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PubMed1997

The impact of system design on the characteristics of Missouri's insanity acquittees.

This study describes the characteristics of Missouri insanity acquittees, which numbered 797 on July 1, 1992. Unlike reports of characterization data from other states, the study endeavors to link the characteristics to the design of Missouri's insanity acquittee system. This is accomplished by analyzing Missouri's insanity acquittee system and comparing it with the system designs and characteristics of insanity acquittees from other states. Overall, Missouri has a high number of annual insanity acquittals, inpatient hospitalization is used as the primary residential setting for insanity acquittees, most insanity acquittees have severe mental illnesses, the majority of insanity acquittees committed serious crimes, most insanity acquittees are hospitalized for extended periods of time, and insanity acquittees now occupy over 50 percent of Missouri's long-term public psychiatric hospital beds. Evidence did not exist for a linkage between the design of Missouri's insanity acquittee system and most of the insanity acquittee characteristics. Further research is needed to identify system designs that can shape insanity acquittee characteristics in intended ways, to assess the degree to which policy implementors may influence the policy implementation process, and to explore the role of symbolic politics in shaping insanity acquittee systems.

Adolescent↗
PubMed1991

The negligible effects of California's 1982 reform of the insanity defense test.

OBJECTIVE: The authors' goal was to determine whether changing the insanity test in California in 1982 actually affected use of the insanity defense. METHOD: They gathered information on all individuals who entered the insanity plea (N = 1,300) and all those acquitted by reason of insanity (N = 665) in seven counties in California 3 years before and 3 years after the change in the test of insanity. They focused on whether California's revision of the insanity test affected the number and rate of insanity pleas, the number and rate of insanity acquittals, the characteristics of individuals using the defense, the target offenses, and the length of stay of insanity acquittees. RESULTS: The reform did not affect the rate of insanity pleas or acquittals, the characteristics of those using the defense, or their length of confinement. CONCLUSIONS: Although the reform had no direct effects on the use of the insanity defense, the authors hypothesize that an indirect change in criminal sentencing practices led to a decrease in the number and rate of insanity pleas and acquittals.

California↗
PubMed1993

Use of posttraumatic stress disorder to support an insanity defense.

OBJECTIVE: The authors examine the allegation that the diagnosis of posttraumatic stress disorder (PTSD) is frequently abused in the legal system as the basis for a defense of not guilty by reason of insanity. METHOD: Data for the investigation were drawn from a study of insanity pleas gathered from court records in 49 counties in eight states. Data on the 28 insanity plea defendants for whom PTSD was diagnosed before or immediately after trial were compared with data on 8,135 defendants whose insanity pleas were based on other diagnoses. RESULTS: Insanity pleas by defendants with diagnoses of PTSD constituted only 0.3% of the cases. There were few significant differences between the two groups on demographic variables, psychiatric histories, previous involvement in crime, or current charges. The defendants with PTSD were more likely to have been married, less likely to have been arrested as juveniles, and less likely to have been detained after trial. CONCLUSIONS: Contrary to previously expressed concerns, PTSD was infrequently associated with an insanity defense in the cases in this study. In the cases in which pleas based on PTSD were used, they were no more likely to succeed than pleas based on any other diagnosis. Defendants with PTSD-related insanity defenses differed little from other insanity defendants, contradicting the stereotype of the person who is driven by PTSD to commit crimes. The data do not support fears of widespread misuse of the diagnosis of PTSD in connection with the insanity defense.

Humans↗
PubMed2003

[Criminal responsibility and confinement of the insane from antiquity to early modern Japan].

