Are juveniles mature enough to receive the death penalty? No, according to a ruling by the U.S. Supreme Court. Medical, psychiatric, psychological and brain-imaging data all supported the decision to ban execution of juvenile death-row inmates.
Comprehensive neuropsychiatric and psychosocial assessments of death-row inmates and imaging studies exploring brain maturation in adolescents played a role in the U.S. Supreme Court's recent decision to forbid the execution of killers who were 16 or 17 when they committed their crimes, according to statements in court documents.
In 1993, 17-year-old Christopher Simmons and a friend, 15-year-old Charles Benjamin, broke into the home of Shirley Crook (Roper v Simmons, 2005). She awoke, and the two young burglars bound her hands, covered her eyes and mouth with duct tape, and shoved her into her minivan. They then drove her to a state park, where they tied her hands and feet with electrical wire, wrapped her entire face in duct tape, and threw her off a bridge into Missouri's Meramec River, where she drowned. Simmons later was found guilty of murder in the first degree and sentenced to die by lethal injection. Benjamin was sentenced to life in prison.
It is Roper v Simmons that recently led the U.S. Supreme Court, in a 5 to 4 decision, to affirm a ruling of the Missouri Supreme Court (Simmons v Roper, 2003). In 2003, the state court held that a national consensus had developed against executing juvenile offenders and that the death penalty imposed upon juveniles is "cruel and unusual" punishment prohibited by the Eighth Amendment to the U.S. Constitution. It set aside Simmons' death sentence and re-sentenced him to "life imprisonment without eligibility for probation, parole or release except by act of the Governor."
For the past 20 years, the U.S. Supreme Court has grappled with the issue of when a child's thinking has matured sufficiently to be considered equivalent to that of an adult. In 1988, the court, in Thompson v Oklahoma, outlawed execution for those who were 15 and younger when they committed their crimes. Yet, a year later in the case of Stanford v Kentucky (1989), the same court decided that 16-year-olds were sufficiently mature to be tried as adults and executed.
The Supreme Court's decision last March bars the execution of those under 18 at the time of the murder. The decision nullifies laws allowing the death penalty for juveniles in 20 states and voids the sentences of 73 death-row inmates in 12 states.
"The death sentences will be vacated, and those inmates will go through a re-sentencing process," Joseph McLaughlin, an attorney with Heller Ehrman White and McAuliffe in New York City, told Psychiatric Times. McLaughlin filed an amicus curiae brief in Roper v Simmons for the American Medical Association (AMA), American Academy of Child and Adolescent Psychiatry (AACAP), American Psychiatric Association and five other organizations (AMA et al., 2004). "The outcome for each individual will vary upon state laws. Some states provide life imprisonment with the possibility of parole, while others do not," he said.
McLaughlin added, since the juvenile offenders will be removed from death row, many of them will have access to psychiatric treatment in those states that provide it.
Considering Psychiatric Issues
The legal briefs filed by Simmons (the respondent in the case) and amicus curiae in support of him described scientific findings of medical, psychiatric and psychological research relevant to the legal issues presented to the court. The brief filed by Simmons (2004), for example, noted that he possessed a low intelligence quotient, had suffered psychological abuse resulting from his parents' bitter divorce, had endured physical abuse, was addicted to alcohol and drugs, and had been diagnosed as "having a borderline personality disorder and a 'schizotypal' personality disorder."
Friend of the court briefs filed by AMA et al. (2004) and the Juvenile Law Center et al. (2004) seeking to ban the juvenile death penalty cited several scientific studies, including those conducted by Dorothy Otnow Lewis, M.D., a psychiatrist at Yale University's Child Study Center, and her colleagues. Lewis has evaluated numerous murderers who committed their crimes as juveniles.
In the late 1980s, Lewis, along with Jonathan Pincus, M.D., chief of neurology at the Veterans Affairs Medical Center in Washington, D.C., and professor emeritus of neurology at the Georgetown University School of Medicine, and others conducted comprehensive psychiatric, neurological, neuropsychological and educational evaluations of 14 juveniles in four states who were condemned to death (Lewis, 1998; Lewis et al., 1988). Their investigation revealed that nine of the 14 had major neuropsychological disorders, seven suffered psychotic disorders antedating incarceration, seven had significant organic dysfunction on neuropsychological testing, and only two had full-scale IQ scores above 90. Twelve reported having been abused, including five who were sodomized by relatives.
