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Concept: Insanity defense


Four assumptions frequently arise in the aftermath of mass shootings in the United States: (1) that mental illness causes gun violence, (2) that psychiatric diagnosis can predict gun crime, (3) that shootings represent the deranged acts of mentally ill loners, and (4) that gun control “won’t prevent” another Newtown (Connecticut school mass shooting). Each of these statements is certainly true in particular instances. Yet, as we show, notions of mental illness that emerge in relation to mass shootings frequently reflect larger cultural stereotypes and anxieties about matters such as race/ethnicity, social class, and politics. These issues become obscured when mass shootings come to stand in for all gun crime, and when “mentally ill” ceases to be a medical designation and becomes a sign of violent threat. (Am J Public Health. Published online ahead of print December 12, 2014: e1-e10. doi:10.2105/AJPH.2014.302242).

Concepts: Health care, Mental health, Sociology, Mental disorder, Violent crime, Psychiatry, Mental illness, Insanity defense


Public perception, fueled not only by popular and news media but also by expert claims that psychopaths are archetypes of evil: incorrigible, remorseless, cold-blooded criminals, whose crimes manifest in the most extreme levels of violence. But is there empirical evidence that psychopaths truly are what they are portrayed to be? If so, should the law respond, and adjust its treatment of psychopaths in court - permitting psychopathy to be admitted under an insanity defense and/or resulting in mitigation? In this paper, we demonstrate that fundamental questions from the law to science remain unanswered and must be addressed before any alternative treatment of psychopathy can be considered. As it stands, psychopaths cannot be reliably defined or diagnosed and, as we will demonstrate, even the presumed link with criminal dangerousness is problematic. We conclude that the current legal approach should not be modified, however, if preliminary findings regarding impairments in impulsivity/self-control are confirmed, some, but not all individuals who fall under one definition of psychopathy may merit different treatment in future.

Concepts: Law, Crime, Mental disorder, Criminology, Antisocial personality disorder, Psychopathy, Insanity defense, Remorse


The experience of hearing a voice in the absence of an appropriate external stimulus, formally termed an auditory verbal hallucination (AVH), may be malingered for reasons such as personal financial gain, or, in criminal cases, to attempt a plea of not guilty by reason of insanity. An accurate knowledge of the phenomenology of AVHs is central to assessing the veracity of claims to such experiences. We begin by demonstrating that some contemporary criminal cases still employ inaccurate conceptions of the phenomenology of AVHs to assess defendants' claims. The phenomenology of genuine, malingered, and atypical AVHs is then examined. We argue that, due to the heterogeneity of AVHs, the use of typical properties of AVHs as a yardstick against which to evaluate the veracity of a defendant’s claims is likely to be less effective than the accumulation of instances of defendants endorsing statements of atypical features of AVHs. We identify steps towards the development of a formal tool for this purpose, and examine other conceptual issues pertinent to criminal cases arising from the phenomenology of AVHs.

Concepts: Auditory system, Experience, Knowledge, Psychosis, Logic, Reason, Legal terms, Insanity defense


Homelessness and mental illness have a strong association with public disorder and criminality. Experimental evidence indicates that Housing First (HF) increases housing stability and perceived choice among those experiencing chronic homelessness and mental disorders. HF is also associated with lower residential costs than common alternative approaches. Few studies have examined the effect of HF on criminal behavior.

Concepts: Psychology, Randomized controlled trial, Sociology, Crime, Mental disorder, Schizophrenia, Homelessness in the United States, Insanity defense


A subgroup of individuals becomes entrenched in a “revolving door” involving corrections, health, and social welfare services. Little research has investigated the numbers of people that are in frequent contact with multiple public agencies, the costs associated with these encounters, or the characteristics of the people concerned. The present study used linked administrative data to examine offenders who were also very frequent users of health and social services. We investigated the magnitude and distribution of costs attributable to different categories of service for those in the top 10 % of sentences to either community or custodial settings. We hypothesized that the members of these subgroups would be significantly more likely to have substance use and other mental disorders than other members of the offender population.

