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Cognitive Dysfunction and Competency Restoration: Using Cognitive Remediation to Help Restore the Unrestorable

Dr. Schwalbe is Psychology Research Fellow, Department of Psychiatry, Columbia University College of Physicians and Surgeons, and Dr. Medalia is Professor of Clinical Psychiatry and Director of Psychiatric Rehabilitation Services, Department of Psychiatry, Columbia University Medical Center, New York, New York. This work was supported by the Kessel Fund. Address correspondence to: Alice Medalia, PhD, Department of Psychiatry, Columbia University College of Physicians and Surgeons, 180 Fort Washington Avenue, HP234, New York, NY 10032. E-mail: am2938{at}columbia.edu

The goal of this article is to present an argument for using cognitive remediation as an adjunctive form of treatment in competency restoration programs. Clinically, it has been generally agreed that the Dusky standard requires a functional analysis of the defendant's current capacities in the current legal context; merely having a mental illness does not mean incompetency. Based on the recent literature that describes the neuropsychological deficits associated with major psychiatric illnesses such as schizophrenia, bipolar disorder, and depression, it is believed that many psychiatrically ill patients are hindered from returning to the legal process by their inability to understand and acquire the information necessary to be found competent. We argue that cognitive remediation would serve as a helpful form of treatment for incompetent patients to improve their cognitive functioning and consequently, their likelihood of being found competent.