The Neuroscience of Trauma Supports Diminished Capacity as a Nuanced Approach to the ICC Case of an Ex-Child Soldier

The 2021 conviction of former child soldier Dominic Ongwen by the International Criminal Court (ICC) for war crimes committed as an adult commander in the Lord’s Resistance Army in Uganda raises questions about the ICC’s approach to mental illness.  During his trial, the defendant unsuccessfully raised defenses of insanity and duress, based on his kidnapping into the militant group as a child.  The court rejected not only those defenses, but also the claim that he had mental illness at all, in spite of his traumatic childhood.  Integrating scientific research, we argue that both the ICC and the defense failed to address the neuroscience of trauma.  But even if this evidence had been presented, the ICC’s all-or-nothing approach to mental illness would still leave outwardly functional trauma survivors in legal limbo.  On the one hand, such survivors may be too functional for the insanity defense.  At the same time, their activated fight-or-flight responses may cause them to perceive and react to threats in ways that the duress defense would not excuse as reasonable.  We propose that sentence mitigation based on diminished mental capacity provides a just and nuanced approach to the dilemma of a trauma victim turned perpetrator

The Neuroscience of Trauma Supports Diminished Capacity as a Nuanced Approach to the ICC Case of an Ex-Child Soldier

The 2021 conviction of former child soldier Dominic Ongwen by the International Criminal Court (ICC) for war crimes committed as an adult commander in the Lord’s Resistance Army in Uganda raises questions about the ICC’s approach to mental illness.  During his trial, the defendant unsuccessfully raised defenses of insanity and duress, based on his kidnapping into the militant group as a child.  The court rejected not only those defenses, but also the claim that he had mental illness at all, in spite of his traumatic childhood.  Integrating scientific research, we argue that both the ICC and the defense failed to address the neuroscience of trauma.  But even if this evidence had been presented, the ICC’s all-or-nothing approach to mental illness would still leave outwardly functional trauma survivors in legal limbo.  On the one hand, such survivors may be too functional for the insanity defense.  At the same time, their activated fight-or-flight responses may cause them to perceive and react to threats in ways that the duress defense would not excuse as reasonable.  We propose that sentence mitigation based on diminished mental capacity provides a just and nuanced approach to the dilemma of a trauma victim turned perpetrator

The doctor-patient relationship during medical internship: The evolution of dissatisfaction

We prospectively examined perceptions of the doctor-patient relationship among interns in two different internal medicine training programs five times during the internship year. All 59 interns in the University of California, Irvine-Long Beach and the Oregon Health Sciences University Medical Programs participated in the study during the 1982-1983 internship year. We serially administered a questionnaire that contained four major items: (1) a choice of one of six empirically developed role paradigms of the doctor-patient relationship; (2) a checklist of positive and negative aspects of internship; (3) a measure of level of satisfaction with the decision to become a physician; and (4) a rating list of mood descriptors. The six role paradigms portrayed a variety of positive and negative aspects of the doctor-patient relationship. At the beginning of the year, the interns were quite positive about the doctor-patient relationship and preferentially endorsed collegial models. As the year progressed, they endorsed significantly fewer positive and more negative models (Pinternship doctor-patient relationship medical education