Tharp v. Psychiatric Security Review BoardTharp v. Psychiatric Security Review Board
This case requires us to determine whether, for purposes of
We review the background of this case and the proceedings below in some detail because that discussion helps frame the specific legal question we decide. Petitioner’s confinement stems from his indictment for a 1999 robbery. Two mental health experts diagnosed petitioner as suffering from paranoid thought disorder and schizophrenia at the time that he had engaged in the criminal conduct. Pursuant to a stipulated judgment, the trial court found petitioner guilty except for insanity, based on mental disease or defect.
See
In 2001, petitioner requested discharge pursuant to
The parties also introduced evidence regarding petitioner’s conduct at the state hospital following his commitment and his mental condition at the time of the release hearing, including hospital tests and evaluations, information regarding petitioner’s participation in drug and alcohol programs at the hospital, and the testimony of two experts, Dr. Ruiz-Martinez and Dr. Schwartz, petitioner’s treating psychiatrist and treating psychologist, respectively, at the state hospital. Ruiz-Martinez testified that petitioner “definitely doesn’t have [a] mental illness,” that he displayed no
signs or symptoms of paranoid thought disorder or
At the hearing, petitioner argued that he no longer was affected by a mental disease or defect because his only current diagnosis was marijuana dependency, which is a personality disorder that is excluded from the definition of mental disease or defect by
Following the hearing, the board issued an order denying petitioner’s request for discharge and continuing his commitment. The board’s findings of fact included the following:
“[Petitioner] is affected by a mental disease or defect as demonstrated by the underlying facts shown by the evidence, including the expert testimony of Luvy Ruiz-Martinez, M.D., at the hearing, as well as the information contained in Exhibits 20,18,15,14,10, and 9.
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“[Petitioner] did not prove, by a preponderance of the evidence his fitness for discharge as required by the standards ofORS 161.351. ”
The board’s conclusions of law included the following:
“[Petitioner], being affected by a mental disease or defect which, when active, renders him a substantial danger to others, is under the jurisdiction of the [board.]”
The board also found that petitioner was an appropriate subject for conditional release but that, because adequate treatment resources were not available in the community, he could not be released at that time. As a result, the board continued petitioner’s commitment to the state hospital until such time as those resources might become available.
On judicial review in the Court of Appeals, petitioner argued that the board erred in finding that he had a “mental disease or defect” because the only expert testimony regarding petitioner’s mental condition at the time of the release hearing — the testimony of Ruiz-Martinez and Schwartz— was to the effect that petitioner had no mental disease or defect, but that he suffered from substance dependency. Petitioner asserted that substance dependency is not a mental disease or defect but, rather, is a “personality disorder” that the legislature, in
The board’s response was twofold. First, the board argued that, regardless of whether substance dependency is a personality disorder or a mental disease or defect, petitioner had the burden of proving that he no longer was affected by a mental disease or defect. Accordingly, the board asserted that, as this court held in
Einstein v. PSRB,
The Court of Appeals affirmed the board’s order, citing two cases,
Rios v. PSRB,
On review, the parties reiterate their arguments in the Court of Appeals. We first consider the board’s argument that, regardless of whether substance dependency is a “mental disease or defect” or, instead, is a “personality disorder,” substantial evidence in the record supported its order and we therefore should affirm. The board is correct that the record contains the 1999 evaluations that diagnosed petitioner as being affected by paranoid thought disorder and schizophrenia, as well as expert testimony at the hearing that he no longer was affected by those mental illnesses (if he ever was) or by any other mental disease or defect. Ordinarily, that record might, if accepted by the board, provide substantial evidence to support an inferential determination by the board that petitioner continued to be affected by the mental illnesses that had been diagnosed as recently as two years earlier.
