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/

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Understanding Psychosis

By  Sara Coffey, D.O.



Often patients and family members have a hard time understanding how a person can be psychotic.  Psychosis is defined as grossly impaired reality testing. Psychosis can be present in several mental illnesses including, schizophrenia, schizoaffective disorder, bipolar disorder and even depression.

The stigma or lack of information surrounding these disorders leaves them feeling guilty or ashamed. I often explain to them that the brain is an organ just like the heart, the kidneys or the liver. And just as our heart, kidneys or liver can become diseased, so can our brain.

The brain is a complicated organ with several different functions. It helps regulate our breathing, our heart rate, and our temperature and handles more complex tasks such as vision and hearing, pain sensations as well as processing complex thoughts or emotions. It is easy for us to understand that if the heart becomes damaged it might not pump as effectively, but it is often harder for us to understand what happens if the brain becomes compromised or unwell. A brain with mental illness may start to hear things that are not there, or experience thoughts that cannot be explained and seem irrational.  A person may become excessively anxious for no reason, or depressed without warning or cause.

In the world of mental illness we use terms to describe such experiences like hallucinations and delusions.  A patient with hallucinations might experience voices talking to them when no one is present. When we recall that one function of the brain is to process and interpret sound it is easy to see how auditory hallucinations might occur if that part of the brain is compromised.

Patients can have delusions that people are out to harm them for no reason, and without proof, or delusions that they are famous powerful figures in history. And again, when we look at how the mind works, how complex processes are taking place that help us navigate who we are and what we do, it makes sense that if something wasn’t working normally in the brain that a person could have a belief that was false.

Although these symptoms might make sense when we look at the brain as an organ, or a tool performing a function, it doesn’t lessen the impact mental illness has on families. Often mental illness takes away what we consider the heart or personality of person and this can be extremely difficult to cope with. Furthermore, the simplicity of understanding is not without criticism. For instance although we are learning more and more about the brain every day, there is still no cure for mental illness, only treatment for symptoms, and often times the treatment cannot fully clear the symptoms of certain diseases.

However, it is important to know that psychosis, like other mental illness symptoms, is not the fault of the person with the illness or the family who cares for them. These symptoms are part of a complex illness that affects patients unwillingly every day.

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