that wrongdoing, while under epileptic seizures there is not a single trace that would suggest that the defendant has a memory of a wrongful conduct. One could also argue that while considering the epilepsy-suffering patient, we are concerned with a single identity that is a subject to a biological illness and therefore, it becomes easy to say that the person’s actions were indeed involuntary, while considering the DID, we are talking about totally different identities with their own mindset within a single individual with a very limited information regarding its etiopathology. It means that the court can be reasonably confident in the reliability of epilepsy truly belonging to an individual, while an DID patient can potentially malinger the illness. Even though a few studies have emerged within the last a few years investigating the neurological correlates of DID, the research in this domain is still in the stage of infancy.

Taking a look at the root causes of the DID, it is found that severe psychological trauma or prolonged abuse in the childhood are the most possible reasons that cause the brain to trigger the self-defense mechanisms and protect itself through the dissociation of identities. As the effect of DID is not happening on its own and is occurring following a severe trauma, it should be considered a mental illness and thus be a sufficient reason for claiming the person to be not guilty by the reason of insanity (NGRI-DID). Moreover, both genders can be exposed to any kind of assault or negative experience in the childhood and the tendency of being diagnosed with DID of those victims is correlated. Both men and women showed similar types of identities and behavior that leads to the conclusion that crimes can be done by anybody regardless of their sex (O’Boyle, 1993). Therefore, the framework of how to justify or punish the person who committed wrongdoings should be the same for both male and female.

Many psychiatrists tend to question whether the person is really suffering from DID or trying to pretend in order to have NGRI-DID. However, involving only one specialist might not be enough as we all are human beings and think subjectively based on our past experience and beliefs. The case of Thomas Huskey was advised by the psychiatrist that already had strong beliefs that the murderer is just a great actor, therefore, he did not attempt to search for the root cause of the behavior that was hard to explain at that time (Haliman, 2015). Moreover, involving a few professionals is no longer enough since the opinion can differ based on individual observation, however, even the final judgment can be affected by groupthink. Based on the case of Ms. Moore, it was easier to find her guilty since both identities were directly involved in the action, so even the presence of other minor identities would not justify her wrongdoings. In particular, she was not even diagnosed with DID during the trial and was found responsible regardless of her mental illness (Moore, 1988).

Regarding the doubts over the reliability of measures for the assessment of DID, there are so far very few mechanisms available to psychiatrists that can be used in an attempt to evaluate patient’s dissociative disorders. It has been found that the long interviews used during the evaluation allow for emerging of different identities present within an individual. The long aspect of the interviews and evaluation also reduce the possibility of patient malingering the diagnosis. Kluft (1999) stated that “simulated DID presents crude manifestations of the disorder, such as stereotypical good/bad identity states and a preoccupation with the circumstances individual hopes to avoid by obtaining an DID diagnosis.” Kluft also suggested that it is difficult for the individual to maintain the voice, set of body gestures, and memory for every personality that he or she is trying to simulate. Hence, it can be suggested that the actual possibility of malingering DID is extremely challenging, and that cases of malingered DID will be very rare compared to correctly diagnosed DID.

Speaking of suggesting the framework for deciding on person’s liability on the basis of DID, the diagnosis has proven itself to be so complex that no universal method can actually be applied. However, there is a set of actions that should be done in order to assess the responsibility for the crime committed. Initially, an evaluation of the patient should be performed by several independent psychiatrists. The DID in our opinion should only be considered valid when all the psychiatrists involved agree on the opinion that the defendant is suffering from DID. Based on the diagnosis, the question of competency to stand trial must be answered. Then, the court should select the appropriate method for assessing the responsibility. The “host-alter” method is best when there is a dominant personality present, and the crime was committed by the alter identity. The “alter-in-control” method should be used when there is no clear evidence of the dominant identity. If the method used provides a result that supports the fact that the identity evaluated is insane at the time of committing a crime, the defendant should be considered not guilty.