This is a VERY detailed article about the insanity defense and forensic psychiatric evaluations (down to the types of questions asked by the psychiatrist). Excellent read but be aware: it is looong.
Insanity Defense Evaluation Procedure -
The defendant’s medical and psychiatric records should be reviewed prior to interviewing the defendant, especially the defendant’s psychiatric records closest in time to the offense. This is important because these records may contain critical information about the defendant’s mental state shortly before or after the offense. Some defendants are psychiatrically hospitalized after committing their crime or placed in a jail mental health unit. If the defendant does not sign a release for these records, a court order should be sought to obtain them.
Victims, witnesses, and police often record detailed statements after a defendant has been arrested. These statements are a rich source of information regarding the defendant’s mental state at the time of the offense. These statements should be reviewed for indications that the defendant was behaving bizarrely, intoxicated, hallucinating, or delusional at the time of the offense. If statements are not available, personal interview with the victims or key witnesses should be attempted.
The defendant should be interviewed as close in time to the offense as possible; however, this may not always be feasible.Defendants are often evaluated for sanity many months after the offense. Early evaluation reduces the likelihood that the defendant will have been coached about the legal criteria for insanity. Further, as time passes, defendants may change their account of the offense due to unconscious distortion or attempts to malinger insanity. Finally, prompt examination enhances the psychiatrist’s credibility in court.
At the outset of the interview, the defendant must be told about the purpose of the evaluation, the disposition of the insanity report, and the lack of confidentiality. Most U.S. jurisdictions exclude from evidence any incriminating statements made during an insanity evaluation to prove guilt. However, in a limited number of jurisdictions, statements made by a defendant during a forensic evaluation can be admitted.
A careful psychiatric history should be obtained from the defendant, including inquiry into the nature of hallucinations, delusions, and past treatment efforts. When focusing on mental state at the time of the offense, the psychiatrist should request a detailed account by the defendant. It is helpful to have the defendant give a step-by step account of his actions beginning 1 day prior to the offense. The account should include full information on psychiatric symptoms, medication compliance, and use of intoxicants.
One approach is to let the defendant give his account uninterrupted. After the defendant has given a detailed narrative account of his actions, the psychiatrist may further examine important details by asking more specific questions. Another approach is to periodically interrupt the defendant at critical moments and ask questions about his purpose, motivation, and mental state. Leading questions should be avoided. When a defendant’s self-report is contradicted by witness statements, the psychiatrist may wish to confront the defendant with the inconsistent information in an effort to clarify the defendant’s account (Resnick, 1999).
Rogers and Shuman (2000) recommend additional evaluation questions for elucidating the defendant’s capacity to appreciate the wrongfulness and nature and consequences of the offense. These questions focus on the defendant’s perceptions and emotional responses during the offense. For example, the examiner may consider asking the defendant:
- What was the victim’s emotional response? Did you know why he reacted this way?
- What were your reactions to the victim’s responses? Why did you react this way?
- How would you have responded if you had been the victim? Why?
- How would you have responded if someone else had committed the act? Why?
Capacity Evidence -
Behavioral Evidence Warranting Analysis
When evaluating knowledge of wrongfulness, the psychiatrist should carefully analyze the defendant’s behaviors, statements, and motives. For example, hiding evidence, lying about the offense, and fleeing from the police or the scene of the crime all suggest that the defendant knew his behavior was legally wrong. In contrast, committing a crime with no rational motive, making no efforts to avoid detection, and making no effort to flee may suggest a lack of knowledge of wrongfulness. The defendant’s statements during or after the offense often provide critical insight into the defendant’s knowledge of wrongfulness. Statements made by the defendant months later that he knew the act was wrong are helpful, but care must be exercised to ascertain whether the defendant’s current mental state allows him to accurately recall his thinking at the time of the crime.
Elucidating the defendant’s motive for committing the offense is a key issue. The examiner must consider the presence of an alternative motive for the offense that does not flow from a mental disease or defect. For example, “ordinary” criminal motives such as revenge or anger must be considered in the case of a jilted wife who kills her estranged husband. Other common nonpsychotic motives for criminal behavior include profit, jealousy, and greed. Genuine psychotic explanations for rape, robbery, fraud, and check forging are quite unusual. Certain crimes are less likely to meet legal criteria for insanity. Such crimes include fraud, white-collar crimes, drug trafficking, and kidnapping for ransom. These crimes require a degree of mental organization that is frequently beyond the capacity of seriously mentally ill individuals (Cochrane et al., 2001). However, it is possible for a kidnapping to be carried out due to a circumscribed delusional belief that a stolen baby belongs to the defendant.
