by Antoinnette Borbon
In an admission by the prosecution’s witness from the Heritage Oaks Hospital, a Sacramento psychiatric facility, jurors would learn Daniel Marsh never expressed any homicidal thoughts or ideations to Dr. Joseph Sison, who evaluated Daniel while the defendant was in the facility.
But, instead, Dr. Sison, in his lengthy testimony, would repeatedly blame the habitual use of marijuana as a possible cause of agitation and aggression in Marsh.
Daniel Marsh is accused of taking the lives of the elderly couple, Oliver Northup and Claudia Maupin, back in April of 2013, in their Davis home.
Dr. Sison repeatedly stated, “I have never liked marijuana being legal, I do not understand why it is legal, it should be illegal.”
He was asked by Assistant Chief Deputy District Attorney Mike Cabral to go through the report he had written while young Daniel Marsh was in the Heritage Oaks facility.
He began with the first meeting with Marsh on December 13, 2012. He said, “Daniel was reclusive, withdrawn, depressed, but was still able to engage, to talk about his feelings.” He stated, “Most kids cannot do that, but Daniel was able to tell me he wanted help, he wanted to feel better, he was focused on feeling better.” He stated, “Daniel was insightful.”
The doctor explained how Daniel was able to express, “I’m just very depressed, haven’t been happy in awhile, just fed up, feeling more and more depressed.”
Daniel was able to tell Dr. Sison that he suffered from emotional abuse by his father and talked about the haunting effects of being bullied at school. He stated to Dr. Sison, “I am angry at school, abused by family members and having suicidal thoughts, feeling very depressed.”
At one point Marsh told the doctor, “If you lived my life, you would know what I mean.” Dr. Sison went on to explain how the evaluation process is done. He said Marsh talked about some of his family members who suffer from schizophrenia, bi-polar and emotional disorders.
Sison said during the evaluation there are several tests they do to be able to assess the patient, to better treat them. He stated, “Daniel had linear thinking and appeared to be have a quiet affect, but was responsive and a lot of kids are not. He had no lucid associations, no threats to harm anyone, just very depressed with suicidal thoughts.” The doctor stated, “But I do not know Daniel enough to know his past, don’t know how he grew up or how those things affected him.”
He said Marsh appeared to be thinking clearly and was able to express his emotions.
Dr. Sison stated, “Daniel talked about smoking marijuana to feel better and was on Prozac for about 8 months but said it did nothing for him.”
The doctor once again asserted, “I personally feel cannabis should be illegal…I try to educate my patients on the use of cannabis people use to feel better, but it can cause permanent distress later on in life, it should not be legal.”
Mr. Cabral then asked the doctor, “So, what about psychotic thoughts?” He replied, “Daniel talked about suicidal thoughts, emotions and wanting to feel better, but no psychotic thoughts.”
He said his diagnosis was severe depression with suicidal thoughts. The doctor stated, “Daniel was compliant, responsive to answers and engaging in conversation, just having a feeling of hopelessness, but did talk about how music helped him cope.”
Marsh was cognitive, showing no flatness of affect, the doctor stated, which was good.
But he did assert that he did not know what Marsh’s level of coping was, since he had no history of his past. The doctor stated that the coping mechanisms are affected by several things and he did not know about Marsh’s level.
He said he started Marsh on a small dose of Zoloft and then, after talking with Marsh a few more times, he increased the levels to 100 ml. He stated, “Daniel was feeling better, not having suicidal thoughts but appeared to be restless right before he was supposed to have a family meeting. Daniel expressed being nervous but I was not sure if it was due to seeing family or the medicine.”
Dr. Sison said Marsh was also taking 75 ml of Seroquel. He stated that he had not been able to contact the family on occasions, but did speak with the mom and got her consent to give him the medicine.
The doctor said he felt Marsh to be an insightful kid and, as the days passed, he became more engaging, getting different types of therapy while inside the facility. He felt the medicine was helping Marsh, but he said, “I did tell Daniel about the side effects of Zoloft, how it can cause aggression, psychosis.”
Mr. Cabral asked, “So, you didn’t hear/see any threats to hurt others?” “No, no discussions of threats, he actually felt relieved, wanting to talk more, became engaged more,” answered Dr. Sison.
