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.

10 comments:

On the Same Page said...

Oddly enough, I have come across more than my share of individuals deemed "incompetent to stand trial" (Cf. Medina v. California ), which is basically interpreted to mean, States may presume a defendant's competence unless he/she chooses to pursue his/her incompetence in which he/she would have to provide a great amount of evidence supporting his/her claim. While I find it hard to imagine, one author has stated Persons found incompetent to stand trial comprise the largest group of psychiatric patients committed to mental hospitals through the criminal justice system in the United States. OK, it was 1980 and I wasn't surprised enough to look further, but even by California standards , it just doesn't seem nearly as difficult a defense as I would have imagined. I might also add that, judging by my interactions with patients in a CA state hospital contained with a super-max prison, most were happy returns. One gentleman, incompetent for 2 cases of manslaughter, was completing an 8-year term for a third (the charm?) manslaughter for which he was found competent. He was, with three weeks to the gate, refusing meds, but looking forward to purchasing dentures.

While I have not (knowlingly) had the opportunity to speak with a cannibal, I was recently consulted regarding an autopsy assistant in possession of 157 lbs. of human remains. I was later told that he was initially found incompetent to stand trial; but a month or so of hospitalization and he was convictable. As to the possibility of his actual consumption of the "goods" in question, he was apparently competent enough not to say.

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.

On the Same Page said...

Blogger timed out so many times, I should have known...

1) Medina v. California

2) From Entrez/Pub Med

3) Penal Code 1370-IST

4) State Forensic Mental Health Services

5) And finally, The Sweeny Todd of Sacramento.

As I've mentioned before, we have Mentally Disordered Offenders (who are mentally disordered & violent), and Sexually Violent Preditors who are involuntarily committed. I've never pursued the numbers.

On the Same Page said...

It didn't work AGAIN and I give up for the night. HTML be damned. Sorry.

ClinkShrink said...

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

On the Same Page said...

One more try:

1) Medina v. California

2) Entrez/Pub Med

3) California Penal Code 1370-IST

4) Summaries of Successful Cases (Better than the original)

5) The Sweeny Todd Of Sacramento

Whew. Now to see if they work...

Anonymous said...

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

Roy 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.

On the Same Page said...

You forced me:

One cannibal came upon another who was eating leaves and bitter herbs. "What's the problem?" "I ate a lawyer for lunch and I can't get the taste out of my mouth!"