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Salinger, Angela Case #: 1234

Forensic Report 12.1.07

2013

Forensic Assessment of Maternal Filicide

Olivia Hall Examinee: Angela Salinger DOB: 2/10/1957 Case #: 1234 Date of Admission: 11/20/1991 (Psychiatric Center) Date of Admission: 8/27/1993 (Outpatient) Date of Report: 12/1/2007
Introduction and Reason for Referral Angela Salinger is a 50 year old African American remarried female charged with 2nd degree murder, 2nd degree attempted murder, 1st and 2nd degree assault, reckless endangerment and endangering the welfare of a child. She has consequently been found Not Responsible by Mental Disorder or Defect. The examiner Dr. Hall is evaluating Ms. Salinger pursuant to criminal procedure law 330.20. This is an order for examination, subsequent to the verdict being entered, that allows psychiatric examiners to determine an appropriate method of action for the indicted mentally ill person(s). In this case, the goal is to determine whether Ms. Salinger is a candidate to be discharged from her Order of Conditions, and released into the community free of any supervision, terms, or treatment. Course of Evaluation Ms. Hall, the examiner, has reviewed the nature and purpose of this evaluation and limits to confidentiality. Angela Salinger has read and signed an informed consent and statement of rights. She has been advised that the assessment and findings are not confidential, because this and any evaluation she has undergone/will undergo are not part of the therapy process, but necessary legal initiatives to determine the best course of action for her and society. When asked to summarize and explain the limits of confidentiality, she repeated that other people would read it and that it was not exclusively private to her and the examiner. She has previously been administered the following forensic and psychological test instruments along with her interview: 1. Weschler Adult Intelligence Scale Revised (WAIS-R), on which her Full Scale IQ, Verbal IQ, and Performance IQ were 91, 91, and 94, respectively. 2. WAIS-R again, the above scores were 97, 91, and 106, respectively. 3. Minnesota Multiphasic Personality Inventory (MMPI), where her scores suggested depression induced by normal bereavement, Schizophreniform Disorder, and Schizotypal Personality Disorder. 4. Validity Indicator Profile (VIP), and was labeled as compliant and valid.

Salinger, Angela Case #: 1234

Forensic Report 12.1.07

2013

5. Personality Assessment Instrument (PAI) was used to determine that Salinger most likely minimized her symptoms at the time in order to portray a more positive and desirable portrait of herself. 6. Historical Clinical Risk-20 (HCR-20) Instant Offense Several days before the incident, Salinger was suffering insomnia. On the day preceding the offense, Salinger began experiencing thoughts about the world coming to an end. She had asked her husband at the time to supervise the children, but he was unable. That night, she put the children to bed, drew all the blinds, and stayed up all night in anticipation of something happening. On October 5th, 1989, Salinger awoke her children, discouraging them from attending school due to her extreme fatigue. A neighbors knock on the door initiated overwhelming feelings and panic. She barricaded herself and her five children in the bedroom, bringing ointment in fear of them burning. Around 2:15 p.m., Salinger instructed Alan (10), who was nude and crying, to jump out of the window, but he did not go. She then assisted Janet (7) in climbing out the window, and although she wanted to come back in, fell to her death. She asked Farah (5) to jump, who refused, but successfully pushed Harry (3) to the ground. In her final attempt to push Anna (1), she heard a knock on the door from who she believed was the devil. All of them were naked when firefighters arrived on scene, with Salinger alleging that she was listening to instructions from the voice of God. She was acting violently, stabbing walls, furniture, and carpets, and was taken to St. Marys Episcopal Hospital in Queens. In recollecting the event she states she was overwhelmed, could not get help, and didnt see a way out of know what to do. From St. Marys, she was transferred to central booking is Roosevelt Hospital, where she remained for approximately five months, and was diagnosed with Schizophrenia and Depression. Salinger pled Not Responsible by Reason of Mental Disease or Defect 8 months later. Relevant History Family Origin Angela Salinger was the third of four children born in Brooklyn, New York. Both her parents had limited education, and she was raised Baptist. Her father worked multiple jobs at one time, including a mechanic, an owner of a taxi business, and a security guard. Her mother passed away in 1991 during the course of her case. At age 15, Salinger began dating someone. She experienced what she acknowledged as a date rape by this boyfriend, but no charges were filed. Significant Social Relationships The next sexual encounter subsequent to her boyfriend was at age 17 with a college man she met at a beach. This event led to a pregnancy, which Salinger kept to herself and aborted without telling anyone. Senior year of high school she reportedly converted to Islam, and met what would be her first husband at a local church. They married after about a year when she was 19 years old, and had their first child 3 years later. She only attended one semester of a local