Although the doctor did admit that Marsh had expressed having ongoing nightmares where he harmed others, he mostly wanted to hurt himself. Dr. Sison said he did not know if it was from the medication. He felt he tolerated the medicine well with no side effects.
He stated, “Daniel had haunting by traumatic events of peers taunting him, but no aggression at all, just severely depressed.”
After being on Zoloft for a few days, the doctor said Marsh was “feeling much better, feeling optimistic, not wanting to hurt himself anymore” and told the doctor, “I know I don’t want to die, I want to feel better.”
Marsh told the doctor he thought the medicine made him feel better, although he was nervous about meeting his family. The doctor said Marsh was even sleeping better and doing very well in therapy, engaging in group sessions with other children.
It was time to read the discharge summary. Dr. Sison said by the 18th of December, Marsh was even smiling, and was ready to go back home. He wanted Marsh to do follow-up care at Kaiser. But he stated he did not see any notes or recommendations from the social worker within Marsh’s file.
As cross-examination began, the defense counsel would bombard the witness with questions of Marsh’s history and whether Dr. Sison had read any prior reports, of Marsh’s previous stay at Alta Bates and other hospitalizations.
The doctor stated, “No, I did not, I spoke with the patient.”
“How did you develop the history of Daniel? quizzed Deputy Pubic Defender Ron Johnson. “I got some information from the emergency room notes, from the patient and some from the mom,” he replied.
“So which previous doctors did you talk to?” asked Johnson. “Oh, I didn’t talk to any of them,” the doctor answered.
“And you thought just from hearing from mom that he had only been on Prozac 8 months?” Johnson asked. “Yes,” the doctor replied.
“So, you never read Kaiser reports, or any others from doctors?” Mr. Johnson inquired. “No, It was Daniel who told me he took Prozac but it did nothing,” he answered.
The defense counsel asked him if he had known about Marsh’s wanting to harm others from other reports but the doctor repeatedly stated he never consulted with any doctors from Kaiser or other facilities.
Dr. Sison said his information was “self-reported.” Johnson asked, “So let me summarize this, you base your opinion on self-reporting? And not any other evidence from all the reports written by Daniel’s doctors, the ones who know the patient?”
The doctor seemed to begin to answer the defense’s questions with a bit of a stutter, “Um…well…I…I…evaluate while patients are in the hospital, I don’t have a disbelief of my patients.”
Mr. Johnson asked the doctor if he ever tried to contact the other facilities. He told Johnson he did, but could never reach them.
Dr. Sison explained to the defense that it takes a long time to get medical records. He said Marsh’s information was not available at the time.
Johnson asked, “What if you’d heard from Alta Bates Daniel had a disassociation state? What if you knew he had graphic thoughts of hurting someone?”
The doctor responded, unaware of what the defense was talking about. “What’s a dissociative state?” the doctor asked, appearing aloof.
Defense inquired into the side effects of certain drugs and whether the doctor knew of Daniel having any. The doctor said if he had known of any side effects, he would have changed the drugs.
He stated, “It is through trial and error that we learn what works on a patient.”
Dr. Sison explained to the defense that he had gained knowledge via the same website as the defense in regard to medicines and other articles written about the effects of them.
He openly admitted, however, that he does not have any knowledge of the recent journal articles written by doctors in other countries.
Johnson asked the doctor if he knew the difference between drug effects on a child’s brain versus an adult’s. The doctor said he did.
Johnson asked the doctor to explain the Black Box warning. Dr. Sison stated that it was a warning of side effects from the FDA, a safety precaution.
The defense asked about a type of “akathisia,” a feeling of restlessness or that one is crawling out of one’s skin, and which may be a side effect from some medications. Marsh had been having those sensations but the doctor stated he felt it could have come from being anxious, nervous to see his family.
Once again, the doctor repeated, “Cannabis was used every day, and those with mental illness, unless prescribed, can get worse, it really kills off a lot of neurons in the brain. Again, I feel it should not be legal.”
DDA Cabral asked about any threats made by Marsh, and if he had heard any would he report them. “Yes, I have to report to authorities and to the person, but…I really do not like breaching patient confidentiality, I really don’t and I did not want to be here but was told I could be arrested.” Laughter broke out in the courtroom.