In contrast, a crime without an apparent motive (e.g., random killing of a stranger) may lend credence to a lack of knowledge of wrongfulness caused by a mental disease. The examiner must also consider the presence of a psychotic moral justification. For example, a mother who delusionally believed that her children were in unremitting excruciating pain may believe that killing the children to relieve their suffering is morally right, even though she knew her act was illegal.
In a minority of U.S. jurisdictions (16 states), the insanity standard allows for consideration of the capacity to conform one’s conduct to the requirements of the law. This is known as the volitional prong. Some states phrase it as inability to adhere to the right, inability to control one’s conduct, or irresistible impulse. Some tests require a complete loss of control. Others, such as the MPC, only require that the defendant lacked substantial capacity to conform his conduct to the requirements of the law.
Ability to Conform Conduct (Volitional Control)
The defendant’s ability to refrain from the specific offense as compared to carrying out some other legal course of action should be explored. For example, if a defendant heard voices instructing him to “clean up the environment,” he may have chosen to pick up litter rather than attempting to kidnap the director of the Environmental Protection Agency for government ransom. A defendant’s claim that “I couldn’t control myself” should not be taken at face value. The examiner must carefully investigate the cause of the claimed inability to refrain. For example, was the defendant’s inability to refrain from committing the offense due to mental illness or some other factor, such as voluntary intoxication or rage? Other areas of inquiry that may elucidate the degree of loss of control include:
- What were the perceived consequences for failing to commit the offense? The magnitude, likelihood, and imminence of consequences for failing to act should be fully examined. For example, the consequences for failing to obey a command hallucination may range from restless sleep to a belief that one’s soul will spend eternity in Hell.
- Did the defendant have any legal course of action available as an alternative to committing the offense? Did the defendant take actions to exhaust this alternative? For example, could the defendant earn money legally rather than carry out a robbery to further a psychotic goals?
- What was the defendant’s ability to avoid circumstances leading to the offense? For example, did the defendant seek police intervention to resolve a paranoid belief that her neighbor was sending laser beams into her mouth before attempting to break into the neighbor’s home to dismantle the laser-emitting device?
- What is the evidence relative to the defendant’s deliberateness of action and decision-making ability during the offense?
The classic “policeman at the elbow test” may also be helpful in assessing a defendant’s ability to refrain from an offense(Rogers & Shuman, 2000). In this test, the defendant is asked whether, at the time of the offense, he would have committed the crime if a policeman was present at the scene. This line of questioning focuses on whether the defendant would have refrained from committing the offense in the face of immediate apprehension and in the presence of an eyewitness. However, this test may not be useful if the defendant held delusional beliefs about the police, the defendant shot at police during the offense, or in the case of a homicide–suicide plan.
Detection of Malingered Insanity-
Malingered Psychosis During a Crime
Malingering should be carefully considered in the case of a defendant who alleges a sudden or irresistible impulse. The psychiatrist should be skeptical of an impulse that is not a symptom usually associated with a recognized mental disorder. If a defendant denies any previous knowledge of an impulse, lying should be suspected. Experience has shown that it is extremely improbable for an obsessional impulse to be uncontrollable at its first appearance (East, 1927). Genuine obsessions are characterized by a pathological persistence of a thought or feeling that is experienced as ego-dystonic (Saddock & Saddock, 2003). They are often accompanied by anxiety symptoms and feelings of anxious dread that leads the individual to take specific countermeasures against the thoughts.
(Note: I think seeking professional help (from Fenton and the other 2 Docs) should/will count as a countermeasure against the thoughts. Maybe the mailing of the notebook -depending on when it was mailed- and the call right before the attack will, as well.)
Dissimulation after Psychotic Crimes-
“Dissimulation” is the concealment of genuine symptoms of mental illness in an effort to portray psychological health. Injustice may result from such dissimulation when an individual commits a crime while genuinely psychotic. The denial of psychiatricsymptoms is not uncommon in persons who have committed crimes (Diamond, 1956).
One reason that defendants dissimulate is to avoid the stigma and consequences of being labeled with a mental illness (Halleck, 1975). For example, in the case of Theodore Kaczynski (the Unabomber), some experts opined that he suffered from paranoid schizophrenia. However, he was highly averse to the notion of raising mental illness as a defense, or even for mitigation of the death penalty, because he believed it would undermine the credibility of his anti-technology “manifesto.” Diamond (1994, p. 166) has noted that, “To admit one’s actions were motivated by delusions, rather than reality, and that one was and is mentally deranged is a public humiliation destructive to one’s self-esteem.”
(Note: If James is or was being uncooperative this could be why. He either might think insanity undermines his “reason” for the shooting and/or he can’t take the hit to his self-esteem)