This is insane!(Law & Justice)

• Author: Vatz, Richard E.

OF ALL THE INVALID components of psychiatric diagnostic categories, perhaps the most invidious, yet mystifying, is the assessment that an accused felon is legally insane. Although there are variations across the country regarding what constitutes legal insanity, it is most frequently ostensibly based on whether a mental health professional says--and can convince a judge and/or a jury--that the accused is incapable of understanding that he or she has committed a crime (generally called the "cognitive test") or that he or she cannot control that which he or she has done (generally called the "volitional test").

What compounds the frustration for victims and their loved ones and supporters faced with criminal perpetrators' pleading insane or "not criminally responsible" is that "insanity" is not a psychiatrically-accepted term within the practice of that field. Traditionally, mental health professionals testily at the behest of hiring defense attorneys or on behalf of the prosecution to the effect that the defendant does or does not have mens rea, or criminal intent, per their being sane or insane.

In the recently released Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the American Psychiatric Association appears to engage the question of whether psychiatrists can assess the responsibility of accused criminals. However, it provides only one page of analysis among the work's approximately 900 pages of text.

Moreover, on that page, titled the "Cautionary Statement for Forensic Use of DSM5," the APA writes elliptically about the appropriate role of mental health clinical diagnosticians. The Manual states that "use of DSM-5 to assess for the presence of a mental disorder by ... nonmedical [personnel] is not advised." In addition, "nonclinical decision-makers should be cautioned that a diagnosis does not carry any necessary implications regarding ... the degree of control over behaviors that may be associated with the disorder."

It even goes further than that, saying "even when diminished control over one's behavior is a feature of the disorder, having the diagnosis in itself does not demonstrate that a particular individual is (or was) unable to control his or her behavior at a particular time."

The fraudulent use of the insanity plea or other excusing psychiatric escapes from legal responsibility by defendants continues unabated, and it is helpful to look at some recent cases illustrating its arrant misuse.

In...