Here, however, we are unable to determine whether the board’s finding that petitioner is affected by a mental disease or defect was based on its inference, from petitioner’s 1999 diagnoses, that petitioner continues to suffer from paranoid thought disorder and schizophrenia or, instead, on evidence that, although he no longer is affected by those mental illnesses, he is affected by the mental disease or defect of substance dependency. The board’s order states that its finding that petitioner is affected by a mental disease or defect was based on the expert testimony of Ruiz-Martinez and several
mental health evaluations that are part of the hearing record. Most of those evaluations, like Ruiz-Martinez’s testimony, concluded that petitioner was affected by only substance dependency. However, the board’s order also states that the board relied on Colistro’s 1999 evaluation, which concluded that petitioner suffered from “schizophrenia, paranoid type,” as well as “polysubstance dependency/abuse.” Because, as we explain below, we conclude that substance dependency is a “personality disorder” and thus is not a “mental disease or defect” within the meaning of
We now turn to the parties’ dispute as to whether petitioner’s admitted substance dependency is a “personality disorder” that the legislature has excluded from the definition of “mental disease or defect.” Petitioner argues that it is. The board disagrees and asserts that substance dependency qualifies as a mental disease or defect under
The procedures for determining when a person may be found not responsible for criminal conduct because of mental disease or defect and those for obtaining release from a state hospital by proving the absence of a mental disease or defect were part of the legislature’s 1971 revision of the Criminal Code. Although those statutes have been amended a number of times, the structure of the 1971 revision continues in the present statutes. See generally Or Laws 1971, ch 743, §§ 36-53 (setting out standards for lack of responsibility for criminal conduct resulting from “mental disease or defect” and procedures for asserting defense, commitment to state hospital, and discharge from hospital). The 1971 law expressed, in a coherent sequence of specific provisions, the policy that a person is “not responsible” for criminal conduct if the person engages in criminal conduct but, because of a mental disease or défect, lacks the capacity to appreciate the criminality of the conduct or to conform the conduct to the requirements of law. Id. at § 36. The law then described the required notice of a defendant’s intent to use that defense, the burden of proof, and other matters related to proceedings in a criminal trial in which the defendant raises that defense. Id. at §§ 38-42. The law next set out the findings that the trial court, following a determination that a person was not responsible for criminal conduct, was required to make respecting commitment to the state hospital, release under supervision, or discharge. Id. at §§ 43-47. Finally, the law established the procedures and standards under which a person who had been committed to the state hospital could seek to be discharged by proving that he or she no longer was affected by a mental disease or defect. Id. at §§ 47(3), 49.
The legislature has amended the statutes relating to responsibility for criminal conduct several times, most notably in 1983, when it adopted the phrase “guilty except for insanity” in place of the 1971 law’s statement that such a person was “not responsible” for otherwise criminal conduct.
See
Or Laws 1983, ch 800, § 1 (amending
When the legislature uses the identical phrase in related statutory provisions that were enacted as the part of the same law, we interpret the phrase to have the same meaning in both sections.
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“(1) A person is guilty except for insanity if, as a result of mental disease or defect at the time of engaging in criminal conduct, the person lacks substantial capacity either to appreciate the criminality of the conduct or to conform the conduct to the requirements of law.
“(2) * * * [T]he terms ‘mental disease or defect’ do not include an abnormality manifested only by repeated criminal or otherwise antisocial conduct, nor do they include any abnormality constituting solely a personality disorder.”
As this court has observed, the legislature has not provided a definition of the term “mental disease or defect,” other than to state that it does not include a “personality disorder.”
See Hanson v. PSRB,
The board asserts that this court resolved the mean-, ing and application of
The analysis in
Mueller
does not answer the question of what the legislature intended to include within the term “personality disorder” when it enacted
As noted, the legislature has not defined the terms “mental disease” and “mental defect.” The legislature has, however, provided some guidance as to the meaning of those terms. The 1971 Criminal Code revision excluded from those terms “an abnormality manifested only by repeated criminal or otherwise antisocial conduct,” Or Laws 1971, ch 743, § 36(2), and the 1983 amendment excluded “any abnormality constituting solely a personality disorder.” Or Laws 1983, ch 800, § 1. This much is clear: whatever “mental disease or defect” means, it does not include an abnormality that constitutes solely a “personality disorder.”
Although our precedents do not require us to rely on the DSM, the parties both begin their arguments concerning the meaning of “personality disorder” with the definition of that term in the DSM-III. According to that definition, “personality disorder” refers to a condition that typically manifests itself no later than adolescence, continues throughout most of a person’s adult life, and involves “enduring patterns of perceiving, relating to, and thinking about the environment and onself’ that “are inflexible and maladaptive and cause either significant impairment in social or occupational functioning or subjective distress.” DSM-III at 305. Petitioner argues that the legislature intended the term “personality disorder” to include substance dependency and, therefore, that substance dependency is excluded from the definition of “mental disease or defect.” The board responds that, in the DSM-III, substance disorders, including drug and alcohol dependence, are not included in the section on personality disorders, but are separately coded in Axis I, which deals with clinical disorders.
