State v. Greene
| Decision Date | 17 August 1998 |
| Docket Number | No. 42000-3-I,42000-3-I |
| Citation | 92 Wn.App. 80,960 P.2d 980 |
| Parties | STATE of Washington, Respondent, v. William B. GREENE, Appellant. |
| Court | Washington Court of Appeals |
David Bruce Koch, Seattle, for Appellant.
Lisa Danette Paul, Everett, for Respondent.
Sheryl Gordon McCloud, Seattle, for Amicus.
State mental health professionals diagnosed William Greene with Dissociative Identity Disorder ("DID"), formerly known as Multiple Personality Disorder ("MPD"), and treated him for almost three years before the events at issue in this case. At his trial on charges of indecent liberties and kidnapping, the court excluded evidence of the disorder and Mr. Greene's diagnosis under the Frye test and ER 702. We reverse and remand for a new trial because DID is generally accepted in the scientific community and was relevant to Mr. Greene's defenses of insanity and diminished capacity.
Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. AMERICAN PSYCHIATRIC ASS'N, DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS 484 (4th ed.1994) [hereinafter "DSM-IV"]. The DSM-IV provides diagnostic criteria for five dissociative disorders, including DID. The diagnostic criteria for DID are:
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
B. At least two of these identities or personality states recurrently take control of the person's behavior.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
DSM-IV at 487. In general, an individual with DID will have a primary identity (sometimes referred to as the "host"), which bears the individual's given name and is usually passive, dependent, guilty, and depressed. Id. at 484. The alternate identities (or "alters") frequently have different names and contrasting characteristics. Id. The alters may vary from the host in a variety of ways, including reported age, gender, vocabulary, general knowledge, or predominant affect. Id. Child and adolescent alters are the most commonly reported types of alternate identities. 1
Alters may exist on a co-conscious basis (i.e., aware of the host's and other alters' thoughts and feelings), a separate consciousness basis (i.e., little or no awareness of the thoughts and feelings of the host or other alters and vice versa), or a mixture of both. 2 For example, in the documented case of Jonah, the three alters each had intimate knowledge of the host, but the host had no awareness of the alters. 3 In addition, one of the alters (Sammy) could either coexist with the host or take complete control, and was fully aware of the existence of the other two alters. 4 The other two alters had only peripheral knowledge of each other or Sammy and would take complete control of behavior upon emergence. 5 Likewise, in the case of Sybil, one of the alters (Vicky) was co-conscious of the host and all of the other alters, but the host was amnesic toward all of the alternate identities. 6
Particular identities may emerge in specific circumstances. DSM-IV at 484. For example, in Jonah's case, one alter would emerge when interpersonal difficulties arose, another alter would appear to deal with sexual problems, and a third alter would take control in situations of physical danger. 7 An identity not in control of the person's behavior may gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). DSM-IV at 484-85. A transition between identities is generally triggered by psychosocial stress. Id. at 485.
