The case of Anders Behring Breivik - language of a lone terrorist.

Anders Behring Breivik carried out a massacre in Norway on July 22, 2011, killing a total 77 persons and leaving 42 others severely wounded. He detonated a bomb in Oslo and then drove to the island of Utøya, where he shot and killed youngsters gathered at a youth camp. The authors performed an analysis of Breivik's writing style in his extensive manifesto which he published hours before the attacks, and also referred to the two psychiatrists' reports. The first report concluded that he suffered from paranoid schizophrenia. The authors concurred with the second report. Breivik seemed to be a person with narcissistic personality disorder, whose grandiosity might have caused him to be regarded initially as mentally deranged; however, closer examination revealed his deliberate attempt to methodically indoctrinate and deceive potential readers, to alarm potential targets and to terrorize a nation.

The forensic and legal implications of water, wet, or fry.

Embalming fluid applied to marijuana cigars or cigarettes, with or without the addition of phencyclidine (PCP), has several names, such as water, wet, illy, and fry. Individuals who commit crimes under the influence of this substance are often violent and may appear psychotic, with symptoms resembling schizophrenia or delirium. Currently, there are no case reports or case law involving the use of this substance. Wet may impair one's competency to stand trial (CST). The authors present a composite case of a man who abused wet for three years and had been sober for three months when he presented for a CST evaluation. The authors posit that individuals who use wet may raise settled (fixed) insanity or defenses of not guilty by reason of insanity in the future.

Survey of forensic mental health experts on pro se competence after Indiana v. Edwards.

In Indiana v. Edwards (2008) the U.S. Supreme Court held that a higher standard may be required for pro se competence (PSC) than for competence to stand trial (CST), but provided little guidance for the trial court judge. This survey of forensic mental health experts studied potential PSC criteria. Sixty-eight (22.7%) forensic evaluators replied. Three McGarry criteria were reported as requiring a much higher standard for PSC: to appraise the available legal defenses (45.6%), to plan a legal strategy (51.5%), and to question and challenge witnesses (44.1%). Sixty percent agreed that standby counsel should be mandatory. Respondents opined that average abilities were sufficient for intelligence (77.9%), literacy (69.1%), and verbal ability (70.6%) were sufficient. PSC examiners may wish to assess appraisal of available legal defenses, planning a legal strategy, and questioning and challenging witnesses for a higher standard than CST. Evaluators should also assess the defendant's willingness to accept standby counsel (SBC) and the defendant's motivation for attempting a pro se defense.

A pilot survey of trial court judges' opinions on pro se competence after Indiana v. Edwards.

In Indiana v. Edwards, the U.S. Supreme Court held that a higher standard may be required for pro se competence (PSC) than for competence to stand trial (CST). However, the Court refrained from elaborating a specific standard. The trial judge is in the best position to make more fine-tuned mental capacity decisions. This pilot study surveyed trial judges' opinions about PSC to help forensic evaluators structure their assessments. Eighteen of 400 New York State trial judges surveyed replied. Trial judges regarded disorders of cognitive impairment (n = 10) and psychosis (n = 4) to be potentially limiting for PSC. Responses relating to which domains should be assessed were heterogeneous, but the most common were intellectual and analytic abilities (n = 10), legal knowledge/experience (n = 9), and language abilities (n = 8). Several judges listed factors that are not traditionally part of CST evaluations, such as having a rational reason for proceeding pro se and a willingness to accept the assistance of standby counsel.

Psychiatric and clinical sequelaeof delirium and competenceto stand trial.

We present the case of a middle-aged defendant who had been incarcerated in a county jail and housed on the mental health unit. It was documented that he had been exhibiting fluctuating levels of alertness and responsiveness. The writers saw him in a forensic capacity, to conduct an evaluation of his competence to stand trial, and recognized that he was having a medical emergency, delirium that was most likely due to brain metastases from inoperable advanced cancer. We recommended an immediate transfer to a medical facility for treatment. The article serves to present an interesting case and to highlight the need for clinical vigilance despite the usual goal of an objective, noninterfering forensic role.