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To learn more about the insanity defense and how it applies to juveniles I spoke to forensic psychiatrist Judith Edersheim the cofounder and co-director of the Massachusetts General Hospital Center For Law, Brain and Behavior. Edersheim has no direct relationship to the case, but agreed to speak with me on general terms.Previously: Will the Teen Charged with Raping and Murdering His Teacher Mount a Successful Insanity Defense?
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Judith Edersheim: Insanity isn't a concept at all in psychiatry or psychology. Psychiatry and psychology have diagnostic categories like mood disorders or thought disorders. But the concept of insanity is something that grew out of the law and it has moral and political dimensions as well as psychiatric.There could be someone who is profoundly mentally ill but whose mental illness has no nexus to the crime. It varies by state, but the standard generally requires that the defendant be either unable to conform their behavior to the requirement of the law—that's the volitional prong of the insanity test—or, depending on the state, be unable to appreciate the criminality or the wrongfulness of what they're doing.Someone can be mentally ill and still form intent to commit a crime. Someone can be mentally ill and still appreciate that what he or she is doing is wrong. So the insanity standards focus a great deal on volition and reasonableness and those two things can still be maintained in the face of even a serious mental illness.There is a classic example that you can have schizophrenia but still rob a bank because you need money.Which came first, the legal definition of insanity or our modern understanding of psychology?
Oh my goodness, it's almost a chasm, it's almost a never the twain shall meet situation. The legal standards for insanity have been around since the at least the 17th century. In terms of the evolution of insanity defenses it started with concepts like the "wild beast" test, the M'Naughten Rule—all of these old English tests that attempted to capture what kind of mental state should excuse someone from doing a very serious thing.
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This is the chasm of diagnostic categories versus legal categories. If you were going to diagnose a 14-year-old, there would be some requirements that you actually not fix a permanent diagnosis because children and adolescents change so quickly.Does the psychological complications regarding diagnosing juveniles play a role in the insanity defense?
The most superficial cut is, not really. The law has an insanity standard that is premised on an examination of behavior. Is this person at the moment of this offense behaving in a folk-psychology way that indicates that he or she has a defect of reason or volition, an inability to control themselves, or an inability to think reasonably? You could ask those same questions of juveniles or adults.The more complicated answer is philosophical moral and neuroscientific. Adolescents are so different [from adults] that we ought to have different standards for them in light of the emerging adolescent neuroscience and how that intersects the moral underpinnings of law.
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If you ask Stephen Morse, a great professor of philosophy law and neuroscience, what he would say is behavior trumps everything. But I should say that I have seen many cases in which planning can occur, but everyone would agree that this person should be held not criminally responsible.I'll give you an example of a case: If you attempt to harm someone because you believe that they are the incarnation of Satan, that they have kidnaped your younger sister and that they are holding her and are about to end her life if you don't save her, then it's a complete psychotic motive. The explanation for that crime is that you have lost your ability to reason through even the most basic reality around you. The fact that you were able to plan to carry out such a psychotically motivated exercise doesn't really negate your ability to mount an insanity defense.
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Competency is the notion that it would be unethical and unconstitutional to put someone on trial if they are not able to participate in the process and understand what they are doing. That's not at the moment of the crime, that's the moment of the judicial process. For example a delusion that really you are being persecuted for being the son of God, that would knock you out of the box for competency.The defense has been careful to depict Chism as someone with a family history of mental illness who just moved to a new state and school. Is that a situation that could lead to a break for someone who might already be prone to mental illness?
How do you know in a 12-, 13-, 14-year-old whether a major mental illness is emerging? I'm afraid clinically it is a billion-dollar question because schizophrenia is such a terrible disorder.Psychosis in general is a break with reality that is usually characterized by hallucinations, delusions, abnormal thought structure. It can have many causes. Psychosis is a symptom, schizophrenia is a disease. The symptom of psychosis can be caused by anything from a primary thought disorder like schizophrenia to substance-induced psychosis.
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I think it's a mistake to work backwards and say anyone who did such a thing must be insane, because "insane" is a legal category. The act of doing something heinous can have all kinds of context and society is making a decision with the insanity law that some people should not be held responsible.There is a diagnostic category called psychopathy. These are the Dexters of the world, they're the methodical, emotionless, unempathetic people who break the rules for their own purposes and feel fine—sometimes that means homicide.Serials killers have been typically cast as psychopaths. There is some controversial literature about whether psychopathic personalities or psychopaths really have a particular kind of illness that is genetic and neuro-imagable and should be exculpatory in criminal cases. For now in the US legal system, we exclude antisocial disorder as a defense to almost everything.But could psychopathy be defined as a mental illness even though it doesn't fit into the criminal system?
Yes, that's a place where legal and medical or psychological characterizations don't map onto each other. It's a moral and ethical conundrum. CLBB had a symposium called "Psychosis vs Psychopathy" where we discussed what would happen if you hospitalized people for pure psychopathy what would happen in the hospital what would happen in the legal system.Is it possible to rehabilitate someone who is a psychopath? What about a adolescent psychopath?
The literature on psychopathy is not robust; it's a new and emerging area. The old wisdom on this issue was that psychopathy was exceedingly treatment-resistant. There are all kinds of reasons why psychopathy is difficult to treat. But the only good evidence for the treatment of psychopathy in terms of being able to make a dent and change the course of that syndrome is for young people.This interview has been edited for length and clarity.Follow Susan Zalkind on Twitter.