The Mad, the Bad, and the Innocent.

• Author: Torrey, E. Fuller

Ever since 1760, when London's Dr. John Monro testified as to the temporary insanity of a man accused of killing his servant, medical experts have argued whether "lunatic killers" should be held responsible for their actions. Dr. Barbara Kirwin, a New York psychologist specializing in issues of crime and sanity, has written an entertaining contemporary account of this genre. She utilizes material from over 300 cases in which she examined the accused (including individuals like Joel Rifkin, who murdered 17 Long Island prostitutes) as well as public records from the trials of John Hinkley, Erik and Lyle Menendez, Susan Smith, Colin Ferguson, John Salvi, and virtually every other high-profile case from the last 20 years.

Dr. Kirwin is at her best in describing the attempts by some defendants to fake insanity and the attempts by some defense lawyers to concoct a "designer defense" (Kirwin's apt term) to get their client off on an insanity plea. She has testified for the prosecution in all except two of her cases and has little sympathy for the his-deprived-childhood-made-him-do-it argument. She includes a solid chapter on the mechanics of examining and testing individuals to determine sanity and is clearly a competent forensic psychologist.

But although entertaining, the book is flawed by poor organization (individual cases are partially described, disappear, then reappear in later chapters), intermittent factual errors, and fuzzy logic when it comes time for solutions. For example, the author says that tardive dyskinesia, a side effect of some antipsychotic medications, "is irreversible and usually progressive," when in fact it is reversible in the majority of cases when the medication is stopped and is only rarely progressive. Mirroring the mantra of politically correct (and almost always politically liberal) mental health professionals, Dr. Kirwin blames "the policy of deinstitutionalization in the Reagan years" for the homeless mentally ill and the sad state of contemporary public mental illness services. In fact, deinstitutionalization moved into full stride under President Kennedy and continued under Presidents Johnson, Nixon, Ford, Carter, and Reagan. Politically it has been an equal opportunity disaster.

Dr. Kirwin's solutions are reasonable as far as they go, but they only reach first base. She provides compelling arguments for keeping television cameras out of the courtroom in cases involving insanity and raises the fundamental...