Most of the juveniles attempted to hide evidence of cognitive deficits or psychotic symptoms and tried to conceal or minimize incidents of parental brutality. For a variety of reasons, the juveniles' vulnerabilities were not recognized at the time of their trials or sentencing.
In 2004, Lewis and colleagues published a study of 18 males who had been condemned to death for homicides committed prior to their 18th birthdays. They were part of a cohort of 26 condemned juveniles in Texas. Lewis and colleagues conducted psychiatric, neurological, neuropsychological and educational assessments. They also reviewed all available medical, psychological, educational, social and family data. One of the purposes of the study was "to clarify the ways in which immaturity of their central nervous systems, traumas to their brains, predispositions to psychiatric illness, and chaotic, violent and abusive upbringings may have diminished their judgment and self-control."
Asked about the major findings of the new study, Lewis told PT, "The group that we saw more recently compared to the group of 14 we saw in the 1980s had a higher and more normal range of intelligence."
But even though most of the juveniles had average to low-average IQs, Lewis said, some were repeatedly not passed to the next grade level in school, while others were placed in special education classes and/or were transferred to alternate school settings.
In the 2004 study, Lewis said she and her team conducted sophisticated neurological, neuropsychological and educational testing. All of the individuals evaluated neurologically and neuropsychologically had signs of frontal lobe dysfunction, Lewis said. The frontal lobe is involved in judgment, making decisions and putting breaks on behavior. The neuropsychological testing was even more powerful than the neurological exam in identifying executive dysfunction, she added.
Another major finding was that the majority of the group (83%) had histories, signs and symptoms consistent with bipolar spectrum, schizoaffective spectrum or hypomanic disorders that long antedated their offenses. Their problem behavior had been seen early but was misinterpreted as being high spirits or lack of discipline, she explained.
Lewis emphasized that most individuals with frontal lobe dysfunction, bipolar disorder or schizoaffective disorder do not commit murder or engage in violent acts. "However, studies have reported those who have such disorders and who come from homes where there is violence and abuse are significantly more likely to be violent than their peers," she said.
Most of the juveniles Lewis and colleagues studied were raised in families where there was extreme violence, sexual and physical abuse, and where some family members exhibited mental illness. The 2004 study provided some of the details. One juvenile was beaten severely by numerous family members and sexually abused at age 7. Another was beaten often and, as a toddler, witnessed his father shoot himself in the head, an experience that resulted in recurrent flashbacks and for which he felt responsible. A third, at the age of 3 or 4, was caught by his stepfather eating chicken meant for adults. The stepfather took a knife and sliced the child's lower lip. The scar is still visible (Lewis et al., 2004).
Particularly shocking, Lewis said, was when the researchers reviewed court records from the trials, most showed that no evaluation of the family had been conducted. In three or four of the records where an evaluation was made, the families were described as "stable" or "model families."
What's more, Lewis told PT, only four of the 18 on death row had undergone pretrial psychiatric evaluations, two for the court and two for the defense, and those were incomplete. To the best of her knowledge, Lewis said no pre-sentencing neuropsychiatric evaluations were conducted.
Another study cited in the amicus curiae briefs was that of Cauffman and Steinberg (2000). In that study of more than 1,000 adolescents and adults (ages 12 to 48), researchers found that psychosocial maturity is incomplete until age 19, at which point it plateaus. Adolescents scored lower on measures of self-reliance and other aspects of personal responsibility. They had more difficulty seeing things in long-term perspective, were less likely to look at things from the perspective of others and had more difficulty restraining their aggressive impulses.
Brain Research Sheds Light
Researchers at Harvard Medical School, the University of California at Los Angeles, the National Institute of Mental Health and others have been collaborating to map the development of the brain from childhood to adulthood and to examine implications of that development. Some of the findings were in the brief presented by AMA et al. (2004).
"Adolescents rely for certain tasks, more than adults, on the amygdala, the area of the brain associated with primitive impulses of aggression, anger and fear," the brief said. "Adults on the other hand tend to process similar information through the frontal cortex, a cerebral area associated with impulse control and good judgment. Second, the regions of the brain associated with impulse control, risk assessment and moral reasoning develop last, after late adolescence."
