emotionally disturbed persons
TRANSCRIPT
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This course is a general overview ofEmotionally Disturbed Persons
It is recommended that prior to starting
the course that you expand the AdobePresenter window in order assist youwith reading the text on each individualslide.
Emotionally Disturbed Persons
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Introduction to this course:
Law enforcement officers are often confronted with people suffering from
mental disorders, sometimes on a daily basis. Many homeless, or street,
people are afflicted with varying types of mental disorders that interfere with
their ability to function within social, familial, and vocational/educational
frameworks. Others are not quite so visible to the untrained eye; they come
and go in everyday society, virtually unnoticed. Some, like John Hinckley, Mark
David Chapman, and Ted Kaczynski, burst into the headlines with acts of
violence.Mental illnesses are generally thought of as disorders of the brain. Like
diabetes is a disease of the pancreas, mental illnesses are diseases of the brain,
which often result in an inability to cope with everyday life. Characterized by
alteration in thinking, mood, or behavior, mental illnesses affect more than 5
percent of adults in the United States. One in twenty people you will contact inyour career have what is considered to be a serious mental illness (SMI). The
cause of many forms of mental illness remain unknown, as they involve the
most complex aspects of the human brain.
Continued
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Mental illnesses can affect personas of any age, race, religion, and
socioeconomic level. Social position, intelligence, or physical health cannot
predict immunity from mental illness. Serous mental illness comprises four of
ten leading causes of disability in the United States: schizophrenia, bipolar
disorder, major depression, and obsessive-compulsive disorder. Research
indicates many persons suffering from mental illness will recover, although a
majority will not. The complex business of law enforcement is further
complicated by decreased funding for mental illness programs and outpatient
treatment centers: a condition that forces the mentally ill onto the street and
brings them in conflict with members of the public and, inevitably, lawenforcement.
The purpose of this course is to distinguish mental illness from mental
retardation, provide a description of the various types of mental illnesses, and
discuss some legal issues affecting the mentally disturbed. The concept of
deinstitutionalizing those with serious mental illnesses, which began in the1960s, continues unabated, forcing law enforcement officers to confront and
mitigate situations involving potentially violent subjects.
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Developmental disability, once known as mental retardation, is the failure of a subject to
adapt normally and grow intellectually at the same rate as his or her peers. In other words, a
person fails to achieve age-appropriate adaptive behaviors, or milestones, during his
development from infancy to adulthood. While there are many medical causes for
developmental disability, the diagnosis of the exact reason is only made in about one-quarter ofthe cases. Research indicates persons with developmental disabilities are seven times ore likely
to be contact by law enforcement officers than persons without the disability.
The primary difference between mental illness and developmental disability is mental
illness can strike anyone at any time, regardless of intellectual capabilities, and may consist of
delusions or hallucinations affecting a persons sight, hearing, and touch. Conversely,
developmental disabilities usually manifest sometime prior to age eighteen and include below
average intellectual functioning, social adaptation, and life skills.
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Those causes for developmental disability that have been identified can be broken down
into several categories:
Unexplained, the largest category, a catch-all for a developmental disability that defiesdiagnosis.
Trauma, either before or shortly after birth. This category would include inadequate
blood supply to the brain or a severe head injury.
Diseases, such as meningitis, rubella, or HIV infection.
Genetic abnormalities.
Pre-birth exposure to poisons, such as alcohol, drugs, mercury, or lead. Malnutrition from birth.
Environmental factors, such as poverty, low socioeconomic status, and deprivation
syndrome, which includes the lack of handling and nurturing.
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While law enforcement officers cannot positively identify persons afflicted by a developmental
disability, the can identify factors that may indicate a disability. Those factors are as follows:
Wearing clothing inappropriate for the season. Poor physical coordination, leading to awkward movement.
An extremely limited vocabulary, evidence by the person using only simple words and terms
in his conversation.
A tendency to parrot or repeat questions.
Residence in a group home.
Attendance of special education classes. Employment or residence in a center for people with developmental disabilities.
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Law enforcement contacts with persons suspected of having a
developmental disability should be conducted in a typically
professional manner, with a few exceptions. If the person is
suspected of a crime, great care must be exercised to ensure the
person understand Miranda warnings and provides a knowing andintelligent waiver of his rights.
Persons with a developmental disability often try to please
those in authority, and may confess to crimes not out of guilty, but
out of a desire to please the officer conducting the interview.
Investigators should exercise special care when interviewing
persons suspected of having a developmental disability to unsurethey do not suggest or lead the persons to give inappropriate or
untrue answers.
If such a person is taken into custody and booked, the jail staff
must be notified before or during the booking process to ensure
the person is not placed with the general jail population, where
the subject may be victimized by other inmates.
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Officers interviewing a person with a
developmental disability who is suspected of criminal
acts should determine as early as possible whether
the person possessed criminal intent, knew thedifference between right and wrong, knew he was
committing crime, and whether he could have
resisted the impulse to commit the act.
Some psychologist use the police officer as the
elbow test to asses a persons knowledge of the
wrongfulness of an act. The suspected offender isasked if she would have committed a certain act if
she were in the presence of a law enforcement
officer. If the answer is no, it is a good indication
the individual knew her act was wrong and possessed
the ability to control her actions.
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In this article, Handle with Care: Dealing with Offenders Who are
Mentally Retarded, published in the FBI Law Enforcement Bulletin,
Arthur Bowker suggests a few street tests that officers may use to
recognize developmental disability. Bowkers list includes the following:
Can the person easily button or unbutton a shirt or coat?
Can the person give coherent directions from one location to
another?
Can the person paraphrase or restate a question, using his own
words?
Can the person write his or her name clearly and without
difficulty?
Is the person able to read and understand a newspaper or
other printed document?
Is the person able to recognize coins or make change?
Can the person tell time from a standard-type clock?
Is the person able to use a telephone?
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Intoxication and drug abuse is included in this course because of its
symptomatic relationship with mental illness, meaning a substance abuse may
resemble mental illness. Although not a physiological disorder of the brain, the
various forms of substance abuse and dependence present problems for law
enforcement that are similar in nature to mental illness. The physiological effects
of substance on the brain, whether they are stimulants or depressants, create
disordered thinking and mood alterations, and, in severe cases, can impactsocialization and employment.
According to the Alcohol, Drug Abuse, and Mental Health Administration
(ADAMHA), at least half of the nearly two millions Americans suffering a severe
mental illness abuse illicit drugs or alcohol, compared to 15 percent of the general
population. The problem of the severely mentally ill having substance abuse
difficulties is so pervasive that mental health professionals have coined the term
dual diagnoses, although this term has been replaced in recent years by
mentally ill chemical abusers (MICA).
The problem confronting law enforcement officers is some symptoms of
substance abuse resemble mental illness or developmental disability. The
converse is also true: persons suffering mental illness or developmental disability
act similar to those under the influence of drugs and/or alcohol. Look again at the
street tests of Arthur Bowker: do these remind you of an alcohol-intoxicated
subject? A person under the influence of an opioid, such as heroin, or
phencyclidine (PCP) will also display symptoms similar to Bowkers list.
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What is meant by the term:dual diagnosis?
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Several subtypes of schizophrenia exist,
with the paranoid type being most common.
Paranoid schizophrenia is characterized
primarily by delusions or auditory
hallucinations, in the context of otherwise
normal functioning and appearance. In other
words, the paranoid schizophrenic does notstand out in a crowd. Compared to other forms
of schizophrenia, the thoughts of paranoid
schizophrenic are coherent, and his delusions
generally revolved around an organized theme.
For example, Ted Kaczynski, the Unibomber,
believed the power of society to control theindividual was expanding rapidly, and if not
stopped, would lead to the end of individual
liberty. Kaczynski also felt entitled to embark
upon his bombing spree in service of his anti-
technology beliefs. The fact that a typical
paranoid schizophrenics thinking is coherent
but is accompanied by delusions makes him, as
in the case of Kaczynski, potentially lethal.