Concepts: Sociology, Distribution, Mental disorder, Mental illness, Subgroup, Welfare economics, Insanity defense, Social welfare function


This paper traces the significance of the diagnosis of ‘moral insanity’ (and the related diagnoses of ‘monomania’ and ‘ manie sans délire’) to the development of psychiatry as a profession in the nineteenth century. The pioneers of psychiatric thought were motivated to explore such diagnoses because they promised public recognition in the high status surroundings of the criminal court. Some success was achieved in presenting a form of expertise that centred on the ability of the experts to detect quite subtle, ‘psychological’ forms of dangerous madness within the minds of offenders in France and more extensively in England. Significant backlash in the press against these new ideas pushed the profession away from such psychological exploration and back towards its medical roots that located criminal insanity simply within the organic constitution of its sufferers.

Concepts: Psychology, Medicine, Mental health, Sociology, Mental disorder, Psychiatry, Social status, Insanity defense


In this article, I compare and evaluate R. D. Laing and A. Esterson’s account of schizophrenia as developed in Sanity, Madness and the Family (1964), social models of disability, and accounts of extended mental disorder. These accounts claim that some putative disorders (schizophrenia, disability, certain mental disorders) should not be thought of as reflecting biological or psychological dysfunction within the afflicted individual, but instead as external problems (to be located in the family, or in the material and social environment). In this article, I consider the grounds on which such claims might be supported. I argue that problems should not be located within an individual putative patient in cases where there is some acceptable test environment in which there is no problem. A number of cases where such an argument can show that there is no internal disorder are discussed. I argue, however, that Laing and Esterson’s argument-that schizophrenia is not within diagnosed patients-does not work. The problem with their argument is that they fail to show that the diagnosed women in their study function adequately in any environment.

Concepts: Psychology, Sociology, Mental disorder, Schizophrenia, Disability, Schizoid personality disorder, Family therapy, Insanity defense


The role of mental illness in violent crime is elusive, and there are harmful stereotypes that mentally ill people are frequently violent criminals. Studies find greater psychopathology among violent offenders, especially convicted homicide offenders, and higher rates of violence perpetration and victimization among those with mental illness. Emotion dysregulation may be one way in which mental illness contributes to violent and/or criminal behavior. Although there are many stereotyped portrayals of individuals with dissociative disorders (DDs) being violent, the link between DDs and crime is rarely researched.

Concepts: Psychology, Sociology, Crime, Mental disorder, Violent crime, Violence, Psychiatry, Insanity defense


This text examines how current scientific knowledge has the potential of fulfilling one of the major functions of the criminal justice system. Scientific knowledge should be used to ensure that the criminal justice system’s functioning results in maximizing societal protection and crime reduction. Abnormal states of the mind contribute to criminal behaviour and are considered in exculpatory defences. The failure of the long standing insanity defence and its utility among cognitively impaired offenders, provided impetus to this work. In estimating the success rates (or lack thereof) of raised defences for the cases of the ‘invisible disorder’, fetal alcohol spectrum disorder (FASD), coming before the Canadian Courts, we sought to expound on the reasons, from knowledge and pragmatic perspectives. We propose that a diminished responsibility defence and verdict that recognizes the ‘grey zone’ between ‘knowing’ and ‘not knowing’ based on neurocognitive disparities in FASD serves the individual, legal system and the society better than the current practice.

Concepts: Science, Law, Crime, Criminal law, Criminal justice, Police, Corrections, Insanity defense


The role of experts and their presentation of testimony in insanity cases remain controversial. In order to decrease possible expert bias associated with this testimony, a number of different alternatives to adversarial presentation have been suggested. Two such alternatives are the use of court-appointed experts and the use of concurrent testimony (or “hot-tubbing”), in which opposing experts provide testimony concurrently and converse with each other directly. An experiment using a sample of venire jurors (n = 150) tested the effect of these alternatives. Results indicate that participants' pre-existing attitudes towards the insanity defense had significant effects on their comprehension of expert testimony, their evaluations of the two opposing experts, and their eventual verdicts, over and above the presentation format (i.e., concurrent vs. traditional testimony) or the use of court-appointed experts (vs. traditional adversarial experts). When concurrent testimony was presented, defense-favoring experts were perceived by jurors as more credible than their traditional counterparts, though comprehension of the testimony did not increase; nor did the presentation format or the affiliation of the experts affect verdicts. The legal and policy implications of the incorporation of the hot-tubbing procedure to US courts are discussed.

Concepts: Critical thinking, Effect, Law, Expert, Jury, Expert witness, Ultimate issue, Insanity defense