“I really want to help my patients through educating them, and not break confidence unless I have to,” stated Dr. Sison.
Ending the day with the last re-cross, the defense asked, “Side effects that occur, can they happen five days after discharge?” “Yes,” replied Dr. Sison. He said Marsh could feel restless, with agitation and aggressive behavior.
Cabral asked, “If you were told Daniel liked to watch violence and gore, would you form an opinion?” The doctor answered, “Yes, but you have to look at data, and some is not accurate…some kids can play violent video games and watch violence and have no effects, others it can be different, a lot of data must be researched.” He stated, “Some kids appear to be fine, having no symptoms of depression or aggression and will commit suicide…you just don’t know.”
Update: The Vanguard has been unable to verify with the author whether this treating physician was qualified as a expert witness with the Court, so is correcting this article to reflect that Dr. Sison was not an expert witness. We apologize for the confusion.
This is an abridged summation of Dr. Sisson’s testimony. Note that qualifier.
Dr. Sission can confidently expect that he will not be called as an “expert witness” again anytime soon. His editorial comments on the legal/social/political aspects of marijuana consumption should never have been volunteered. He’s supposed to be a Man of Science, and confine his expert opinion to that specialty. His comments there invite the suspicion that his analysis was biased. I’ve accepted the invitation.
Sission got properly skewered for his failure to thoroughly research past medical history, instead relying on the comments of a patient under a program of behavior and thought altering medication. Correction, Daniel might have been medicated. Nowhere is their mention or questions and answered on the ingestion of these medications, including marijuana. Tia will confirm that patients are not always reliable in conforming to a prescribed medication program, particularly patients in emotional/mental crisis.
Marijuana made Marsh more agitated and aggressive? And here I always thought grass was a downer, taken to mellow out. Maybe the combination of the drugs produced this affect. Confusing.
All this is a sidebar story anyway. Marsh cannot claim his meds (legal and illegal) caused him to commit the murders. Well, he can, but it does not remotely suffice for an acquittal verdict.
good summation.
the question is whether marsh was legally sane, not the doctor’s opinion of marijuana. i’m really stunned that the da’s office would allow this kind of testimony.
Mr. Coleman, have you ever read the Journal of Neuroscience?
While this doctor may take a position that is not PC, recent research from Northwestern Medicine® and Massachusetts General Hospital/Harvard Medical School has shown that even casual use can alter the brain of teenagers.
I’m sure this will get poo-pooed in Davis. Several years ago I read I believe a German study which revealed that heavy marijuana usage can reduce a teenagers IQ by up to ten percent. And having met with a PhD in Psychology, I’ve heard first hand about how such a drug can interfere with the connections being made in the young brain, as well as “higher level” functions. (Any doctors here can correct me if I have used the wrong terminology.)
I am not arguing that marijuna use caused the murders, but I don’t think such self-medicting is a positive, and I think the complex interaction between patient, and prescribed drugs, becomes even more complex when you add in the factor of daily THC.
Article: CASUAL MARIJUANA USE LINKED TO BRAIN ABNORMALITIES
First study to show effects of small time use; more “joints” equal more damage
” ‘This study raises a strong challenge to the idea that casual marijuana use isn’t associated with bad consequences,’ said corresponding and co-senior study author Hans Breiter, M.D. He is a professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine and a psychiatrist at Northwestern Memorial Hospital.”
“Scientists examined the nucleus accumbens and the amygdala — key regions for emotion and motivation, and associated with addiction — in the brains of casual marijuana users and non-users….
“…Both these regions in recreational pot users were abnormally altered for at least two of these structural measures. The degree of those alterations was directly related to how much marijuana the subjects used….”
“A recent Northwestern study showed chronic use of marijuana was linked to brain abnormalities. “With the findings of these two papers,” Breiter said, “I’ve developed a severe worry about whether we should be allowing anybody under age 30 to use pot unless they have a terminal illness and need it for pain.”
– See more at: http://www.northwestern.edu/newscenter/stories/2014/04/casual-marijuana-use-linked-to-brain-abnormalities-in-students.html#sthash.hIQmcUwd.dpuf
Those of us who work with the mentally ill have regularly seen young adults who have had a first psychotic episode in association with marijuana use. Many physicians and other clinicians in this field share Dr. Sisson’s views about the ill effects of marijuana on growing brains.