Another, more recent example is Russell
Weston, the man who shot two U.S. Capitol
police officers to death on July 24, 1998.Weston murdered Officers Jacob Chestnut and
John Gibson inside the Capital building. His
motivation for going to the Capitol was a
delusion that a government satellite was spying
on him, and the control for the satellite system
was located on the first floor of the Capitolbuilding. Weston survived three bullet wounds
and is awaiting trial on two counts of murdered.
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Systems of paranoid schizophrenia are
delusional thoughts of a grandiose nature-suchas Westons surveillance satellite suspicions-
anxiety, anger, violent tendencies, and an
argumentative posture. Close relatives, such as
siblings or children, are likely to develop
schizophrenia, as evidence of genetic links to
the disease exists.
Although medication to treat
schizophrenia is available, many afflicted with
schizophrenia have no insight into their illness
and, therefore, refuse to acknowledge their
need for regular doses of medication. Those
who have taken anti-psychotic medicationshave experienced undesirable side effects, and
refuse to continue taking them. Coupled with
the fact that schizophrenic is usually unable to
maintain meaningful employment, his resultant
lifestyle is not conducive to obtaining adequate
medical care. Physical illnesses and substance
abuse are prevalent amount those suffering
from schizophrenia.
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Woman pushed in front of train, dies
New York- A young man approached Kendra Webdale as she waited for the N train in a
New York subway station and asker for the time. When she replied, the man pushed her
onto the tracks as the train pulled into the station. Webdale, 32, was killed instantly.
Andre Goldstein made no attempt to flee, but sat down against a wall in the station.
When officers arrived, he told them, it was her turn. He admitted to officers that he
had stopped taking medication to control his schizophrenia. The drugs curb the voices,
irrational behavior, and delusions that mark the mental disorder.
This incident is similar to one involving Goldstein that occurred six months earlier. In an
event unreported to police, Goldstein tried to push another woman in front of a subway
train at a station in Brooklyn, but the woman was able to fight him off and escape.
Over a 10-year period, Goldstein has spent time as an in-patient at four New York
psychiatric hospitals. Court records indicate Goldstein committed more than a dozen
assaults, many against psychiatric staff, during 1997 and 1998 alone.
Goldstein was charged with second-degree murder and is being held without bail
pending trail.
January 3, 1999
By The Backup news staff
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Mood disorder is a term describing a variety of mental
illnesses, which may be classified as psychotic in that they areserious mental illnesses, or neurotic in that they are minor in
nature and usually short-lived. Mood disorders include bi-
polar disorder- formerly manic-depression- major depression,
and dysthymic disorder, which is a prolonged minor
depressive episode.
Bi-polar Disorder
Bi-polar disorder is the most distinct and dramatic of the
depressive disorders. Unlike major depression, which occurs
at any age, the onset of bi-polar disorder is usually before age
thirty. Almost two million Americans suffer from bi-polar
disorder.
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Bi-polar disorder results in mood swings from mania-
exaggerated feelings of well-being- to depression, generallywith periods of normal moods in between. Some subjects
cycle back and forth between extremes without periods of
normalcy. People with this condition are called rapid cyclers.
Bi-polar disorder has a tendency to recur and subside
spontaneously, with either the manic or depressive states
predominating.During manic episodes, a subject feels on top of the
world, and displays an abundance of energy. He seems to
talk and think faster, and may also think he is invincible,
leading to reckless behavior and acts that endanger his well-
being. During the manic phase, a subject sleeps less, is easily
distracted, and tends to be more irritable. The subject mayexhibit poor temper control and excessively irresponsible
behavior patterns. Delusions, or false beliefs, and
hallucinations may also be present in the manic phase.
During the depressive phase, a person may lose all
interest in daily activities and people close to him,
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and exhibit hopelessness. The subject will
demonstrate persistent daytime sleepiness,difficulty in concentration, loss of appetite,
diminished interest and pleasure in daily
activities, and memory loss- amnesia. A person
in the depressive phase is a suicide risk.
The causes of bi-polar disorder, or manic-
depression, are unknown. However, certainfactors have been identified that have a role in
persons suffering from the illness. Heredity
may contribute to bi-polar disorder, for it runs
within families and may be carried by a gene
inherited from one to both parents. Chemical
changes in the brains neurotransmitters havebeen identified as a possible contributing factor
to bi-polar disorder. Lower than normal levels
of two of these are neurotransmitters,
serotonin and norepinephrine, are thought to
play an especially important role in bi-polar
disorders. Stress, caused by physical illness,
death of a loved one, or financial problems may
trigger a bi-polar episode.Research indicates bi-polar disorders in the
most treatable of the serious mental illnesses.
A combination of psychotherapy and
medications enables many who suffer from bi-
polar disorder to enjoy happy lives. The most
common medication used in the treatment ofbi-polar disorder is lithium carbonate, which
works to help balance neurotransmitters in the
brain, reducing the swings from mania to
depression. Taking lithium without a physicians
supervision, however, is dangerous. Side effects
include delirium, confusion, seizures, coma, andeven death in rare instances.
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Bi-polar disorder consists of two phases, the depressed phase and the manic phase. During
the depressed phase, the subject will display persistent daytime sleepiness, difficulty in
concentration, loss of appetite, diminished interest and pleasure in daily activities, and memory
loss otherwise known as amnesia. A person in the depressed phase is a suicide risk and should
be monitored closely. During the manic episodes a person is usually elated and feels on top of
the world and displays an abundance of energy. He seems to talk and thinks faster, may think he
is invincible leading to reckless behavior and acts that endanger his well-being. During the
manic phase, the subject sleeps less, is easily distracted and tends to be more irritable. Thesubject may exhibit poor temper control and excessively irresponsible behavior patterns.
Delusions or false beliefs, and hallucinations may be present during the manic phase.
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Major Depression
Major depression is not a debilitating mental illness. If it was debilitating, Abraham Lincoln and
Theodore Roosevelt would not have been able to govern the United States, particularly in time of war.
Robert Schumann and Ludwig von Beethoven would not have been able to write the beautiful music they
composed. Edgar Allen Poe and Mark Twain could not have written their memorable novels. Each one of
these men suffered from major depression: I am now the most miserable man living. If what I feel were
equally distributed to the whole human family, there would not be one cheerful face on earth.
While it is common for people to say how depressed they feel, such depression is usually sadness
associated with lifes disappointments. True depression is very different from occasional sadness. Majordepression profoundly impairs the ability to function in everyday life by affecting moods, thoughts,
behaviors, and physical well-being. Major depression interferes with a persons ability to eat, sleep, or get
out of bed in the morning.
According to the National Institute of Mental Health, depression strikes about seventeen million
American adults each year- more than cancer, AIDS, or coronary heart disease. An estimated 15 percent of
chronic depression cases end in suicide. Research indicates women are twice as likely to suffer from major
depression.Clinical depression consists of two types: major and dysthymic. Major depression is severe and
episodic, likely to come and go repeatedly in a persons life. Dysthymic depression prevents a person from
functioning well or feeling good. Persons suffering from dysthymic depression are able to function in
everyday life, such as working, socializing, and attending to religious callings, but in a state of depression.
Symptoms of major depression include depressed mood, loss of interest or pleasure in almost all
activities, sharp changes in appetite and weight, disturbed sleep, fatigue or loss of energy, feelings of
worthlessness, and difficulty thinking, concentrating, and making decisions.
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Personality disorders are, perhaps, what makes the job of law enforcement so interesting, diverse, and
dangerous. According to the U.S. Census Bureau, there are approximately 5.9 billion people living in the
world today. That means there are 5.9 billion different personalities walking around on the plant, many
having exchanges with law enforcement personnel. Following is a brief description of some types of
personality disorders that may be of interest to law enforcement officers.
