Originally posted by mes1955:
I believe that mental health diagnoses become complicated by various factors, a big one being drug usage. It is my understanding that it would be very difficult to profile an individual whose behaviors have been influenced by use of drugs and/or alcohol. There are indications that the use of substances may be an issue here, which throws the typical "slotting" out the window.
I fully agree and own my bias about the need for skilled substance abuse
assessment in every mental health evaluation, and certainly in every
forensic evaluation. (If this seems overstated, I'll gladly defend my position.)
But there is a ubiquitous problem of accurate substance abuse assessments
when interview or SA surveys are the only data. What is offered in the
Casey Anthony case, however, is direct, photographic observation of the effects of substance abuse, as well as the reports of significant others,
both of which are more reliable than self-report in a substance abuser.
There is a tendency for objective personality results to be contaminated by
the neuropsychological effects of post-acute substance withdrawal (during the first 3-4 months abstinence), but so are our direct observations.
For example, while most characteristics & behaviors seem relatively stable,
we can observe a dramatic difference in KC's emotional lability in the
July/August jail-family visits versus 1/08 Court appearances, which
may be associated with post-acute substance withdrawal. Also, her
loading on "snacks", especially chocolate, (frequently mentioned by NG)
is common in post-acute substance withdrawal. Thanks for calling attention to this often overlooked problem in evaluation.
I, too, cringe when questions about mental health evaluations form the basis for an overly-subjective gossip fest. But, I do look forward to sharing
information and learning from others in our mutually respectful and
objective effort to understand what has become an incredibly perplexing
and compelling psycholegal problem.