ANTIQUITY: The third Japanese legal code, Youro Ritsuryo, was compiled in 718. The code classified the insane people as severely handicapped, exempted them from taxes and reduced their punishments when they committed a crime. MEDIEVAL: We cannot find any description on criminal responsibility of the insane in the legal documents of this age. EARLY MODERN: In 1742, the Tokugawa government enacted a criminal code named Osadamegaki-hyakkajyo, which contained a clause on the criminal responsibility of the people suffering from insanity or alcoholism. In principle, even if the criminal who committed homicide had been insane, he or she was sentenced to death. However, when the criminal had been obviously insane and the master or relatives of the victim appealed for mercy the judge could spare his/her life. The case of killing under the influence of simple alcohol intoxication was considered to be fully responsible. However, the case of pathological intoxication was treated in the same way as the case of insanity. There was a strict rule for confinement of the insane. When people thought that confinement was inevitable, a petition for confinement was submitted to the court under the joint signature of the family, the members of goningumi (a mutual responsibility unit), and the head of the town or village. In big cities like Edo (now Tokyo), a medical certificate of a doctor was attached to the petition. After receiving the petition, the court dispatched officials to inspect the case. When the court could confirm the necessity of confinement, they gave the permission and sealed the lock of a private cell where the insane was confined. People had to appeal to the court again when they wanted to free the insane from the cell.

Commitment of Persons with Psychiatric Disorders↗
PubMed1996

Revisiting the insanity defense: contested or consensus?

The author assesses the accuracy of both the public's opinion and researchers' conclusions regarding the method of adjudication of insanity cases and investigates the impact of the various types of reforms enacted in the 1980s on the degree to which insanity cases are contested. Data from seven states are analyzed. The public's view that insanity cases are typically resolved by a jury trial is inaccurate. Only 14.4 percent of the 7,299 insanity cases involved a jury trial. Likewise, scholars' views that most cases are resolved through plea-bargained insanity acquittals are inaccurate. Only 42.9 percent of all insanity cases are plea bargains, and 87.9 percent of all plea bargains are to a conviction. Jury trials are most likely to occur when the case involves a violent crime such as murder and the defendant has not been diagnosed with a major mental illness. Public fears that defendants easily "fool" juries into an inappropriate insanity acquittal are also unfounded. Only 16.1 percent of all jury trials result in an insanity acquittal. In three states, the figure is 10 percent or less. Contrary to the conclusions drawn by some scholars, this author finds that several types of reforms enacted in the 1980s affected the processing of insanity cases.

Adult↗
PubMed1993

Informed decision making in persons acquitted not guilty by reason of insanity.

Deciding to raise an insanity defense carries serious consequences. This is especially true for persons charged with minor offenses, for whom an acquittal not guilty by reason of insanity (NGRI) might lead to a longer period of incarceration than would conviction. Before raising an insanity defense, a defendant should be provided with information necessary to make an informed decision and should be competent to understand the consequences of the verdict. This study attempted, through retrospective review and concurrent evaluation, to determine the degree to which trial courts in Virginia attended to these important aspects of informed decision making before finding defendants charged with misdemeanors NGRI. The study also attempted to assess the degree to which defendants were competent and informed at the time of adjudication. In most instances, trial courts did not consider defendants' competence to make decisions regarding the insanity defense and did not consider whether defendants were informed about the consequences of a successful insanity defense at the time of adjudication. The average length of stay for these patients was (at least) 21 months; most would have been released earlier had they been committed civilly rather than committed as a result of insanity pleas. We stress the need to educate judges, attorneys and forensic evaluators to the importance of considering defendants competence to plead insanity and of providing information about the consequences of a successful plea. We also propose that laws be changed to recognize the importance of these elements in the decision making process regarding pleas of insanity.

Adult↗
PubMed2003

The insanities of the third age: a conceptual history of paraphrenia.

