The Insanity Defense: Fact or Fiction?

By Molly McVoy, M.D. 

When you hear about a defendant pleading insane at the time he or she committed a crime, what thoughts cross your mind?  You may be thinking of those infamous court cases: John Hinckley, Andrea Yates, Brian David Mitchell (Elizabeth Smart's kidnapper), and most recently, Jared Laughner.  It's common to feel conflicting emotions - anger, confusion, even sympathy - as you remember these high-profile defendants and traumatic court cases.

The word “sanity” is a legal term, not a mental health or clinical term.  Generally, a determination of “sanity” in a court of law refers to whether a “mental disease or defect” (also a legal, not clinical term) causes a person to be unable to know the wrongfulness of his or her action.

Over time, the court clarified what qualifies as a “mental disease or defect,” and it's not always directly related to clinical diagnosis as used by practicing psychiatrists.  Typically, severe mood and psychotic disorders do classify as a “mental disease or defect,” but many other psychiatric illnesses and personality disorders do not.  Courts ultimately determine what illnesses do and do not qualify as a “mental disease or defect” under the “not guilty by reason of insanity” defense. 

The application of this defense has also changed in scope.  Early in American law, only if someone had total loss of memory or understanding would this defense apply.  But in time, that became more liberal -- applying if someone was unable to know the wrongfulness of his or her actions or, because of illness, was unable to resist the urge to commit the crime.

After the attempted assassination of Ronald Reagan by John Hinckley, the standard became narrower once again, returning to apply only to those whose “mental disease or defect” prevented him or her from knowing the wrongfulness of the crime.

Finally, some states have an additional “guilty but mentally ill” statute that affects eventual sentencing but not strict guilt or innocence.  You will probably hear more debate about the insanity defense in media's coverage of Jared Laughner.  There may always be misunderstanding and controversy for this complicated, highly sensitive issue.

 

For more information:

http://www.aapl.org/

Posted in: Molly McVoy MD,psychosis