Research consistently links DID with childhood trauma, most commonly physical or sexual abuse or both. 8 Other forms of childhood trauma include neglect, abandonment, wartime experiences, witnessing the death of a parent or sibling, near death experiences, and painful medical procedures. 9 Individuals with DID frequently satisfy the criteria for Posttraumatic Stress Disorder ("PTSD"), the characteristic symptoms of which are persistent reexperiencing of a traumatic event, persistent avoidance of stimuli associated with the trauma, and persistent symptoms of increased arousal (e.g., difficulty sleeping or concentrating, hypervigilance, exaggerated startle response). 10
Sigmund Freud posited that the ability of the ego to split is one of its normal functions. 11 Modern research appears to confirm that dissociation occurs to some degree in normal individuals, and that a continuum exists between the minor dissociations of everyday life (e.g., daydreaming, "getting lost" in a book or movie, highway hypnosis) and the major or pathological forms of dissociation (e.g., DID). 12 Although dispute exists concerning the etiology of DID, the most accepted explanation is that childhood trauma disrupts ego formation in such manner as to advance the individual toward the pathological end of the dissociation continuum. 13 As further explained by Dr. Greaves:
One needs to also bear in mind what, exactly, it is that dissociation accomplishes. Sybil did not escape torture through dissociation; she did not alter her insane environment. Instead, she was able to find lifesaving retreat in an altered phenomenal state, in much the way that a hypnotized person is able--not to escape pain--but to dissociate from the experience of pain. The inability to dissociate under such circumstances might very well lead to death by cardiac arrest. 14
Dissociative Identity Disorder is diagnosed three to nine times more frequently in adult females than in adult males. DSM-IV at 485-86. Data concerning the diagnosis frequency ratio between female and male children is limited. Id. at 486. Possible explanations for the lower incidence of DID diagnosis among men include: (i) male children are not abused as frequently as female children; (ii) adult males do not seek treatment as often as adult females; and (iii) adult males with DID are incarcerated more frequently and are therefore less likely than adult females with DID to be diagnosed or participate in studies. 15 Women tend to manifest more identities than men, averaging 15 or more, whereas men average roughly eight identities. DSM-IV at 486. Individuals with DID spend an average of six to seven years in the mental health care system and receive at least one, and often multiple, incorrect diagnoses before being properly diagnosed with DID. 16
Opponents of DID offer four interrelated criticisms: (i) the child abuse reported by DID patients is unsubstantiated; (ii) DID is an iatrogenic 17 artifact; (iii) clinicians cannot determine whether DID patients are malingering or faking the disorder; and (iv) the diagnostic criteria for DID are vague. 18 Each of the above criticisms is addressed further below in connection with the application of the Frye and ER 702 standards.
During childhood, William Greene experienced severe physical, sexual, and emotional abuse. At the insistence of his mother, Mr. Greene became a ward of the State of California at the age of eight; he spent the following nine years in various juvenile facilities and foster homes. He continued to endure both physical and sexual abuse, including a gang rape at the age of 12 by three older boys. Sometime during this period, Mr. Greene developed a substance abuse problem; he reports having used a variety of drugs, including cocaine.
At the age of 17, Mr. Greene escaped from a juvenile facility and fled to Washington with another youth. He was eventually arrested and convicted in 1972 of taking a motor vehicle. From that point forward, Mr. Greene spent most of his life in prison. He was convicted in 1975 of sodomy, in 1980 of attempted burglary, in 1984 of indecent liberties, and in 1988, again of indecent liberties. Following the last conviction, Mr. Greene participated in the Sex Offender Treatment Program at Twin Rivers Correction Center. While in the program, Mr. Greene was diagnosed with both Major Depression and Multiple Personality Disorder (or DID).
After Mr. Greene's diagnosis with DID, a total of 24 "alters," of both genders, different races, and varying ages, were identified. The alters relevant to this case are Sam, Auto (or Otto), and Tyrone. Sam was initially violent, but after addressing abuse issues in therapy, Sam "vowed to never cause physical harm to anyone again." Auto/Otto is a helper personality with a generally flat affect. Tyrone originally presented as an adult, black male who used "rough and assaultive" language. After Mr. Greene began addressing his childhood abuse issues, Tyrone started regressing in age.
Mr. Greene was released from Twin Rivers in November 1992. From then until April 1994, Mr. Greene voluntarily continued therapy by attending each week: one group session through the Sex Offender Treatment Program; at least one Cocaine Anonymous meeting; and two 90-minute individual sessions with M.S., the psychiatric mental health nurse who was Mr. Greene's primary therapist at Twin Rivers. In addition, during this period, Mr. Greene was gainfully employed, maintained a non-abusive, intimate relationship, and had a number of healthy friendships.
During the two months prior to April 1994, Mr. Greene's condition began deteriorating. Due to a fire at his employer's facility, Mr. Greene was scheduled to be laid off. M.S. considered Mr. Greene to be a suicide risk and she instructed him to call her on a daily basis. On April 29, 1994, alarmed by a...
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