Phenomena and topics of significance in forensic psychiatry Amnesia

Amnesia is important in forensic psychiatry because it is commonly encountered and often requires exploration in the assessment and treatment of offenders. Its medico-legal status is less significant; in the United Kingdom, amnesia provides grounds neither for unfitness to plead nor the insanity defence. It is most commonly encountered in crimes of violence; commonly at least 25 per cent of those charged with homicide claim amnesia for the offence. Persistence of the claim is considerably varied.

Taylor*!52) provides a comprehensive review and identifies four common factors associated with amnesia:

• violent crime, when perhaps due to extreme emotional arousal, may also affect victims and eye-witnesses

• extreme emotional arousal, particularly in the unpremeditated homicide of wife, lover, or other family member

• alcohol abuse or intoxication, particularly in cases where the victim is not previously known to the assailant

• depressed mood, though not necessary depressive disorder, is often present for some time prior to the offence.(!53)

Amnesia may be present in association with various psychiatric and physical conditions; the temptation to divide these into organic, dissociative, and malingered is appealing but leaves little room for the overlap between them which is common. Amnesia in association with organic brain disease in offenders is rare. It can occur after head injury, or in association with epilepsy, hypoglycaemia, or other causes of organic transient memory loss (e.g. a toxic state). Dissociative amnesia or a dissociative fugue (in which there is an inability to recall one's past) are occasionally seen in offenders; when present they are unlikely to account for the offence but rather to develop after its commission.

The thorny issue of distinguishing authentic (dissociative) amnesia from the malingered version is unresolved and unresolvable. The line between unconscious dissociative amnesia and its feigned opposite is indistinct. Strenuous efforts to diagnose one or the other in offenders have, at least for British psychiatrists, little purpose. Both may serve a useful function in enabling a pretrial defendant to cope with emotional trauma, but neither will affect a finding of guilt. Detailed exploration of these cases is normally only feasible after conviction and during detention in either hospital or prison. Collateral information from independent sources is crucial in reaching conclusions.

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