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PubMed2002

AAPL practice guideline for forensic psychiatric evaluation of defendants raising the insanity defense. American Academy of Psychiatry and the Law.

The insanity defense is a legal construct that excuses certain mentally ill defendants from legal responsibility for criminal behavior. This practice guideline has delineated the forensic psychiatric evaluation of defendants raising the insanity defense. The document describes acceptable forensic psychiatric practices. Where possible, standards of practice and ethical guidelines have been specified. And where appropriate, the practice guideline has emphasized the importance of analyzing the individual case, the jurisdictional case law and the state (or federal) statute. This practice guideline is limited by the evolving case law, statutory language and legal literature. The authors have emphasized the statutory language of current legal standards, as well as the state or federal courts' interpretation of those standards because the same statutory language has been interpreted differently in different jurisdictions. Similarly, this practice guideline has reviewed the state and federal trends that determine which diagnoses meet the criteria for mental disease or defect. These trends yield to jurisdictional court interpretations. Finally, the authors hope this practice guideline has begun the dialogue about formulating a forensic psychiatric opinion by surveying the various approaches used to analyze case data. The forensic psychiatrist's opinion in each case requires an understanding of the current jurisdictional legal standard and its application, as well as a thorough analysis of the individual case. The psychiatrist's analysis and opinion should be clearly stated in the forensic psychiatric report. It should be noted that the role of a psychiatric expert witness in the criminal justice system is predicated on the law's interest in individualizing the criteria of mitigation and exculpation. Forensic psychiatric analyses and formulations of opinions are, therefore, subject to change as the legal guidance changes.

Ethics, Medical↗

PubMed2002

Hendricks v. People: forcing the insanity defense on an unwilling defendant.

At least 17 jurisdictions permit insanity defenses to be entered over the objections of defendants. Those jurisdictions believe that society's interest in a just determination of the charges outweighs a competent defendant's choice. If competency includes the ability to rationally choose a plea, competent defendants should not be forced to enter insanity defenses against their wills.

Colorado↗

PubMed2004

Venirepersons's attitudes toward the insanity defense: developing, refining, and validating a scale.

Given the prevalence and predictive strength of negative attitudes toward the insanity defense, we conducted three studies with 426 venirepersons to develop an understanding and a measure of public attitudes toward the insanity defense. In these studies, we developed, iteratively refined, and cross-validated the insanity defense attitude-revised (IDA-R) scale. The results suggest that IDAs are underpinned by one's degree of (a) orientation toward strict liability, and (b) concern about perceived injustice and danger associated with the defense. The IDA-R assesses these two-dimensions with good internal consistency, convergent and divergent validity, and predictive utility. The IDA-R's predictive utility generalizes across jurisdictions and manipulation of case facts. Theoretical and practical implications for research and for identifying impartial jurors at voir dire are discussed.

Attitude↗

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↗

PubMed1985

The insanity defense: a difficult necessity.

The author considers the merits of the insanity defense in light of three premises. First, a defendant's sanity must be taken into account both in assessing culpability and in assigning punishment for a crime. Second, all members of society must be protected against harmful acts. And third, it is the responsibility of psychiatrists to assess, but not to predict, the existence of mental illness. After briefly discussing the limitations of expert testimony and the adversarial demands of the judicial system, the author concludes that the insanity defense should be retained but altered, and that psychiatrists should bear the burdens of advocating for the mentally ill.

Commitment of Persons with Psychiatric Disorders↗

PubMed1985

The insanity defense: the case for abolition.

The author discusses psychiatrists' objections to the insanity defense, including the negative publicity generated by murder trials in which psychiatrists provide expert testimony. He also examines the legal profession's attitudes toward the defense and the pressure applied to expert witnesses through our adversarial system of justice. The abolition of the insanity defense might expedite the legal process, the author concludes, but it would not greatly affect the courtroom role of psychiatrists. Psychiatric evaluation would still be required in certain cases, such as those involving diminished responsibility and competency to stand trial.

Commitment of Persons with Psychiatric Disorders↗

PubMed1987

The insanity defense: asking and answering the ultimate question.

The authors address the main questions in the insanity defense debate: Should it be abolished? Should psychiatrists participate as expert witnesses? Is the profession damaged by such testimony? Is there a logical leap between providing psychiatric findings and providing an opinion to the ultimate question? Because the free will/determinism model underlying the current insanity defense positions can be used to argue either side of the debate, it does not supply any rational answers. The authors reframe the discussion, using a systems approach, and suggest answers to these questions that are in line with the clinical realities and on a firmer philosophic ground.

Expert Testimony↗

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↗

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↗

PubMed1989

The New York State Insanity Defense Reform Act of 1980: a legislative experiment.

