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PubMed1981

Mania, crime and the insanity defense: a case report.

A case has been presented of a young manic depressive man whose first contact with a mental health professional was in connection with a criminal act performed during a manic episode. Information that is often not available or inadequate, especially a comprehensive family history, enabled the author to infer the presence of the illness at the time of the crime. An extended follow-up allowed the diagnosis to be confirmed, treatment to be instituted and reasonable certainty to be attained that the crimes occurred only as a manifestation of or in conjunction with the active phase of the illness. The obstacles to accurate diagnosis in such cases and their appropriate management are discussed in hopes of heightening the awareness of readers to the possibilities of such unsuspected cases in their midst.

Adult↗
PubMed2006

Shared psychotic disorder and criminal responsibility: a review and case report of folie à trois.

We present a case of shared psychotic disorder involving three sisters who were successful in establishing an insanity defense on numerous felony charges in the South Carolina criminal court system. Two of the authors of this article were court-appointed examiners in this case. We then present a history of shared psychotic disorder, an overview of the use of this diagnosis in the defense of insanity, and a discussion of the disposition of individuals with "temporary insanity." Finally, we compare shared psychotic disorder, culturally based belief systems, and religious cults, with a focus on their common and contrasting characteristics.

Adult↗
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↗
PubMed1986

Pathological gambling and criminal responsibility.

There exists significant interdisciplinary support for eliminating the volitional component of the insanity defense. Somewhat in contrast to this trend is the presentation of pathological gambling as a potentially exculpatory condition in criminal trials. The authors discuss three federal appellate court decisions on this attempted inappropriate usage of psychiatric diagnostic nomenclature. All have upheld convictions, and thereby rejected contentions that such an impulse disorder can form the basis for a valid plea of lack of criminal responsibility. It is suggested that the public interest will be served by statutorily making disturbances of behavioral control insufficient to raise a defense of insanity.

Crime↗
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↗
PubMed1986

Oregon's Psychiatric Security Review Board: a comprehension system for managing insanity acquittees.

The insanity defense is a particularly controversial aspect of the interaction between law and mental health. During the past decade, many states have revised or abolished their insanity defenses. Oregon, however, chose in 1974 to retain its existing defense and create a new, unique system for the post-adjudication management of insanity acquitees. Oregon's legislature established the Psychiatric Security Review Board (PSRB), which is composed of five part-time members drawn from different disciplines, to conduct periodic hearings to determine the placement and supervision of defendants who successfully raise the insanity defense and remain mentally ill and dangerous. The PSRB has received national attention as a promising approach to managing mentally ill offenders. The authors first describe the structure and operation of the Oregon system. Then they summarize the empirical studies they have conducted of the PSRB in action.

Forensic Psychiatry↗
PubMed1991

Monitored conditional release of persons found not guilty by reason of insanity.

This article reviews the recent literature documenting changes that have taken place in the management and treatment of insanity defense acquittees with the development of conditional release and monitored community treatment. The review demonstrates that conditional release is particularly important as a means of balancing the protection of society with the treatment of insanity defense acquittees in the least restrictive environment. The review also highlights the development of community programs based on treatment models for the chronically mentally ill. In addition, monitored community treatment programs appear cost-effective when compared with hospital-based programs. These factors point to the development in the 1990s of program standards for the release of insanity defense acquittees.

Civil Rights↗
PubMed1990

Post-Hinckley insanity reform in Oregon.

The 1983 Oregon legislature responded to public pressure to narrow the application of the insanity defense by eliminating personality disordered individuals from consideration for an insanity verdict. This article examined the effects of the statutory change, and found no significant change in the frequency of insanity acquittals of personality disordered subjects between the three pre-reform years (n = 21) and the three post-reform years (n = 14). We also reviewed how the Psychiatric Security Review Board handled these patients once committed to their jurisdiction. We constructed a matched comparison group of psychotic acquittees and found that in the pre-reform years the personality disordered subjects spent less time in the system and less time in the hospital than the psychotic patients. However, in the post-reform years their time in the system and time in the hospital was the same as the psychotic controls. There were fewer decisions to discharge personality disordered patients from the system after the reform, although this difference may be due to factors other than the statutory reform itself. The conclusion is that narrowing the insanity defense is a worthy goal which may be difficult to achieve.

Adult↗
PubMed1983

Elimination of the exculpatory insanity rule. A modern societal need.

The author argues that on rational, humanitarian, professional, societal, and constitutional grounds, the insanity defense as currently employed in the United States should be abolished. This comprehensive article discusses the constitutionality of abolition, alternatives to the insanity defense, and much more.

Adolescent↗
PubMed1989

The psychiatrist's guide to right and wrong: Part III: Postpartum depression and the "appreciation" of wrongfulness.

Whether or not the psychiatrist testifies on the ultimate issue in insanity defense cases, it is critically important that he familiarize himself with the applicable legal standards and interpretations in order properly to relate his clinical findings to the relevant criteria for insanity and thereby enhance the probative value of his testimony. This is the third in a series of articles which attempts to explicate judicial and statutory standards of insanity and correlate them with the psychiatrist's findings of psychopathology. This article analyzes the Model Penal Code formulation of insanity, with special emphasis on the all important distinction between "know" and "appreciate." This formulation permits the defendant possessed of mere surface knowledge or cognition to be exculpated, requiring that he have a deeper affective appreciation of the legal and moral import of the conduct involved if he is to be held criminally responsible. The Model Penal Code approach more readily lends itself to application as a standard of responsibility in cases involving affective disorders. An important disorder within this group, postpartum depression, is discussed in the context of raising the insanity defense in a case of infanticide.

Adult↗
PubMed2006

Law & psychiatry: insanity, guilty minds, and psychiatric testimony.

This column describes a recent Supreme Court case, Clark v. Arizona, in which an adolescent who had schizophrenia was convicted of first-degree murder of a police officer who he believed was a hostile space alien. The Arizona courts had rejected his insanity defense as well as a second defense that he lacked the required intent to commit the crime (mens rea) because his delusions interfered with his knowing that the victim was a police officer. The Court ultimately declined to overturn Arizona's rules regarding the insanity defense and mens rea. However, the column highlights the points in Justice Souter's decision that may have implications for any case involving mental health issues.

Adolescent↗
PubMed2002

The defense of extreme emotional disturbance in New York County: pleas and outcomes.

A number of studies have investigated the use of the insanity defense; however, there are few reports on the use of other types of psychiatric defenses. This study explored the use of the affirmative psychiatric defense of extreme emotional disturbance (EED) in New York County (one of the five counties which comprise New York City). The results of the study indicate that, as in the case of the insanity defense, EED is rarely proffered by criminal defendants (plea rate 0.84%). The defense only prevailed on one occasion at a jury trial. While the EED defense was successful 39% of the time that it was entered, this was usually only when the prosecutor accepted the argument that was offered by the defense.

Forensic Psychiatry↗