Sanity Evaluations: The relationship between the mental state and the criminal behavior.

By fpamed Forensic Psychiatrist, Ayesha Ashai, MD

The insanity defense is a traditional affirmative defense that dates back to biblical times with more relevant application dating back to English common law. Simply defined, the insanity defense determines whether a defendant is capable of being held criminally responsible for his or her actions. How sanity is more specifically defined differs between states and in Clark v. Arizona, 548 U. S. 735 (2006), the U.S. Supreme Court reaffirmed that states are free to define their own insanity standards.

Most recently, the insanity defense was re-examined in Kahler v. Kansas, 589 U. S. _____ (2020). In Kansas, state law modified the traditional insanity plea in 1995 and in particular, adopted the cognitive incapacity test, which examines whether a defendant was able to understand what he was doing when he committed the crime. It did not recognize whether a defendant’s illness left him unable to distinguish right from wrong with respect to his or her criminal conduct (moral incapacity test). In 2009, Mr. James Kahler was arrested in Kansas and charged with four counts of capital murder. The defense’s expert witness stated that Kahler was suffering from severe major depression at the time of the crime and that “his capacity to manage his own behavior had been severely degraded so that he couldn’t refrain from doing what he did.”

While the prosecution’s expert witness agreed with the defense that Mr. Kahler had a diagnosis of depression, the prosecution’s expert witness argued that Mr. Kahler was still capable of planning the murders. Mr. Kahler was found guilty and sentenced to death. Mr. Kahler appealed his case to the Kansas Supreme Court and argued that the abolishment of an insanity defense violates the 8thamendment and the process clause of the 14th. The Kansas Supreme Court rejected the appeal. On writ of certiorari, the U.S. Supreme Court found that the due process clause does not require states’ criminal laws to adopt a particular theory of moral culpability and the 8th amendment does not require a moral capacity defense. It upheld that the States have always had broad sovereign power to define crimes and that moral capacity is not a constitutional prerequisite to imposing criminal liability. It also recognized that Kansas had not abolished the insanity defense, but rather modified it. In fact, four other states – Alaska, Idaho, Montana and Utah – have done the same. Therefore, while statutory law defines the test for criminal responsibility in most states and the federal system, U.S. jurisdictions have adopted a variety of legal criteria for what constitutes insanity. In certain jurisdictions, if the defendant understands the subjective (moral) or objective (legal) wrongfulness of their act, they can still be held criminally responsible.

Depending on the state’s definition of insanity, the sanity opinion typically addresses:

  1. The determination of the presence of a mental disease or defect at the time of the crime;
  2. The relationship between the mental disease or defect and the criminal behavior; and
  3. Whether the defendant’s mental state at the time of the crime satisfies the jurisdictional criteria for the insanity defense.

Important considerations for determining sanity include:

  1. Evidence of mental illness: presently, in the past, and most importantly, at the time of the crime;
  2. Motive for the crime;
  3. Planning and preparation for the crime;
  4. Evidence of impaired function in days leading up to crime;
  5. Detailed understanding of the defendant’s thinking and behavior: before, during, and after the crime; and
  6. The defendant’s ability to refrain from the specific offense (“policeman at the elbow test”).

Additional evaluation questions to elucidate the defendant’s capacity to appreciate the wrongfulness and nature and consequences of the offense focus on the defendant’s perceptions and emotional responses during the offense (See Richard Rogers and Daniel W. Shuman,

Conducting insanity evaluations (2d ed. 2000)) example:

  1. What was the victim’s emotional response? Did you know why he reacted this way?
  2. What were your reactions to the victim’s responses? Why did you react this way?
  3. How would you have responded if you had been the victim? Why?
  4. How would you have responded if someone else had committed the act? Why?

For the forensic psychiatrist, it is critical to establish the relationship, if any, between the defendant’s mental state and the defendant’s criminal behavior. Although the defendant may have a mental illness, the defendant’s behavior could have been voluntary and knowing. Whereas, in certain jurisdictions, the history of mental illness may not excuse the defendant’s actions, it can still be used a part of the mitigation process. Therefore, careful analysis of the collateral information and the defendant interview is vital.

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