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PubMed1988

What price insanity?

The insanity defence in Canada is defined by the use of Section 16 of the Criminal Code. Legal sanity is determined by the application of an outdated set of rules which require only that the accused be able to determine right from wrong in the particular circumstances that appear to have applied at the time of the alleged offence. The actual application of the defence suggests that its interpretation in practice is considerably affected by factors other than the mental state of the accused. The arbitrary and ill-understood nature of these interposed factors removes any certainty that justice, or the well-being of the accused, is to be found by use of the existing law. Psychiatry should not rest content that its understanding of the determinants of human behavior is in any way accurately represented by Canada's Criminal Code.

Adult↗
PubMed1994

Not guilty by reason of insanity: getting it right or perpetuating the myths?

In Exp. 1 50 subjects were randomly assigned to one of two videotape conditions. The experimental group watched a TV news program designed to expose some myths about the not-guilty-by-reason-of-insanity plea (NGRI) while controls watched a neutral program. A seven-item test designed to measure knowledge about each myth was administered before and twice after exposure to the videotapes. Analysis showed no significant difference for any exposure. Exps. 2 and 3 showed that reading a brief factual report about NGRI significantly reduced the belief in these myths as compared to beliefs of groups who watched a TV news program.

Adolescent↗
PubMed1995

Insanity and adultery: forensic implications of a divorce case.

Legal responsibility for acts presumes that a person's behavior is rationally intentional and under voluntary control. Automatism, a type of insanity defense, contends that the person's conscious, voluntary control of behavior has been impaired by a mental disorder. In a recent case in South Carolina, automatism was offered as a defense to adultery, an at-fault grounds to divorce. On appeal, the State Supreme Court recognized the novel application of mental impairment defenses in domestic litigation and remanded the case for rehearing. Implications of the ruling for clinical and forensic practice in family court are discussed.

Adult↗
PubMed1988

The history and present status of moral insanity.

Psychiatric taxonomies, always a little uncertain, are most confused and illogical when they endeavour to encompass the moral and legal aspects of human behaviour. The concept of moral insanity represented a step backwards when it came into being, but it has persisted for a century and a half, changing only its title. Its creation and its subsequent history exemplify some of the common errors in psychiatric theorising.

Australia↗
PubMed1996

Crime, psychiatry and the insanity defence: a report on some recent reforms in the United States.

There have been substantial developments in mental health law in the United States over the last 10-15 years. Once focal point has been the insanity defence, discussed here. The operational consequences of the legal changes remain to be assessed empirically, but informed speculation is possible. Both a description of the reforms and the assessment of their potential effect are relevant to members of the psychiatric profession in Australia, whether they be forensic specialists or traditional practitioners or researchers. Selective consideration of the American experience, as opposed to contemplating Wholesale transposition, is the appropriate posture for Australian policymakers.

Australia↗
PubMed2001

The insanity defense: examination of the extent of congruence between psychiatric recommendation and adjudication.

The insanity plea is a known defense often utilized in courts of law. In such cases the accused may be referred for an outpatient psychiatric examination or for hospital observation. In this study, we examined the extent of the accord between the medical recommendations of the forensic unit of the Yehuda Abarbanel Mental Health Center and judicial decisions. It was found that in 99.4% of the cases, the court accepted the psychiatric recommendation. In only 2 cases the recommendations were not accepted. We discuss this issue and recommend improvements and strengthening of the relationship between the psychiatric and court systems.

Adolescent↗
PubMed1975

Problems surrounding release of persons found not guilty by reason of insanity.

The problem of release from institutionalization of those not guilty by reason of insanity is a most troublesome one. Psychiatric criteria for release are to be balanced by what judges see as the needs and protection of society. In 1972, New Jersey in the Maik decision adopted an extremely stringent rule which, if strictly followed, would condemn most NGIs to life imprisonment. Judge Weintraub's demand for assurance that the underlying or latent condition was no longer present put psychiatric examiners in an untenable position. The psychiatrists of the state took the unusual step of preparing a critique of the Supreme Court decision and distributing it to the legal profession through a law periodical. In the interim, the inequities of the Maik rule were recognized and an evolutionary set of standards laid down in the Carter case which provides some flexibility and set standards for conditional release. This clarification will undoubtedly be of great assistance to both courts and psychiatrists in dealing with a complex issue which can never have simple guidelines.

