Understanding Oscar's evaluation

2014-06-30 18:02
(Daniel Born, The Times)

(Daniel Born, The Times)

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Cape Town - A month-long mental assessment of Oscar Pistorius has concluded that he was not suffering from mental disorder or defect the night he shot and killed Reeva Steenkamp.

But how do doctors reach their conclusions? News24 finds out.

Psychiatric assessments are often used by courts to determine whether or not a defendant was mentally able to tell the difference between right and wrong when they committed a crime.

Judge Thokozile Masipa ordered a panel of mental health experts to assess Pistorius’s mental state and establish whether he was “capable of appreciating the wrongfulness of his act or acting in accordance with appreciation of the wrongfulness of his act” when he pulled the trigger.

Here’s how doctors conduct their assessments:

Evaluation of the individual

Dr Saths Cooper, president of the International Union of Psychological Science, said: “The most important thing to do is start with a complete make-up of the individual”.

This will involve interviewing the patient to make a full assessment of the individual’s responses, attention, demeanour, how they respond to issues and how they respond to stressful situations.

According to PsychCentral, interviews will include questions about a person’s personal and childhood history, recent life experiences, work and school history and family background.

Much can also be learnt from a person’s general appearance and speech – how they take care of themselves, present themselves and communicate to the interviewer.

Medical past

Doctors will also look at an individual’s physical condition, and whether it is causing or worsening a mental condition.

As the Merck Manual for health care professionals states: “In addition to having direct effects [such as symptoms, including mental ones], many physical conditions cause enormous stress and require coping mechanisms to withstand the pressures related to the condition.

“Many patients with severe physical conditions experience some kind of adjustment disorder, and those with underlying mental disorders may become unstable”.

Doctors will look at personal and family medical history.

Focus on the crime

During the evaluation, doctors will also concentrate on two important points connected to the crime.

Firstly, the doctor will seek to determine whether the accused person understands the charges brought against them, and the proceedings related to those charges.

Secondly, the doctor will be looking to see if the accused suffered from a mental disorder at the time – did they understand what they were doing and if it was wrongful.

To establish this, Cooper said the psychologist would “take the person to the event [in an interview] and make their determination based on the responses”.

Keeping patients under observation

Evaluating a person’s mental health is “very subjective”, said Cooper. Which is why people are often assessed over a long period in a medical institution – a whole month in Pistorius’s case.

“There are often things that emerge from time to time, but may not be obvious at first,” said Cooper.

The patient will also be assessed on the basis of his or her interaction with staff, and by how they react to the confined space and loss of freedom.

“It does impose a certain constraint and that in itself will put stress on the individual,” said Cooper.

Pistorius, however, was an out-patient and was not kept under watch 24/7 - which meant that staff were not able to observe him at night, Cooper pointed out.

Doctors would, therefore, been unable to see how Pistorius might have reacted to staff at night, what his sleep patterns were, if he suffered from nightmares and so on.

A panel of three psychiatrists and a clinical psychologist observed the murder-accused athlete for 30 days at Weskoppies Psychiatric Hospital.

Pistorius had to attend the hospital for observation between 09:00 and 16:00 Monday to Friday.

Summarising the findings of the panel at the North Gauteng High Court in Pretoria on Monday, prosecutor Gerrie Nel said: “The panel has provided reports and they will be handed over to the court. A mental disorder did not affect his ability to distinguish between right or wrong”.
Read more on:    gerrie nel  |  reeva steenkamp  |  thokolize masipa  |  oscar pistorius  |  pretoria  |  pistorius trial

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