Thank you for giving some validation to my somewhat recent education (in life) re: marijuana use. I have taken part in trying to steer a young person away from a strong marijuana habit, plus whatever other “goodies” come down the pike, but it has been extremely frustrating. It seems to be quite common that the kids are using multiple drugs, legal and illegal: ADHD / mood meds, marijuana, nicotine, red bull / forloco, booze and / or molly (ecstasy).
Many of the parents I have seen seem to be enablers / Egyptians (they live in de-Nile), paying for life’s luxuries (iPhone, car, clothes) while the kids blow their money on drugs while severely under-performing in high school. Several have chalked this up to “normal high school experimentation”, but it seems a few steps up from what I remember.
I am extremely disappointed in our President tacitly OK’ing pot use, while dodging the question about his not wanting his daughter’s to lite up. Our “brilliant” President mist not know the Hippocratic oath: first, do no harm.
My hope is that the recent Harvard study will spur numerous new studies.
http://www.ncbi.nlm.nih.gov/pubmed/18482435
There is a growing body of scientific literature linking marijuana use to the development of psychosis, bipolar disorder and schizophrenia.
I have read about this, and was informed of this by a local PhD / psychiatrist.
I’d like to know what kind of structure this young man had. Did he have a job, chores, responsibilities, or was he navel-gazing 18 hours a day?
@Phil…clarify, “a sidebar story,?” please….and yes, if we wrote everything, it would be way too long…I try to put the most important stuff, interesting things, facts, evidences…etc…but avoid summaries…or opinions although, indirectly may exhibit some still? Personality hazard…lol
I like to write in more of a dialogue form as to give my audience an idea of what went on, or is going on…but, never claimed to be any seasoned journalist…not me, I’ll leave to the pros…( David, Sac Bee, Enterprise, News10…etc..)
Appreciate the feedback…
Daniel seems to know exactly what to say to the psychiatrists and psychologists. The difference in what he relates to his friends and what he relays to professionals illustrates a high level of sophistication and ability to manipulate others. I really wonder if we are dealing with a true psychotic – pure evil in the body of a child. We can focus on his care (or lack of care), but we must not lose track of the criminal and his crime. He’s saying that he couldn’t help himself, but he certainly has demonstrated a high level of self-control in his dealings with doctors and mental health professionals. Telling him that a particular drug might have the same side effects that he was already experiencing without drugs (which he failed to mention) gave him an out.
I also don’t buy the marijuana theory. Ludicrous.
Ryan, what one says to your friends and what one says to your doctor are quite different things. The conversations are different – the questions asked by a psychiatrist are not like the ones your friends ask you. The conversations he may have had in school would have looked quite different than those he had with his friends, and it would be correct to say that he “knew” exactly what to say to the teachers. The testimony provided in the article doesn’t prove anything of the sort of what you are claiming. People who are psychotic may show behaviors that to observers may be quite intentional and logical but may be the product of grandiose delusions or other types of psychotic beliefs. Although the Unabomber’s actions were amazingly deliberate and carefully carried out, the expert called in the case found him to have delusions and paranoid beliefs, and fit the criteria for Schizophrenia, Paranoid Type.
“Daniel seems to know exactly what to say to the psychiatrists and psychologists. The difference in what he relates to his friends and what he relays to professionals illustrates a high level of sophistication and ability to manipulate others. ”
I think that’s pretty accurate.
“I really wonder if we are dealing with a true psychotic.”
I think you mean sociopath rather than psychotic.
Yes, that’s right, David. A sociopath.
Def. of psychotic: having or relating to a very serious mental illness that makes you act strangely or believe things that are not true.
Def. of sociopath: someone who behaves in a dangerous or violent way towards other people and does not feel guilty about such behavior
Someone who is psychotic might not have violent tendencies toward others and it is unfair to place Daniel in the same grouping with people who are suffering from that particular type of mental illness.
I’m not sure there is a clinical difference, but the term which I think applies in the case of Marsh is psychopath, not sociopath.
