Saturday, June 24, 2006

With A Nice Chianti

OK, I've behaved myself for almost an entire week while Dinah was gone. I blogged about topics that were relevant, serious and (hopefully) thought provoking. I haven't made a single reference to the Support Duck.

Now let's talk about cannibals.

After all, I'm a forensic psychiatrist. A friend of mine once described a forensic psychiatrist as "the person who is leaning forward in fascination while everyone else is leaning backward in disgust." I'll try not to be (too) disgusting.

What brought this topic to mind was a recent CNN story about a conditional release hearing for a New York insanity acquittee accused of killing and eating bits of his former student. I can't really blog about cannibals in general since I've only met one---he seemed like a nice enough fellow---so instead I'll write about the insanity defense.

The first step in an insanity defense is to determine whether or not any given psychiatric condition meets the legal definition of "mental disease or defect". This determination is made at trial by the "factfinder", in other words either the judge or the jury. The "mental disease or defect" does not have to exist in the DSM. For example, some novel "diseases" are urban stress syndrome, "road rage" and the infamous "Twinkie Defense". Similarly, a disease that is defined in the DSM may be barred as an insanity defense by law. The classic example of this is alcohol intoxication. Alcohol intoxication is a recognized clinical syndrome, but you can't use it to excuse criminal responsibility. Anyway, the first step in a successful insanity defense is a legal decision that the defendant suffer's from a mental disease. At the release hearing for Mr. Cannibal his doctor testified that he suffered from "sexual sadism and pedophilia". Both of these disorders are recognized psychiatric conditions defined in the DSM-IV.

The next step in an insanity defense is to see if the defendant meets the legal test for insanity. A legal "test" is a written definition or standard. In general, there are two insanity tests in common use: the ALI test and various derivations of the McNaughton test. The McNaughton test states that a defendant is insane if he is unable to understand the nature or quality of the act, or---if he did understand the nature of his actions---that he didn't understand that they were wrong. In 1955 the American Law Institute (A.L.I.) wrote the Model Penal Code in an effort to make criminal laws uniform across the country. The Model Penal Code's insanity test, also called the ALI test, states that a defendant is insane if he "lacks substantial capacity to appreciate the criminality of one's conduct or to conform one's conduct to the requirements of the law". It has two parts, a cognitive standard and a volitional or behavioral standard.

In the case of Mr. Cannibal, neither sexual sadism and pedophilia alone would be likely to impair one's appreciation of reality by either the ALI or McNaughton standard. The only remaining argument for our New York gentleman was that he was unable to control his behavior for some reason. The CNN article doesn't provide enough information, but I'd be willing to bet there's an additional diagnosis in there we haven't heard about, like psychosis or mania, that also affected his reasoning ability.

OK, so I really didn't talk about cannibals. To make up for this I'll post some relevant cannibal-themed music links:

Just a modest proposal for those with a taste for such music.


ClinkShrink said...

Foo, all your links lead back to this comment page. I'm left in suspense & curiosity by your references.

It doesn't surprise me that most criminally committed patients are there as incompetent. The only other way you can get criminally (as opposed to civilly) committed is by being found insane, and that happens in less than one-half of one percent of all felony cases. What this means is that most incompetent defendants who are restored to reason are either convicted or they withdraw the insanity plea.

Successful insanity defenses are rarely contested by the state, in other words usually both the state and the defense agree that the defendant was mentally ill enough to meet the standard. The high profile contested insanity cases you see in the media (eg. Andrea Yates, the Long Island Railroad shooter, etc) represent just a tiny fraction of all felony cases in the nation where mental health is an issue. They just get the most attention.

ClinkShrink said...

Poor Foo; I truly appreciate the effort. Try again when you don't feel like throwing Blogger out the window!

Anonymous said...

if I provide the ketchup, will you eat some of my patients??

Steve & Barb said...

This blog reminds me of my favorite joke (one of the few I can remember and deliver):

Two cannibals are eating a clown.
One turns to the other and says: "Does this taste funny to you?"

ClinkShrink said...

Foo, congrats---all your links worked and they were interesting. Looks like my jurisdiction and yours have very similar procedures, with the exception that we don't have outpatient commitment for IST.

Anonymous, I could eat your patients but that would make me the consumer. I'm the doctor.

Roy, how about this one---
What do cannibals do at a wedding?
They toast the bride and groom.