In 1863, Kahlbaum used the term 'paraphrenia' to refer to insanities related to transitional periods life (there were adolescent and senile forms); Kraepelin used paraphrenia to refer to a form of paranoid psychosis with attenuated hallucinatory disturbances; and Leonhard named with it at least seven types of insanities. Since the turn of the 20th century the population hit by 'old age' has grown larger and cases of 'late-onset' insanity seem to be on the increase. Some of these insanities have different clinical features and respond differently to treatment and it is unclear whether this is due to pathoplastic effects, organic factors or social expectation. In the 1950s, the Newcastle school introduced 'late-paraphrenia'. The problem of how to classify the insanities of old age remains parasitical upon beliefs about the insanities affecting people. Historians see science and medicine as examples of social narrative and practice; clinicians see science and medicine as purveyors of absolute truth and as the only way to understand the insanities. This lack of convergence is hampering the understanding and management of elderly people suffering from insanity and must be resolved.

Aged↗
PubMed1991

The volume and characteristics of insanity defense pleas: an eight-state study.

The authors document the very complex process involved in identifying insanity defense pleas in eight states. Each state and each study county in each state required an individual approach. Most often, county court dockets were hand searched to identify those pleading insanity, although numerous other methodologies were used. The frequency and rate of insanity pleas and acquittals are presented for the study states as well as descriptive data on the characteristics of persons pleading and acquitted NGRI. Overall, the insanity defense was raised in one percent of all felony cases. Further, only 26 percent of those raising the insanity defense were actually acquitted NGRI. The necessity of obtaining data on insanity pleas to adequately understand and ultimately inform future directions of insanity defense research is discussed.

Commitment of Persons with Psychiatric Disorders↗
PubMed1989

The psychiatrist's guide to right and wrong: Part IV: The insanity defense and the Ultimate Issue Rule.

In the wake of Hinckley, widespread public dissatisfaction with the role of psychiatrists in insanity defense litigation prompted Congress in 1984 to amend the Federal Rules of Evidence to prohibit psychiatric testimony on the ultimate legal issue of whether or not a defendant is insane. APA's Statement on the Insanity Defense served as the ably articulated premise for this evidentiary amendment. APA argued that in going beyond their psychiatric expertise by answering ultimate issue questions as to whether defendants are legally insane, experts are likely to confuse the jury and undermine public confidence in psychiatry. APA also asserted that there was an impermissible logical leap between scientific psychiatric inquiry and moral-legal conclusions on the ultimate issue of insanity. This article reviews the origins, history, and vicissitudes of the Ultimate Issue Rule and analyzes the Statement on the Insanity Defense from both a legal and psychiatric perspective on the issue of whether psychiatrists should answer the ultimate question in insanity cases. The analysis suggests that APA's conclusions are not supported on scientific or evidentiary grounds, but may be warranted as a policy consideration to safeguard the public image of psychiatry.

Expert Testimony↗
PubMed1986

Not guilty by reason of insanity: a research note.

The question of the insanity defense centers around the moralist-determinist debate. Insanity defense laws are premised on the assumption that individuals choose between right and wrong, and are responsible for that choice. Mental disease, however, can overpower, and thus, not of their own volition, insane persons become out-of-control. Hence, they cannot be held responsible for their behavior or subject to criminal punishment. It is the purpose of the insanity defense, of course, to distinguish between offenders in need of punitive disposition and ones where a medical-custodial disposition is best. The research presented here indicates that defendants who successfully raise the plea of NGRI do not beat the rap. In other words, they do not spend fewer days in confinement via an NGRI plea than had they been convicted and sentenced. Thus, for the reasons of justice, equity, and fairness the insanity defense should be kept intact. The wave of public fear and reaction to the decision in a few highly publicized cases is insufficient grounds for eliminating the plea. Not only is the use of the insanity defense infrequent, but defendants who select it give up important safeguards. Namely, they are unable to plea bargain, are stigmatized as "mad and bad," have no access to probation or parole, and are confined for an indeterminate amount of time. That some would call this leniency we find surprising. And, of course, we should not forget the findings reported here. NGRI acquittees spend more time being locked up. Defendants who successfully raise the NGRI plea are confined until professionals say they are no longer dangerous.(ABSTRACT TRUNCATED AT 250 WORDS)

Colorado↗
PubMed2006

An empirical investigation of insanity defense attitudes: exploring factors related to bias.

