Opinion ID: 1158206
Heading Depth: 3
Heading Rank: 5

Heading: Whether PTSD Testimony is Admissible

Text: After reviewing the relevant case law, we look first at whether PTSD is grounded in valid scientific knowledge, employing the principles outlined above. Then we consider its probative value, that is, whether it reliably and accurately proves what it purports to prove and thus whether it would assist the trier of fact. The next step is to determine whether its probative value is substantially outweighed in a Rule 403 balancing analysis. Finally, we address some limitations on expert testimony regarding PTSD evidence. [9]
We have yet to pass on the admissibility of PTSD or RTS evidence. The Court of Appeals, however, in State v. Bowman, 104 N.M. 19, 715 P.2d 467 (Ct.App. 1986), assumed without deciding that expert testimony regarding RTS was admissible. Id., at 21, 715 P.2d at 469. The Court noted that in New Mexico, the admission or exclusion of evidence is discretionary with the trial court, and it stated that New Mexico courts liberally allow the admission of expert testimony. Id., at 22, 715 P.2d at 470. Employing the abuse of discretion standard in reviewing the trial judge's decision, the Court opined that it might not reverse a trial court which had allowed the introduction of RTS evidence, but that conversely, it does not necessarily compel reversal of a trial judge who excluded such evidence, which is what the trial judge had done. Id. The Court went on to state that its affirmance of the exclusion of RTS evidence was supported by the prosecution's insistence on using the emotion-charged terminology of rape trauma syndrome despite the psychologist's repeatedly expressed preference for the neutral term of post-traumatic stress disorder. Id. The Court of Appeals has held that PTSD or RTS testimony is admissible for purposes other than to prove that a crime was committed. In State v. Barraza, 110 N.M. 45, 791 P.2d 799 (Ct.App.), cert. denied, 109 N.M. 704, 789 P.2d 1271 (1990), the Court of Appeals again did not directly address the admissibility of RTS in general because the issue had not been preserved below, but the Court held that RTS testimony was relevant to establish the element of mental anguish in second degree criminal sexual penetration. Id., at 48, 791 P.2d at 802. In State v. Newman, 109 N.M. 263, 784 P.2d 1006 (Ct.App.), cert. denied, 109 N.M. 262, 784 P.2d 1005 (1989), a child therapist testified that the victim exhibited symptoms that were consistent in her experience with child abuse victims, but she did not use the terms PTSD or RTS. Id., at 265, 784 P.2d at 1008. The Court held that the expert's testimony was admissible to assist the jury to understand the behavior of sexually abused children. Id., at 266, 784 P.2d at 1009.
Several other jurisdictions have considered the admissibility of expert testimony regarding PTSD or RTS. Almost every court that has addressed this issue, like the Court of Appeals in Newman, has concluded that PTSD evidence is admissible to explain a victim's behavior that is apparently inconsistent with having been raped if the defense has made it an issue. [10] In addition, the jurisdictions are virtually unanimous in disallowing expert testimony that comments directly on the credibility of the rape victim. See, e.g., State v. Moran, 151 Ariz. 378, 385, 728 P.2d 248, 255 (1986). But see State v. Bachman, 446 N.W.2d 271, 276 (S.D. 1989) (allowing opinion testimony that child victim's allegations were truthful). As to the issue of whether such evidence is admissible to prove sexual abuse or nonconsensual intercourse, the courts are about evenly split. Some jurisdictions allow PTSD testimony to show that the victim was sexually abused or to rebut the defense of consent. [11] Other jurisdictions forbid PTSD testimony for the purpose of proving that sexual abuse in fact occurred. [12] At least one court has upheld the introduction of PTSD testimony for the incongruous purpose to show lack of consent but not to prove rape. See State v. Huey, 145 Ariz. 59, 63, 699 P.2d 1290, 1294 (1985) (in banc). Some courts specifically prohibit an expert from testifying that the alleged victim suffers from rape trauma syndrome while allowing PTSD testimony because of the former term's latent assumption that the only cause of the syndrome is rape. See State v. Roles, 122 Idaho 138, 145 n. 4, 832 P.2d 311, 318 n. 4 (Ct.App. 1992); State v. Gettier, 438 N.W.2d 1, 6 (Iowa 1989). The concern with unfair prejudice is largely reduced when the terminology does not equate the syndrome exclusively with rape. State v. Allewalt, 308 Md. 89, 517 A.2d 741, 751 (1986). In holding that PTSD testimony was inadmissible, however, at least one court found no meaningful semantic distinction between RTS and PTSD. See State v. Black, 109 Wash.2d 336, 745 P.2d 12, 19 (1987) (en banc). Other courts have concluded that PTSD evidence is a scientifically reliable or generally accepted means of determining whether sexual abuse occurred, but have excluded it on Rule 403 grounds. See, e.g., People v. Taylor, 75 N.Y.2d 277, 552 N.Y.S.2d 883, 891, 552 N.E.2d 131, 139 (1990). In addition, many courts recognize that PTSD is founded upon good science, but even some of those jurisdictions that found PTSD to be generally accepted conclude that it will not assist the trier of fact to determine whether a rape occurred because it is a therapeutic method that was not intended to be used as a forensic tool. See People v. Bledsoe, 36 Cal.3d 236, 203 Cal. Rptr. 450, 459-60, 681 P.2d 291, 300-01 (1984) (in bank); People v. Beckley, 434 Mich. 691, 456 N.W.2d 391, 409-10 (1990); State v. Hall, 330 N.C. 808, 412 S.E.2d 883, 889 (1992). That is another way of saying that the testimony is not relevant in the sense that it is not probative.