Salinger, Angela Case #: 1234

Forensic Report 12.1.07

2013

college, studying Home Economics. Another 3 years later, she had her second child. Two years later, during the birth of her third child, her husband became very withdrawn and spoke of cheating until their fourth child was born (4 years later). Salinger stopped going to church and was not receiving any monetary support. She recalls feeling overwhelmed by the maternal responsibilities and believed her husband was cheating with multiple partners. The next year, she put her husband out of the house completely. First Psychological Episodes/Instant Offense Salinger maintained steady jobs, did not have previous incidents with the police, and had no history of alcohol or substance abuse up until the offense. Socially, there is no account of any close or meaningful relationships with friends, family or coworkers other than boyfriends/husbands/romantic relationships, of which there were many. In the days prior to the offense, Salinger reported thoughts of the world coming to an end, and did not sleep the night before. She reports hearing songs on the radio that included personal messages, command hallucinations, and paranoid delusions regarding the end of the world and Gods encouragement to save her children. The day of the offense, she prohibited them from going to school but states her fears had dissipated. However, at the moment a neighbor knocked on the door, fear flooded her once again. She immediately barricaded them all in her bedroom, feeling as though the devil was coming for them and that her children were going to be burned. The incident was discovered by several fireman driving by after responding to a separate call in the area. When taken into custody, she was diagnosed with Schizophrenia and Depression, and began a regimen of an antipsychotic and antidepressant medication, specifically Haldol & Pamelor. Her symptoms notably decreased in both severity and intensity. She remained on these medication after sentencing, and was considered in remission only five months into hospitalization. Early Treatment to Present The next year, Salinger underwent various psychological testing, including intelligence testing, personality testing, and mental state at the time of the offense assessment. Five months into hospitalization, her depressed was labeled in complete remission. She then experienced another episode, claiming she had sexual desires towards male patients and that she was unable to communicate to them that she was unavailable for sex. She was thinking that songs on the radio were targeting her again, combined with sudden feelings of depression, flashbacks, and crying at thoughts of her children. She began a regimen of Ativan for anxiety. She was found mentally ill (not dangerous) and transferred to a less secure facility. Just under a year later and continuing her medications of Haldol, Pamelor, & Cogentin, she was determined to be in control and a model patient. Back in remission, she was released into the community in 1993. As an outpatient, Salinger demonstrated no symptoms and stopped her medication for approximately two months. No acute symptoms were present, and she regularly visited her children and attended monthly psychiatric appointments. She then violated her Order of Condition by visiting her children without supervision, and was uncompliant with medication for a brief period.

Salinger, Angela Case #: 1234

Forensic Report 12.1.07

2013

In 1995, she entered into a relationship with a male friend, became pregnant, acquired a sexually transmitted disease, had her second abortion, and again kept it to herself. She began another relationship in 1998 with a man from Church, got engaged, suspended the marriage, and then ended the relationship herself. She upheld a full time job at Bernard M. Baruch College and lived in a three bedroom apartment while her father was in a nursing home. A few months later she entered yet another relationship with a different man and married him within 7 months. She expressed strong desires to get pregnant, and was not complying with her medications for some time. She did become pregnant, but had a miscarriage some time into her term. She expresses no significant grief associated with this event, and states she believes it was good for her. Salinger was able to maintain two jobs, and enrolled herself in college level classes at LaGuardia Community College in 2002. A year later, she attested that her husband began showing signs of OCD and that she was disappointed with and distant in the marriage. She is complying with her medications, currently taking Haldol. She still shows no signs of paranoid symptoms delusions, or psychosis. She holds an Associates Degree and still resides with her husband, but asked him for a divorce in 2006. He denied her, and they still remain together. She is on track to earn her Bachelors Degree from New York College, and made the Deans List with a cumulative GPA of 3.3. She feels she cannot get away from the past, especially because it has prevented her from obtaining jobs. She continues to keep her regular psychiatric and medical injection appointments, has had a meeting with her children and the treatment team, but lost her job at the college for unknown reasons. As of today, Salinger resides with her husband, considering herself selfemployed baking cakes. Evaluation Findings As described above, Angela Salinger was administered 5 different forensic assessments during the course of her case. Regarding her intelligence testing results, she did better the second time she was examined. Typically, adult IQ scores remain the same over a lifetime, suggesting an abnormal or external issue accounted for the difference in scores. Her overall IQ is average in both cases, demonstrating that she has the intelligence of the average person, and understands, comprehends, and learns in ways similar to that of the general population. Her performance scale being elevated after the second administration may suggest that she was more coherent and in touch with reality the second time administered, supporting treatments and medications. Her attention and comprehension of instructions and communication with the administrator may have improved, especially since her symptoms surrounding the crime were diminishing. According to the Validity Indicator Profile (VIP), her answers were consistent with those that are truthful and not attempting to feign mental illness. This works in her favor, demonstrating that her symptoms were real and her delusions and hallucinations truly impacted her behavior toward her children. However, Minnesota Multiphasic Personality Inventory (MMPI) scores suggested Schizotypal Personality Disorder. Although Salinger experienced true mental ailments, this disorder characterizes her with discomfort in close relationships and perceptual/cognitive distortions. She appears to be primarily defined by discomfort with and problems with relating to others, especially interpersonally. This is also defined by marked paranoid ideation, and cannot regulate a full range of affects within themselves. Associated features and diagnoses include