Wikipedia has a full explanation of what psychopathy entails, and explains how some distinguish sociopathy and psychopathy:
http://en.wikipedia.org/wiki/Psychopathy
the two are used interchangeably and psychopath has fallen into disuse mainly because of the confusion between psychopath and psychotic.
DP, yes, that is what one writer, Robert Hare expressed in a book in 1999, and it notes that in the Wikipedia entry. However, Hare also noted a distinction of origins in how the two terms are often used. From Wikipedia:
“Hare contended that the term sociopathy is preferred by those that see the causes as due to social factors and early environment, and the term psychopathy preferred by those who believe that there are psychological, biological, and genetic factors involved in addition to environmental factors.”
In other words, the behavior of the sociopath and the psychopath may be the same–using Hare’s origins theory–but if you call someone a sociopath, whose behavior and thoughts are like those expressed by Marsh, according to witness testimony at least, you are probably thinking he became that way due to “social factors and early environment.” My own view, based on the reading I have done (in layman’s journals) regarding neurobiological science, is that, while social factors can play a small role, the primary cause of this thinking and behavior is biological, with genetics playing a significant role. In other words, if Hare’s distinction of the terms is used, I prefer the term psychopath for those who harm others, even enjoy harming others, and feel no remorse at all, even lacking any ability to sympathize.
interesting since hare is basically my knowledge on the subject.
In forensic psychiatry and psychology the term psychopath is considered a descriptive or diagnostic term. I think Rich’s description from Bob Hare is accurate. And these days, psychopathy is often (too often some would say) is defined as the score on Hare’s scale – the Psychopathy Checklist – Revised. The Wikipedia description is a good description and also provides some of the current debate about the use and misuse of the term psychopathy. Many forensic experts these days are leary of labeling someone a psychopath because of the power of the term and the way it is used in the media and film – from Silence of the Lambs to This American Life’s having it’s staff all take the PCL-R.
I don’t think it was central, but it played a big role in his self-medication, partying, however you choose to define it. And we have clinical proof (recent) that it causes changes in the brains of teenagers. (See above article and link.)
I’d like to hear more about this “emotional abuse” inflicted by his Father. Was he a real tyrant to him? Or did he ask him to do chores, get a job, stop getting high, and get going with his life?
We also don’t know, yet, how many times this doctor called the previous doctors. If those doctors were unresponsive, that makes it more difficult to try to paint him as the bad guy. The Mother should have been able to communicate a decent summary of what had transpired in the past, which would be instructive.
This kid was already on at least two prescribed drugs, adding a 3rd unregulated drug to the mix which is proven to change the teenage brain in several ways is a dangerous addition.
RyanKelly……interesting, you have a valid point…I am intrigued with this case on many levels…far beyond what I expected.
Appreciate the comments…
Phil wrote:
> I always thought grass was a downer, taken to mellow out
If a group of aging boomers smoke out most of them will mellow out, but pot has a different effect on many young kids (both boys and girls). I’m no expert on the subject but growing up in the 70’s lots of kids started smoking pot at very young ages (I had a hippie babysitter get me stoned for the first time at 10). If a group of young adults gets stoned they probably won’t head out to break in to schools, ride their BMX bikes inside homes under construction or ride BMX bikes on the roofs of local business, but this was common behavior for stoned 14 year olds in the 70’s. Smoking a lot of pot as a young kid also really messes people up (every kid I know who was a daily pot smoker in Junior High failed to graduate from college)…
If a student is spending a lot of their time stoned (getting marijuana, finding a place to smoke it, having fun when on it, etc.), then likely they are not studying, so poor academic performance can be typical. However, there are many Davis kids who smoke to battle symptoms of stress and do fine. (They also use other drugs that allow them to maintain their focus during long hours of studying.) None that I know of experience aggression and homicidal thoughts as a result of consuming marijuana.
i have never seen a case where marijuana has caused aggression and i’ve worked in the judicial system for more than three decades.
SOD, my understanding is that marijuana use is starting much younger, and patters are set by college.
Marijuana today is also much stronger than it was in the 1970s (although some have overstated by how much). The amounts of THC in a joint, bong, or pipe is much higher. In addition, there is a new rage in some circles to “dab” or “wax”; I’m told it is similar to smoking hash, and the kids use a Butane lighter to heat the substance (wax) to 5,000 degrees to get an immediate, powerful high.
