Thread by @alysanmati

The trial in the Toronto van attack continues today with the testimony of Dr. John Bradford. We are dealing with some feedback issues from the renowned forensic psychiatrist.

thestar.com/news/gta/2020/…

Sharing this great Ottawa Citizen feature on Dr. Bradford, who did assessments on Paul Bernardo and Russell Williams, and spoke about the impact that had on him.

ottawacitizen.com/health/Tough+f…

Dr. Bradford is logging off and logging back in to see if that will resolve the feedback issues (Zoom court perils)

It has not resolved them.

The heroic Addi Khan, the court registrar, is troubleshooting.

The judge is now involved in the troubleshooting.

Seems like it's been fixed (for now) so we are going to get going. Dr. Bradford is being sworn in as a witness.

Boris Bytensky, Alek Minassian's defence lawyer, says he's proposing to call Dr. Bradford as an expert in forensic psychiatry. The Crown and the judge have no issue with this, he's testified in Canadian courts for decades.

He is one of the founders of the Forensic Psychiatry section Royal College of Physicians and Surgeons of Canada (he helped set up the examination system). He's been practicing forensic psych for more than 40 years.

He's now at McMaster University and St. Joseph's in Hamilton but spent a long time at the Ottawa Hospital.

He's spent a lot of his career doing not criminally responsible assessments (which is why he's testifying today) and has been a member of the Ontario Review Board for around 40 years (the ORB oversees people found NCR or unfit to stand trial).

He's written 57 book chapters and a tonne of peer-reviewed articles, presentations, reviews. He's been an expert witness/involved in some of the most "notorious cases", Bytensky said. He was involved with the Picton case in BC though did not testify.

He met with Minassian "ten times or more."

Defence asks why he involved other doctors at St. Joe's during the assessment of Minassian. Bradford said it was important to do psychological testing once it became clear Minassian was on the autism spectrum.

Defence asks about the other forensic psychiatrist in this case, Dr. Alexander Westphal. Bradford met him at Yale while guest lecturing in recent years and knew he had expertise in autism. Bradford recommended him to the defence.

Bradford is now doing a limited amount of clinical work, mostly doing academic work now. Clinical work means doing forensic evaluations for things like unfitness to stand trial or NCR.

Also involves treating those individuals.

Bradford has treated individuals with autism, though not that many. He says are sometimes "co-morbidities" meaning that the person has other disorders as well as autism. Minassian is the first person he's seen who "purely" has autism spectrum disorder.

He says there had not been much research in forensic psychiatry linked to autism in the 1990s. Research emerged relatively recently (he says around 2006).

He is explaining the evolution of research into schizophrenia and how there is now increasing knowledge around how it works, how it can interact with substance use, how it can be managed.

Defence points to a presentation given by Bradford in 2018 that dealt with autism spectrum disorder and violence (which is the interest of forensic psychiatry). There is not a "causation relationship," he said. The presentation was a review of the research.

He has not published in the area, but has been reviewing research and is part of developing a research project looking into mass murders. "Most people on the autism spectrum are not violent at all," he notes.

Bradford: There is a small fraction of people on the autism spectrum who may engage in criminal behaviour, including homicides and mass murder.

Bradford notes that mass murders are very rare and often the perpetrators die by suicide, so not often much examination of them. Often limited to research of materials they've written.

He says the research has been done using the "Mother Jones database" which I think may be this one: motherjones.com/politics/2012/…

The research has shown there there is a "small group" of the perpetrators who have or may autism spectrum disorder, he says.

Around 1 per cent of the general population has autism spectrum disorder, Bradford says. Based on that there is an overrepresentation of people on the autism spectrum disorder involved in mass murders BUT not known to be a causation relationship.

"It's more complicated," he says, pointing to the understanding of how, for example some delusions can cause violent behaviour. Not saying at all that autism spectrum disorder causes violence, people with ASD far more likely to be victims.

Defence points to Minassian's attempt to be shot dead by police. How would this case have been evaluated if he wasn't alive to answer questions? Bradford said it is known that he was diagnosed with ASD, intelligent, went to college and got a degree.