Antisocial Personality Disorder
This is the individual who will come to your attention as a violator, suspect, defendant, or inmate. He is
the person who does not function well in society. His antisocial personality has developed and is apparent
by the time he reaches fifteen years of age. A person is classified as having antisocial personality disorder if
three or more of the follow descriptions apply to him:
Continually committing unlawful acts
Deceitfulness, as indicated by repeated lying, using aliases, or conning other for personal gain Impulsively or failing to plan, the concept of the future is not acknowledged
Aggressively and irritability, as indicated by repeated physical fights or assaults against others
Reckless disregard for the safety and welfare others; others just do not matter to this person
Consistent irresponsibility, indicated by a repeated failure to sustain employment and honor
financial obligations
Lack of remorse, indicated by being indifferent to having hurt, mistreated, or stolen from another
person
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Persons suffering from antisocial personality disorder do not necessarily possess all of these attitudes and
behaviors, and the degree varies from subject to subject. For example, there is a wide gap between a person who
is a petty thief and a person who is a serial killer, but they share common antisocial personality disorders. The petty
thief is not concerned about the property of another. As far as he is concerned, everyone elses property is his; he
just has not gotten around to taking possession of it. The petty thief continually gives false names to law
enforcement, has not had meaningful employment during most of this life, fails to plan for future periods of morethan an hour, and jeopardizes others in his flight from the police. Yet, this person would not commit a robbery with
the intent of committing murder to facilitate his escape.
All murderers are not afflicted with antisocial personality disorders. The so-called mom and pop murders,
committed during the heat of a domestic violence incident, are evidence of this. However, those murderers who
have an antisocial personality disorder fall into a category of extreme psychopath; nothing and no one stands in
their way.
Bonnie Parker and Clyde Barrow, the robbery and murder due from the American Midwest of the 1930s, are classicexamples. The fictional character Hannibal Lecter, aka Cannibal, from the movie Silence of the Lambs, is another.
These are the people law enforcement officers prepare, through training and attitude, to deal with. Officers
seek out these people every day during their careers. TI sis when one is found, unexpectedly, that an officer is in
extreme jeopardy. When we speak of the bad guys, this is the group to whom we are referring: the really bad
guys. Take a look around your town; chances are you can name people who fit into this antisocial personality
disorder classification. You may know them so well you can recite their dates of birth and describe their tattoos.
When we speak of the bad guys,this is the group to whom we are
referring: the really bad guys.
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Borderline Personality Disorder
A person suffering from a borderline personality disorder (BPD) displays a pervasive pattern of
instability of interpersonal relationships, self-image, and impulsiveness beginning by early adulthood.
Everyone, especially adolescents, has all of these traits, but persons with BPD have them for long periods of
time-years-and they are intense.
While BPD comprises 10 percent of all mental health outpatients, 75 percent of those diagnosed with
BPD are women. Seventy-five percent of those suffering from BPD have a history of sexual or physical
abuse. The characteristics of a BPD subject include the following:
Frantic efforts to avoid real or imagined abandonment by a romantic partner;
A pattern of unstable and intense romantic relationships, characterized by extremes. The term
love/hate relationship describes a BPD subject; his or her relationships change from love to hate
and back again in a matter of seconds. The 1971 film Play Misty for Me and the 1987 film FatalAttraction contained chilling examples of this BPD tendency;
Remarkable and persistent instability of self-image, contributing to suicidal behavior, threats, or
self-mutilation;
Intense impulsivity in areas that are self-damaging, such as spending habits, substance abuse,
deviant sexual behavior, reckless driving, and binge eating; and
Inappropriate, intense anger or difficulty controlling anger; frequent displays of temper, constant
anger, or recurrent physical fights.
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Research indicates there is no such thing as a pure BPD; it coexists with other forms of
mental illness, such as posttraumatic stress disorder, mood disorders, panic/anxiety disorder,
substance abuse, gender identity disorder, and obsessive-compulsive disorder. It is important to
remember such characteristics naturally exist in every healthy persons personality. It is when
they are extreme and intense in nature that the person becomes a danger to you.
Obsessive-Compulsive Disorder
In order to discuss obsessive-compulsive disorder (CPD), it is necessary to define the terms.
An obsession traps a person in a myriad of recurrent and unwanted ideas or impulses, such as
when a person is obsessed with neatness. A compulsion is a strong, irresistible impulse to
perform a certain act, such as washing ones hands, checking the stove to ensure the gas isturned off, or counting the number of steps taken. Persons suffering from obsessive-compulsive
disorder have fears that a lack of order, neatness, or cleanliness will endanger their personal
safety or that of a loved one.
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A compulsion is a behavior based on an obsession. People perform compulsive behaviors
according to rules they make up for themselves that accompany obsessive thoughts. For
example, a person may have profound fear of germs and infection, and may spend hours
washing her hands after using a public restroom. The repeated hand washings temporarily
easies her fears, but the fears return and the routine is repeated all over again. Most peoplewith OCD are aware their obsessions are compulsions are ridiculous, but are unable to ignore
them. Some common obsessions include the following:
An unnatural fear of dirt, germs, or contamination;
An overriding concern with order, symmetry, and exactness; and
Worry that a task has been performed poorly, even when the person knows it is not
true.
OCD was at one time thought to be rare. However, the actual number of affected people
was hidden from public statistics because of embarrassment. Recent studies have found more
than 1 percent of the population, or more than two million people, suffer from OCD.
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The cause of OCD is thought to be similar to that of other forms of mental illnesses: an
imbalance of brain neurotransmitters, in this case, serotonin. Serotonin serves as a bridge in
sending nerve impulses from one nerve cell to the next, and in regulating repetitive behaviors.
Medications are available to help relieve the symptoms of OCD.
Persons suffering from OCD often experience other forms of anxiety, such as phobias (fearof snakes or fear of flying), panic attacks, and depression. Research indicates people with OCD
have an episode of major depression at some time in their lives. Alcohol and drug abuse
become a complicating factor when people with OCD turn to them for relief. Some common
compulsions include the following:
Frequently cleaning and grooming oneself, such as excessive hand washing, showering,
or tooth-brushing; Checking rituals involving drawers, doors, locks, and appliances, making sure they are
shut, locked, or off;
Repeating rituals, such as going in and out of a door, sitting down and getting up from a
chair, touching certain objects several times, and avoiding lines on the sidewalk;
Counting over and over to a certain number; and
Saving newspapers, mail, or containers when they are no longer needed.
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According to the
National Institute of
Mental Health, more
than nineteen million
Americans sufferfrom some type of
anxiety disorder.
According to the National
Institute of Mental Health,
more than nineteen million
Americans suffer from some
type of anxiety disorder,including panic disorder,
posttraumatic stress disorder,
phobias, and generalized
anxiety disorder. Tormented by
panic attacks, irrational
thoughts and fears, flashbacks,nightmares, or innumerable
frightening physical symptoms,
people suffering from anxiety
disorders are frequent users of
emergency room and other
medical services.
Many people having
anxiety disorders are likely to
experience depression, alcohol
and/or drug abuse, or other
mental disorders. Because ofwidespread lack of
understanding and the stigma
associated with these disorders,
many victims suffer privately, as
they are not diagnosed properly
or are not receiving treatmentproven successful through
research.
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Posttraumatic Stress Disorder
Posttraumatic stress disorder (PTSD) is a persons reaction to witnessing or otherwise
experiencing a major traumatic event is in his life. Once thought to be an illness suffered by
military, law enforcement, firefighting, and emergency medical services personnel, PTSD is
estimated to afflict 5 percent of the general, civilian population. Women are twice as likely toexperience PTSD as men.
Typically, PTSD results from extreme stressors, such as serious accidents or natural
disasters, rape or criminal assault, combat exposure, child sexual or physical abuse, hostage
situations, or the sudden, unexpected death of a loved one.
A person experiencing PTSD has three types of symptoms: re-experiencing the traumatic
event, avoidance and emotional numbing, and increased arousal. Re-experiencing of the eventconsists of flashbacks, during which the person feels as if the event is recurring while he is
awake; nightmares; exaggerated emotional and physical reactions to events similar to the
subject event; and overpowering recollections of the event itself.
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Avoidance and emotional numbing is indicated by avoidance of activities, locations, and
conversations related to the traumatic event, loss of interest in general, feelings of detachment,
and restricted emotions.
