Amnesia and Crime: Dominique Bourget, MD, and Laurie Whitehurst, PHD
Amnesia and Crime: Dominique Bourget, MD, and Laurie Whitehurst, PHD
Amnesia and Crime: Dominique Bourget, MD, and Laurie Whitehurst, PHD
A R T I C L E
The forensic literature is replete with reports of offenders who have claimed total or partial amnesia for
violent crimes, including murder or attempted murder.114 Claims of amnesia have been reported in an
estimated range of 10 to 70 percent of homicides.
Memory impairment during the commission of
crimes has also been reported by perpetrators of domestic violence1519 and by sex offenders.13,6
Dissociation and Dissociative Amnesia
While memory disturbances are often associated
with organic brain disease, crime-related amnesia
raises the question of dissociation, a term that refers
to the disruption of normally integrated functions of
consciousness, memory, identity, or perception of
the environment. A dissociative state is an altered
state of consciousness concurrent with a traumatic
experience. Dissociative amnesia, formerly termed
psychogenic or functional amnesia, is a disorder
characterized by the inability to remember important
personal experiences and events after a traumatic experience of psychological origin.20
Current psychiatric diagnostic systems differ in
their definition of the term dissociation and in the
Dr. Bourget is Associate Professor, Department of Psychiatry, and
Part-time Professor, Department of Psychology, University of Ottawa,
and Forensic Psychiatrist, Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada. Dr. Whitehurst is Professor, Department of
Psychology, University of Ottawa, Ottawa, Ontario, Canada. Address
correspondence to: Dominique Bourget, MD, Royal Ottawa Mental
Health Centre, 1145 Carling Avenue, Ottawa, ON K1Z 7K4. E-mail:
[email protected]
classification of dissociative disorders. These inconsistencies have, in part, resulted in confusion surrounding how dissociation is conceptualized. Spitzer
and colleagues21 reviewed recent efforts to clarify the
conceptualization of dissociation by distinguishing
between types (pathologic versus nonpathologic dissociation) and related phenomena (detachment versus compartmentalization). Pathologic dissociation
has been viewed as a categorical phenomenon characteristic of individuals with dissociative disorder,22
while nonpathologic dissociation has been conceptualized as a dimensional construct that may range
from common daydreaming to severe dissociative
disorders.2326 Although there is some empirical evidence of a distinction between pathologic and nonpathologic dissociation,22,27 there is ongoing controversy over its application to clinical diagnosis and
classification.21
Detachment is thought to arise from intense
fear or trauma and has been defined as an altered
state of consciousness involving a disconnection
from ones sense of self (depersonalization) or the
external world (derealization).28 Dissociative amnesia may result when detachment interferes with
the encoding and storage of traumatic information.21,28,29 Compartmentalization is characterized by the failure to control cognitive functions or
actions normally amenable to intentional control
(including the inability to bring normally accessible information into conscious awareness).28 The
affected functions and related information are pre-
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Crime-Related Amnesia
Various frameworks have been put forth to account for how and why dissociative amnesia might
occur. Many psychological explanations include the
proposal that dissociative amnesia serves a protective
function of minimizing the adverse emotional consequences of trauma, either by impairing encoding of
the traumatic experience,30 or by repressing the experience from conscious awareness.10,11 Although
repressed memory may be a plausible explanation for
dissociative amnesia, the lack of scientific evidence of
repression has been noted.31
Another explanation holds that dissociative amnesia
is best understood from a biological and neurological
perspective.32 In this view, biological reactions to psychological trauma, such as neuroendocrine dysregulation resulting from extreme stress, have acute effects on
attention and memory encoding and consolidation.30,32 Repeated exposure to stress may result in
widespread alterations in neurotransmission33,34 and
direct effects on brain function.32,35
Studies of glucocorticoid treatment in humans
have shown that elevated glucocorticoid levels reduce traumatic memory retrieval36 40 by inhibiting activity in the medial temporal lobe.37 Acute
psychosocial stress may impair delayed memory
retrieval in humans.41 Kuhlmann and colleagues41
suggest that retrieval of emotionally arousing material is particularly sensitive to the effect of psychosocial stress.
It has been noted that the distinction between organic amnesia and dissociative amnesia may be arbitrary, as both may be a consequence of brain changes
that lead to disruptions of memory processes.