Minassian had not written a suicide note or manifesto as other people have, beyond the brief Facebook post, Bradford said. Would have been hard to do a deeper evaluation into why he did what he did.

Taking a short break now.

Now getting into questions about Bradford's process re taking notes. Bradford said he'd sometimes video an assessment, usually where a patient is in a psychotic state that would be expected to change with treatment.

Clear that Minassian was not psychotic, so did not do a video. Took written notes and then dictated the notes into "an electronic record." Defence says there are around 1000 pages of notes from the hospital.

Minassian, when he came to the hospital for the assessment, had just attempted suicide by drinking soap in jail and had made it clear he would attempt suicide again if he could, Bradford notes.

Explains the interviewing style he uses is more open-ended questions but sometimes has to use more direct, intrusive question. Defence asks if the kind of question matters when looking at the response.

It might, Bradford said. Context can be helpful doesn't mean the note of just the answer isn't useful.

Goes through with some of the questions that they had while assessing Minassian. Was he in a psychotic state, was he in a depression (no to both). What symptoms of autism spectrum disorder did he have (this is where Bradford got Dr. Chauhan in).

Bradford says there was a team involved, including a social worker and other doctors who observed Minassian. This is not unusual.

Had questions about whether he was engaged in "ritualistic behaviours." Getting the family history was important, important to understand how the individual adapted to having autism. Also important to find out if there was psychosis, if the family saw anything different before

The family, we've heard from Minassian's dad, did not seem to see anything at all unusual preceding the attack on April 23, 2018. No indication at all of psychosis.

Defence asks what the significance of having "rituals" are. Bradford says it can be an indication of autism spectrum disorder.

Defence asks about obsessions, hyper-focus, fixations. Bradford said Minassian in 2008/9 became interested in mass murder. Seemed like "an interest" that stayed with him, fluctuating, but gained momentum again in 2016.

Bradford did not observe any psychosis and there was no signs from his history or in any of the information available.

Defence: Why is the important, why is that something you looked for

Bradford says the not criminally responsible evaluation, for most of his career, is often based on whether or not the person is psychotic. 80 or 90 per cent of people found NCR has to do with a psychotic condition.

Defence says there is a difference between psychosis and psychopathy. Bradford explains psychosis is heritable, but people can go through life without that being activated. This is key because psychosis is a "state" during which can have delusions. But not a "trait."

Psychopathy may include a brain disorder. It is a "trait" not a "state" condition. The term psychopath is not an official one, but it's applied to persons at the high end of a personality disorder including callous disregard for others.

Psychopathy is something sometimes seen in sexually-motivated homicides (Bradford uses the example of Ted Bundy) or gratuitous violence like torturing. Also disregard for others, very "ego-centric." No real effective treatment for it. It's a lifelong condition.

Bradford said Minassian does not show signs of psychopathy, which includes showing signs of anti-social behaviour before the age of 18. No history of violence. Does have some issues with empathy, but had not harmed anyone. Had lied to his parents a bit, but not consistently

Bradford has opined that Minassian doesn't fit into the "traditional" basis for a not criminally responsible finding. Looking at some slides he prepared to explain psychosis and delusions. Delusions are "fixed beliefs" not amenable to change in light of conflicting evidence.

People who are in psychosis can have a "primary delusion." People would notice a change preceding the onset of the psychotic state. In that state could have a delusion like being a member of the royal family. Could demand to move into Rideau Hall, cannot be persuaded otherwise.

"It's a profound condition that takes over the person's operating mind." But he stresses that it is a "state" and that a state can be changed, unlike a "trait" which is permanent.

Now looking at a slide about "overvalued ideas" which are less than delusions i.e. the person can acknowledge the idea may not be true. People with autism can have "hyper-focus" or narrow interests but that is not at the level of delusions.

Bradford points to the Unabomber as an example of someone with an "overvalued idea" but not delusions who committed mass killings.

Bradford says "overvalued ideas" are different from delusions. With a delusion the beliefs control the mind, but "overvalued ideas" the person is capable of debating the idea.