The PTSD symptom of increase arousal is demonstrated by difficulty in sleeping, having
outbursts of anger when inappropriate, hyper vigilance, and an exaggerated startle response.There are three levels of PTSD severity: acute, chronic, and delayed. Acute PTSD lasts from
one to three months. Chronic PTSD symptoms continue for longer than three months, and will
continue without medical and/or psychological intervention. Delayed PTSD symptoms appear
weeks, months, or even years after the traumatic event, and are likely to occur on the
anniversary of the event or when a similar traumatic incident occurs.
The closer a person is to a traumatic event the more likely he is to suffer from one of thethree levels of PTSD. A person who is shot at and see the muzzle flash is more likely to
experience PTSD than a person who heard the gunshots and later leaned the shots barely
missed him. A rape victim who reasonably believed her life was in danger is more likely to
experience PTSD than a rape victim who did not believe she was going to be killed. Victims of
violent crime are more likely to experience PTSD than people who experience life threatening
natural disasters, such as hurricanes and earthquakes.
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The severity of the trauma symptoms displayed by a person
suffering from PTSD depends on several factors; the severity of
the incident, the length of time it lasted, the closeness of a
person to the incident, the perception of danger exposure, the
frequency of the event, and negative reactions from friends andfamily members.
Research reveals a link between PTSD and substance abuse.
First, persons with PTSD are more likely to report to drug and
alcohol abuse as a means of easing and symptoms associated
with PTSD. Second, substance abusers, of both drugs and alcohol,
are more likely to experience PTSD than non-abusers. Finally,PTSD is found to be more prevalent in subjects with a history of
cannabis (marijuana) dependence but not alcohol dependence.
Mild forms of PTSD are normally treated with psychotherapy.
More severe forms are usually treated with psychotherapy and
medication. Statistics indicate women are more likely to suffer
chronic and acute PTSD.
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Panic Disorder
Panic disorder, or panic attacks, is a serious condition that affects slightly more than 1
percent of the United States population. Usually appearing in late adolescence or early
adulthood, the causes of panic disorder are unclear, although there seems to be a link between
the attacks and major live transitions, such as graduating from college, getting married, andmoving far away from ones childhood home. Research has shown a genetic predisposition;
persons with panic disorder are likely to have family members who have also suffered it.
A panic attack is a sudden urge or overwhelming fear that comes without warning and
without any obvious reason. A true panic attack is far more intense than the feeling of being
stressed out them any people experience. The symptoms of a panic attack include a racing
heartbeat, difficulty breathing, paralyzing terror, dizziness, trembling, sweating, tingling in thefingers and toes (pins and needles), and a feeling that death or insanity is imminent.
Many people would recognize the symptoms of panic disorder as similar to those of fight
or flight syndrome, which humans experience when confronted with dangerous situations. The
major difference between the two is panic attacks occur when there is no basis for the attack;
they seem to come out of nowhere. They can even occur when a person is asleep.
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Panic attacks occur without any warning or way to stop them. Luckily for those persons
experiencing panic attacks, they are usually short in duration, passing within minutes.
Unfortunately, repeated attacks can continue to recur for hours at a time.
Panic disorders are not physically dangerous to its victims, but it can be terrifying, mainly
because the person feels out of control. Panic disorder may also lead to other complications,such as phobias-irrational fears- depression, substance abuse, medical complications, and
suicide. The effects of panic disorder range from mild social impairment to a total inability to
face the word.
Many people have experienced panic attacks, but do not suffer from panic disorder. That
is, they have suffered one or two panic attacks, usually based on a life transition. The key
symptom to panic disorder, however, is the persistent fear of future attacks, which lead tophobias, depression, and other medical complications. The cause of panic disorder has yet to be
identified but, as indicated, there is evidence of a genetic predisposition and life transitional
causes.
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Phobias
Phobias are marked and present fears that are excessive or unreasonable, often brought
on by the presence of anticipation of a specific object or situation. Most are familiar with
phobias of flying in airplanes, heights, animals, or receiving medical injections, but there are
many more phobias. Literally numbering in the hundreds, phobias range from fear of
stepmothers, fog, gold, clutter, and men, to being alone, certain colors, and gravity.
Persons suffering from chronic cases of specific phobias are likely to experience an
immediate anxiety response, which may resemble a panic attack. Pointing out the irrationality
of a persons phobia is of little to no value, as people suffering from phobias recognize the fear
is excessive or unreasonable.
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Posttraumatic Stress Disorder is often identified by the following characteristics. A person
experiencing posttraumatic stress disorder has three types of symptoms:
1. Re-experiencing the traumatic event;
2. Avoidance and emotional numbing;
3. Increased arousal;4. Nightmares;
5. Exaggerated emotional and physical reactions to events which may be similar to the original
traumatic event; are often common;
People suffering from posttraumatic stress disorder have:
1. Overpowering recollections of the event itself;
2. Difficulty in sleeping;
3. Outbursts of anger when inappropriate;
4. Hyper vigilance; and
5. Exaggerated startle response
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Panic Disorder is marked by the following. The symptoms of a panic attack include:
1. Racing heartbeat
2. Difficulty breathing
3. Paralyzing terror
4. Dizziness5. Trembling
6. Sweating
7. Tingling in the fingers and toes
8. A feeling that death or insanity is imminent
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Many people recognize the symptoms of panic disorder as similar to those of the fight or
flight syndrome. Panic disorder may also lead to other symptoms, such as phobias or un-
rational fears, depression, substance abuse, medical complications, and even suicide.
Phobias are common to many people. Literally numbering in the hundreds, phobias range
from fear of stepmothers, fog, gold, clutter, and men to being alone, certain colors and gravity.
Persons suffering from chronic cases of specific phobias are likely to experience an immediate
anxiety response which may resemble a panic attack. Pointing out the irrationality of a persons
phobias is of little or no value as those suffering from phobias recognize their fears as excessive
or unreasonable but are unable to control the emotion evoked by the stimulant or fear.
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Organic disorders, for the purpose of this course, are
medical conditions of the brain causing abnormalities of
emotions, thought, and behavior. The causes of brain
disorders are numerous, but can be grouped into two
categories: environmental factors, such as a head injuryresulting from a vehicle collision, or the intentional misuse
of a drug resulting in brain damage; and internal factors,
such as aging or disease, that lead to the disruption of
blood flow to the brain. The two most common groups of
symptoms, known as syndromes, are delirium and
dementia.Delirium refers to a sudden change in mental
functioning caused by an injury or other challenge to the
brain caused by a medical condition. It is typically intense
and, if the medical cause is threated promptly, short-lived.
Delirium can be a serious conditions requiring immediate
medical attention to prevent permanent brain damage.
Some of the symptoms of delirium
are a quick onset of symptoms,
disorganized thinking,
disorientation as to time and place,
reduced level of attention, andincreased agitation.
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Delirium can be caused my many medical conditions, such as urinary tract infections, low
blood pressure, dehydration, and alcohol withdrawal. The delirium associated with alcohol is
called delirium tremens (DT), which is a disturbance of the brain occurring during the late states
of severe alcohol dependence or withdrawal. They symptoms of DT are confusion,
hallucinations, tremors, irrational over-activity, and profuse sweating. Like other forms of
delirium, DT is a medical emergency; research indicates a mortality rate of 15 percent if the
symptoms are left untreated.
Delirium tremens usually begins three to several days after removal of alcohol, but as
indicated above, may also affect a person in the late stages of severe dependence. When
treated medically, DT usually runs its course within three to five days.
The other organic disorder is known as dementia. Where delirium occurs suddenly,dementia is a gradual loss of intellectual functioning occurring over a long period of time.
Memory, as a highly integrated brain function, is particularly sensitive to developing dementia:
memory loss, especially recent, is often the first symptom noted. The causes of dementia
include Alzheimers disease, strokes, long-term alcohol abuse, a reaction to medication, Vitamin
B12 deficiency, thyroid disease, and depression.