Adult↗
PubMed2003

Attempted suicide by cop: a case study of traumatic brain injury and the insanity defense.

Over the years, there have been a number of well-publicized incidents involving persons who seemingly maneuver police officers into shooting them. Such cases, while relatively rare compared with most forms of violence, nevertheless pose difficult challenges to law enforcement agencies. Relatively little is known about persons who engage in suicide by cop incidents. To our knowledge, there has been no published indepth research on instigators of suicide by cop who survived. In this paper, we present a case study of an individual who engaged in and lived through three separate "attempted suicide by cop" incidents. After describing relevant history as well as events of the most recent incident, we compare the case with the extant literature on suicide by cop and analyze commonalities and differences. Finally, we examine the legal considerations involved, with particular attention devoted to the role the individual's traumatic brain injury played in applying the insanity defense.

Agonistic Behavior↗
PubMed2005

The use of the insanity defense as a jail diversion mechanism for mentally ill persons charged with misdemeanors.

Heightened awareness and concern regarding the large number of mentally ill misdemeanants in jails has led to a search for alternatives to jail and to the development nationwide of jail diversion programs for offenders with mental illness. Two such mechanisms-diversion to civil commitment and the use of mental health courts-are briefly reviewed. In Oregon, however, a rather unique mechanism is used to defer mentally ill misdemeanants (in addition to felons) from the criminal justice system: the insanity defense, with subsequent placement of the individual under Psychiatric Security Review Board jurisdiction. Statistics regarding such use from 1978 to 2001 are provided. The authors compare and contrast this jail alternative with both mental health courts and diversion to civil commitment, and discuss questions related to the feasibility of larger-scale use of this mechanism.

Commitment of Persons with Psychiatric Disorders↗
PubMed2005

Child murder committed by severely mentally III mothers: an examination of mothers found not guilty by reason of insanity. 2005 Honorable Mention/Richard Rosner Award for the best paper by a fellow in forensic psychiatry or forensic psychology.

Forensic hospital records of 39 severely mentally ill mothers adjudicated Not Guilty by Reason of Insanity for filicide (child murder by parents) were analyzed to describe characteristics preceding this tragedy and to suggest prevention strategies. Almost three-quarters of the mothers (72%) had previous mental health treatment. Over two thirds (69%) of the mothers were experiencing auditory hallucinations, most frequently command hallucinations, and half (49%) were depressed at the time of the offense. Over one third (38%) of the filicides occurred during pregnancy or the postpartum period, and many had a history of postpartum psychosis. Almost three-quarters (72%) of the mothers had experienced considerable developmental stressors, such as death of their own mother or incest. Maternal motives for filicide were predominantly "altruistic" (meaning murder out of love) or "acutely psychotic" (occurring in the throes of psychosis, without rational motive). Psychiatrists should perform careful risk assessments for filicide in mothers with mental illnesses.

Adolescent↗
PubMed1990

Part I: The NGRI Registry: initial analyses of data collected on Connecticut insanity acquittees.

The NGRI Registry is a comprehensive census database collected by the Law and Psychiatry Division of the Department of Psychiatry at the Yale University School of Medicine. This longitudinal database was compiled following a systematic search of all available docket books from the superior courts and mental health records from the state hospitals in Connecticut beginning in January 1970. Detailed life span information is available for 364 insanity acquittees identified during the search. Comparative analyses with four other locales suggested that there were regional differences in diagnoses of and crimes committed by the acquittees. These initial analyses demonstrate the promise of this registry becoming one tool for collaborative research on issues relevant to law and mental health.

Connecticut↗
PubMed1989

Returning the not guilty by reason of insanity to the community: a new scale to determine readiness.

The very difficult and very important decision on the readiness of an insanity acquittee for community treatment is often based on informal, invalidated criteria. A more standardized approach is needed. The bases for decisions can then be more clearly articulated and the adequacy of recommendations evaluated. This article describes the development of a scale designed to help guide decisions on readiness for community treatment.

