Trial of alleged Fort Hood shooter renews call for restraint

One year ago this month, after the theater shooting in Aurora, Colo., I wrote a column for this newspaper headlined, “The Aurora Shootings: Why the Mental Health Community Must Show Restraint.” In this column, I talked about the risks inherent in offering public comments about a defendant’s mental state and about Section 7.3 of the American Psychiatric Association’s Principles of Medical Ethics, which state:

“On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself or herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general.

However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

This section, also known as the Goldwater Rule, was created prior to the invention of the Internet and social media. Modern digital communication now has the power to transmit off-the-cuff, casual comments globally. Mental health professionals must practice additional care about making unwarranted or unsupported statements about individuals in the public eye whom they’ve never met or examined. This is particularly true for those facing trial, where freedom or even life itself may be at stake.

Three months after my column, the APA Assembly voted unanimously to accept an action paper urging the organization to update and amend Section 7.3 to include a discussion and cautionary statement regarding the impact of public commentary on the criminal prosecution, sentencing, and suicide risk of individuals charged with high-profile crimes.

This amendment is not made lightly or without careful consideration. Those making public statements about a criminal defendant have often not had the opportunity to review information available to an expert witness. When making a decision about sanity or the presence of mental illness, a forensic psychiatrist typically reviews a lengthy list of information sources: medical records, investigation and other police reports, witness statements, crime scene photos, surveillance videos, medical examiner’s reports, audio tapes of 911 calls, interrogation transcripts or videotapes, school records, jail or prison treatment records, criminal history reports, Internet search histories, social media content, cell phone records, and text messages.

In addition, a pretrial evaluation would include an interview with the defendant, his friends and family or co-workers, witnesses, investigating officers and the victim, if living.

Considering this, I was dismayed to see this tweet by APA President Jeff Lieberman come across my APA twitter feed:

“Fort Hood shooter is an ideological zealot, not mentally ill as originally claimed.”https://twitter.com/drjlieberman/status/363290629696409600

The tweet included a link to a Reuters story http://www.reuters.com/article/2013/07/27/us-usa-crime-forthood-idUSBRE96Q0B120130727 that relied upon a Fox News report. Fox released quotes from a six-page statement sent to the service by alleged Fort Hood shooter Major Nidal Hasan. Hasan reportedly did not discuss the offense directly in this letter. Nevertheless, Dr. Lieberman relied upon this 274-word press release from a secondary source to globally express a professional opinion about a defendant whose trial begins this week. If convicted, Hasan could face the death penalty.

I would urge mental health professionals to be mindful of the limitations of publicly available information, which is likely to be incomplete or may even be inaccurate.

<[QM]>—Annette Hanson, M.D.

Dr. Hanson is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson's employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.

One year ago this month, after the theater shooting in Aurora, Colo., I wrote a column for this newspaper headlined, “The Aurora Shootings: Why the Mental Health Community Must Show Restraint.” In this column, I talked about the risks inherent in offering public comments about a defendant’s mental state and about Section 7.3 of the American Psychiatric Association’s Principles of Medical Ethics, which state:

“On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself or herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general.

However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

This section, also known as the Goldwater Rule, was created prior to the invention of the Internet and social media. Modern digital communication now has the power to transmit off-the-cuff, casual comments globally. Mental health professionals must practice additional care about making unwarranted or unsupported statements about individuals in the public eye whom they’ve never met or examined. This is particularly true for those facing trial, where freedom or even life itself may be at stake.

Three months after my column, the APA Assembly voted unanimously to accept an action paper urging the organization to update and amend Section 7.3 to include a discussion and cautionary statement regarding the impact of public commentary on the criminal prosecution, sentencing, and suicide risk of individuals charged with high-profile crimes.

This amendment is not made lightly or without careful consideration. Those making public statements about a criminal defendant have often not had the opportunity to review information available to an expert witness. When making a decision about sanity or the presence of mental illness, a forensic psychiatrist typically reviews a lengthy list of information sources: medical records, investigation and other police reports, witness statements, crime scene photos, surveillance videos, medical examiner’s reports, audio tapes of 911 calls, interrogation transcripts or videotapes, school records, jail or prison treatment records, criminal history reports, Internet search histories, social media content, cell phone records, and text messages.