Through a statistical analysis of major changes in postacquittal procedures of the Insanity Defense Reform Act of 1980 (IDRA 1980), the study reveals the Act's success in formalizing, regularizing, juridicizing, accelerating, and extending to all acquittees psychiatric examinations and review and release procedures. Although more persons are reviewed and released at postacquittal hearings than in the matched pre-1980 cohort, fewer enter nonsecure facilities at commitment or during first 18 months of hospitalization, and fewer are released at the six-month review. After 18 months more acquittees remain inmates in secure facilities. Interviews with leading figures in the formulation and enactment of IDRA provide retrospective and prospective judgments on insanity defense reform issues.

Criminal Law↗

PubMed1999

The mental disability requirement in the insanity defense.

This paper offers a discussion of some of the nuances of mental disease or defect as required for the insanity defense in criminal law. It also compares and contrasts the mental disease or defect definitions of criminal law with those definitions used in clinical practice. It points out a general pattern of vagueness and dispute regarding the proper interpretation of the mental disability requirement in the insanity defense and in other legal provisions. It reports a variety of interpretations by courts and commentators regarding the meaning of these phrases, and it reports attempts by state legislatures to narrow the range of applicable conditions by excluding various mental or emotional states.

Antisocial Personality Disorder↗

PubMed2003

Toward a culture-bound syndrome-based insanity defense?

The American Psychiatric Association's recent inclusion of a Glossary of Culture-Bound Syndromes within DSM-IV draws upon decades of medical anthropological and cultural psychiatric research to afford culture-bound syndromes (CBSs) a newfound legitimacy within professional Western psychiatric nosology. While DSM-IV's recognition of the CBS concept as a category of psychosocial distress has important clinical implications for mental health care practitioners throughout the world, it also has significant legal implications. Given that several CBSs involve a degree of psychological impairment that may satisfy the standard for legal insanity under certain circumstances, this essay focuses on the potential emergence of an insanity defense based on the claim that an immigrant or minority defendant was suffering from a CBS at the time of his or her criminal act. Aimed at initiating interdisciplinary debate over the reification of the CBS concept, the essay discusses the theoretical ambiguity and status of CBSs within professional Western psychiatry, describes what a CBS-based insanity defense might look like, and considers the relevant challenges facing medical anthropologists and cultural psychiatrists, on the one hand, and legal practitioners, on the other. The essay identifies a pressing need for interdisciplinary debate concerning the validity, scope, and viability of CBS-based insanity defenses.

Cultural Characteristics↗

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↗

PubMed1993

Excluding personality disorders from the insanity defense--a follow-up study.

Examining the effects of Oregon's statutory reform excluding personality disordered individuals from the insanity defense, we previously identified a study sample of insanity acquittees, each of whom was given a primary diagnosis of a personality disorder during subsequent evaluation at the state hospital. In the present study we explore the relationship between that diagnosis and the pretrial psychiatric diagnosis presented to the trial court. By reading the forensic mental health evaluations used at trial we found that 50 percent of our study sample of 34 personality disordered patients were diagnosed with psychotic disorders, affective disorders, retardation, and organic brain disorders. In addition to investigating the diagnosis offered as evidence at trial, we performed assessments of 38 mental health reports using published standards for forensic evaluation reports. We found compliance rates in the various categories ranged from 8 to 84 percent with a mean of 45 percent. We question the value of the mental health input to these trials, and believe that the data tend to validate past aspersions of forensic practice.

Adolescent↗

PubMed1992

The insanity defense: a South African perspective.

The insanity defence has always been a contentious issue. This study was carried out on a sample of 95 consecutive forensic, psychiatric observation cases. The cost-effectiveness of ordering routine investigations during the observation period appeared to be questionable since the results of selective special investigations yielded more useful information. It was found that there was little calculated abuse of the insanity defence, but that the situation was rather one of barely literate persons naively attempting to use it, especially in cases of serious crime. The incidence of these naive users might have been greatly reduced had there been adequate screening before the accused were sent for observation. The court generally accepted the psychiatrist's opinion with regard to mental illness and criminal responsibility. It, however, differed on occasion when it came to the disposal of those accused who were found to be mentally ill.

Adult↗

PubMed1983

The insanity defense: a tale of two cities.

The M'Naghten case and the Hinckley matter are in some ways remarkably similar. The attempted assassination of a ruling figure, the public discomfort with the insanity defense, and problems in the application of the legal rules characterized both. An explosion of media criticism occurred in 1843, as it did in 1982. The English ultimately handled the M'Naghten case in a dispassionate manner that determined Anglo-American law for more than a century and provided the basic law by which Hinckley was tried. Fears expressed in 1843 were never realized; the final chapters of the Hinckley case remain to be written.

District of Columbia↗

PubMed2003

[Insanity defense in post-traumatic stress disorder].

We report the forensic psychiatric evaluation of a 40 year old Iraqi who suffers from a posttraumatic stress disorder (PTSD). She committed multiple non violent shopliftings. We mention criteria for a possible causal relationship between the PTSD and the crimes and discuss, why we affirm a insanity defense in this case.

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↗