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The case of Lee Boyd Malvo, who is now on trial for murder as a sniper in Virginia, is a classic illustration of the diagnostic complications inherent in the insanity defense. To psychologists, insanity is one thing. To lawyers, judges, and jurors, it is another. Malvo’s case shows the tensions between them. Malvo’s attorneys are asserting that Malvo is not guilty by reason of insanity, on the basis that John Muhammad, convicted last month of another of the sniper murders, brainwashed Malvo. But a defense of brainwashing, medically speaking, is slippery. Brainwashing is not a valid psychiatric diagnosis. It is not listed in the Diagnostic and Statistical Manual of the American Psychiatric Association. It has not achieved the professional respectability of, for instance, post-traumatic stress syndrome. There are competing definitions of brainwashing. In the popular parlance, it is used to describe an overwhelming experience that wipes one’s mind clear of prior impressions. More technically, brainwashing is a description of a form of torturous incarceration that was first remarked on at the time of the Korean War. It was applied to prisoners of war who had been subjected to extreme physical and mental trauma, and were subjected to isolation, sensory deprivation, or sensory overstimulation. When weakened by the physical regimen, the victims were subjected to their captors’ re-education. THE BIOLOGY OF BRAINWASHING Even if brainwashing has not yet risen to the level of a psychological diagnosis, there are still concrete physical manifestations associated with it. Brainwashing physiologically wipes out memory and appraisal synapses of the brain. The circuits of the brain that appraise a stimulus, intention, or emotion become disabled, either through physical trauma to the brain, or from the kind of stress that decreases the supply of oxygen in the blood vessels feeding the brain cells. During torture, this intense stress weakens individuals’ capacity to resist, or to sustain beliefs and perceptions other than those imposed or suggested by the torturers. Despite these physiological effects of brainwashing, older subjects of brainwashing attempts have intellectual resources they can call on to sustain themselves. Priests have memorized their missals and can recite them; intellectuals might remember books of poetry and prose, or play against themselves in imagined games of chess. Such tactics help the individual retain a sense of control over their thinking, memory, judgment, and emotions. Brainwashing techniques are far more effective on younger people — children and adolescents — for both physiological and psychological reasons. Frontal lobes — which control executive functioning, initiative, judgment, and common sense itself — are the portions of the brain targeted in brainwashing. The frontal lobes are also the last part of the brain to fully develop. As a result, young people are particularly vulnerable. Further, youths have little sense of their own identity or ego, and may be unduly affected by harsh conditions and isolation. Judging from media reports, as one who has not met or evaluated Malvo, he seems more susceptible to brainwashing than even most young people. Test scores which were offered into evidence at trial suggest either neurological developmental delays or emotional impairment of cognitive functioning. Witnesses have offered credible evidence that, as a young child, Malvo was frequently beaten and abandoned by his mother. He had a series of caretakers while growing up, and was removed from their care when he bonded with them. His domicile and school were changed often. He had problems in peer relationships, was often marginalized by his classmates, and was physically small and socially immature. His tightly constrained anger (visibly apparent in his jailhouse drawings) was expressed in shoplifting, killing cats, and threats of suicide as a child. A DIFFERENT DIAGNOSIS? In addition to increasing his vulnerability to brainwashing, this sort of patient history offers strong support for an established mental health diagnosis: reactive attachment disorder. This is usually the appropriate diagnosis for children who have been abused by their biological parents or parent-surrogates, and who are placed in a series of foster homes, in some of which various kinds of abuse are repeated. The disturbance is characterized by pathogenic care evidenced by persistent disregard of the child’s basic emotional needs for comfort, stimulation, or affection, and repeated changes of the primary caregiver that prevent formation of stable attachments. The behavioral consequences, according to the Diagnostic and Statistical Manual IV, include “Persistent failure to respond in a developmentally appropriate fashion to most social situations,” “excessively inhibited or highly ambivalent contradictory responses,” and “diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments.” Thus it affects the young person’s ability to distinguish reality from delusion in intimate or social relationships. The condition often is a precursor to schizoid manifestations in adolescence. Schizophrenia evolves from early childhood pathological experience, and from aberrations in brain chemistry. According to the National Institute of Mental Health, “People with schizophrenia often suffer terrifying symptoms such as hearing internal voices not heard by others, or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them.” Insanity means that an individual is dissociated from reality or is unable to distinguish between hallucinations, delusions, and reality; or suffers a brain anomaly (such as a seizure disorder, lesion, or obstruction) that precludes making these appraisals or judgments. By definition, schizophrenia is insanity. All this is the psychology of what might be going on in Malvo’s mind. But Malvo not only is appearing in front of psychologists so that they can make a diagnosis and hopefully treat him, he also is appearing in a court of law that will determine whether he is guilty of committing murder. In the language of the court, the ultimate question is not whether Malvo has a psychological condition that is a potential precursor to insanity. Rather, it is whether he had the ability to distinguish right from wrong. Psychologists and psychiatrists can only try their best to offer medical science as a basis for the jury’s ultimate decision about the defendant’s state of mind. A JURY OF 12 MINDS But it is a jury of 12 men and women that makes the decision. None are likely to be psychiatrists or psychologists, and all have their subjective impressions of how the defendant’s behavior comports with their ideas of insanity. For them, it need not matter that brainwashing is not a clinical diagnosis. After hearing testimony of Malvo’s actions, and also hearing testimony from experts about what was going on in his mind, they will decide whether he is not guilty by reason of insanity. They will have their own subjective reactions to the experts and the evidence. Maybe they will believe that his psychological condition negates guilt. Or maybe they will believe experts providing testimony that his bizarre behavior and his abnormal background are typical of a psychopath or sociopath who is incurable and who will always act against society. Even if jurors believe the latter, the expert testimony is still important to the criminal process; at the sentencing phase, it might provide a basis for mitigation. And in the end, that might make the difference between life and death. Rona M. Fields is a clinical and forensic psychologist who has written books on torture, terrorism, and the effects of social violence on children. Her newest book is Martyrdom: The Psychology, Theology, and Politics of Self Sacrifice (2004).

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