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The attention of many of us was riveted for months on the trial of a youthful mother, Casey Anthony, who was accused of murdering her beautiful two-year-old daughter.  

After three years in jail and a lengthy court trial, Ms. Anthony was found not guilty. 

But the puzzles remained.  Was the child killed? Was it an accident? If not her mother, who could have possibly been the perpetrator?  

Many people were incensed by the verdict just as they had been incensed by the video of Casey doing exhibitionistic dancing in a local bar after her daughter had gone missing. 

As the trial unfolded, more and more evidence was presented.  All of which seemed to implicate Casey, the mother.  However, no clear picture of who Casey was emerged.  “Cold,” “manipulative,” “a chronic liar,” “psychopathic,” “narcissistic,” and “sociopathic.” Television personalities, lawyers, physicians, psychologists, psychiatrists all joined the chorus.  Near the end of the trial, the judge requested psychological assessment of the defendant.  A forensic psychologist reported that Casey “passed” the Minnesota Multiphasic Personality Inventory-2 with flying colors.  There were no indications of any psychiatric diagnosis nor personality diagnosis.  How could this be?  The MMPI-2 is a well-validated and highly-regarded test.  Furthermore, it has a series of validity scales that can detect “faking” (both “bad” and “good”).  She “passed” these scales as well.  If neither a psychiatric illness nor a personality disorder could explain Casey, what other factors might be involved.  Aberrations of behavior and mood changes can be caused by a variety of things including psychological trauma, brain damage, disease and so forth. 

From watching Casey on TV, little could be deduced about her character.  However:

She appeared flat in affect perhaps at her lawyer’s suggestion.  She looks slightly puzzled at times, raising a question about slowed processing speed.

The prosecutor repeatedly commented on her chronic lying.  As Dr. Drew pointed out, that is not a psychiatric diagnosis.  Was it bad judgment?  Was she constantly trying to please others?

Her flamboyant behavior after her daughter’s disappearance suggested a lack of understanding of the consequences of her behavior and poor impulse control.  These behaviors raise a question of possible frontal lobe involvement.

It was noted that her parents have been angry and frustrated with her at times. On occasion, they apparently treated her as “a bad girl”, “a failure”, “stupid” and so forth.

It was noted that Casey did not graduate from high school and had held few, if any, jobs. 

These symptoms all raise questions about the possibility of some kind of brain damage.

Following the trial, it was reported that, in fact, Casey had at least three seizures while she was in jail.  To my knowledge, this important medical information, which may implicate some kind of brain damage, was not available until after the trial was over.  This is not to suggest that Casey murdered her daughter in the midst of a seizure.  Aberrant behavior usually occurs between seizures and not during seizures, i.e., it is interictal.

However, the existence of a seizure disorder can be confirmed by the finding of unusual spiking on an electroencephalogram (EEG).  Sometimes the finding is localized to a given brain area and sometimes it is more general.  The existence of these abnormal EEG findings suggest there is a dysfunction in the brain.  This, in turn, may be linked to behavioral or personality changes.

Could this possibly explain some of Casey’s appearance, attitude and character?  Although persons with seizure disorder usually have no behavioral or temperamental impairments, some do.  Some authors have noted the frequency of seizure disorder among inmates on death row.  There are many things that might account for Casey’s behavioral and temperamental problems.  For example, we do not know how long she had the seizure disorder.  We do not know if there was a focus, e.g., a possible frontal lobe focus or was it a generalized seizure.  Was any neuropsychological testing done? At all? Ever? 

What accounted for her troubles in school and her inability to hold a job?  What was her estimated IQ?  Were her parents frustrated and angry because they did not fully comprehend the impact of her seizure disorder?  Where are the medical records?  Where are the school records?  Was she given any kind of neurocognitive re-training? Ever?

In my clinical experience, some young persons with seizure disorder have symptoms that are very similar to Casey’s.  This is particularly true when the seizure disorder has been very long lasting.  Such patients may lack impulse control and have impaired cognition.  They may try to please others in whatever way they can.  They have no confidence in their own talents.  Family and friends are often frustrated and angry with them and feel they are being obstinate, difficult or on street drugs. 

The need for neurocognitive rehabilitation may not be recognized by the family and consequently never made available to the patient.

Note that this puzzle cannot be completely unraveled until all of the above questions are answered.  The information however should be rather easily available. 

Please note, again, that many or most seizure patients have neither behavioral nor cognitive problems.  However, a lifelong seizure disorder with limbic/frontal lobe focus and lack of neurocognitive treatment may be related to the Casey that we saw on TV. 

The question of whether or not she killed her child will not be answered by a resolution of these issues.  Clearly, having a seizure disorder does not “excuse” anyone from criminal activity. 

If the seizure disorder played an important role, then the possibility of an accidental killing followed by bizarre behavior, not reporting the incident, etc., may be more plausible.

Children or teens with academic and behavioral problems should not be dismissed as willful and “bad children”.  What appears to be psychological dysfunction may have a neurological basis. 

Neuropsychological testing can be very helpful in making a correct diagnosis.  In turn, this diagnosis may offer hope of remedial help. 

Unfortunately, brain damage is often occult and not at all readily apparent especially if language is not particularly affected, walking and talking are intact, the person may appear quite normal. 

Even the best intentioned parents may be unaware of the problems and consequently not seek treatment for their child. 

 Date: 12.31.11

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