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The most common type of dementia is dementia of the Alzheimers type (DAT). This brain
disorder results in several years of progressive loss of cognitive abilities and eventually death.
DAT is caused by an irreversible and incurable deterioration of brain cells. As brain cells die off,
the brain shrinks in size.
DAT is not confined solely to the aged: it may appear early in a persons life, earliest
indicators appearing prior to age 60. Known as presenile, it is thought to b related to genetic
factors, but this is as yet not understood. Persons suffering DAT are likely to wander away from
their homes and have no recollection of the way back, or even the location where their journey
began.
The speech of a person suffering from
dementia usually remains normal but many
people experiencing dementia have difficulty
finding the correct words to use in
conversation. Dementia also is likely to includea general loss of cognitive abilities, such as
reasoning, attention, concentration, and
behavioral control.
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Delirium and dementia are both classified as organic disorders. Delirium is marked by the
following symptoms: There is usually a quick onset of symptoms such as 1) disorganized
thinking, 2) disorientation as to time and place, 3) reduced level of attention, and 4) increased
agitation.
The delirium associated with alcohol is called Delirium Tremens or DT, which is a
disturbance of the brain occurring during the late stages of severe alcohol dependency or
withdrawal. The symptoms of DT are: 1) confusion, 2) hallucinations, 3) tremors, 4) irrational
over-activity, and 5) profuse sweating.
Where delirium occurs suddenly, dementia is a gradual loss of intellectual functioningoccurring over an extended period of time. Memory is a highly integrated brain function and is
particularly sensitive to developing dementia. Memory loss, especially recent, is often the first
symptom noted. Causes of dementia include Alzheimers disease, strokes, long-term alcohol
abuse, reaction to medication, a vitamin B12 deficiency, thyroid disease, and depression.
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Diabetes and epilepsy are not conditions
of an emotionally or mentally disturbed
person. However, much like someone
suffering from schizophrenia or a phobia,
his potential for mistreatment is very
real. For that reason, the these topics
will be discussed in this section of the
course.
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As a patrol officer, consider
the following scenario:
You are working a one-man car
in a town that might be in Maine or
California. It is late at night. You get
a call from dispatch saying a citizen
has called on his cell phone to
report a suspected DUI offender.
Since you are on the same road and nearwhere the suspected driver is traveling, you take the
call and spot the late-model vehicle described by
dispatch. Similar to the numerous DUI offenses you
have handled, the driver weaves within his lane. He
also crosses the fog line a couple of times, and his
speed is erratic- sometimes too fast and then
sometimes too slow. You think to yourself it is a
good thing traffic is light at this time of night.
You pull in behind the diver and activate your
overhead lights. There is no doubt in your mind the
driver has to be aware of your marked unit, but he
fails to slow down quickly.
Several blocks down the roadway the driver clumsilypulls over, buy only after your sirens have been
wailing. You then clear your situation with dispatch.
Walking up to the vehicle you notice the drivers
head snap down and if he is tired and then come
back up slowly. Deuce, for sure, you think.
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When you ask the driver for
proof of insurance and his drivers
license, he greets you with a comicalsmile, as if you have just told a funny
joke. He does not respond at all to
your request for identification, and
you get the feeling this drunken
driver will require just a little moreeffort than the usual DUI. Sure enough, when the
driver gets out of his vehicle after several repeatedrequests, he stumbles against the car door and
almost falls down. You immediately notice his face is
pale and clammy. His speech is severely slurred, and
he looks shocky. As you speak to him about the
reason for the stop, you can easily tell he is confused
and uncooperative to the point of annoyance.Several times, the driver shows real flashed of
irritability and anger.
Sure enough, he fails your field sobriety tests.
In fact, you decide he is so drunk that the roadside
tests do not need to be finished. Instead, you place
the driver in handcuffs and inform him he is under
arrest for suspected DUI.
As you drive to the county jail, youcongratulate yourself on taking another drunk driver
off the public roads. You do not know it yet, but you
are in for an unpleasant surprise when you get to the
jail with your arrestee.
Why? Well, your deuce is not drunk; he does
not drink alcohol at all. As a matter of fact, he has
not touched alcohol since he was diagnosed withdiabetes seven years ago. But YOU arrested him and
hauled him in for an alcohol-related crime, rather
than calling for medical assistance for a flare-up of
his disease.
Sound far fetched? Not according to the
American Diabetes Foundation and Lt. Chuck Hayesof the Oregon State Police.
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Hypoglycemia and Law Enforcement Officers ...
What do they have in Common?
Lieutenant Chuck HayesOregon State Police
A routine DWI, the kind that happens everyday. Get them off the road before another innocent victim
suffers. It's a common scene, but it isn't always as it seems. In Albany, Oregon, a man was involved in an
incident that has unfortunately happened once too often to law enforcement officers throughout the
country. After some very poor driving his vehicle was stopped and he was arrested on suspicion of DWI. The
driver, however, was actually diabetic and suffering from low blood sugar, known as hypoglycemia. The
driver later sued the law enforcement agency and was awarded $13,000 in damages.
Recent lawsuits by people with diabetes and their family members emphasize the importance of taking
precautions before a DWI arrest. Juries are sympathetic toward people who are falsely arrested based on a
medical condition, even if that condition is not obvious to the arresting officers. Unfortunately, this type of
situation has affected police departments and law enforcement officers too many times. Everyday, law
enforcement officers stop drivers under the influence of alcohol and other drugs who are DWI. Many ofthese drivers exhibit some of the same actions as a diabetic suffering from hypoglycemia.
Hypoglycemia is defined as an abnormal decrease of sugar in the blood. Individuals suffering from
hypoglycemia can feel cold and clammy. They can appear nervous, shaky, and very weak. Often, their face is
a pale color. They may experience headaches and have blurred vision.
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They become dizzy, demonstrate irritable behavior, and may exhibit personality changes. They may
seem confused, uncooperative, and may have slurred speech. In severe stages, they may even have seizures
or become unconscious, which can result in death. Most diabetics properly monitor and regulate their sugarintake to ensure they do not have adverse reactions. This condition can, and will, at times, happen suddenly
and dramatically while the individual is driving a vehicle. The result can often mirror the responses of a
suspected DWI driver. (Editors Note: this is where training in distinguishing between DUI and hypoglycemia
becomes invaluable.)
Soon after the Oregon incident, a support group from Albany General Hospital developed a means to
assist law enforcement officers in identifying vehicles operated by diabetics. The result was the "DM Med-
Aware" sticker. This light-reflective, all-weather sticker, is placed on the automobile to the left of the rear
license plate. This sticker is very visible and can communicate to a police officer, emergency response
personnel, and others, the driver may be diabetic.
Law enforcement officers cannot totally depend on diabetics to wear medical tags or jewelry. In
addition, officers often cannot search a wallet or purse in a critical situation. The "DM Med-Aware" sticker
can be a positive addition in assisting in the identification of diabetics in emergency situations.
The use of the sticker is voluntary. It is currently in use and recognized by many law enforcementofficers in the state of Oregon. The Albany General Hospital Foundation received a $20,000 grant from the
Oregon affiliate of the American Diabetes Association to produce an educational video of the "DM Med-
Aware" sticker program. The 8-minute video, primarily aimed at law enforcement, educates police officers
on how to observe and detect the signs and symptoms of hypoglycemia and provide proper treatment in
emergencies. The Oregon State Police is a sponsor of the program and has added the video to Medical First
Responder and DWI training.
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The DM Med-Aware sticker is not a "free ticket" to drink and drive. It is designed to alert police officers
that the driver may be a diabetic and may be suffering from hypoglycemia. With this information, officers
can be better prepared to seek additional signs of medical impairment and ask questions that may or may
not support alcohol or drug impairment. Learning to recognize clues that identify a DWI suspect as
hypoglycemic can help officers avert further injury to the patient and possibly avoid an unnecessary costly
lawsuit.
For more information about the "DM Med-Aware" sticker or the training video, contact the Albany
General Hospital, 1046 Sixth Avenue S.W., Albany, Oregon 97321.
