The psychiatrist's guide to right and wrong: judicial standards of wrongfulness since M'Naghten

In insanity defense litigation, the precise legal definition of wrongfulness is often critically important. References in the M'Naghten Rules to the appropriate standard of wrongfulness were ambiguous, resulting in a divergence of judicial opinion as to whether wrongfulness means legal wrong, subjective moral wrong, or objective moral wrong. This article reviews and analyzes these three judicial standards of wrongfulness in the context of case law from jurisdictions that follow each of the respective standards. The evolution of knowledge of right and wrong tests of criminal responsibility is traced back to its philosophical roots. Most psychiatrists claim no expertise in matters of morality or law. The American Psychiatric Association would bar psychiatric expert testimony on the ultimate issue of insanity, on the grounds that there are "impermissible leaps in logic" when psychiatrists opine on the probable relationship between medical concepts and moral-legal constructs. Whether or not they testify on the ultimate issue, psychiatrists should ascertain the applicable standard of wrongfulness in order to properly relate their findings to the relevant legal criteria for insanity and thereby enhance the probative value of their testimony.     

Barring ultimate issue testimony

This research focuses on one of the major changes wrought by the Insanity Defense Reform Act of 1984: the exclusion of expert mental health testimony on the “ultimate issue,” that is, testimony specifically addressing the expert's opinion that the defendant is sane or insane. Subjects in this research were presented with 1 of 10 variants of an insanity case in which experts testified for the defense, prosecution, both, or neither. The testimony was at one of three levels: diagnostic only, penultimate issue, or ultimate issue. Results showed that level of testimony had no effect on the verdict pattern. There was evidence to suggest that this effect may occur because jurors infer, and/or mistakenly recall, higher levels of expert testimony than was actually presented to them. In addition, general and specific constructs (Finkel & Handel, 1989) that predict verdict yieldedR ² values from .500 to .668 and were not significantly affected by the level of expert testimony. Implications of these findings are discussed.     

Moral wrongfulness and insanity: a New Zealand sample

Introduction: This study sought to identify the common characteristics amongst defendants found legally insane, compared to those who were psychiatrically evaluated yet convicted of their crime. Method: A retrospective review of court-ordered psychiatric court reports and legal outcomes was conducted, for all defendants referred for insanity evaluations in the largest city in New Zealand (and its surrounding rural regions) for a 7-year period. Results: The majority (60%; 37) of those referred for evaluation were found legally insane. The opinion regarding moral wrongfulness was the single factor that differentiated successful insanity defendants from those who were found guilty. Conclusions: Despite the centrality of the insanity defence to forensic psychiatry, few studies internationally consider characteristics of those found insane, particularly in comparison with those who are found guilty. Psychiatrically evaluated defendants in this sample were relatively homogenous, perhaps due to the court liaison nurse screening process.     

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.     

"Insanity" in civil law

The issue of "insanity" is rarely alluded to in the area of civil law. As a consequence, the legal standard for insanity is not clearly understood by many psychiatrists. The standard derives from case law and is based upon statutory law in the criminal sector. A civil case will be presented where the question of "insanity" was raised. In this case an individual committed suicide and his insurance company refused to pay the beneficiaries of his life insurance policy based upon a provision in his policy that excluded payment in situations of suicide. His beneficiaries sued, claiming that the deceased was insane at the time of his suicide and therefore not responsible for his actions. The standard for insanity in New Jersey and the reasoning of the psychiatrists will be presented.     

Insanity, methamphetamine and psychiatric expertise in New Zealand courtrooms

The use of methamphetamine in New Zealand has increased significantly over the last decade. Due to the potential of methamphetamine to induce, exacerbate and precipitate psychotic symptoms, this drug has also taken centre stage in several criminal trials considering the sanity of defendants. Highly publicised and often involving contested expert evidence, these criminal trials have illustrated the limits of using psychiatric expertise to answer legal questions. This article considers the implications of such cases in light of material from a qualitative study that aimed to generate insights into the difficulties forensic psychiatrists and their instructing lawyers face when providing expert evidence on the relationship between methamphetamine, psychosis and insanity. It reports material from 31 in-depth interviews with lawyers and forensic psychiatrists and observation of one criminal trial that considered the relationship between methamphetamine and legal insanity. The findings are correlated with the clinical and medico-legal literature on the topic and subjected to scrutiny through the lens of "sanism". The article concludes that the continued use of forensic psychiatry to meet the legal objectives of insanity, where methamphetamine is involved, has the potential to reinforce sanist attitudes and practices.     

司法实务中用法律精神病替换临床精神病的思考

对《刑法》第18条"精神痛"的理解,法学界和医学界的一些人观念中有整体偏差,致使法律对健康人群的保护不够,纠偏的有效措施是用法律精神病替换临床精神病。     

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.     

The forensic psychiatrist of the future

The rate of change in scientific knowledge and the growing psychiatric sophistication of attorneys and courts have made it increasingly difficult for forensic psychiatrists to retain proficiency in the full spectrum of potential professional activities. As the consumers of forensic services become more sophisticated, forensic psychiatrists have an increasing need to become scientifically informed and a decreasing need to become legally informed. Traditional training in forensic psychiatry, which emphasizes clinical, legal, and institutional knowledge and experience, gives short shift to behavioral science and other technical knowledge that can enhance the validity of forensic assessments and their value to the legal system and society. Forensic psychiatrists can best respond to these changes and maximize the value of their assessments by narrowing their focus to some subset of the four branches of the discipline: criminal behavior, mental disability, forensic child psychiatry, and legal aspects of psychiatric practice. Maximal proficiency in each of these four branches requires a greater depth of knowledge and experience than was once sufficient among those who practiced in all four areas. Fellowship training programs and professional organizations should lead forensic psychiatry into the twenty-first century by organizing their efforts along these four parallel tracks.     

Predicting verdicts,adherence to judge's instructions,and assumptions about the disposition of the defendant in a case involving the insanity defense

Abstract

296 college students and jury eligible adults completed attitudinal measures and read a case summary of a murder trial involving the insanity defense. The case summary included opening and closing arguments, testimony from expert witnesses, and judge's instructions. Although broader legal attitudes (the PJAQ) predicted verdicts, the Insanity Defense Attitudes-Revised scale provided incremental predictive validity. Attitudes related to the insanity defense also predicted adherence to judge's instructions, whereas more general legal biases predicted a juror's willingness to change their verdict after being provided with accurate information about the defendant's disposition following the verdict. Importantly, misconceptions concerning the insanity defense impacted verdicts and many jurors made decisions that failed to adhere to the judge's instructions, though the nullification tendency does appear to vary as a function of pretrial juror attitudes. Implications for instructing jurors in insanity defense cases will be discussed.     

Who's afraid of forensic psychiatry?

Forensic psychiatry has come under mounting criticism from the press and other medical professionals, largely for its participation in the insanity defense. The author argues that the expertise available from the specialty is of increasing importance to psychiatry as a whole, as more and more legal issues become relevant to the practice of general psychiatry, and should be actively encouraged and legitimized rather than ostracized. All psychiatrists should be exposed to forensic principles and practices during their training, and the ability of forensic psychiatrists to serve as transducers between the clinical and the legal/judicial should be increasingly used to present the clinical viewpoint effectively in courts and legislatures.     

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.     

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.     

Forensic psychiatry and the birth of the criminal insane asylum in modern Italy

This paper focuses on the creation of the criminal insane asylum in Italy between unification in 1861 and World War I. The establishment of criminal insane asylums was a triumph of the positivist criminology of Cesare Lombroso, who advocated for an institution to intern insane criminals in his classic work, Criminal Man (1876). As a context for the analysis of the birth of the criminal insane asylum in Italy, this essay also outlines the history of the insanity plea in Italian criminal law and the young discipline of psychiatry during the fifty years after Italian unification.     

Insanity plea: predicting not guilty by reason of insanity adjudications

Using 35 variables and discriminant analysis procedures, it was found that, of 133 male defendants entering the insanity plea in Colorado, 87 percent were classified correctly into the disposition groups "adjudicated insane" and "convicted." Most positively related to an insanity adjudication were a psychiatric evaluation of insanity and a diagnosis of schizophrenia. Negatively related to the insanity verdict were diagnoses of substance use and personality disorders.     

The Impact of Insanity Acquittees on Missouri's Public Mental Health System

Even though state departments of mental health have primary responsibility for the care, custody, and treatment of insanity acquittees, the impact of insanity acquittees on the public mental health system is generally lacking in policy discussions and as a topic for policy research. This issue has received increased attention in Missouri, where insanity acquittees now occupy half of the long-term public psychiatric hospital beds. This article examines the presence of Missouri's insanity acquittees on the state's public mental health system and includes the impact on goals, fiscal costs, inpatient and community psychiatric services, and inpatient treatment staff. As states consider managed care and other cost containment measures, it remains to be seen if the high costs associated with extensive use of hospitalization of insanity acquittees to promote public safety will influence policy changes to more community-based insanity acquittee systems.     

Automatism: comparison of common law and civil law approaches--a search for the optimal

This article reviews common and civil law approaches to automatism with discussion of legal definitions and the conditions in which automatism occurs. The common law approach to sane (exogenous) and insane (endogenous) automatism is examined. Despite a change in the law, which obviates mandatory incarceration for all persons found not guilty on the basis of insane automatism, the stigma of insanity remains. A number of Continental jurisdictions, though, have adopted an approach divorced from judgmental labels, whereby acts, which result from automatism, are classified under the rubric of unconsciousness. The article draws upon this approach, analyses alternatives to insane automatism and proposes instead an analysis by reference to "cognitive dysfunction", thereby removing all reference to the concept of insanity.     

De facto departures from insanity instructions

De facto departures form the law (de jure) have been noted in such areas as jury revolts, jury nullification, extralegal concerns, and insanity. The thesis developed here is that (a) when such departures have occurred in insanity cases, acritical rather thaninstructive view of jurors has prevailed; (b) this critical view impedes efforts to empirically understand jurors' constructs of insanity and thereby restricts considered legal changes; (c) the Insanity Defense Reform Act of 1984 is illustrative of such narrowly considered changes, and, based on empirical findings, this act fails to instruct jurors or produce verdicts different from its predecessors; and (d) based on empirical findings, the common sense construals ofsane andinsane do emerge, complex though they be. Suggestions toward an empirically derived common law test of insanity, one that harmonizes legal, psychological, and common sense perspectives, are offered.This article is based in part on a paper, De Jure and De Facto Insanity Tests, presented at the American Psychological Association's Annual Convention, August 14, 1988, Atlanta, Georgia.     

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)     

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.