Steven Miller was 17 years old when he was charged with the shooting death of a Subway store clerk. A former honor student whose grades slipped dramatically before the alleged act, Steven pled not guilty by reason of insanity. He languished for nine months in a university-affiliated hospital before the judge ordered a transfer to a state hospital for an immediate evaluation to determine the existence of any physical, emotional or psychological defects.
Seven months later, his evaluation report was finally available. A picture of Steven emerged as a young man who was socially isolated and experienced interpersonal discomfort. He allegedly had a history of self-mutilation.
He was administered a battery of tests, including two MMPI-IIs. The results of the first MMPI-II were discarded because the evaluator suspected that Steven either did not read the items or tried to exaggerate psychiatric problems. For the next five months, Steven's attorneys filed numerous motions for additional testing. He retained a psychiatrist to determine if he suffered from organic brain disorder. He then requested an examination to determine if he had fetal alcohol syndrome. Dr. Joe Alford, a clinical neuropsychologist, conducted a second assessment. He determined that Steven may have had mild to moderate brain dysfunction and poor impulse control. The fetal alcohol syndrome was ruled out. Steven's attorneys alleged their client was shocked by the report and his attorneys requested a continuance in order to find an out-of-state neuropsychologist. A competent professional, they argued, could not be found in Arkansas. The trial judge refused the request.
At trial, Dr. Alford testified under cross-examination that an Antisocial Personality Disorder cannot be diagnosed until after age 18. An individual with such a diagnosis would present a history of criminal acts and aggression towards others. A juvenile who presented such behavior would be diagnosed with Conduct Disorder. Dr. Alford also stated that he would not diagnose a person under the age of 18 with a Borderline Personality Disorder. Clinically, an individual with such a diagnosis would present a pattern of unstable intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. Regardless of his age, however, he determined that Steven Miller lacked the typical interpersonal symptoms that are seen in an interview with somebody with the disorder.
Mr. Miller was convicted and sentenced to life in prison. On appeal, he argued that his constitutional rights to equal protection were violated because he had not been given the same mental evaluation as adult defendants charged with the same crime.
Holding: The life sentence was confirmed. No constitutional violation occurred because a valid clinical basis was present for Dr. Alford's decision not to diagnose Steven Miller with a personality disorder. The trial court's decision to credit the expert's testimony was sound; Steven did not present sufficient signs or recognizable traits of the condition. The appeals court also noted the lack of expert documentation to buttress Steven's argument that he was not diagnosed with the disorder because of his youth.
The Minnesota Multiphasic Personality Inventory-2 is a testing instrument frequently used to validate psychopathology and assist in diagnosis.
| Carl P. Malmquist,, M.D. University of Minneapolis |
Dr. Malmquist comments: Juveniles who commit violent acts raise difficult psychiatric questions. Particular attention must be paid to what may motivate or lead to the behavior, the youth's background and more immediate life situation, and, in Steven Miller's case, his relationship to the 18 year-old who accompanied him on the night he shot the clerk. Without this information, the debate may turn toward issues that seem only tangentially relevant. Groping attempts are made to find some psychiatric diagnosis, with the mistaken belief that a diagnosis, in and of itself, will lead to a conclusion of an underlying legal question. In Miller's case, a constitutional argument was even raised about Dr. Alford's belief that a juvenile could not be given a diagnosis of Antisocial or Borderline Personality Disorder.
The answers to the legal question of responsibility do not lie within a DSM-IV label, or a debate about the proper age to make a diagnosis of a personality disorder. While some psychiatrists adhere to a strict age cutoff, clinical matters are never that rigid. It is far better to see what the persistent behaviors may have been, and then specifically see how, and if, they might have been related to the homicidal behavior and the underlying question of criminal responsibility.
The juvenile transfer hearing should provide the opportunity to air issues about diagnosis, personal conflicts, family background, amenability to rehabilitation, dangerousness, etc. It appears the appeals court did not consider any issues that may have arisen at that time, including the fact that Mr. Miller was a former honors student. The Arkansas Supreme Court can only puzzle that "for all we know, there may have been a stipulation of facts." For Steven Miller, that may not have been enough.