Salinger, Angela Case #: 1234

Forensic Report 12.1.07

2013

Schizophreniform and Depression, of which she has both. While the chicken or egg dilemma regarding which disorder caused the next may be apparent here, clues in her patterns of social behavior suggest her personality is a comorbid and longstanding setback. With most personality disorders, the disordered person does not objectively observe it as an issue or inappropriate way of living. Consequently, Salinger acts in negative patterns relating to sexual relationships and situations. She disregards common respect for her body as well as the bodies of children in her several abortions and attempts to kill her children. She appears unable to form the cognitive capacity to appreciate (or connote as fragile) young forms of life, asserting her power over their helplessness and making poor decisions for the wealth of herself. Especially because it has occurred so often, she fails to maintain responsibility for it, even regardless of the political abortion argument of it being right or wrong. Additionally, her Personality Assessment Instrument (PAI) scores parallel this idea, determining she minimized her symptoms in order to portray a more positive and desirable portrait of herself. She is someone that shows acute disorders that affected her behavior, but consciously knows it is better to portray more societally acceptable traits. HCR-20 When evaluating risk based on the HCR-20, Salinger presents an overall somewhat elevated risk. The most relevant aggravating factors in this case include relationship instability, major mental illness, future exposure to destabilizers, and future stress. Historically, all of Salingers relationships with men have been impulsive and dualistic. She lacked insight in choosing partners, then found herself in unfortunate circumstances each time, whether it be being taken advantage of monetarily or emotionally. She did experience childhood maladjustment educationally, not completing more than a semester of college, as well as communally, being sexually explicitly victimized by an older man. Even more importantly, the development of her psychosis and depression is essentially what put her over the edge. If she is released from all supervision, which includes medication, there is a moderate likelihood that she will experience similar symptoms. Her medications appear to be the sole protective factor in her situation, eliminating almost all symptoms for the duration of her commitment. In the case of Salinger being released and deciding to cease medication, no one may predict the severity of her actions, and there is no evidence that she will be able to grasp reality on her own. She is currently doing well principally because of the medications, and there is no strong evidence of another lifestyle aspect that has helped her heal equally or more. While is it not of utmost concern in comparison to the crime at hand, personality disorder (Borderline is plausible along with the actually diagnosed Schizoid) is significant due to lack of stable affect. The onset can be hypothesized around age 15, brought about by the trauma of manifesting before and leading to the specific rape incident. While there is no fault put on Salinger in the case of a personality disorder, there are correlations in her pervasive social coldness and repetitive disposable actions against lovers and children. Clinically, while Salinger understands and recognizes the delusions and beliefs that allowed her to carry out such a crime, she does not demonstrate as much self-judgment or self-hate. In addition, her insight remains in the past. She fails to shed light on the cycle she continues to find

