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Maintenance of an insanity defense under Montana's "abolition" of the insanity defense.

In 1979, Montana's insanity defense was replaced with the more restrictive mens rea defense, a change that has been described as an example of "abolition" of the insanity defense. The authors identified cases in which mental health was an issue in seven Montana counties for 3 years before and 3 years after the 1979 reform. They found that acquittals based on the insanity plea markedly declined, but that dismissals based on incompetence to stand trial increased substantially following the reform. They conclude that dismissal based on incompetence to stand trial became a substitute for acquittal based on the insanity plea under mens rea.

Forensic Psychiatry

The military insanity defense.

This article describes the military insanity defense. The success of the litigated insanity defense is explored through the number of insanity acquittals over a 28-month period. A questionnaire distributed to all United States Army psychiatrists provided information on the number of forensic evaluations performed, the number of not criminally responsible (NCR) opinions made, and the disposition of noncontested NCR opinions. The questionnaire also tested the Army psychiatrists' knowledge about recent changes in the military insanity defense. This pilot study raises interesting questions about the military insanity defense that further research can address.

Forensic Psychiatry

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

Is the insanity defense "unconscionable"?

The debate over the meaningfulness and utility of the insanity defense has continued unabated ober the years. President Nixon has referred to the "unconscionably abuse" of the defense. This paper, presented as part of a panel on the subject, has propounded the view that the defense is unconscionable, using that aspect of the definition dealing with unreasonableness. The historical antecedents and the religious and social philosophy of the concept of responsibility and nonresponsibility have been reviewed. In addition to the inapplicability of the concept to current social problems, and the difficulties of applying current psychiatric knowledge to effect a rational delineation between the two legal entities encompassed under the rubric of responsibility and nonresponsibility, the potential problems and the potential opportunities which may result from the abolition of the plea are presented. With these factors in mind, as well as the obvious failure of the legal-social-penal system in handling the problems of the behaviorally deviant, I believe that the use of the current system has hampered the development of possibly more reasonable alternative systems and that, therefore, the maintenance of the insanity defense is unreasonable and harmful to our society. The insanity defense, as currently constituted and institutionalized, has evolved into a rigid and archaic vestige of the legal system of an earlier era and therefore its use has, in the sense defined, indeed become "unconscionable" and lacking in social meaningfulness.

Ethics

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

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

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

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

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

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

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

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

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

Posttraumatic stress disorder as an insanity defense: medicolegal quicksand.

A growing awareness of posttraumatic stress disorder has led to recent use of the disorder as a legal defense against criminal responsibility for both violent and nonviolent crimes. Diagnosis of posttraumatic stress disorder is difficult because the symptoms are mostly subjective, often nonspecific, usually well publicized, and, therefore, relatively easy to imitate. Accurate psychiatric testimony in such cases requires diligent searching for collateral sources of information. The authors argue that the insanity defense is appropriate only in the rare instance that a dissociative episode related to posttraumatic stress disorder directly leads to criminal activity.

Criminal Psychology

The insanity defense to suicide.

The certification of suicide as the manner of death can result in either the complete loss or a significant reduction in life insurance benefits to the victim's survivors. It is, thus, not uncommon for these beneficiaries to contest suicide as the manner of death. Insanity is a recognized defense in law against suicide. It is recognized in law that, in some cases, an insane man cannot intentionally destroy himself. However, it is also recognized that life insurers can exclude suicide by an insane man from coverage. This article discusses the common law doctrines upon which the insanity defense to suicide is based, with references to judicial opinions from cases which involve contested suicides and the issue of insanity.

Coroners and Medical Examiners