Davis Progressive: I don’t think we have any idea, we are only now starting to really even measure driving while stoned (impaired), and those figures have shown a 300% increase in accidents / violations. I’ve also heard that the young man in Furgeson may have been high on marijuana, so your anecdote is easily rebutted by other ancedotes. I’ve seen kids smoke a joint on the playgrounds, and 15 or 30 minutes later pop someone upside their head. But these are mere anecdotes, not scientific data.
The author ought to make a distinction between who this witness is – i.e. what role he has. He is not an “expert” witness. He is the treating psychiatrist and is testifying to the facts in this case.
An expert witness is called by the prosecution and/or defense and testifies to what the care should have been, or whether Mr. Marsh is competent to stand trial. An example of a fact witness is the girlfriend in the movie “My Cousin Vinnie.” The girlfriend is called to speak to auto mechanics and what the correct parts or procedure is used in the situation at hand. Dr. Sisson was called only to testify to the treatment he gave Marsh – not whether his treatment was right/wrong, etc. And since he’s not been called as an expert, he’s allowed to opine about just about anything – including his opinions about the legality of marijuana. If he says it on direct examination he then can be asked about it again on cross-examination.
Good point, and ironically I just watched “My Cousin Vinnie” over the weekend.
Sorry, but you are wrong saying Dr. Sisson is not an expert witness. Only an expert witness (qualified as such by direct examination and approval by the court) can offer an “opinion” in addition to any facts offered. The good doctor opined in several instances, none of which would be admissible if he were not an expert witness.
Phil, a fact witness can offer an opinion based on his treatment of the patient. For instance, if I was treating someone at elevated risk for suicide, I might be asked my opinion of his/her risk for self-harm and I would give it – based on my knowledge of the patient, etc. My opinion – or rationale – could explain why I chose a certain treatment. In this case Dr Sison opined about his treatment of Mr. Marsh and probably offered a diagnosis and rationale for that diagnosis. Also, there is no mention of Dr. Sison being qualified or called as an expert. Expert witnesses opine about the standard of care and whether it was met in the case at hand.
Phil
“Sission got properly skewered for his failure to thoroughly research past medical history, instead relying on the comments of a patient under a program of behavior and thought altering medication. Correction, Daniel might have been medicated. Nowhere is their mention or questions and answered on the ingestion of these medications, including marijuana. Tia will confirm that patients are not always reliable in conforming to a prescribed medication program, particularly patients in emotional/mental crisis.
I will certainly confirm your entire comment. This is the most troubling aspect of Daniel’s care that has been presented so far.
Far worse to me that prescribing a medication that while having differing side effects ( some severe) for different individuals, is not having reviewed previous medical records for at least two critical bits of information. What were his previous diagnoses and what diagnostic criteria were they based on, and a fully accounting of previous medication regimens with desired responses and / of any side effects. I find this very, very difficult to understand when records from Kaiser would have been readily available in the time frame of a hospitalized patient such as Daniel.
It would be interesting to know how many times he called the previous hospitals / treatment facilities.
ryankelly
“I really wonder if we are dealing with a true psychotic – pure evil in the body of a child”
I find this comment quite disturbing. It is one step from this thought process to be willing to call in an exorcist or to “torture” the
boy in an effort to “drive out the evil spirits” both of which had been considered “best practices” in the not so very distant past.
To clarify – I’m wondering if we are dealing with a sociopath, rather than someone who is psychotic (a severe mental illness that causes great suffering, but not necessarily violent tendencies).
I don’t think an exorcism or torture would cure a sociopath. What a bizarre statement to make.
Don’t let your compassion blind you to the dangerousness of Daniel’s condition. We can face it or, like Daniel’s friends, go on hoping that giving him love and friendship will keep him from doing something to hurt us.
Don’t let your compassion blind you to the dangerousness of ________?
Just fill in the blank.
I see this type of thinking as its own malady and hazard. Maybe had someone knowing this killer thought differently… that he was worthy of consideration for being dangerous and not just a troubled person in need of a hug or someone to talk to… the victims might be alive today.
“Maybe had someone knowing this killer thought differently… that he was worthy of consideration for being dangerous and not just a troubled person in need of a hug or someone to talk to… the victims might be alive today.”