This study's primary aim was to evaluate factors that influence attitudes toward the insanity defense in a sample of 578 college undergraduates. In addition to a comprehensive demographics survey, participants completed the Insanity Defense Attitude Scale-Revised (IDAS-R) and the Attitude Toward the Death Penalty (ATDP) Scale. Favorable attitude toward capital punishment and misperceptions about overuse of the insanity defense were related to negative attitudes toward the insanity defense. Hierarchical regression analyses demonstrated that possessing a favorable attitude toward capital punishment was the most robust predictor of a negative attitude toward the insanity defense. These findings provide valuable information about factors that create and maintain biases against the insanity defense and suggest areas of inquiry that could aid attorneys in selecting unbiased jurors.

Adolescent↗
PubMed1999

Empirical research on the insanity defense and attempted reforms: evidence toward informed policy.

This paper addresses some common questions about the insanity defense and issues raised by commonly proposed "reforms." The first section begins with a brief description of the insanity defense and the reasons for its existence in the law. It then examines some of the popular myths and public misperceptions surrounding the insanity defense. The next three sections discuss proposed "reforms" and the empirical research that addresses their effect. These reforms, including various procedural changes in definitions, burden of proof, and expert testimony, the institution of a guilty but mentally ill verdict, and the abolition of the insanity defense itself, are reviewed, along with relevant research findings and policy issues. Finally, the development of sound conditional release programs for criminal defendants found not guilty by reason of insanity is proposed as a reform option which could serve the objectives of enhancing public safety and access to appropriate treatment while continuing to meet the objectives of the insanity defense within criminal jurisprudence.

Attitude↗
PubMed1999

Empirical research on the insanity defense and attempted reforms: evidence toward informed policy.

The paper addresses some common questions about the insanity defense and issues raised by commonly proposed "reforms." The first section begins with a brief description of the insanity defense and the reasons for its existence in the law. It then examines some of the popular myths and public misperceptions surrounding the insanity defense. The next three sections discuss proposed "reforms" and the empirical research that addresses their effect. These reforms, including various procedural changes in definitions, burden of proof, and expert testimony, the institution of a guilty but mentally ill verdict, and the abolition of the insanity defense itself, are reviewed, along with relevant research findings and policy issues. Finally, the development of sound conditional release programs for criminal defendants found not guilty by reason of insanity is proposed as a reform option which could serve the objectives of enhancing public safety and access to appropriate treatment while continuing to meet the objectives of the insanity defense within criminal jurisprudence.

Expert Testimony↗
PubMed1991

A prospective comparison of four insanity defense standards.

OBJECTIVE: Controversy about the formulation of the insanity defense has been intense, but little empirical work is available regarding how different standards affect court findings. The major aims of the present study were to determine if different standards for determining insanity produced different judgments and to provide a broad descriptive picture of those cases in which the standards appeared to make a difference. METHOD: Four forensic psychiatrists were asked to indicate whether they thought 164 defendants met any or all of four insanity tests: 1) the American Law Institute (ALI) cognitive criterion, 2) the ALI volitional criterion, 3) the APA test, and 4) the M'Naghten rule. RESULTS: The four psychiatrists determined that 97.5% of the defendants met the ALI volitional criterion, 73.9% met the APA criterion, 70.3% met the M'Naghten rule, and 69.5% met the ALI cognitive criterion. Nearly two-thirds of the defendants met all four insanity tests, and 24.4% met only the ALI volitional test. Few defendants met cognitive tests without also meeting the ALI volitional test. Elimination of the volitional test for insanity reduced the rate of psychiatric recommendations of acquittal by 24.4%. CONCLUSIONS: These findings highlight the fact that the primary logical division between volitional and cognitive standards appears to be powerful but that distinctions between types of cognitive standards are not terribly powerful. In addition, the variation among individual raters must be viewed as an important determinant of how any insanity standard is applied.

Adolescent↗
PubMed1982

The insanity defense on trial.

