Opinion ID: 2365387
Heading Depth: 3
Heading Rank: 2

Heading: Defendant's Medical Records

Text: Defendant's mental health records disclose additional facts concerning her condition. Defendant was counseled at a community health center after her 1987 arrest for weapon possession. Defendant stated that after her mugging she had become increasingly paranoid about getting mugged again, and that she had been suicidal for the past year. The interviewing clinician's diagnosis was atypical depression, possibly schizoid personality disorder and post traumatic stress disorder. Documents also indicate that defendant had profound problems with low self-esteem, severe problems with social withdrawal, obsessive thoughts, paranoid, suspicious hostility, and problems of modest proportions [with] dependency, delusions, anxiety, tension, inappropriate affect, relationship with siblings, interaction with peer groups, deals with conflict and stress, [and] judgment. Treatment notes also indicate that defendant said she had experienced suicidal ideation ever since she was a child. However, some notes indicate that defendant had no idea of suicide or homicide and no future plans for himself. When defendant was involuntarily committed to the Camden County psychiatric facility in 1988, the primary diagnosis was adjustment disorder with depressed mood and mixed personality disorder with schizoid, borderline, and antisocial traits. However, the prognosis was guarded because defendant had exhibited little insight and no interest in follow-up. In the social discharge summary, a psychiatric social worker wrote that it [was] quite conceivable that [defendant] could become depressed seriously enough to injure himself or others, and recommended further psychotherapy. Another psychological evaluation by Dr. Philip Slonim indicated that Nelson manifested [m]arked schizoid tendencies. In that evaluation, he stated the only thing defendant said she would bring with her on a desert island was a gun for target practice. Dr. Barbara Anderson interviewed defendant in preparation for his surgery. She said that defendant would be a high risk of suicide if denied surgery. Nevertheless, Dr. Anderson believed that defendant might still present a high risk after surgery if his expectations were not met. Anderson wrote that defendant was without the capacity for or appreciation of empathy, and was solely focused on becoming a woman, even though he did not feel as if he were a woman trapped in a man's body, feelings generally associated with people who become transsexuals. Pre-surgery notes from another psychiatrist, Dr. Mobilio, indicated no evidence of psychosis, no delusions, no hallucinations, no thought disorder, no suicidal or homicidal ideations, and minimal anxiety and depression. Social judgment also was evaluated as good. There were no gross deficits in memory, intellectual functioning, attention, or concentration. When defendant applied to the transgender program at Pennsylvania Hospital, the Minnesota Multiphasic Personality Inventory Test indicated that he appeared to be suffering from a depressive disorder and may receive a diagnosis of dysthemic disorder and major affective disorder. Defendant was rejected by the program. He was again diagnosed with dysthemia and adjustment disorder with depressed mood by Dr. Lisa Giunto, the staff psychiatrist at a community mental health center.