I’m quite sure no one thinks that a person who presumably has psychopathy is simply “in need of a hug” or “in need of someone to talk to.”
I really have no idea what can or should be done a priori, unless perhaps a psychiatrist diagnoses clinical psychopathy and claims the person is a grave danger to himself or others. In a case like that, I guess he could be put in a locked psychiatric hospital.
Yet, a posteriori I do think it makes good sense to make as good a clinical diagnosis as possible and see if he does or does not have the symptoms of psychopathy. One thing which is well known is that the brain scans of psychopaths are distinct from normal brains. However, I don’t think everyone who has a psychopathic brain is or will become dangerous. There are other components to this disorder.
Interestingly, one of the leading neurobiologists who studies the brains of psychopaths revealed last year that his own brain has the characteristics of a psychopath, and while he is not a dangerous person, he says he does have some character traits common with dangerous psychopaths.
http://www.smithsonianmag.com/science-nature/the-neuroscientist-who-discovered-he-was-a-psychopath-180947814/?no-ist
I agree with you to a point, Rich. A priori predictions of dangerousness are very difficult to make with a high degree of certainty. And even though someone may be dangerous to themselves or others there are many limitations on their confinement. The way confinement for dangerousness works in California is that one has to be dangerous due to a mental disorder. Psychopathy is not a recognized diagnostic category, so the evaluator would have to find some other rationale.
Another thing to consider is that psychopathy is not considered categorical (psychopath or not a psychopath) but more of a dimensional construct. Just like many aspects of personality or mental disorder. On the PCL-R that Dr. Hare created, there is a cut-off score over which someone is considered a “real” psychopath, but those who are under it may be dangerous too.
ryankelly
I did not mean to come across as flip as I obviously did. I was responding only to your comment about “pure evil in the body of a child.”
I realize that I have will likely have the minority opinion here. I do not believe in “evil” as an
inhabiting force. I believe in genetic predisposition and disturbances in neurotransmitters.
Unfortunately, we are not yet sophisticated enough in our knowledge of these areas to be able to accurately, specifically diagnose and treat and therefore are frequently forced to do the best we can knowing that we our dealing with inadequate information.
Tia, do you have no comment on the recent studies (multiple) showing the deleterious affects of marijuana on the teenage brain? (Even casual use.)
I would think pot is at least as dangerous as cigarettes, which are nearly banned in Davis. Quite the contradiction.
TBD
I have had no comment about the recent studies regarding marijuana because any point I would have made has been covered. I will however, disagree with you that post has been shown to be “at least as dangerous as cigarettes”. Notice I am not saying that it may not be in future. However, these very preliminary studies do not even begin to compare with the decades long proven deleterious effects of cigarette smoking fully demonstrated to be causal in many cancers including: oral, pharyngeal, bronchiolar, lung and cervix, cardiovascular disease including heart attack, deep venous thrombosis with the potential for stroke and pulmonary embolism, to way nothing of the proven risks of preterm delivery and intrauterine growth restriction affecting the fetus of a smoking pregnant woman. The known potential for harm between cigarette use and marijuana use are not even close at this point in time.
You’re right, cigarettes have well-documented physical affects for some individuals.
I believe some of the effects regard “executive decision making”, which affects numerous aspects of a person’s life, potentially forever. Unless there were some glaring mistakes made, this has potential to open up a whole can of worms, but I know these potential revelations will rock the boat.
This rides counter to the current pro-pot stance for many on the Left. Ironically, when stoners in the 70s used to say “I’m gonna go kill some brain cells, dude”, they may have been spot on.
I find the level of care by Dr Sisson and Heritage Oaks dismaying. He is not alone in eschewing the patients records and relying on his own impressions based solely on his interactions with the patient. All of the help he got was spotty, dismissive and lacked continuity. I believe this typical of the mental health services available not only to children but also adults.
dr. sisson i believe was not caring for marsh, he was the prosecution’s psychiatrist.
I believe that Dr. Sisson is the treating psychiatrist from Heritage Oaks – not an expert witness called by the prosecution. It’s usual in these sorts of cases for the treating psychiatrist to be called.
It’s not clear whether Sisson was the treating doctor. In the past he has done the intake evaluation, along with a social worker, to determine whether the person meets criteria to be admitted to the hospital.