We are on the lunch break now till 1:15

Back up now. Defence is asking about the difference between a "traditional pathway" to an not criminally responsible verdict (which is a legal finding) and an "autism pathway."

Bradford: Before, during and after the offence, for someone in a state of psychosis, their state of mind is profoundly affected and they are unable to know what they were doing is wrong.

Bradford: I am not an expert in autism, says the "theoretical argument" about how "high-functioning autism" can be linked to NCR criteria in two ways. One is defects in empathy leading to defects in moral reasoning. The other is "abnormal narrow interests"

He says neurotypical people can balance their interests through social interaction, vs a situation of "hyper-fixation" on one thing.

Bradford's view is that Minassian doesn't fit the traditional pathway for NCR but the "autism pathway" could be up for legal interpretation. He views it as a "theoretical issue" and doesn't think it applies.

He thinks the "hyper-focus" is more like an overvalued idea than a delusion and therefore that it would not meet NCR criteria. Other countries have struggled with this issue, he said. Has been looked at in far less severe cases than this.

Bradford has noted that he is not an autism expert and has limited experience in working with autistic people. This is why he recommended Dr. Westphal among others.

Bradford said he couldn't find any not criminally responsible cases in Canada where autism spectrum disorder was the only diagnosis, there was always a co-occurring disorder. There were some in other countries.

He later did become aware of one Canadian NCR case with a sole autism spectrum disorder, but it was "on consent" so it wasn't really tested in court. The case is a youth case (J.F).

Bradford said he looked at cases in Ireland and Israel. Different countries have different standards for these things and apply different tests, he notes. To summarize, he said, it's something that is still being sorted out legally.

Defence asks if he's aware of cases in Canada where NCR due to autism spectrum disorder alone been raised unsuccessfully. Bradford said no.

Defence does this lack of cases have any impact. Bradford says it does have an impact, since it's a legal test. Bradford said he doesn't have the expertise in autism to really give an opinion, though if he is right about overvalued ideas then it would not lead to an NCR finding.

Now looking at a slide looking at lack of empathy in psychopathy vs autism. Key difference is that psychopaths manipulate and take advantage of other's feelings and emotions. People with autism struggled to recognize the feelings/emotions of other people.

That should be people with autism GENERALLY struggle to recognize feelings/emotions -- there is a lot of variation in autism spectrum disorder.

The team of doctors did put Minassian through the psychopathy test and Bradford said he did not score high. People who are psychopathic have a "callous lack of empathy" towards their victims. The contrast with autism is that autism involves a "lack of awareness" (not deliberate)

Minassian describes what he did in a blunt, unnerving way with a lack of empathy to the victims and his own family.
"I don't think it's conceptually the same as the callousness we see in psychopathy," Bradford says.

Bradford said he's seen the video interview of Minassian by Dr. Westphal. Doesn't change his opinion.

Bradford also reviewed Minassian's school assignments. He was hoping there was a manifesto or something written prior to the attack but there was not. The material he looked at "shows some degree of moral reasoning."

(At least at face value, he says. Minassian's dad testified Minassian needed help with some of these assignments).

Defence is asking about the Facebook post made by Minassian just before the attack.

Bradford said it sound like a "mini-manifesto statement." Bradford said his understanding is that it was actually posted shortly after Minassian had begun the attack.

Bradford says some mass murderers do follow other mass murderers online prior to their crimes, as Minassian did.

Bradford is asked if it matters what Minassian tells him about his motivations. Bradford said it's important to know about before, during and after the attack. Minassian lied to Det. Thomas in the police statement to "increase the notoriety value of what he had done."

He told Bradford he'd had an interested in mass shootings since 2008/2009 and particularly in Elliot Rodger, whose manifesto he read more than once. He lied about being in contact with him though.

Bradford said Minassian was focused on common points with Rodger, ignoring differences. Motivations also include: noteriety, and puzzlingly, anxiety about his job. Bradford said the latter one doesn't make much sense.