Markowitsch and colleagues42 46 described several
patients with dissociative amnesia who, compared
with nonamnesic patients, showed metabolic brain
alterations in memory-processing regions. In one patient, positron emission tomography (PET) imaging
did not show increased right-hemispheric glucose
metabolism during a task requiring autobiographical
memory,42 whereas another patient displayed sub470
Crime-related amnesia may occur due to the presence of a psychotic episode. Psychosis is associated
with an increased prevalence of violent crime, including homicidal behavior.5259 Taylor and Kopelman14 reported that 7 of 19 offenders who claimed
amnesia for their violent crimes had a primary diagnosis of schizophrenia. A recent study of the psychiatric aspects of 118 cases of criminal homicide found
that psychotic disorder, mainly paranoid schizophrenia, and alcohol intoxication accounted for the offenses of 24 percent of offenders who claimed amnesia for their crimes.60 It has been suggested that the
presence of psychosis impairs attention, impeding
the encoding of events.2,9
Studies of dissociative amnesia in relation to criminal behavior report an association between a claim of
amnesia and several variables relating to the offense
or to the offender. Although there are reports of full
or complete dissociative amnesia, it is usually described as a hazy or patchy memory for events directly related to the crime and localized to the actual
time of the act itself.2 The amnestic period has a
sudden onset2 and has been described as blurred at
the beginning and end.73 While few studies have
examined follow-up information regarding recovery
of memory, there are reports of transient memory
loss for crimes.73,80
Dissociative amnesia is associated with crimes that
are committed in a state of extreme emotional
arousal and in which the victim is known intimately
by the offender.2,12,14 19,73,79,81 Frequently, the
crime is unplanned and no motive is discernible.14,73,79 The incidence of amnesia claims increases with the severity of the violence.13,12,14,49,82
Crime-related dissociative amnesia is associated with
471
Crime-Related Amnesia
Current DSM-IV criteria for sleepwalking disorder include behavioral arousals in slow-wave sleep,
unresponsiveness during the episode, confusion or
disorientation after awakening, and amnesia for the
episode after full awakening.20 Disturbed psychological functioning can continue for as long as one hour
after an episode of violent behavior.70 Sleep terror
disorder differs from sleepwalking disorder by the
presence of autonomic and emotional arousal. The
two parasomnia disorders may occur in the same episode and may overlap.70 In both disorders the violent behavior typically follows an episode of partial
arousal from early non-REM sleep, usually within
two hours after sleep onset.112 This episode of partial
arousal from deep sleep is characterized by the appearance of waking brain functioning in some but
not all brain areas.70 Highly complex activities can be
engaged in for extended periods during both sleepwalking and sleep terrors.70,113
A recent comprehensive review of non-REM parasomnias in adults114 concludes that sleepwalking
may result from the interaction of physical and environmental factors in a genetically susceptible individual. Factors that may contribute to the onset of
sleepwalking episodes by increasing slow-wave sleep
or making arousal from sleep more difficult include
prior ingestion of alcohol, drugs, and (or) medication, prior sleep deprivation, and situational stress.
A review of 50 reports of sleepwalking violence
noted that the violent behavior was often described as
unpremeditated.112 Most of the offenders were men
between the ages of 27 and 48, with a marked personal and/or family history of parasomnia disorders.
473
Crime-Related Amnesia
475
Crime-Related Amnesia
other mental health professionals are frequently required to provide expert testimony in cases involving
amnesia in relation to crime.
Dissociative amnesia often has legal repercussions,
in part due to its relevance to the legal constructs of
competency to stand trial and criminal responsibility. Amnesia can affect an individuals competency to
stand trial if he or she cannot plead or advise the
lawyer. Experiencing a dissociative state can decrease
an individuals capacity to control his or her actions
and therefore diminish criminal responsibility.
Moreover, defendants who claim amnesia are usually
regarded as having limited credibility or are even disregarded because of the inherent possibility of malingering. When a defendant claims not to remember
the event in question, the court can have considerable difficulty formulating a decision. Wrongful decisions regarding the authenticity of an individuals
amnesia can be very costly, with the outcome that
lighter or harsher sentences are given than is just.
The controversy surrounding crime-related amnesia is in part due to the potential for fabrication of
memory loss. Undoubtedly, some do feign amnesia
for their crimes. However, genuine amnesia for
crimes is often seen in clinical practice, whether due
to a dissociative state, a psychotic episode, or organic
causes. In accepting evidence supporting the validity
of amnesia claims, it seems clear that the important
issue should be determining how to distinguish between genuine amnesia, whatever the cause, and malingered amnesia in cases raising an index of suspicion. Despite several attempts to solve this
dilemma,2,1113,84 there is still no clear answer.
While case studies suggest the efficacy of the Symptom Validity Test (SVT) in identifying malingered
amnesia,127,128 others have argued that the SVT
lacks sensitivity.129 Moreover, limitations to its use
in the clinical or forensic setting have been noted
(e.g., Ref. 116). As the potential will always exist for
offenders to feign memory loss for their crimes, it
seems important that future studies focus on developing and testing valid and reliable screening and
diagnostic tools to assess the likelihood of malingered
amnesia.
In a medico-legal context, forensic psychiatrists
examining individuals who have committed a homicide are required to offer an opinion on the mental
state of the person at the time of the offense. In
clinical practice, it may be difficult to differentiate
between organic, dissociative, and malingered amne-
477
Crime-Related Amnesia
ing during an alleged crime may be enabled by consideration of the individuals predisposition to sleepwalking, the existence of precipitating factors associated with
sleepwalking, and the duration between sleep onset and
the time the criminal act took place.
While it is beyond the scope of this article to provide an in-depth review of neuropsychological and
neuroanatomical studies of memory, advances in
neuroimaging techniques and the development of
new paradigms and theories on the human memory
system serve to remind us that much remains to be
learned in the area of normal and dysfunctional or
abnormal memory.137 From a medico-legal perspective, a better understanding and determination of
cognitive capacities in an individual presenting with
a memory disorder is likely to affect assessments of
fitness and criminal responsibility. The fact that a
brain injury or brain damage contributing to the amnesia can be demonstrated objectively would be of
invaluable assistance in the context of a forensic psychiatric assessment.
A review of the literature reveals several clinical
features observed in cases of crime-related amnesia.
Consideration of the characteristics of the report of
the event and of the individual claiming memory loss
may facilitate an evaluation of the amnesia. As it now
stands, the forensic assessment of individuals who
claim amnesia represents a most interesting challenge. Further research aimed at delineating such features would be useful, as developing a profile of aspects characteristic of crime-related amnesia would
enable a fuller clinical understanding of the different
types of amnesia and build toward establishing important guidelines for the issue of dissociative amnesia in legal contexts.
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