Defenses: Insanity

Jared Loughner’s federal court arraignment is today. It is expected that he will plead “not guilty,” and that at trial his lawyer will offer an insanity defense. Insanity defenses rarely get a defendant acquitted, but an insanity defense might help Loughner avoid a death penalty.

I’m already seeing a re-hash of the same misinformation about “insanity” that was sluicing around after the massively psychotic Andrea Yates drowned her five children in 2001. For example, some genius always points out that the mentally ill are, statistically, no more likely than the general population to be violent. Which I believe is true. Therefore, they figure, mental illness doesn’t cause violence.

Let’s assume that, statistically, people with heart disease are no more or less likely to cause traffic accidents than people without heart disease. And then let’s say someone has a sudden heart attack while driving, loses control, and causes a five-car smash-up on an interstate. How logical, then, is it to say that the heart attack was not a factor in the accident because statistics tell us heart diseases don’t cause accidents?

By the same token, while mental health experts agree that most mentally ill people are no more likely than anyone else to become violent, I doubt many of them would willingly lock themselves in a room with an armed paranoid schizophrenic.

The next thing we’re gong to hear, and I’m sure it’s been said already, is that Loughner “knew” what he was doing because he planned it. But as I understand it, people with some types of schizophrenia are perfectly capable of making plans and carrying them out. The issue is that the motivation to act largely is being generated by the disease. Dr. Beatriz Luna, an associate professor of psychiatry and psychology, wrote in the New York Times:

For example, Jared Loughner’s criminal act appears to have involved careful planning that required voluntary and well-thought out steps. However, the aim of this planned behavior may reflect a disordered, diseased state. Neuroimaging studies could show that such a criminal engages brain systems to support voluntary acts in a similar way as the normal population. However they could also show abnormalities in brain processes that support the ability to have empathy and control over anger, or show that reported hallucinations recruit brain processes that support real sensory experiences. Although such a person would be able to operate in a voluntary planned manner, their acts would reflect brain abnormalities that contribute to their urge to commit crimes.

The larger problem is that “insanity” is not a medical term. The best psychiatrist in the world couldn’t tell you if Jared Loughner is “insane” under the law, because psychological science doesn’t recognize a condition called “insanity.” The insanity defense is based on antiquated ideas about mental illness that don’t apply to reality.

Dr. William T. Carpenter Jr., a professor of psychiatry, writes in the New York Times:

In the post-Hinckley era, the standard in many states has become a simple cognitive test that has little relationship to the scientific or clinical knowledge regarding psychotic illness. Rather than state of mind and the defendant’s understanding of his or her actions, the standard is close to simply whether the defendant knew the act was unlawful. Insanity acquittals, already rare, now face an almost impossible standard.

One wrinkle in this issue is that Arizona is, I believe, the only state with a “guilty, but insane” verdict. I’m not sure how this works, but I think this gives the court the ability to sentence the convicted-but-insane person to a secure psychiatric facility, but if he gets better and no longer needs hospitalization he is transferred to a prison to finish his sentence. I guess we’ll learn more about this when we get into the state proceedings.

8 thoughts on “Defenses: Insanity

  1. This explains a lot, and what a murky area! My money is on Loughner beats the death penalty but gets life or thereabouts. Ted Kacyzinski also beat the death penalty but got four life sentences plus 30 years, same defense attorney.

  2. “One wrinkle in this issue is that Arizona is, I believe, the only state with a “guilty, but insane” verdict.”

    “Guilty, but insane,”
    And here I was thinking that was some prerequisite in AZ for running for office.

  3. Words do have power. Perhaps it’s time to stop talking about “insanity” and start calling the condition a “psychotic illness”, as the good Dr. Carpenter does.

    I too remember the Andrea Yates case. If ever there was an example of someone who was extremely mentally ill, it was Yates. The law really has to get rid of its unhealthy, outmoded attachment to the useless word “insanity”.

    • I too remember the Andrea Yates case. If ever there was an example of someone who was extremely mentally ill, it was Yates.

      I followed her first trial closely, and as her defense lawyer said, if the insanity plea didn’t apply to her, it didn’t apply to anyone and they might as well take it off the books. In order for Yates to even appear in the courtroom and sit quietly in a chair, she had to be given a cocktail of several different anti-psychotic meds. She seems to have had only a vague idea what the trial was about.

  4. “…disordered, diseased state…” reminds me of what a woman whose husband was killed by Jared said at an interview, “I hate what he did, but I don’t hate him.” Also reminds me of Ricky Ray Roberts who was so mentally retarded that he asked his jailers to ‘save’ his pecan pie for his next day dinner because he was too full to eat it then, not able to comprehend that he was to be killed by the state the following morning. (Bill Clinton, governor of Arkansas at the time, and also actively seeking the presidency signed off on his assassination – by the way – which is why I never voted for Clinton.)

    Insanity, severe mental retardation should invoke pity not the death sentence.

  5. Slightly off-topic here, but if the authorities want to execute Loughner (or anyone else), they may not be able to thanks to a shortage of sodium thiopental:

    Shortage of Drug Holds Up Some U.S. Executions
    http://www.msnbc.msn.com/id/39385026/ns/health-health_care/

    But the “shortage” is not just limited to sodium thiopental. It’s now MANY cheap generic drugs:

    U.S. Facing Largest Hospital Drug Shortage in Decades
    http://abcnews.go.com/Health/CancerPreventionAndTreatment/largest-hospital-drug-shortage-decades/story?id=12452389

    It’s not happening anywhere else. Entirely an American thing. Why? After some heavy-duty googling, what I’ve been able to discern is this:

    1) First, corporate mergers reduced the supply of these drugs to a single US manufacturer.
    2) US manufacturer doesn’t make much profit from selling cheap generic drugs; expensive patented drugs are much more profitable.
    3) Importing the cheap generics from abroad requires FDA approval, which is being mysteriously withheld (excuse is that foreign drugs are of inferior quality).

    Even generics are expensive in the USA, when available. There is one drug which I took when I was in the USA – here in Asia I find it available at 1/20th the price, and no shortage. Many “third world” countries do not recognize US drug patent laws, and have big drug manufacturing industries as a result, though they face US trade sanctions if they export these drugs:

    The Right Fix?
    http://www.economist.com/node/2020463

  6. Loughner seems to have been pretty out of touch with reality for some time. This was and wasn’t politically motivated. The Congresswoman and her staff were targets because they were in politics but the shooter does not seem to have had any rational political philosophy. I mean he was even crazier than the teabaggers.

    A lot will come out in the trial we don’t know.. but if I was deciding today, I could not vote for the death penalty. On the other hand, I could not approve any sentence that would ever allow Laughner to walk free.

    I may be in the minority, but there have been cases where I think the death penalty was/ would have been appropriate. I concede that far too often, it’s been applied with only circumstantial evidence or unreliable eyewitness testimony.

    How it can be done, I’m not sure, but there needs to be a better standard based on modern psychiatry and legal definitions with guidelines for juries to determine the capacity of defendants. As it stands now, a jury can be as readily manipulated by a skilled prosecutor as a slick defense lawyer. When it’s a capital case, justice demands a better standard than we have.

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