California↗
PubMed1986

Evaluation and treatment of insanity acquittees in the community.

This paper describes the monitored outpatient treatment program for Psychiatry Security Review Board (PSRB) clients in the largest single community treatment agency in the Oregon system. We describe 161 persons referred to this agency for evaluation and treatment. Ninety-one PSRB clients received treatment and of this group 51% had their conditional release revoked by the PSRB. The most frequent cause of revocation was noncompliance with treatment. There were only 11 crimes committed during the study period, four of which were in the felony range. The majority of PSRB clients are chronically mentally ill persons. We discuss both the treatment approach and our results in light of a recently published research agenda for insanity acquittees.

Adult↗
PubMed1980

Myxedema psychosis--insanity defense in homicide.

In the course of a hypothyroid psychosis, a young man committed murder. He was later judged to be not guilty by reason of insanity, although he was clearly sane at the time of his trial. Diagnostic, treatment and longer range management problems are discussed.

Adult↗
PubMed1993

The relationship between insight and control in obsessive-compulsive disorder: implications for the insanity defense.

In this paper the authors examine the relationship between insight and control in patients with obsessive-compulsive disorder (OCD) in an effort to better understand the concept of volitional control of behavior especially as it relates to changes in the insanity defense that were recommended by the American Psychiatric Association (APA), specifically that the volitional prong be dropped. Yale-Brown Obsessive Compulsive Scale ratings in 56 subjects with OCD were reviewed with specific attention to items measuring the patients' subjective sense of decreased volitional control over their compulsions and their insight into their behavior. No statistically significant correlation was found between the control over compulsions item and the insight item. The authors conclude that the experience of volitional control in patients with OCD is not significantly related to the level of insight they have into the irrationality of their behavior. The authors then review cognitive therapy literature and show that though cognition and volition may appear to be dissociated in some disorders, even in the absence of insight, a relatively gross measure of legally relevant cognitive disturbance, subtle cognitive changes can be identified in patients with seemingly purely volitional disorders such as OCD.

Adult↗
PubMed1996

Simulation of insanity: case report.

This is a case report of an accused who appeared before a High Court in Accra, Ghana and who has had no previous history of psychiatric illness and no family history. He was sent to the Accra Psychiatric Hospital "for observation and report." A diagnosis of feigned madness or stimulation of insanity was made purely on clinical grounds.

Adult↗
PubMed1997

Not guilty by reason of insanity of murder: clinical and neuropsychological characteristics.

We examined archivally clinical status, neuropsychological functioning, and perpetrator-victim relationships of 28 adult patients who had committed homicide and had been subsequently involuntarily committed to a forensic hospital. We divided patients into two groups: (1) not guilty by reason of insanity (NGRI) acquittees (n = 13) and (2) convicted murderers (n = 15). In comparison with convicted murderers, NGRI acquittees were more likely to be seen as psychotic at the time of the index offense and also were more likely to have killed blood relatives, especially a parent. By contrast, convicted murderers were more likely to have killed a significant other, mainly a spouse or lover. At the time of the index offense, substance abuse was more likely to have occurred in the convicted murderers than in the NGRI acquittees. NGRI acquittees and convicted murderers did not differ on neuropsychological tests, with both groups generally scoring within normal limits on all tests. Taken together, these results suggested that NGRI murderers may be driven by acute psychosis directed toward blood relatives and occurring against a backdrop of relatively preserved neuropsychological functioning.

Adult↗
PubMed1984

Epilepsy and insanity during the early 19th century. A conceptual history.

During the first half of the 19th century, epilepsy and the insanities were considered as closely related "neurotic" disorders. Under the influence of factors such as the decline of the 18th-century Cullean concept of neurosis, the development of the new descriptive psychopathology, the introduction of statistics, and the availability of longitudinal observations of hospitalized cohorts, epilepsy was redefined as a "neurological" disease by the 1850s. The reaction of psychiatry to the exclusion of the mental disorder as a defining feature of epilepsy manifested itself in the creation of the "masked epilepsy" concept. This notion is behind the later development of categories such as "borderland" and "equivalent," which are still of some relevance to 20th-century views of epilepsy.

Brain↗