The underlined sentences in the article are considered important for understanding this medicalcondition, and its potential to affect law enforcement officers, especially those patrol officers who make
numerous DUI arrests. When ANY medical condition, including epilepsy, mimics a common Crime, it is
absolutely in your interest as an officer to distinguish between a crime committed and a medical emergency.
Too many officers do not and they and their agencies pay the price- either in employment or lawsuits.
To illustrate that this type of situation is not confined to American police, and is a widespread
phenomenon, read the following incident that occurred in Australia.
Officers in New South Wales arrested a woman suspect of shoplifting. The woman, Cherie Evans, hashad diabetes for 17 years and was totally aware of how to control the symptoms. When she felt the onset of
those symptoms, she paid for her groceries and went outside to her vehicle, where she sucked on lollipops
to quickly bring her blood sugar imbalance into normal ranges.
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Evans claims she as approached by security agents from within the store who then accused her of
shoplifting. Noticing her pale, confused, and shaking states they misinterpreted those symptoms as showing
guilt, and being indicative of intoxication in the bargain. Local officers were called who subsequently placedEvans in custody. Her slurred speech and mental confusion further convinced the officers they had a
arrested a criminal. She was told, A cup of coffee will sober you up.
Despite telling the store security guards and the arresting officers about her medical problem, she was
arrested, handcuffed, and taken to the local lockup.
Police officers thought I was drunk and my diabetes story was a cover for stealing. I was so
humiliated, Evans said later.
Her case was dismissed after authorities examined her blood glucose monitor, which showed a low
reading at the time of her arrest.
The CEO of Diabetes Australia, Liz Peers, summed up the incident accurately enough, saying, Police
these days should understand the difference between a medical condition and the effects of too much
alcohol.
Fair enough, you say. What are the differences and how can an officer readily distinguish between
them? Although appearing inebriated, a diabetic suffering from low blood sugar (hypoglycemia) will NOTshow Nystagmus. There will be NO odor of alcoholic beverages on the persons breath or clothing.
If your arrestee claims to be diabetic, do the right thing and dispel any doubt by calling for EMTs to take
a small drop of your suspects blood to get a quick, easy estimate of the blood sugar. If an IV is started and
the person immediately gets better, then you have solved the reason for the impairment.
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It is unfortunate, but many of the symptoms shown by diabetics with a low blood sugar
conditions closely mimic a person who is under the influence of alcohol. Nervousness,shakiness, paleness, and irritability overlap in both DUI offenders and hypoglycemia.
Other signs of hypoglycemia that are readily observable by an officer may include:
Sudden violent fear
Fainting
Inward trembling
Emotional disturbances
Hand tremors
Dilated pupils
Mental cloudiness
Complains of chilliness
Numbness
Pallor around the mouth
Complains of hunger
Apprehension
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As an officer whose duty it is to monitor thepublic for possible lawbreakers, you cannot depend
upon diabetics in public to wear medical alert
bracelets or even carry documents that identify them
as having this disease. Also, some diabetics drink and
drive. Some diabetics use illegal drugs as well. This
further middies the water from the standpoint of anofficer who feels he has a valid DUI arrest.
As hypoglycemia progresses, the followingsymptoms may appear. If they do, you can be
assured you do not have a DUI in custody but a
person suffering from the effects of low blood sugar:
Headaches
Double vision
Inability to walk
Muscle twitching
Disorientation
Coldness of the extremities
Unless these are treated, severe low blood
sugar can lead to convulsions and unconsciousness.
Do yourself a favor, and learn these symptoms and
what they mean. It will make you a better, moreinformed officer. It might also help you to help a
citizen who is undergoing a medical crisis, not
committing a crime.
Similar to diabetic symptoms being confused
with a possible DUI by officers another medical
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with a possible DUI by officers, another medical
condition often confronts officers who work closely
with the public. Consider the following scenario you
might encounter as an officer. It is a situation that,
without the correct information, could lead to an
arrest which will come back to embarrass you.You get a call to respond to a street location in
the center of town. During a crowed street fair, a
man in a group of shoppers has uttered a strange cry
and is bothering people with his behavior.
Responding to the location you see the man acting
strongly. He is mentally unfocused and apparently
staring with intensity at a nearby wall. Passers-bywho have attempted to help him have found the
individual to be unresponsive and staring blankly. He
does not respond to their inquiries. While standing
there, you notice he has started to shake violently
and has defecated in his pats. Your first though is,
Great! another guy on PCD (or meth, or cocaine, or
alcohol)! Your inclination is to take the person intocustody, as he is obviously disturbing the peace and
obstructing your duties- both are certainly
misdemeanors. But you would be wrong to do so.
This person is experiencing the first stages of an
epileptic seizure. It is a medical condition you are
witnessing, NOT a crime. To arrest the individualwould be akin to putting out fire with gasoline.
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The following is a list of common symptoms of
epilepsy:
Episode may begin with a blank stare or cry
Unresponsiveness to inquiries
Absence of alcohol on breath
Incontinence (not always, but a possibleeffect)
Possible belligerency or aggression when
approached
Frightened aspect, easily upset, unable to
communicate
Convulsions- these will result in the personthrashing about on the ground. This will
not be hostile physical behavior, but
uncontrollable spasms of the body and
musculature.
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What is epilepsy? It is a brain disorderthat affects more than two million citizens in
America. It is easily treatable with medication, just as
diabetes. Seizures affect behavior because the
electrical system within the persons brain
malfunctions. Instead of a controlled discharge of
electrical energy, the brain fires a surge of energythat may cause unconsciousness and massive
contractions of the persons muscles. If the episode
does not progress as far as this, generally it is over
within about two minutes. Small episodes such as
this, or petit mals, generally cloud awareness,
block meaningful communication, and may produce
uncontrolled physical movements.If you have never witness a full-blown epileptic
seizure, or grand mal, it can be frightening the first
time around. Ask a jailor in your jurisdiction.
Chances are they have witnessed numerous inmates
suffering from this malady while in custody. The
potential in a confined setting for possible injury on
hard, unforgiving custodial surfaces is real.
Once you recognize this for what it is, your instinct
will be one of sympathy for the person, rather than
enmity. It is not a crime to be ill; people sufferingfrom epileptic episodes need medical treatment, not
incarceration. To the public witnessing an epileptic
seizure, it must appear as if the person is evincing
anti-social or drugged behavior. The corollary to this
is that law enforcement officers are often called to
the scene. Sadly, many times the officer is no more
aware of epilepsy than the complaining citizen.
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What should an officer do when encountering a person in this
situation? The first approach should be to guardedly assume it is a medical
condition unless events quickly prove otherwise. This is the only way a
persons rights can be safeguarded. It is not a crime to suffer from a
medical disability; the quickest way to find yourself find yourself in court is
to arrest a person based on the assumption they are committing a criminal
act. Ti is entirely possible t find yourself involved in a lawsuit based on theAmericans with Disability Act (ADA). Taking a person into custody based on
their actions while suffering a disability deprives them of their rights, and
could be construed by an irate plaintiff as a violation of that federal law.
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Basic first aid treatment should be observed.
People with epilepsy are NOT dangerous to others.
A person experiencing a seizure will NOT swallow his/her tongue. Do not fall
prey to this old myth.
Place the person on their side to avoid possible choking. Place nothing in their mouth.
Do NOT put them face down or put them in a choke hold. You are asking for a
possible fatality if you do.
Do NOT forcibly restrain them or grab them aggressively. Coherent thought is
not possible for the seizure sufferer and may trigger an involuntary reaction.
Gently shepherding a standing epileptic away from crowds is advisable, if
possible. Try it.
A calm, non-threating tone works bet. Loud commands are superfluous and
ineffective. Remember, the persons consciousness is impaired.
Seizures block the sufferers ability to understand police instructions. This is
NOT obstruction of justice or resisting arrest or disturbing the peace.
People in these situations are vulnerable, and should NOT be left on their
own.
How do you as a professional patrol officermanage a situation such as has been described?
Consider the following points:
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Generally, seizures last for less than two minutes and an
ambulance does not need to be called by officers. However, call for
medical assistance if:
Another seizure begins immediately after the first subsides;
If confusion is prolonged and does not improve in a timely
fashion;
If the seizure lasts for more than (5) minutes;
If the person is injured, diabetic, pregnant or has a known
history of cocaine or other drug use;
If you can determine that this is the first seizure the person has
experienced; and/or
If the person does not regain consciousness after muscle
spasms have ended.
As an officer, when youconfront this situation, there
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confront this situation, there
are also several things you
should NOT do. They include
the following:
Do not interfere with the persons movement, unless
something more threatening appears, such as steps orcurbing.
Do not expect a response.
Do not raise your voice or appear threatening.
Do not interpret struggles as hostile or ill willed.
Do not leave the person alone in this vulnerable situation.
Do not expect focused, clear communication for a little while
after the seizure. The person is apt to be dazed andconfused.
It is NOT advisable to use pepper spray at ANY time during
seizure situations. Also, hog-typing or restraints of any kind
are NOT advisable as they may trigger an aggressive
response.
Any additional help to an officer is the presence of medicationfor the treatment of Epilepsy, including Klonopin, Tranxene,
Depokote, Diamox, and up to a dozen more.
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If you must take an epileptic into custody, arrangements
need to be made to secure medication. Missing prescribeddosages can possibly lead to prolonged and more serious seizures
that can threaten life. You do not want it to appear as if you
withheld medication from anyone who needs it. Epileptics should
be monitored while in custody. A confined, hard-surfaced setting
may lead to injuries during a seizure; an episode of non-stop
seizures can kill. Major lawsuits have been filed and successfullyargued regarding epileptic seizures of people while in custody.
The bottom line here is simple: in situations involving
persons suffering from diabetes or epilepsy, the burden is on the
responding officer to recognize and properly respond to the
disability. It is of small comfort, and no legal protection, to say
you were unaware of epileptic symptoms or did not know howhypoglycemia affected driving ability. Convulsions, confusions,
and episodes of agitated behavior in any person who is in police
custody- on the street or in jail- should not be dismissed as
deliberate acting up or as a cause for discipline until the real
possibility of diabetes or epilepsy has been ruled out.
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Involuntary Commitment
Most states have given law enforcement
officers, medical physicians, and psychiatricprofessionals the ability to force a subject into
treatment when certain conditions are met. Usually,
those conditions have to do with a mental condition
or a persons inability to care for his or her own
after, the after of others, or be gravely disabled.
Mental conditions, as used above, is a term that many officers have difficulty defining.Most jurisdictions require that the mental condition be linked with the inability to care for ones
own safety or the safety of others; it is not sufficient for a person to act as if is way out there
or looney. A person attending to his basic needs of food, clothing, and shelter in an otherwise
reasonable manner, even though he might be hearing voices and wearing an aluminum cap to
ward off satellite surveillance ray sis not usually a candidate for involuntary commitment. A
person exhibiting these symptoms walking in traffic lanes on a freeway, lying in a gutter during asnowstorm, or making statements or gestures indicating suicide might be. Consult the statutes
governing involuntary commitments in your jurisdiction; do not assume someone talking to
imaginary being is crazy and subject to involuntary commitment.
To view the Idaho statute that deals with the hospitalization of the mentally ill, see Idaho
Code 66-326.
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Criminal Acts
Since the Roman Empire, civilizations have
recognized certain persons to be exempt fromcriminal sanctions due to mental illness. Lunatics, or
those who were influenced by the phases of the
moon, were not accountable for their actions and,
therefore, not subject to criminal penalties under
the law. An insanity defense is based on a theory
that most people can make rational choices to obey
or disobey the law; those who cannot, due to mentaldefect, should be tried for a crime in a similar
manner as an otherwise sane person. Such people
needs special treatment, as punishment will not
deter future antisocial behavior in a mentally
disordered person.
A person under arrest and indictment for an
offense must be capable of assisting his attorney in
defense of his guilt. A person suffering a serious
mental illness may not be able to perform this vital
function and, therefore, will not be permitted by the
court to stand trial for his crime.
How does a person become capable of
assisting in his defense? Generally, persons suffering
From SMI are treated with a combination ofpsychotherapy and medication in order to improve
their mental capacity to comprehend the nation of
the charges against them and to assist in their own
defense. Such persons agree to this treatment, or
the court ordered it.
In the case of Russell Weston, the accused
murderer of two U.S. Capitol police officers in 1998,the defendant refused to sign documents agreeing to
the administration of medication that would enable
him to stand trial. When prosecutors sought a court
order to forcibly medicate Weston, his attorneys
intervened. Since July, 1999, Westons lawyers have
preented the government from medicating him,
saying to do so is to march him to the execution
changer. The possible motivation for this tactic is to
prevent Weston from being tried for murder, herby
preventing him from being punished-executed-for
the crime. Court appointed psychiatrists have
testified Westons mental condition has worsened.
He remains in custody.
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The Insanity Defense
Insanity defenses became matters of the court process in 1843 with the attempted
assassination of Prime Minister of England Robert Peel, the father of modern law enforcement.Daniel MNaghten, a psychotic individual, believed he was being persecuted by Sir Robert Peel
and attempted to murder him. Sir Robert Peels assistant was killed in the attack. At trial
MNaghten was declared insane and the prosecution was discontinued.
Queen Victoria and the House of Lords strongly disapproved of the verdict, and
commissioned a panel of fifteen judges to establish a specific test to be applied by a jury in
determining insanity. The outcome became known as the MNaghten Rule, and was to be the
standard in the United States from the mid-1800s until 1954. The MNaghten Rule, also known
as the right-wrong test, required the jury to determine if the person accused of the crim know
it was wrong at the time of the commission of the crime. The prosecution only needed to prove
a person understood the moral consequence of the crime; mental illness did not matter.
During the late 1800s,many states expanded the MNaghten Rule, adding the concept ofirresistible impulse to the test of insanity. While it was widely acknowledged everyone has
impulses, insanity defense language was adopted indicating a person should be acquitted If he
was incapable of preventing himself from committing the act despite the knowledge of it s
wrongfulness. The theory was that a mental disease could for a person to act against his own
will, if driven by an irresistible impulse.
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Interest in psychology surged during the 1950s. The mental problems experienced by
returning military personnel brought government attention to psychiatric disorder. The
invention of psychiatric drugs gave the public hope for a cure for mental illness. The U.S.Supreme court, in the case of Durham v. United States, adopted the Durham Test, which
provided a person was not criminally responsible for an act if the act was the produce of a
mental disease of defect. Recognizing for the first time that a mental illness was a disease that
could be treated and possibly cured, juries were required to answer two questions: (1) Did the
defendant have a mental disease of defect?; and (2) Was the disease or defect the reason for
the unlawful act? If the answers to these questions were yes, the person was not guilty byreason of insanity. The test never received wide acceptance in the United States. By 1972, the
Durham Test was abandoned in favor of the American Law Institute Test.
The American Law Institute, a group of distinguished medical and legal professionals,
developed an alternative insanity test in the late 1950s, one which lowered the insanity
standard from MNaghtens absolute knowledge of right from wrong to a substantial incapacity
to appreciate the difference between right and wrong, thereby recognizing degrees of mentalincapacity. Once enough evidence was presented at trial to raise an insanity defense, the
burden was on the prosecution to prove was not insane. In a period of time just over 150 years,
the pendulum of insanity defense had swung from one extreme to the other, shifting from a
defense burden to the prosecution. All this was to change, however, was the 1981 assassination
attempt of President Ronald Regan by John Hinckley.
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One June 21, 1982, just fifteen months after shoot the president and three others, John
Hinckley was found not guilty by reason of insanity. The public outcry and backlash following
the acquittal by reason of insanity was tremendous. During the three years following theverdict, Congress and half of the states enacted changes in the insanity defense, all limiting use
of the defense. Two states, Idaho and Utah, eliminated the insanity defense altogether.