The treating doctors on the units at Heritage Oaks, who prescribe the meds and see the patients daily, or almost daily, are better than Sisson and the social worker. For example, in one case, Sisson and the SW asked the prospective patient if she wanted to talk about her family. She said she did not. Based on that, Sisson and the S.W. decided that she was homeless. Her intake eval. was not only lacking, but ridiculous in its conclusions and assumptions.
Psychosis and voices: It appears that Sisson didn’t ask questions so much as he expected Marsh to volunteer information. It’s rare that patients volunteer that they’re hearing voices. A good doctor asks whether the patient ever hears “whispers”.
Very difficult for a 15 year old to admit that he’s hearing voices, let alone volunteer the information.
Psychosis is simply bad brain chemistry which can be corrected with the right medications.
Marsh talked to Sisson about lots of mentally ill relatives, and lots of stress. The odds of Marsh being schizophrenic and/or bipolar should have been immediately obvious to Dr. Sisson.
Sounds like you may have read the transcript of the trial. Given that Dr. Sison prescribed medicaitons, I assumed he was a treating psychiatrist. Also, it was noted in the article that Marsh started out as an involuntary, not voluntary patient but by the time he was seen by Dr. Sison, he was voluntary. I’m also not sure why you say it is “rare” for patients to admit to hearing voices. My experience is that oft times patients admit they are hearing voices because the voices are quite disturbing and persecutory. I have had a number of patients hesitate about talking about their hallucinations, but I would not say in my experience it has been rare. A “good doctor” asks a lot of questions during a mental status exam. I’m not sure that I would agree that psychosis is “simply bad brain chemistry” and that medications correct it. I really think it is more complex than that. Also, there are other diagnoses besides schizophrenia that include hallucinations.
I think that there are lots of folks on this blog who think they “know” what Dr. Sison did or did not do. I also believe that this is the kind of case that is frought with hindsight bias. Remember that Sison and others who treated Marsh treated him before he committed the acts for which he is on trial. There is tremendous pressure to be biased by the fact of these horrendous murders and to be biased about facts that preceded them – his psychiatric treatment for one.
Well said, Dr. Canning…I did not realize you were a medical doctor?
I am enlightened by the comments; both intellectual and educational. I am well pleased to read and learn…
I would suppose that are both sides to the proverbial coin on, “marijuana use,” I have also experienced knowing several teens addicted; some whose reactions were mellow and some who may have been become agitated once they couldn’t smoke anymore. But, in my years, I, personally, never met a kid/adult who, by the use of the stuff ever experienced homicidal thoughts/ideations…however, it’s just personal experience, not medical research/expertise.
I do know some of the medications can make you feel thoughts like what Daniel talked about. I also know about the nightmares as I learned from my son’s seizure med experience but if you think about it, Daniel had so many factors contributing to his actions, sure it was not one simple thing…but the combination that may have pushed him over the edge.
Too, just to clear up Dr. Sison, yes, he was the doctor who evaluated him at the psyche facility…I am sure he has some expertise but he was just one of the doctors testifying about what he knew of Marsh and his diagnoses and prescribed meds.
And so far, he isn’t the only one talking about Marijuana use…
Daniel obviously felt more comfortable expressing himself with certain doctors who treated him.
We do not know what emotional abuse he was talking about just yet. Nor do we know if Daniel was just being disobedient to his parents? I am sure before it is over there will be more clarification on those questions.
Antoinette
Dr. Canning is not a medical doctor. He is a PhD psychologist with extensive knowledge and experience in suicide prevention.
Awesome!
I would love to learn more about his knowledge of suicide and prevention of; lost two siblings from it.
Rereading the article, yes, you are right, Dr. Sisson was treating Marsh.
Based on what happened in the one case I know quite well, Sisson could be said to be “out to lunch”, lacking common sense and lacking the basic training or IQ to make the most basic decisions about patient care. It’s really a shame he’s treating patients, and that he treated Marsh.
Can I assume that young patients who talk to you about voices and hallucinations are gently led by you to talk about them? You don’t just ask about these things out of the blue without making sure the patient is comfortable, not afraid of you, not afraid of your reactions, not afraid of bad consequences to admitting the voices?