The Court of Appeals was correct in holding that the proper initial inquiry for the admissibility of expert opinion testimony, or any evidence for that matter, is the purpose for which it is being offered. In both of these cases, the prosecution sought the introduction of expert testimony to show that a crime had been committed: that is, in Alberico to show that the alleged victim did not consent to intercourse; and in Marquez to show that sexual abuse had taken place. The issue is not, however, as the Court of Appeals stated, whether a diagnosis of PTSD or RTS is a valid means of determining whether a rape occurred; rather, it is whether PTSD evidence is probative of whether a rape occurred. In other words, the issue is whether the evidence has any tendency to make the existence of [a material issue] more probable or less probable than it would be without the evidence. See SCRA 1986, 11-401. There is no requirement that a scientific technique or method prove conclusively what it purports to prove. See Daubert, ___ U.S. at ____, 113 S.Ct. at 2795 (stating it would be unreasonable to conclude that the subject of scientific testimony must be `known' to a certainty; arguably, there are no certainties in science.).
We hold that PTSD testimony is grounded in valid scientific principle. DSM III-R is specialized literature that specifically catalogues the symptoms of mental disorders and prescribes the method by which the psychological evaluation should take place. DSM III-R, according to the State's experts, is widely used in courtrooms, not only for issues of sex abuse, but for issues concerning sanity and competency as well. PTSD is generally accepted by psychologists and psychiatrists as a valid technique for evaluating patients with mental disorders. The existence of DSM III-R and its general acceptance in psychology indicate that PTSD has been exposed to objective scientific scrutiny and empirical verification. Furthermore, the PTSD diagnosis appears to be grounded in basic behavioral psychology. See McCord at 1187. DSM III-R accumulated the symptoms of mental disorders by examining human reactions to certain events or stimuli. The theory behind PTSD is that a severe traumatic experience impacts upon the human psyche and exhibits itself in certain identifiable symptoms that are linked to a specific stressor or cause. In evaluating an alleged victim of sexual abuse, the psychologist compares her symptoms with known reactions to sexual abuse and attempts to correlate the victim's symptoms with the known causes of behavioral patterns that have been categorized. In that way, the PTSD diagnosis is no different from any other method or technique in behavioral psychology. In addition, several jurisdictions that have disallowed PTSD testimony on the issue of whether sexual abuse occurred emphasized that psychologists could not pinpoint the cause of the PTSD although they could diagnose the symptoms. In the present cases, however, the experts testified that psychologists can isolate the cause of the symptoms because different stressors manifest themselves in different symptoms. Even the defense's expert in Marquez admitted as much. We are more persuaded by evidence as to the current state of the technique than by judicial determinations of validity based on evidence that is many years old. Cf. Allewalt, 517 A.2d at 747 (finding that psychiatrist acted within his field of special training and experience not only when making PTSD diagnosis, but in identifying recognizable stressor as well).
