TORONTO -- Alek Minassian has an “extreme form” of autism that is similar to psychosis, and that type of “severely distorted” view of the world is enough to be a mitigating factor in culpability, an American forensic psychiatrist testified at the Toronto van attack trial Tuesday.

“Whether you are talking about autism or psychosis – and these are the only conditions I think where this could be relevant – you have something which is defined ultimately by a disruption in how you see and how you understand the world,” Dr. Alexander Westphal said.

“On both ends of this sort of spectrum of how it alters the way in which you see and interact with the world, it’s just as different, it’s just as different, it really is.”

On the afternoon of April 23, 2018, Minassian drove a rented white van down busy sidewalks along Yonge Street, between Finch and Sheppard avenues, and struck dozens of pedestrians.

Eight women and two men were killed in the attack and 16 others were left with various injuries.

Minassian has already admitted to planning and carrying out the deadly attack. He has pleaded not guilty to 10 counts of first-degree murder and 16 counts of attempted murder as defence attorneys argue he should be found not criminally responsible (NCR) under Sec. 16 of the Criminal Code.

Sec. 16 states that a person is not criminally responsible if they were suffering from a mental disorder that rendered them “incapable of appreciating the nature and quality of the act or omission or of knowing that it was wrong.”

Minassian’s state of mind at the time he carried out the deadly attack is the sole issue at trial.

If he is found to be NCR, Minassian would be sent to a hospital indefinitely rather than prison.

Court has heard Minassian is not psychotic, and as such, does not suffer from any sort of hallucinations.

Alek Minassian

His only diagnosis is autism spectrum disorder (ASD), which is a topic of research Westphal, who is based out of the Yale School of Medicine, specializes in.

More than 90 per cent of people found NCR in Canada experienced psychosis, court has heard, and it would be a legal first if an autism spectrum disorder alone rendered Minassian incapable of knowing his actions were morally wrong.

Westphal was hired by Minassian’s defence attorneys for this case and is the last witness they are calling to the stand at the judge-only trial. He is expected to be the lone voice to state that the now-28-year-old from Richmond Hill, Ont. should be found NCR due to ASD.

During his first two days of testimony, Westphal has not yet provided a clear pathway for how Minassian’s diagnosis leads to a ruling of NCR.

Dr. Alexander Westphal

But, on Tuesday, when asked by the defence if a diagnosis of psychosis is necessary for a ruling of NCR, Westphal said that psychosis is “really defined as a severe mental disorder in which thoughts and emotions are so disrupted that contact is lost with external reality.”

“The point is that (ASD) causes just as much differences as being in the throes of a psychotic or delusional state in an extreme form, for what I think is in this case.”

Court views clips of Minassian’s interviews

On Tuesday, court viewed multiple short video clips from Minassian’s interviews with Westphal and his colleagues, which were conducted one year ago.

Throughout those interviews, Minassian described carrying out the deadly attack and spoke to his reasoning behind it.

Westphal said Minassian showed the same “dissociative quality” of someone playing a video game when he “completely dispassionately” talked about carrying out the attack.

“It’s as abstract as killing people in a video game, which is a horrific concept… but that is really how I feel he was sort of thinking about this,” Westphal said.

“He still doesn’t have any emotional connection with what he did. He doesn’t experience remorse, he doesn’t experience regret, but he also doesn’t experience sadism, it doesn’t feel to him like he’s great now, it’s just nothing.”

Van Attack

Westphal went on to state that the way Minassian described his actions is “the same way you or I would describe going shopping and the order of things we purchased when we went shopping.”

“It’s completely devoid of any emotional context whatsoever and the impact that this had on other lives,” he said.

In the first video clip played in court, Minassian is heard describing the sequence of events during the attack, but the defence pointed out this is not an accurate account.

“Once I crossed Steeles… (I thought about) how I would go from the street onto the sidewalk… As soon as I got to the Yonge and Finch intersection I stopped and as soon as the light turned green… I slammed the accelerator and I just mounted the sidewalk,” he said.

“There were several people standing at the southwest corner waiting to cross the street and then I just immediately hit… right off the sidewalk. Then after that first batch, I was driving for about a second and there was another batch… I hit them all in a line and then after that I thought ‘oh, did I really just do that?’ And then everything else… my worries about whether I was going to do that disappeared because I already hit the first people, I can continue to hit people.”