Both petitioner’s and the board’s interpretations of “personality disorder” are plausible interpretations of that term as used in
In a case that the Court of Appeals decided after its decision in this case, that court, in an opinion by Judge Landau, engaged in a detailed review of the legislative history leading to the legislature’s decision to exclude personality disorders from the definition of mental disease or defect in
“ORS 161.295 originated as House Bill (HB) 2075 during the 1983 legislative session. The bill was the product of an interim legislative committee that focused on public concerns with the so-called ‘insanity defense’ in criminal cases. At the first ofthe many hearings on the bill, the witnesses who testified in support urged that the determinative term ‘mental disease or defect’ — not be defined solely in psychiatric terms, but rather in legal or multidisciplinary terms. The Executive Director of [the board], for example, testified that the American Psychiatric Association had released a report on the ‘insanity defense’ in which it recommended that the ‘decision to release’ a person under such a scheme ‘not be made solely by psychiatrists or solely on the basis of psychiatric testimony regarding the person’s mental condition.’ Minutes, House Committee on Judiciary, HB 2075, Apr 6,1983, 2 (statement of Felicia Gniewosz). Similarly, a professor of psychiatry at Oregon Health Sciences University (OHSU) submitted written testimony stating that he View[ed] the insanity defense as a legal issue. Psychiatrists and physicians did not invent the insanity defense. It came from the law and serves legal ends.’ Minutes, House Committee on Judiciary, HB 2075, Apr 27, 1983, Ex E (statement of Professor Joseph D. Bloom, M.D.).
“The original version of the bill did not exclude ‘personality disorders’ from the ‘mental disease [s] or defect [s]’that would be subject to a defense of guilty except for insanity. At an early hearing on the bill, the Executive Director of [the board] suggested that the bill should address that issue:
“ ‘The legislature should take a position to either include or exclude “personality disorders” from the definition [of “mental disease or defect”]. It should be noted that personality disorders include the following diagnoses: antisocial, inadequate, passive-aggressive, sexual conduct disorders, drug dependent, alcohol dependent and paranoid.’
“Minutes, House Committee on Judiciary, HB 2075, Apr 27, 1983, Ex D (statement of Felicia Gniewosz).
“At the same hearing, the chair of [the board] testified that the board supported the exclusion of ‘personality disorders’ from the definition of‘mental disease or defect.’ She explained to the House Judiciary Committee that ‘personality disorders’ include child molestation, other sex offenses, and persons ‘suffering from a drug-induced syndrome.’ Tape Recording, House Committee on Judiciary, HB 2075, Apr 27,1983, Tape 270, Side A (statement of Judy Snyder). She added as a further example of a ‘personality disorder’:
“ ‘[P]eople who have an alcohol problem and who maybe stabbed someone while they were in an alcoholic stupor and they’re put under our jurisdiction. * * * The problem the board has is that kind of person can be very dangerous if they drink alcohol but the doctors will testify that’s not a mental illness, they don’t have a mental illness [.]’
“Id. at Tape 269, Side B.
“The subject of defining the conditions that constitute a ‘personality disorder’ arose again at a later hearing. During the course of further testimony from the Executive Director of [the board], Representative Hill asked whether the distinguishing characteristic of a ‘personality disorder’ is the individual’s self control. The Executive Director replied that some individuals can control their disorders, while others cannot. She explained that ‘the perfect example would be that one of the personality disorders would be somebody that’s alcohol or drug dependent.’ Tape Recording, House Committee on Judiciary, HB 2075, May 13,1983, Tape 324, Side A (statement of Felicia Gniewosz).
“It was at that point that the current wording of the statute was first proposed. Representative Courtney asked Jeffrey Rogers, the chair of the legislative interim task force that had drafted the bill, to propose wording that would accomplish the exclusion of‘personality disorders’ from the statutory definition of ‘mental disease or defect.’ Rogers responded with the wording that is, in substance, the current law. The wording was adopted by the House Judiciary Committee without objection. Tape Recording, House Committee on Judiciary, HB 2075, May 13,1983, Tape 324, Side A.
“The House Judiciary Committee ultimately approved the bill, including the exclusionfor ‘personality disorders.’ Interestingly, in the staff measure analysis prepared for the benefit of the committee members, the effect of the bill was summarized in the following terms:
“ ‘The bill as amended further limits the scope of mental diseases or defects for which a person may be found, under present law, “not responsible.” Existing law excludes abnormalities manifested only by repeated criminal or otherwise antisocial conduct. The bill would exclude, in addition, any abnormality which constitutes solely a personality disorder, which includes such diagnoses as sexual conduct disorders, drug dependent and alcohol dependent.’
“Staff Measure Analysis, House Committee on Judiciary, HB 2075 (1983).
“The bill moved to the floor of the House, where the floor manager, Representative Courtney, explained that it contained a ‘personality exclusion’ that accomplished a narrowing of the definition of ‘mental disease or defect.’ Quoting from a letter from [the board’s] Executive Director to the House Judiciary Committee, he explained:
“ ‘Right now if a person has what is considered a personality disorder, by that I mean what they call “antisocial, inadequate, passive-aggressive, sexual conduct disorders, drug dependent, alcohol dependent, or paranoid,” if they fit into that personality disorder category they’re able to claim that they have a mental disease or defect. We now no longer, with this piece of legislation, will allow an individual to say that I have a mental disease or defect because I have a personality disorder.’
“House Floor Debate, HB 2075, June 16, 1983, Reel 19, Track I (Rep Peter Courtney).
“After passage by the House, the bill [proceeded to the Senate, where it] was referred to the Senate Judiciary Committee. At the first hearing on the bill, Representative Courtney introduced it to the committee and explained that it ‘would remove personality disorders as a category that could be relied on for use of the insanity plea.’ Tape Recording, Senate Committee on Judiciary, HB 2075, June 29, 1983, Tape 234, Side A (Rep Peter Courtney). A ‘personality disorder,’ he explained, included such conditions as ‘antisocial, inadequate, passive-aggressive, sexual conduct disorders, drug dependent, alcohol dependent, paranoid, etc.’ Id.
“Rogers also testified before the Senate Judiciary Committee. He explained the findings of a recently completed study that he and two professors from OHSU had completed concerning the insanity defense in Oregon. The report explicitly categorized alcohol and drug dependency as ‘personality disorders.’ Senate Judiciary Committee, HB 2075, June 29, 1983, Unmarked Exhibit (‘Oregon’s New Insanity Defense System: A Review of the First Five Years — 1978-1982’).
“The Senate Judiciary Committee, concerned that the concept of ‘personality disorder’ was too difficult to define, deleted the exclusion from the bill, and the Senate approved the bill as amended.
“The bill then moved to a conference committee. The first topic of discussion was the deletion of the ‘personality disorder’ exclusion. Representative Courtney explained that he was satisfied that the term was practicable. He referred to the Rogers insanity defense study and its list of diagnoses — including, among other things, drug and alcohol dependency — that qualified as ‘personality disorders.’ Tape Recording, Conference Committee, HB 2075, July 13, 1983, Tape 550, Side A. The committee ultimately agreed to restore the ‘personality disorder’ exclusion. The staff measure analysis of the final version of the bill explained that, as amended, the bill ‘would exclude * * * any abnormality which constitutes solely a personality disorder, which includes such diagnoses as sexual conduct disorders, drug dependent and alcohol dependent.’ Staff Measure Analysis, House Committee, HB 2075,1983. As amended by the conference committee, the bill was passed by both houses and signed into law.”
Despite the foregoing evidence of legislative intent, the board insists that “[t]he legislative history does not. clearly express the legislative intent.” The board observes that several witnesses testifying before the legislature proposed an explicit adoption of the DSM and its standards in
As we explained above, we cannot determine from the board’s order in this case whether it based its conclusion that petitioner continues to suffer from a mental disease or defect on a finding that petitioner was affected by substance dependency only or, instead, on a finding that petitioner was affected, either solely or in part, by a mental disease or defect. A decision based solely on the former ground would be legally incorrect, for the reasons stated above, while a decision based on the latter ground would be legally correct if it were supported by substantial evidence in the record. The board on remand must clarify which ground it finds to be the correct one here and, having done so, issue an order accordingly.
The decision of the Court of Appeals is reversed. The order of the Psychiatric Security Review Board is vacated, and the case is remanded to the board for further proceedings.
Notes
The statutes distinguish between “conditional release” from the state hospital and “discharge,” in which the person is released without conditions.
See
We note that, in a case decided after its decision in this case, the Court of Appeals overruled its decisions in
Rios
and
Hanson
and held that, under
The petitioner in
Menzl v. PSRB,
As we discuss in detail below, the 1983 law also added the “personality disorder” exclusion to the definition of “mental disease or defect.”
See
Or Laws 1983, ch 800, § 1 (amending
The DSM-III is a reference work compiled by the American Psychiatric Association that categorizes mental disorders. The DSM-III uses five axes for classifying disorders. The first two axes aire for mental disorders, and the third is for physical disorders and conditions. The fourth and fifth axes provide information supplementing the official diagnoses under the first three axes. In 1987, the DSM was revised (DSM-III-R), and in 1994, it was superseded by DSM-IV.