All of the expert testimony in these two cases establishes that victims of sexual abuse may exhibit identifiable symptoms that have been catalogued in DSM III-R. If a complainant suffers from PTSD symptoms, it indicates that she might have been sexually abused. Thus, testimony regarding a complainant's PTSD symptoms has the tendency to show that she might have been sexually abused. From our perusal of all of the pertinent case law concerning PTSD, we perceive two flaws. First, of the courts that have held PTSD or RTS testimony to be inadmissible to show the cause of the symptoms, several have predicated that ruling, at least in part, upon the assumption that jurors will be awed by the aura of infallibility of expert opinion testimony. See, e.g., State v. Saldana, 324 N.W.2d 227, 230 (Minn. 1982); State v. Taylor, 663 S.W.2d 235, 241 (Mo. 1984) (en banc); Hall, 412 S.E.2d at 890. For example, the Supreme Court of California, quoting Saldana, reasoned that RTS testimony creates an aura of special reliability and trustworthiness that unduly prejudices a defendant, but it then held that the admission of RTS testimony was not prejudicial in that case. See Bledsoe, 203 Cal. Rptr. at 460-61, 681 P.2d at 301-02. As we stated earlier, we are not persuaded that jurors are as enthralled by experts as many appellate courts assume they are. In any event, the jury has the discretion to believe or disbelieve any testimony that it hears. A careful analysis of the opinion in Bledsoe uncovers a second logical inconsistency as Judge Bivins noted in his dissent: that is, admitting PTSD evidence to explain the post-rape behavior of alleged victims but not to show that such behavior is consistent with sexual abuse. The Bledsoe court premised its holding that PTSD is not admissible to prove sexual abuse on the belief that jurors are competent enough to adjudge the significance of the alleged victim's post-rape behavior without the aid of expert testimony, utilizing their common sense to determine whether she consented to intercourse or not. Id., 203 Cal. Rptr. at 460-61, 681 P.2d at 301. Yet it held that PTSD evidence is admissible, for the purpose of rebutting the defense that the victim's behavior is inconsistent with post-rape behavior, to allow an expert to apprise the jurors of the common misconceptions surrounding victims of sexual abuse about which the jurors are presumably ignorant. Id., at 457-58, 681 P.2d at 298. The Court of Appeals in Alberico, relying on Bledsoe, agreed that a psychologist may testify about a diagnosis of PTSD symptoms but not about the cause of the symptoms. The Court claimed that while it is generally accepted that rape victims exhibit identifiable symptoms, PTSD does not allow a psychologist to predict back to the cause of the symptoms. Of course, the Court of Appeals and some of the other courts listed earlier [13] would allow PTSD testimony to rebut the defense of inconsistent behavior only when the defense has made it an issue. The issue, however, is whether PTSD testimony is grounded in scientific knowledge, and the scientific validity of PTSD is not dependent on whether the defense has made it an issue in the case. Allowing an expert to testify that PTSD symptoms are a common reaction to sexual assault for the purpose of rebutting the defense that the victim's reactions to the alleged incident are inconsistent with sexual assault is no different from allowing the expert to testify that the alleged victim's symptoms are consistent with sexual abuse. Although the Court of Appeals and some other courts maintain a bright-line distinction between these two purposes for the admissibility of PTSD testimony, we see no logical difference. Both of these purposes for which PTSD evidence is offered rest on the valid scientific premise that victims of sexual abuse exhibit identifiable symptoms. Either the PTSD diagnosis is a valid scientific technique for identifying certain symptoms of sexual abuse or it is not. Expert testimony in these two cases show that it is valid.
Under a Rule 403 balancing test, probative evidence is admissible unless substantially outweighed by its prejudicial effect. Of course, all of the state's evidence is prejudicial to some extent to the defendant because it is offered to prove his or her guilt. Again, we turn to the fallacy underlying the distinction between two of the purposes for which PTSD evidence is offered. Allowing PTSD testimony to explain a complainant's apparent inconsistent behavior after the alleged incident is no less prejudicial than allowing an expert to testify that the complainant's symptoms are consistent with sexual abuse. In the first instance, the jury can just as easily infer from the explanatory testimony that the complainant was raped because the expert is testifying that rape victims act a certain way and the complainant acted that way. We perceive two drawbacks in allowing PTSD testimony, however, both of which we address in more detail in the following section. The first is that the diagnosis relies in large part upon what the alleged victim reports to the examining psychologist. Any prejudice that might result from self-reporting, however, can be cured by cross-examination addressing the point that the diagnosis is based upon what the complainant says, not upon an independent evaluation of her truthfulness. The other consideration is the cautionary note in DSM III-R pertaining to the different meanings of the same terms in a clinical setting and in a legal setting. For example, credibility in psychology is not the same as credibility in the courtroom. As we discuss below, this concern is allayed by avoiding testimony regarding the complainant's credibility altogether. Thus, PTSD testimony is not unduly prejudicial. Accordingly, because PTSD evidence is both valid and probative and because it is not unduly prejudicial, it is admissible for establishing whether the alleged victim exhibits symptoms of PTSD that are consistent with rape or sexual abuse.