It also noted that brain imaging studies have confirmed that the "frontal lobes are still structurally immature well into late adolescence" with both myelination and pruning being incomplete.
Supreme Court Opinion
In writing the majority opinion for the U.S. Supreme Court, Justice Anthony Kennedy cited from psychological and sociological studies. There are three general differences between adults and juveniles under 18, he said, that demonstrate juvenile offenders cannot with reliability be classified among the worst offenders:
First, as any parent knows and as the scientific and sociological studies respondent and his amici cite tend to confirm, a lack of maturity and an underdeveloped sense of responsibility are found in youth more than in adults and are more understandable among the young. These qualities often result in impetuous and ill-considered actions and decisions ... It has been noted that adolescents are overrepresented statistically in virtually every category of reckless behavior.
Additionally, childhood is more than a chronological fact, he wrote. It is a time and condition of life when a person may be most susceptible to influence and to psychological damage. Juveniles' own vulnerability and comparative lack of freedom to extricate themselves from a criminogenic setting means they have a greater claim than adults to be forgiven for failing to escape negative influences in their whole environment.
The third broad difference, according to Kennedy:
is that the character of a juvenile is not as well formed as that of an adult. The personality traits of juveniles are more transitory, less fixed ... The reality that juveniles still struggle to define their identity means it is less supportable to conclude that even a heinous crime committed by a juvenile is evidence of irretrievably depraved character.
He pointed out that an individual must be at least 18 years of age before being diagnosed as having antisocial personality disorder.
"If trained psychiatrists with the advantage of clinical testing and observation refrain, despite diagnostic expertise, from assessing any juvenile under 18 as having antisocial personality disorder," he added, "we conclude that States should refrain from asking jurors to issue a far graver condemnation--that a juvenile offender merits the death penalty."
Kennedy also warned that there is simply too great a risk that jurors would be influenced by the cold-blooded nature of a juvenile's crimes even when an offender's lack of maturity, vulnerability and lack of true depravity should require a sentence less than death.
Kennedy further explained that "evolving standards of decency," which led the U.S. Supreme Court in 2002 to ban the execution of mentally retarded people, are similar with respect to juveniles and that the "United States is the only country in the world that continues to give official sanction to the juvenile death penalty."
Commenting on the Supreme Court's ruling, Richard Sarles, M.D., AACAP president, said, "This decision does not diminish the crimes that place juveniles on death row, but it does recognize that there are considerations to be made because of their age." David Fassler, M.D., a child and adolescent psychiatrist at the University of Vermont, noted to the press that the ruling affirms the Children and Family Justice Center, Center on Children and Families position held by nearly every major national religious denomination, child advocacy group, and legal and medical organization, including the AMA and hundreds of others who have called for an end to the juvenile death penalty.
AMA, APA, American Society for Adolescent Psychiatry et al. (2004), Brief submitted as amicus curiae in Roper v Simmons.
Cauffman E, Steinberg L (2000), (Im)maturity of judgment in adolescence: why adolescents may be less culpable than adults. Behav Sci Law 18(6):741-760.
Juvenile Law Center, Children and Family Justice Center, Center on Children and Families et al. (2004), Brief submitted as amicus curiae in Roper v Simmons.
Lewis DO (1998), Guilty By Reason of Insanity: A Psychiatrist Explores the Minds of Killers. New York: Ivy Books.
Lewis DO, Pincus JH, Bard B et al. (1988), Neuropsychiatric, psychoeducational, and family characteristics of 14 juveniles condemned to death in the United States. Am J Psychiatry 145(5):584-589.
Lewis DO, Yeager CA, Blake P et al. (2004), Ethics questions raised by the neuropsychiatric, neuropsychological, educational, developmental, and family characteristics of 18 juveniles awaiting execution in Texas. J Am Acad Psychiatry Law 32(4):408-429.
Roper v Simmons 543 U.S. (2005).
Simmons (2004), Brief for the respondent in Roper v Simmons.
Simmons v Roper 112 S.W.3d397 (Mo. 2003).
Stanford v Kentucky 492 U.S. 361 (1989).
Thompson v Oklahoma 487 U.S. 815 (1988).