He said Minassian didn't have "complete hyper-focus" on the incel movement though it did play some role. He had both supportive and non-supportive opinions of the movement, Bradford said of what he recalls now.

A note from me: Bradford's report on Minassian hasn't been released and I haven't read it so it's a little hard to follow.

Bradford said there is a question being raised about whether people on the autism spectrum are more vulnerable to the "online influence/ online indoctrination" of other mass murderers.

Defence asked whether it was possible to figure out whether Minassian was trying to mislead him or other doctors. "On the contrary he was very blunt and forthcoming...even if it wasn't in his best interest."

Defence asks if he though Minassian was misleading other doctors. Bradford says no.

(Note from me: Minassian's affect in the police interview doesn't seem different from how he was with the doctors so I'm not sure how we can know from that where he was lying.)

Bradford said there are places online that "elevate" the status of mass killers. As a person without a problem hyper-focus, it could be an interesting study. With someone with difficulties in filtering it could go into an "abnormal, repetitive interest" that could be a problem.

Bradford said Minassian's "mission" (a word Minassian used) could be infamy.

Defence: Obviously he set out to kill people but was there more than that?

Bradford: He talks about an incel uprising but ultimately he's looking at infamy and noteriety.

He also talked about suicide by cop and wanting to get a toy gun to provoke being killed. Also talked about failing at his job "which almost doesn't make sense."

(Note from me: Not hearing from Bradford about hatred of women as a defining motivation for Minassian, more about infamy/notoriety)

Bradford said Minassian doesn't seem to be depressed and that doesn't seem to be part of the suicide attempt. More that it was what other people he was following did.

Defence asks about this moment in the police interview where Minassian appears for a moment to be crying (this is unclear). What if he was crying? Bradford said it could matter bc if there was major depression it could help him. He doesn't think that was the case.

Taking another ten-minute break.

We are back. Defence says Bradford's report doesn't mention narcissism though other reports do. Asks whether Minassian has "narcissistic personality disorder." Bradford says no.

At face value could say notoriety has a narcissistic component (colloquially) but in Minassian's case he doesn't think narcissism is what provoked violence. More about how he was following others like Rodger.

Bradford doesn't think Minassian suffered any narcissistic injury from being discharged from the army.

Defence: Has Minassian expressed remorse at all? Bradford said Minassian's first response was that he hadn't thought about it. When pressed further he said it wasn't a good thing or remarks to that effect. Could be an "evolution" of responses.

Bradford was trying to understand what Minassian understood about morality. Minassian said there are rules about what you can and can't do. Killing is immoral and what he did would be seen as immoral by the public.

Minassian seemed to be aware that, re notoriety, he would not be praised by the general public. He said he "felt good about" what he'd done (kill ten people and injure 16).

Defence asks what Bradford means by 'empathy deficit". he says there is a continuum. There is cognitive empathy and emotional empathy. Bradford says Minassian seems, at a cognitive level, not to have empathy. Doesn't have experience to know where he is on the continuum.

Bradford says empathy deficits can lead to to a misinterpretation of emotional states. But the split between emotional and cognitive empathy is complicated and someone with more expertise would need to explain that, he said.

Bradford said the question re Minassian is that he focused on Rodger's manifesto and video. What he took from it was similarities re inability to have relationship, lonely. But also differences. Minassian had a cohesive, supportive family. He focused on the negative not positive.

He had an abnormal, repetitive hyper-focus on this. Defence asks if this can affect moral reasoning. Bradford said he can't fully answer due to lack of expertise, but it could. It is possible, is as far as he will go.

To sum up here so far: Basically Bradford thinks there may be a route to NCR due to autism spectrum disorder, via empathy deficits and/or hyper-focus but he doesn't have the expertise in autism to offer an opinion.

And he is somewhat skeptical about the hyper-focus route, given that he isn't sure that can rise to the level of a delusion that overpowers the operating mind.

Back from a break. Defence asks about the phrase converting "life status to death status" which Minassian used in the police interview. Bradford says its the most "flat, impersonal way" of describing a mass murder and video-game like.