Changes to the insanity defense were sweeping nationwide. Congress and nine states
limited the substantive test of insanity; Congress and seven states shifted the burden of proof
from the prosecution to the defendant, and eight states created an additional verdict of guilty
but mentally ill (GBMI). As of the turn of the century, most states have adopted changes ininsanity defenses that used the federal rule as the model.
In 1984, Congress passed the Insanity Defense Reform Act of 1984, which reads:
It is an affirmative defense to a prosecution
under any federal statute that, at the time of
the commission of the acts constituting the
defense, the defendant as a result of a severe
mental disease or defect, was unable to
appreciate the nature and quality of the
wrongfulness of his acts. Mental disease or
defect does not otherwise constitute a
defense.
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Theodore Kaczynski was diagnosed as aparanoid schizophrenic, as well as Russell Weston.
Kaczynski, otherwise known as the Unabomber,
transported packages containing bombs to postal
service offices around the West, hoping to evade
detection by origin. Did any law enforcement officer
on patrol duty stop him for a vehicle equipment
violation? Russell Weston, the murderer of two U.S.
Capitol police officer, traveled from his parents
home in Illinois to Washington, D.C., to locate and
destroy the surveillance satellite controls that he was
convicted were on the first floor of the Capitol.
While he was en route, did any officer share a
table with him at a fast food restaurant? How many
New York City police officers stood near AndrewGoldstein on a subway platform, and were luck
enough not to have been pushed in front of an
arriving train, unlike Kendra Webdale?
The point here is officers are frequently in the
company of persons suffering mental disorders,
some innocuous, some lethal. The danger
associated with persons suffering from serious
mental illnesses (SMI) is that their behavior is
unpredictable. They do not live in the world most of
us do, where the force of law has an affect on a
persons conduct.
The character played by Jack Nicholson in the
movieAs Good As it Getsis obsessive-compulsive,obnoxious, and rude, but not a danger to law
enforcement. Kaczynski, Weston, and Goldstein
were a danger to law enforcement, and continue to
be correctional officers at the prisons in which they
are confined. This section will provide suggestions
for police response to calls involving persons with
mental disorders.
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Prior to the 1970s, most people diagnosed with serious mental illness (SMI), such as a paranoid schizophrenia, were
institutionalized and, therefore, kept away from public interaction. During the 1970s, the institutionalization pattern
reversed, due to the advent of antipsychotic medications, changing attitudes about people with mental illnesses, and
concerns about costs of confining these people, which were primarily borne by the public. This pattern of outpatient care,
rather than institutionalization continues today.
The turn of the century has seen many people with SMI lead normal lives, thanks to advances in medications and
their personal commitment to do so; without the commitment, and a lack of funding for community-based care facilities,
persons suffering from SMI may deteriorate and lapse into behavior that becomes a law enforcement issue.Law enforcement knows what is happening; the hand-writing is on the wall. Your agency is the community-based
care agency. You probably should have seen this coming: whenever society is confronted with an issue that defies easy
classification and assignment to some public agency, you are elected. Many examples of this tendency exist, such as public
intoxication- illness or crime?- and unit homes. Those who signed on to what they thought was a law enforcement career
are finding themselves working in a twenty-four-hour mobile social service, roadside assistance agency. Get used to it:
more of the same is on the way.
At one time, contrary to public opinion, mental health professionals denied a link between mental illness and
violence. Recently, however, researchers have found persons suffering from SMI, primarily schizophrenia, are five times
more likely to be engaged in violent acts than persons with no disorder.
Schizophrenia in prisons and jails remains three times higher than the general population. The percentage of those
people, who actively experience psychotic symptoms, such as delusions or hallucinations that are involved in incident of
violent behavior is several time higher than the general population with no disorders.
Several factors may elevate the risk of violence
in a person with SMI. Drug and/or alcohol abuse is
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p g /
the most common. Paranoid schizophrenics often
feel a need to protect or defend themselves against
an imaginary enemy, and arm themselves with
weapons, thereby increasing their feelings of safety
and power. These factors, coupled with a nearabsolute distrust of everyone and their delusions and
hallucinations, make these people potentially
violent, unpredictable, and dangerous. What a
combination: under the influence, paranoid
schizophrenic, task directed, and distrustful of
police.
Some subjects who believe others intend to harm them may make a preemptive strike to stay safe.Others, like the Unabomber, may hear voices commanding them to harm others.
Certain delusional beliefs may compel individuals to commit crime that can escalate into
confrontations with law enforcement, e.g. hostage or barricade situations. The actions of these subjects
challenges law enforcements resourcefulness to prevent action of violence and possible confrontations.
When confronted with a person who exhibits unusual behavior, officers should initially focus on deescalating
the situation and the safety of those involved, rather than criminal responsibility. A criminal investigation
should not be the primary concern upon arrival.
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Early Warning Signs
Prior to committing acts of violence, many subjects suffering SMI provide clues to their illness in letters
written to government agencies, telephone calls, and personal visits. Russell Weston, the murderer of theU.S. Capitol police officers, drove to the Central Intelligence Agency headquarters from his home in Montana
to report the existence of a surveillance satellite and accuse governmental officials of outrageous
misconduct. The challenge for law enforcement is not to perceive these individuals as nuisances, but to
make an assessment of the level of their debilitation and conduct an intervention before violence occurs.
One method of assessment that has been successful is the New Orleans Police Department mode, in
which teams of mental health professionals respond to psychiatric emergencies and provide crisis
intervention and health evaluations. These teams respond to calls from patrol officers who have made initial
assessment of the psychiatric impairment. Comprised of volunteers working everyday between noon and
midnight, members of the unit are not sworn law enforcement officers, but have a limited commission that
empowers them to make involuntary psychiatric commitments whenever necessary. Deployed since 1983,
volunteers have sustained physical injury in only two cases. The program has been very effective in reducing
citizen complaints and lawsuits and saving New Orleans approximately $300,000 each year by accurately
diagnosing mental illnesses and making proper referrals.
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Law enforcement officers should conduct assessments of people who are thought to have a mental
disorder. This assessment should include the following:
Whether the person is organized and coherent, or is disorganized and unable to engage in goal-
oriented actions;
Whether the person remains fixed on one or more themes or explanations for their concerns that
involve blame for their problems, or if they are confused as to the natural and causes of his
delusions;
Whether the persons focus is on a particular person, as opposed to not having determine who or
what is responsible for their problems; Whether an action imperative has been developed, a plan generated because of the persons
perceptions that other alternatives have been exhausted. They now believe matters that have to
be taken into their own hands; and
Whether a time imperative exists, and a sense of urgency and desperation is communicated.
If any of the above behaviors are present, it should indicate to law enforcement that an intervention is
necessary to prevent violence, particular if the person has a history of violence, weapons access, substanceabuse, delusions, and hallucinations. Many of these individuals communicate with law enforcement for
years at a relative harmless level, providing humorous locker room anecdotes, and they rapidly escalate into
violent episodes, usually because of medication issues.
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In their FBI Law Enforcement Bulletinarticle, Understanding Subjects with Paranoid Schizophrenia,
Dr. Kris Mohandie, a police psychologist for LAPD, and James Duffy, an FBI agent assigned to the Behavioral
Sciences Unit, suggest intervention techniques useful to first responding or negotiating officers whendealing with a person who has a serious mental disorder.
From the beginning to the end of the exchange with the person, strive to show respect and treat
the person with dignity through verbal comments and physical actions. Maintain a professional
demeanor no matter how bizarre the persons delusions or hallucinations may seem.
Make a noticeable attempt to understand the context of the subjects comments. Tell the subject,
I understand what you are saying, but I cannot hear the voices. Can you tell me about them?
Avoid arguing about the subjects delusions while attempting to develop reality-based issues.
Telling the subject the belief of this delusion is foolish will damage your intervention.
Use active listening skills such as paraphrasing emotion labeling- I understand that you are upset at
your neighbor- and other I statements to show you identify with the subject.
Use suggestibility statements and empathy to attempt a behavioral exchange.
Allow the subject to vent frustration