While PTSD testimony may be offered to show that the victim suffers from symptoms that are consistent with sexual abuse, it may not be offered to establish that the alleged victim is telling the truth; that is for the jury to decide. We have held before that expert testimony is admissible even if it touches upon an ultimate issue to be decided by the trier of fact. See State v. Martin, 101 N.M. 595, 605, 686 P.2d 937, 947 (1984). Rule 704, however, does not sanction the practice in all cases of calling an expert witness to tell the jury that a witness is telling the truth. Each of the experts in both of these cases testified that while they try to determine if the victim's story is inherently consistent, that does not translate into a determination of whether the victim is telling the truth. One of the experts characterized psychology as having no truth-telling machine. The experts testified that it was not their function to pass on the credibility of complainants in the legal sense. Accordingly, we expressly prohibit direct testimony regarding the credibility or truthfulness of the alleged victim of sexual abuse. See Townsend v. State, 103 Nev. 113, 734 P.2d 705, 709 (1987) (holding that it is improper to directly characterize alleged victim's testimony as either truthful or false). In reaching this conclusion, we are particularly impressed with the analysis of the Supreme Court of Arizona, which stated: We are aware that Rule 704 permits testimony in the form of an opinion or inference even though such testimony embraces an ultimate issue to be decided by the jury. However, Rule 704 was not intended to permit experts to tell the jury what result to reach. When the only evidence consists of the victim's accusation and the defendant's denial, expert testimony on the question of who to believe is nothing more than advice to jurors on how to decide the case. Such testimony was not legitimized by Rule 704, and is not admissible under Rule 702. Moran, 151 Ariz. at 383, 728 P.2d at 253 (citations omitted); see also State v. Brodniak, 221 Mont. 212, 718 P.2d 322, 329 (1986). The quoted language from Arizona's Rule 704 in the above block is identical to New Mexico's Rule 704. Both of the State's experts in Marquez testified that it was not their function to determine if the complainant was telling the truth, but then both testified in effect that the complainant was telling the truth and that she said she was abused by her father. What they meant, no doubt, was that the complainant's story was highly consistent within the psychological meaning of that term. Being highly consistent, however, was incorrectly translated into the legal conclusion that the complainant was not fabricating her story. This is a good example of the cautionary note in DSM III-R about using psychological terms in the courtroom being ignored.
In addition to prohibiting expert testimony as to the alleged victim's credibility, the expert may not testify as to the identity of the alleged perpetrator of the crime. See Moran, 151 Ariz. at 383, 728 P.2d at 253; State v. McQuillen, 236 Kan. 161, 689 P.2d 822, 829 (1984); State v. Hudnall, 293 S.C. 97, 359 S.E.2d 59, 62 (1987). Allowing such testimony encroaches too far upon the jury's function as arbiter of the witnesses' credibility. Although a psychologist can independently evaluate the victim's allegations of sexual abuse by cross-checking her symptoms with those recognized in DSM III-R, there appears to be no similar verification for identifying the alleged abuser. The psychologist must rely in large part upon the victim's story, and allowing the psychologist to testify as to the identity of the accused serves only to repeat what the complainant told the examining expert and thus bolster her credibility. Incidental verification of victim's story or indirect bolstering of her credibility, however, is not by itself improper. All testimony in the prosecution's case will tend to corroborate and bolster the victim's story to some extent. Direct comments on the victim's credibility, however, like those by the State's experts in Marquez, are beyond the scope of permissible expert opinion testimony.
We hold that expert testimony concerning RTS is inadmissible mainly because it is not part of the specialized manual DSM III-R like PTSD is, even though there is evidence in the record that RTS is generally accepted by psychologists just like PTSD is. We do not pass on the question of whether the diagnosis itself, rape trauma syndrome, is too suggestive or so emotionally charged as to be unduly prejudicial.
It almost goes without saying that the expert will not be allowed to state an opinion in terms of causality; in other words, the expert may not testify that the victim's PTSD symptoms were in fact caused by sexual abuse. This again vouches too much for the credibility of the victim and encroaches too far upon the province of the jury to determine the truthfulness of the witnesses. See State v. McCoy, 179 W. Va. 223, 366 S.E.2d 731, 737 (1988). Allowing an expert to couch his or her testimony in terms of causality may also breach a cardinal rule of science. As the Supreme Court stated in Daubert, arguably, there are no certainties in science. ___ U.S. at ___, 113 S.Ct. at 2795. In other words, allowing an expert to testify that a complainant was in fact raped would allow the expert to give testimony that is not grounded in scientific principle and which does not tend to show what the testimony is offered to prove.