In addition, a pretrial evaluation would include an interview with the defendant, his friends and family or co-workers, witnesses, investigating officers and the victim, if living.

Considering this, I was dismayed to see this tweet by APA President Jeff Lieberman come across my APA twitter feed:

“Fort Hood shooter is an ideological zealot, not mentally ill as originally claimed.”https://twitter.com/drjlieberman/status/363290629696409600

The tweet included a link to a Reuters story http://www.reuters.com/article/2013/07/27/us-usa-crime-forthood-idUSBRE96Q0B120130727 that relied upon a Fox News report. Fox released quotes from a six-page statement sent to the service by alleged Fort Hood shooter Major Nidal Hasan. Hasan reportedly did not discuss the offense directly in this letter. Nevertheless, Dr. Lieberman relied upon this 274-word press release from a secondary source to globally express a professional opinion about a defendant whose trial begins this week. If convicted, Hasan could face the death penalty.

I would urge mental health professionals to be mindful of the limitations of publicly available information, which is likely to be incomplete or may even be inaccurate.

<[QM]>—Annette Hanson, M.D.

Dr. Hanson is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson's employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.

One year ago this month, after the theater shooting in Aurora, Colo., I wrote a column for this newspaper headlined, “The Aurora Shootings: Why the Mental Health Community Must Show Restraint.” In this column, I talked about the risks inherent in offering public comments about a defendant’s mental state and about Section 7.3 of the American Psychiatric Association’s Principles of Medical Ethics, which state:

“On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself or herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general.

However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

This section, also known as the Goldwater Rule, was created prior to the invention of the Internet and social media. Modern digital communication now has the power to transmit off-the-cuff, casual comments globally. Mental health professionals must practice additional care about making unwarranted or unsupported statements about individuals in the public eye whom they’ve never met or examined. This is particularly true for those facing trial, where freedom or even life itself may be at stake.

Three months after my column, the APA Assembly voted unanimously to accept an action paper urging the organization to update and amend Section 7.3 to include a discussion and cautionary statement regarding the impact of public commentary on the criminal prosecution, sentencing, and suicide risk of individuals charged with high-profile crimes.

This amendment is not made lightly or without careful consideration. Those making public statements about a criminal defendant have often not had the opportunity to review information available to an expert witness. When making a decision about sanity or the presence of mental illness, a forensic psychiatrist typically reviews a lengthy list of information sources: medical records, investigation and other police reports, witness statements, crime scene photos, surveillance videos, medical examiner’s reports, audio tapes of 911 calls, interrogation transcripts or videotapes, school records, jail or prison treatment records, criminal history reports, Internet search histories, social media content, cell phone records, and text messages.

In addition, a pretrial evaluation would include an interview with the defendant, his friends and family or co-workers, witnesses, investigating officers and the victim, if living.

Considering this, I was dismayed to see this tweet by APA President Jeff Lieberman come across my APA twitter feed:

“Fort Hood shooter is an ideological zealot, not mentally ill as originally claimed.”https://twitter.com/drjlieberman/status/363290629696409600

The tweet included a link to a Reuters story http://www.reuters.com/article/2013/07/27/us-usa-crime-forthood-idUSBRE96Q0B120130727 that relied upon a Fox News report. Fox released quotes from a six-page statement sent to the service by alleged Fort Hood shooter Major Nidal Hasan. Hasan reportedly did not discuss the offense directly in this letter. Nevertheless, Dr. Lieberman relied upon this 274-word press release from a secondary source to globally express a professional opinion about a defendant whose trial begins this week. If convicted, Hasan could face the death penalty.

I would urge mental health professionals to be mindful of the limitations of publicly available information, which is likely to be incomplete or may even be inaccurate.

<[QM]>—Annette Hanson, M.D.

Dr. Hanson is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson's employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.