Minassian then said he kept driving before he spotted more people and “hit them all in a line.” Then, he said, he spotted a man standing by himself on the sidewalk.

“Once I was coming close, he turned… before he had a chance to react, I hit him.”

He then said he saw an “old lady with a walker.”

“I ran over her with the front right tire. I continued driving… (someone) crossing the street had a drink in their hand, I hit them and the drink splashed all over the windshield, I was panicking, my visibility was extremely reduced and I couldn’t see much and I wasn’t sure what to do.”

Minassian said at that point he was about to hit a second cinderblock so he “swerved left and started going southbound in the northbound lanes on Yonge Street.”

Then, before the video clip ends, Minassian said he saw an “old man jaywalking and hit him.”

After that video clip was shown, Westphal said from a diagnostic standpoint, Minassian’s manner is “really shocking.”

He said it strikes him because of the “complete absence of negative emotion, remorse, regret, anything like that.”

“It’s just a sort of clinical cold description.”

Furthermore, Westphal said, it also strikes him in another way.

“It’s also not celebratory, there’s nothing, he’s not deriving pleasure… he’s just telling a set of facts, which are kind of similar to another set of facts in his life,” he said. “There’s no emotional valiance to it, there’s no empathic valiance to it, it’s just shocking how he doesn’t sort of get that aspect of it.”

van attack

The next video viewed in court was of Minassian detailing his arrest following the attack. In this clip, he is heard saying “as soon as I got down on the ground and he got on top of me and he put the handcuffs on me and told me I was under arrest, that was when I felt a sense of defeat.”

Westphal said Minassian felt “completely defeated” because part of his mission that day was to die by suicide by cop, adding that “this was not a suicide attempt, he just needed to die because the mission was accomplished.”

Minassian lacks cognitive and emotional empathy, Westphal says

A third video clip played after those two started with a colleague of Westphal’s asking Minassian about the motive behind the attack.

Minassian initially told police it was an act of rebellion for the incel subculture, but court has heard he then changed his story during these psychiatric assessments.

Van attack

“If I was worried about my job then… that would have seemed really random and people would be confused by it but if I copied or if I used some other narrative, such as Elliot Rodgers’ narrative, then everyone already knows about this…then people would get extremely hyped up about it and talk about it for a lot longer,” he said.

Rodgers killed six people near the campus at the University of California, Santa Barbara on May 23, 2014 and is notoriously connected to the incel subculture.

After going through all of the motivations stated by Minassian at one point, Westphal said, “ultimately at the end of the day the only explanation which makes any sense to me is that he didn’t understand or didn’t have the sort of slightest insight into the horror and devastation that he was inflicting.”

Westphal said Minassian’s distorted view of the world has to do with his lack of both cognitive and emotional empathy.

Furthermore, Westphal said he believes Minassian “is stuck at an early developmental stage of the development of moral judgement.”

“He understands the rules, he can articulate the rules, he has a very sophisticated understanding of the rules,” he said. “There is no question that he has a very highly-developed concept of the rule nature of the wrongfulness, the problem is his comprehension of the real horrific impact that something like this would have on other people, which I really honestly…I don’t think he understands that.”

Following this statement, Justice Anne Molloy, who is overseeing the trial, asked what Westphal specifically believes Minassian does not understand.

“He referred to converting the life status to death status, so that’s kind of not how you or I think about death, when we think about death we think of the grief dimension of death, we know the impact that it would have on people who loved the person who has died and that’s about the worst thing we can think of,” Westphal replied.

Molloy then said she does not believe that is the proper way of measuring wrongfulness, adding that if someone is killed and no one is there to grieve, it is nonetheless a murder.

“I see what you are saying,” Westphal said. “I do think though that woven into our fabric of how we think about things is that kind of impact on other people dimension of it.”

“We think of death as a final or a transition to a different aspect of life but our time on earth ends with death, but we also have this entire thing surrounding it, this other people aspect of it, which I don’t think you can extricate those two things.”

The trial resumes Wednesday at 10 a.m.

Here are live updates from the court proceedings: