Was the first legal standard for the insanity defense in the history of the American legal system

The book presents a general historical, theoretical, and ethical analysis of the insanity defense.

The history of the insanity defense is traced from its origins in Christian ethics and Roman jurisprudence, through British laws requiring guilty intent, to the McNaughton rule and subsequent case law developments. The McNaughton rule required that defendants be laboring under a defect of reason or disease of the mind which rendered them incapable of knowing the nature and quality or the wrongness of their acts. Subsequent decisions incorporated a volitional, irresistible-impulse test which was difficult to prove and often resulted in opposing psychiatric testimonies. Subsequent tests of the insanity defense have included the Durham test, the Durham-McDonald Test, and the American Law Institute's Model Penal Code test. The confluence of a number of factors in the 1960's and 1970's, including attention to patient's rights and changes in statutes regarding committment of the mentally ill, contributed to moves to reform the insanity defense. Many States opted for a guilty-but-mentally-ill verdict. Others have called for abolition of the insanity defense. However, the question of responsibility lies at the very heart of the criminal justice system. It is concluded that the insanity defense should be retained because it permits forgiveness where there is no blame. However, the defendant in such cases cannot be naively absolved of all responsibility. While the defendant may be relieved of criminal responsibility and legal guilt, there is a moral and practical duty that society's compassion is not rewarded by further harm. Source notes and an index are provided.

The insanity defense as a legal concept was born in England, in 1843. A man named Daniel M’Naghten attempted to assassinate the British Prime Minister who he believed was conspiring against him. Due to his psychosis, the court acquitted him and thus established the Mr. M’Naghten Rule. It requires that a defendant is to be found not guilty of an offense if, at the time it occurred, his mental disorder was so grave as to (1) interfere with his ability to know or understand the nature or quality of his criminal behavior, and (2) to have compromised the defendant’s ability to know or understand the legal or moral wrongfulness of his behavior. This two-pronged rule became the legal standard for an insanity defense in the United States as well.

Fast forward several decades when an American jury had to consider the fate of Charles Guiteau after he successfully assassinated President James Garfield on July 2, 1881. At his trial, Mr. Guiteau claimed to be an agent of God when he shot the President. His defense team argued that their client believed he was responding to a deific decree and following God’s command when he assassinated the president. He certainly gave the jurors ample evidence of his bizarreness. Interrupting and constantly insulting his defense team in court, he sang and recited poems and he solicited legal advice from courtroom strangers.

Nonetheless, the jury found the defendant guilty of murder. They did not believe he met the M’Naghten standard of insanity. Soon afterward, the courts in some jurisdictions established Deific Degree Doctrine as another prong to the insanity defense which, when called for, may be formally considered during insanity hearings. Though not recognized in California as a prong of the insanity defense statute per se, a delusional belief about a divine command still requires an analysis of its implication regarding a defendant’s comprehension of moral wrongfulness. Believing one has received a deific command can obscure an understanding of moral righteousness, as God is considered the ultimate arbiter of moral conduct, beyond man-made laws. The hard question that needs to be resolved and opined upon by jurors is whether the defendant actually believed he (or she) was commanded by God to break the law.

When researchers survey people about the insanity defense, most express a great deal of dissatisfaction about it, and with mental health defenses in general. The public generally feels it is used by criminals to avoid their "just desserts." This isn’t surprising, given the media’s attention to cases like the Son of Sam (David Berkowitz) case I profiled in the preceding blog. Berkowitz first claimed he killed by order of a demon, transmitted to him via his neighbor’s dog. He later admitted it was a sham excuse. It is notorious cases like this that retail as prototypical of the insanity defense claims. The facts tell a different story. The insanity defense is employed at an extremely low rate, less than 1%. As a defense, it’s rejected by the trier of fact 75% of the time.[i] And those 25 percent that are found insane usually have an unequivocal history of severe mental illnesses that were manifestly active at the time of the crime.

Conducting an insanity evaluation and rendering an opinion on a defendant’s state of mind at the time of a crime is among the most complex tasks faced by a forensic psychologist. It’s a weighty responsibility, particularly when the crime was heinous, the victim brutalized or worse, family members traumatized, and the legal consequences for the defendant stark and onerous. As with many if not all complex situations that cry out to be understood, the devil is in the details of facts and context, along with a deep understanding of the psychological factors that drove the behaviors in question. When a deific degree claim is presented by the defendant, the forensic situation becomes even more complicated.

In my next blog, I’ll discuss a case that, I think, typifies the complex interplay of circumstance and psychology that jurors and forensic examiners face when insanity is under consideration.

References

Melton, G. B., Petrila, J., Poythress, N. G., Slobogin, C., Otto, R. K., Mossman, D., & Condie, L. O. (2017). Psychological evaluations for the courts: A handbook for mental health professionals and lawyers. Guilford Publications.

Borum, Randy, and Solomon M. Fulero. (1999). "Empirical research on the insanity defense and attempted reforms: evidence toward informed policy." Law and human behavior 23 (1), 117-135.

Psychiatry (Edgmont). 2005 Sep; 2(9): 24–25.

Published online 2005 Sep.

PMCID: PMC2993532

Involvement in cases that concern the insanity defense is without a doubt the best known of the roles that psychiatrists play at the interface of medicine and the law. In fact, before the formalization of psychiatry as a specific discipline within medicine, doctors were involved in assisting the courts with members of society who were acting outside of generally accepted standards and who were clearly “not themselves.”

In the legal system, there are two general requirements for criminal sanction against an individual: mens rea and actus reus. Mens rea refers to the intent to commit an act and have a desired consequence (e.g., intending to pull a trigger and having the escaping bullet hit someone for a murder charge), and actus reus refers to the act fitting within the criminal statute (e.g., someone needs to be dead for there to have been a murder).

The insanity defense derives from the idea that certain mental diseases or defects can interfere with an individual's ability to form mens rea as required by the law.

One thing that may not be apparent to those who read about cases or hear about them on television is that the insanity defense standard is not static. Like most things in the law, it constantly is evolving and does so within the greater cultural context. For example, in the wake of the shooting of Ronald Reagan, there was widespread and rapid reaction to the finding that the perpetrator, Mr. Hinckley, was not guilty by reason of insanity. The reaction was, in general, toward a narrowing of who could qualify and with what standard they should be examined.

It is difficult to imagine how the standard might change without experience in the field, and there are some standards that all should be aware of who delve into the field, as follows:

The M'Naughten standard. This standard is the classic example of the insanity defense. It originated in Britain where, in 1843, M'Naughten murdered the secretary of the Prime Minister (in an attempt to kill the Prime Minister) believing there was a conspiracy against him involving the government. The high court found him insane and he was hospitalized. The court described what is now known as the M'Naughten Standard, and in simplified form it says that at the time of the act, the person had a mental disease or defect that interfered with his ability to understand the nature and quality of the act he was performing or if he knew so, he did not know it was wrong.

Irresistible impulse. The irresistible impulse standard focuses on the ability of the defendant to have control over his or her actions at the time of the crime.

The Durham rule. The Durham rule is so named because it grew from a decision in 1954 in a case called Durham v. United States. This rule generally is considered a broadening of the insanity defense as it focuses on whether the action was the result or product of a mental disease or defect. It is therefore often referred to as the “product rule.”

Comprehensive Crime Control Act. Following the assassination attempt on Ronald Reagan, legislation was passed in the United States called the Comprehensive Crime Control Act. This act set a standard that in some ways returned to the historic rule of knowing right from wrong. The language of the statute includes this standard and pushed back the Durham product rule.

It may seem from the description above that the insanity defense may leave a loophole for individuals who seemingly break the law, but do so under the influence of drugs, such as alcohol and hallucinogens. In such cases, people are obviously in an abnormal state of mind and to some degree are not aware of their actions and the subsequent ramifications. If someone is under the influence of hallucinogenic compounds and, therefore, in a psychotic state, it is easy to see how they can act under the influence of the paranoia or hallucinations that often result.

This particular question has been taken care of in general through specific statutes in municipalities that describe the criminal ramifications of clear actus reus in the setting of a person where mens rea might be absent for reasons that are in the apparent control of the individual.

Understanding the different standards makes it easier to perform an examination, but more important for psychiatrists than the general information above is that the insanity defense standard varies from state to state. You should become familiar with the statute in your state in the event you become involved with such a case.

One way that psychiatrists get involved in insanity cases is through their patients. This would necessitate the unfortunate event where a patient is involved in a criminal matter. The patient and his or her counsel choose to make his or her state of mind at the time of the alleged incident an issue and you, as the treating physician, are called to testify.

The other common way psychiatrists end up playing a role in these cases is as a consultant who is serving to evaluate the individual as well as the circumstances of the crime. In such a case, you are actually seeing the person under a court order or at the request of one of the attorneys, and it is quite different than seeing a patient, especially when issues such as confidentiality come up.

When a defendant is found not guilty by reason of insanity it does not mean he or she necessarily goes free. Commonly, states have requirements for treatment or institutionalization after such a finding. Some states require such confinement for the length of time the person would have received if convicted as a minimum, so he or she may end up spending more time confined than if he or she did not raise such a defense. Like other areas of the law, this varies from state to state.

The insanity defense is a significant area at the nexus of law and psychiatry. This introduction merely provides a glance at the issues that run deeper.

Articles from Psychiatry (Edgmont) are provided here courtesy of Matrix Medical Communications