What was once a great romance between law and psychiatry has ended in disenchantment on both sides. Legal rulings during the 1950s intended to increase the psychiatric presence in the courtroom have been repudiated, and there is now a mood to abolish the traditional insanity defense. Abolitionists charge that the insanity defense has been successfully employed by large numbers of dangerous criminals to avoid punishment, that psychiatrists are dishonest because they serve as expert witnesses for both sides, and that the existence of the defense is evidence of a permissive society that coddles violent criminals. Each of these charges is rebutted by the author, who contends that until recently the insanity defense was a profound hypocrisy: the courts found the defendants not guilty by reason of insanity and then relied on psychiatry to confine them for the rest of their lives. But legal reforms and changes in psychiatric practice during the past 20 years have made it more difficult to confine such persons, and thus the insanity defense has real meaning for the first time. The author believes that despite the loss of protection to society, there are important legal and moral barriers to abolishing the insanity defense.

Commitment of Persons with Psychiatric Disorders↗
PubMed1999

The unconditional release of mentally ill offenders from indefinite commitment: a study of Missouri insanity acquittees.

Using a database of all Missouri insanity acquittees committed on July 1, 1997 (N = 873) and all insanity acquittees unconditionally released from 1986 through 1997 (N = 193), this study calculated the lengths of commitment and identified variables associated with the unconditional release of insanity acquittees from indefinite commitment by the mental health and criminal justice systems. The study found that 85 percent of insanity acquittees were still under commitment 5 years after acquittal and 76 percent 10 years after acquittal. Factors that decreased the odds of being unconditionally released included never having been married; having a psychotic disorder, a mood disorder, a substance abuse disorder, or mental retardation/borderline intellectual functioning; and having committed a serious crime. These results support achievement of the intended goal of Missouri's insanity acquittee statute, which is to maximize public safety considerations, but have had the unintended effect of increasing the inpatient insanity acquittee population, resulting in fewer resources for voluntary patients.

Adult↗
PubMed2003

[History of psychiatry and the criminally insane in Japan].

This paper illustrates how insane offenders were perceived and treated at the turn of the 20th century, focusing on legal reforms. In accordance with overall reorganization of legal systems after the Meiji Restoration in 1968, the Criminal Law of 1880 stipulated criminal responsibility, ruling that "a person, who was unable to discriminate right and wrong because of loss of mental capacity at the time of committing crime, shall not be punished." Article 39 of the current Criminal Law, which was enacted in 1907, redefined criminal responsibility, to say that "an incompetent person shall not be punished; a person with diminished competence shall be given a mitigation of punishment." Meanwhile, the Law for the Custody for Insane Persons of 1900, which was the first law dealing with the mentally ill, aimed to establish strict regulations with regard to the custody of the insane. However, neither of these laws did not provide any procedures for subsequent management of persons acquitted because of insanity. Under the social changes in the early decades of the 20th century, concern about dangerousness of the criminally insane was intensified. In connection with reform of the Criminal Law, several plans for the management of the criminally insanes were formulated. The author examines these circumstances, referring to the current debate on the management of mentally ill offenders.

History, 19th Century↗
PubMed1986

Schizotypal personality disorder and the insanity defense.

What constitutes a "mental disorder" for purposes of the insanity defense? Does mental disorder denote any diagnosable condition listed in the third edition of the Diagnostic and Statistical Manual of Mental Disorders? Is a mental disorder a disturbance wherein the functional criteria of the appropriate insanity law appear to be met? Or does insanity law define mental disorder apart from functional criteria of insanity? The answer to the last question is that some insanity laws attempt to define or qualify mental disorder, but many do not. Unclarities in the law leave room for unnecessary disagreements between expert witnesses even before the functional criteria for insanity are to be addressed. The potential for confusion is compounded when the defendant's disturbance is ambiguous, amphibious, or both. Schizotypal personality disorder is offered as an example of such a disturbance, and inferences are discussed.

Expert Testimony↗