Minassian also used the phrase "no longer alive as a result." It showed a "profound lack of empathy" and is "quite chilling," Bradford said.

That is it from Dr. Bradford in examination in chief. Crown John Rinaldi is going to do the cross-examination. We understand that the report will be made an exhibit (not sure when).

Rinaldi said about 40 per cent of what Bradford said today is new information so he wants to wrap at around 4 today.

Rinaldi says Bradford interviewed Minassian 17 times in hospital and once at the jail, and interviewed his parents four times (not sure if it was both parents or not).

Rinaldi said his parents think he was "acting" or "reading from a script" in the police interview. Bradford said it should be kept in mind. Interview was ten hours from in the incident, his state there would go to psychosis.

(Go to determining if he was in a psychotic state).

Rinaldi says Minassian also said that his attachment to Rodger and the incels was for notoriety and that he made up what he said in the interview for notoriety. Rodger is also the only one with a long manifesto.

Rinaldi: The other mass killers left notes that show they were angry, that they wanted retribution. Rodger however went through his "day to day" drudgery in his manifesto -- but it was not a call to arms.

Bradford agrees with all of this. Rinaldi calls the manifesto a "diarrhea" from Rodger about his life, like a diary. Minassian also mentioned Anders Breivik but said his killing was political and completely different.

Minassian differentiated his motives from the motives of other mass killers, Rinaldi suggests. Bradford agrees. Rinaldi: You wrote he "hitched a ride" with Rodger because he was the most recent person to gain the most fame.

Rinaldi suggests, If minassian was putting on an act for his incel friends, it would "behoove him to show some empathy now.' Bradford said he doesn't follow this suggestion.

Rinaldi says if Minassian lied to "spice it up" why would he "spice it down" by pretending to be remorseful? He wasn't seeking notoriety from the public but the incels.

Showing remorse would be counter-productive. Bradford agrees in that context.

(For clarification, apparently Minassian used the phrase "spice it up"). Rinaldi says we don't really know when Minassian lying -- in the police interview or to the assessors.

Rinaldi notes that malingering testing is not a lie detector test. Doesn't tell us if he was lying about other things than symptoms. Bradford agrees.

Rinaldi has gone through an exhaustive list of all the material Bradford has gone through for his report and after. Asking about empathy deficits, theory of mind mentioned in the report which he calls a "hypothetical" route to NCR.

Rinaldi suggests Bradford spends more time on what he calls a "hypothetical route" to NCR than the actual analysis of the material.

I haven't seen the report so I don't know. Bradford said he doesn't think Minassian is not criminally responsible, but that there is a "hypothetical" pathway that the legal system could weigh in on.

Bradford has said a number of times he doesn't have the expertise for this hypothetical pathway (which he doesn't personally agree with) and this is where Dr. Alexander Westphal will come in.

Crown is trying to tease out what the difference between his own view and this hypothetical view. Minassian never suffered from psychosis, hallucinations and delusions. Psychosis is needed for a not criminally responsible finding, Bradford said his view is.

Bradford's view is that autism spectrum disorder doesn't go that far, to the intensity of a delusion, and therefore his opinion is that Minassian is not NCR. The closest you get with autism is to an "overvalued idea."

Crown: For NCR, there has to be something that deprives you of an operating mind.

Bradford agrees.

Crown: Your opinion about this other pathway is that it doesn't affect the operating mind.

Bradford agrees.

Defence objects to questions that seem to ask for Bradford to provide a legal opinion. Crown says the question is about his expertise.

Bradford says he doesn't have expertise in autism spectrum disorder. Gave an overview of the literature in his report. His personal opinion is that ASD, including high-functioning, is a significant mental disorder. Doesn't believe it reaches the level of psychosis.

Says he "can't get his head around" how it would lead to an not criminally responsible finding.

Bradford said autism spectrum disorder, which is recognized under the DSM-V, would probably qualify as a disease of the mind under the NCR test. For a judge to decide.

We are done with Dr. Bradford for the day. Cross will continue tomorrow. Hopefully we will get the report then.