Salinger, Angela Case #: 1234

Forensic Report 12.1.07

2013

herself in or perceive it as inappropriate. This includes the turbulent wishes to date fellow patients, entering and ending relationships quickly, and attempting to get pregnant and have an abortion more than once. These are all the steps that lead her to the incident in the first place, and if symptoms appear again once the medication is taken away, she could easily fall back into the violent and delusional pattern. According to the Diagnostic and Statistical Manual (DSM-IVTR), there is no long term summary of the concrete outcome of Schizophrenia. Although her episodes have ceased, there is no evidence in life to be able to say she is/will ever be in remission. Looking into the future based on her previous scores, Salinger present a noticeable risk of violence, or recklessness in the least. While she is completing an educational degree and has made attempts to find a job, all of her other decisions are being made under selfish presumption. Her husband appears checked out, and she has already asked for a divorce. She has not managed to find a stable or healthy relationship yet in her life, and seemingly will not anytime soon. If children were the primary focus of the instant offense, there is no reason to continue to allow her to independently expose herself to that again. Although Salinger is more emotionally and physically connected with her children, she broke regulations to see them on her own, and they are not a positive influence in her immediate ecological chromosphere. Salingers mother died, her dad does not seem to be in the picture, and there remains no other personal support to aid in her independent, unsupervised recovery. This means that rather than adapting socially, finding strength in friendships and loving encouragement, she will continue to surround herself with impersonal, failing amalgamations with her current lover and ones after that. A final area of concern is the stress aspect. In Salingers case, her stressors are reflected in what would otherwise be considered positive life events to society as a whole; pregnancy, marriage, love, etc. Because she has not only experienced negative situations surrounding these events, but expresses poor/lacking affect regulation regarding them, suggests a reckless cycle that will only allow her apathy and irresponsibly selfish decisions to continue. The simple fact that after her miscarriage in 2000, Salinger did not express significant grief, is probably more alarming and unpromising that if she had fallen back into her depression. It shows a lack of remorse and inappropriate emotional response that is projected onto most important human beings she encounters. Diagnostic Impressions Salinger has not only projected her own internal distraught onto her children, but does the same to other people as well. Despite her single attempt to end her childrens lives, she continues to get pregnant and have abortions, as well as enter and terminate significant relationships and marriages. She appears to be minimizing the importance of other human lives, and taking an easier path that appeases herself. A lot of this behavior and thinking appears to stem from her sexual foundations, notably the event when she was 15. She was most likely grieving the initial rape from what she perceives as her boyfriend, having it escalate through marital problems afterward. Unconsciously, her physical actions reflect that everyone was taking something from her; the radio was mentally raping her but targeting her and exerting power over her thoughts. Presently and throughout treatment, she had deviant thoughts about sex, pregnancy, and partners. Each time she starts the pattern all over again, she misjudges character in male partners, and then

Salinger, Angela Case #: 1234

Forensic Report 12.1.07

2013

relies on religion and external sources to explain her lack of touch with reality and apathetic decisions. Regarding the doctors opinions describing Salinger as a model patient: A model patient is not someone that makes no mistakes, but rather someone who recognizes and correctly interprets the wrong path, weighing consequences not only for themselves, but others as well. He/she then does everything in his/her power to prohibit poor behavior further, without disregard for its cost to others. The patient in this case does not maintain the full capacity of conscious thought to stop herself from repetitively entering into immoral circumstances. Further, there is a narcissistic nature surrounding her need for entitlement (not necessarily attention), probably accounted for by events early on. The pattern of falling in love recklessly, becoming pregnant, ending the pregnancy, and requesting a divorce is blatant at least three times, and in some combination, throughout the interview. Forensic Opinion/Psycho-Legal Formulation In my opinion, Angela Salinger displays a moderate risk for violence at the present time. She also depicts an apathetic view of most life events that she will have to experience in the future. It is highly likely that she will have difficulties in forming benevolent and romantic relations with others, forming a family, appropriately making medical decisions and caring for another child. While she is an exemplary patient and currently has not relapsed into any delusional manners or thoughts, it may be most appropriate to not discharge her from her Order of Conditions, and therefore eliminating requirements to take medications and continue mandatory treatment. It is unclear whether Salinger can appropriately grasp reality currently, or if she will be able to at all. Although her medications have prevented psychotic episodes almost completely, there is no certain way of knowing whether she would continue them voluntarily if released from her order. In that case, her symptoms may relapse, and she is vulnerable to another psychotic or schizophrenic episode of paranoia and delusion. In addition, continuing to rely solely on the medications is only satisfying her individual need to dismiss control and responsibility over her own life. It appears more necessary that she accompanies the chemical treatment with introspective and cognitive behavioral therapy. If we assume the past is the most significant negative influence, Rational Emotive Behavior Therapy would provide a way to dispute her minimization of sex and loving relationships. It may be wise to overall, give her the means and time to reconstruct her adaptations of life and love, thinking futuristically and weighing consequences, because it seems unlikely she is able to do this on her own. If she is able to sculpt a more fruitful belief system, it is highly possible she can change her life positively, communicating better with others and being trusted to make more responsible decisions.

Salinger, Angela Case #: 1234

Forensic Report 12.1.07

2013

Sources of Information Diagnostic & Statistical Manual IV. http://online.statref.com.ez.lib.jjay.cuny.edu/Document.aspx?docAddress=mFPkvAYgaXVoH6 NXUCYmMw%3D%3D&SessionId=1C2E2B0FRQMHSISA&offset=36328 Kunst, J.L. 2002. Fraught with the utmost danger: The object relations of mothers who kill their children. Bulletin of Menninger Clinic, 66 (1), 19-38. Stanton, J., &Simpson, A. I. F. 2006. The aftermath: Aspects of recovery described by perpetrators of maternal filicide committed in the context of severe mental illness. Behavioral Sciences & The Law, 24, 103-112. DOI: 10.1002/bsl.688. Willemsen, J., Declercq, F., Markey, S., & Verhaeghe, P. 2007. The role of affect regulation in a case of attempted maternal filicide-suicide. Clinical Social Work Journal, 35, 215-221. DOI: 10.1007/s10615-007-0128-y.