How do we define insanity?

 
Kelsey Patterson spent much of the 1980s in-and-out of mental hospitals in Texas. No one questioned that he had a severe mental illness –paranoid schizophrenia – that often caused him to become violent. 
In 1980, he shot and seriously wounded a co-worker. Patterson believed his food was being poisoned by the man even though they’d only met that morning.
Three years later, Patterson wounded another man during a delusional assault.
In 1986, Patterson assaulted yet a third victim.
Finally, on September 25, 1992, just days after his brother had tried unsuccessfully to get him committed to a psychiatric facility, Patterson fatally shot a businessman and his secretary.
He then put his gun down, stripped to his socks, and paced, shouting incomprehensibly until the police arrived.
There was no doubt that Patterson had committed two murders.
There was no doubt that he had a severe mental illness and was delusional at the time of the murders.
Did that mean he couldn’t be held accountable for his actions because he was legally “insane?”
 Most people believe that if someone is “insane” when they commit a crime, they can not be held accountant for their actions. But our legal system always has had trouble dealing with persons with mental illnesses and the Patterson case is the perfect example.
First a short history lesson.
In 1843,  an Englishman named Daniel  M’Naghten fired a pistol at the British Prime Minister, but instead hit one of his aides who died five days later. The House of Commons appointed a panel to decide when someone was so “insane” that they were not legally responsible for their actions. They came up with what is called the M’Naghten rule and it is still the basis for nearly all of our laws that deal with mental illnesses. The key part of the rule states:
“to establish a defence on the ground of insanity, it must be clearly proved that, at the time of the committing of the act, the party accused was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing; or, if he did know it, that he did not know he was doing what was wrong.
Now, back to Kelsey Patterson.
 Did Patterson understand that what he had just done — committed murder — was wrong?
 Psychiatrists for the prosecution testified that Patterson did understand that murder was wrong when he committed the killings — so a Texas judge ruled that Patterson could be found guilty and given a death sentence.
What happened next is rather extra-ordinary.
 
In only the second time in its history, the Texas Board of Pardon and Paroles sent a recommendation to the Texas governor asking that Patterson’s life be spared. By a 5-to-1 vote, the panel said Patterson deserved mercy because he was simply too sick to be punished.
The governor, Rick Perry, ignored that recommendation. In a statement, he wrote:
“This defendant is a very violent individual. Texas has no life without parole sentencing option, and no one can guarantee this defendant would never be freed to commit other crimes were his sentence commuted. In the interests of justice and public safety, I am denying the defendant’s request for clemency and a stay.”
On May 18, 2004, a clearly delusional Patterson, still rambling incoherently, was put to death.
This case outrages me for several reasons.
*Why wasn’t something done about this man before he murdered two innocent persons? He had a long history of mental illness and violence — more than two decades of warnings. Did we really expect that he would somehow heal himself?
*The governor’s reasoning is cold-blooded and it completely ignored the fact that Patterson had a severe mental illness. The governor said  Texas couldn’t lock him up forever and couldn’t keep the public safe so the only alternative was to kill him. How about actually treating him? How about sending him to a forensic hospital?
*We have learned many things about the brain since 1843. The DSM differentiates between anti-social behavior and schizophrenia. Yet, we are still basing our insanity laws on antiquated information. The courts need to re-think the definition of insanity. One change that would help is to put an end to the use of psychiatrists-for-hire. Rather than having the defense and prosecution hire psychiatrists who make their livelihood either testifying that someone is sane or insane, a judge should hired three psychiatrists and have them report to the court. This also would cut back on having attorneys using the insanity defense when their client is obviously guilty and they don’t have any other rational explanation to fall back on. Such cases are an insult to persons who have legitimate brain disorders and increase public stigma.
*The U.S. Supreme Court’s current practice of focusing on whether a defendant knew the difference between right and wrong shows a lack of knowledge about mental illnesses. In Miami, I met a man who believed that he was possessed by a devil. He began chewing through his own skin and hit an artery because he wanted to cast out the devil.
Now let’s assume that this man believed that a stranger had been possessed by the devil so he fatally shot the stranger. Did he know murder was wrong? Absolutely, but he also knew that the devil was inside that man and that was who he was killing.
The questions that I am raising in this blog are important because there are currently more than 200 Kelsey Pattersons on death row in America.
Recently, the U.S. Supreme Court ruled that persons with mental retardation can be exempt from execution because of their obvious diminished culpability.
It’s time, I believe, for the court to extend that same reasoning to persons with legitimate mental disorders.
That’s my opinion. I would enjoy reading your point of view.
Thanks for reading my blog.
About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.

Comments

  1. davealmeida says

    Pete-

    Whenever this issue comes up, I can't help recalling the line from Cervantes “Don Quixote,” when after tearing up an Inn and engaging in duels with a number of individuals because of his delusional state, the landlord, to those fighting with Don Quixote “…shouted at them to leave him alone, for he had told them the man was mad, and as such, he would be acquitted even if he killed everyone of them.”

    Don Quixote was first published in 1605. I can't help but to think that when it comes to how our legal system views the actions of those with mental illnesses who today find themselves in Mr. Patterson's sad state of circumstances, that they would have been far better off living in the 1600s.

    We seem to like to believe that as a human race we continue on an upward course of progress. That evolution continues to make us better human beings. Perhaps, that's the case most of the time. But when it comes to how we view people with mental illnesses and their ability to control their actions, I think Mr. Patterson's case, and as you reference the other “Kelsey Pattersons” in this world, provides ample evidence that we are moving in the opposite direction.

    Sorry for the rambling message, but here's my conclusion. I understand that many of the laws on our books today are rooted in laws that date back hundreds of years. And, there's good reason for that. But, when it comes to 1843 and M'Naghten, I think an update is long overdue. As you point out, understanding the difference between right and wrong is irrelevant if that understanding has as its roots, the delusional thinking of a very ill person. The only fact that I believe is relevant is whether, because of a person's mental illness they could keep their actions within the guardrails defined by law.

    Dave Almeida

    • Dave,
      Thank you for your thoughtful comment, which is especially poignant because of your efforts to help Jamie Wilson, a man with severe schizophrenia, who is on South Carolina’s death row. That case is yet another example of how the legal system is ill equipped to deal with persons who have a brain disorder.
      You know far more about this case than I do, but I recall that it is strange because the judge found “…that the defendant at the time of the commission of the acts constituting the offenses had the capacity to distinguish right from wrong, or to recognize his acts as being wrong…but because of mental illness or defect, he lacked sufficient capacity to conform his conduct to the requirements of the law.” The judge then accepted a plea of “guilty but mentally ill” and sentenced him to death.
      This ruling says to me that a person’s mental state is immaterial even if the court acknowledges that the individual is so incapacitated he can’t do anything to stop himself. As long as he admits that he did something wrong, he can be executed.
      How does this reasoning fit with the court’s decision to put a moratorium on executing persons who were found to be “mentally retarded.”
      –Pete

  2. Pete Earley says

    Dave,
    Thank you for your thoughtful comment, which is especially poignant because of your efforts to help Jamie Wilson, a man with severe schizophrenia, who is on South Carolina’s death row. That case is yet another example of how the legal system is ill equipped to deal with persons who have a brain disorder.
    You know far more about the Wilson case than I do, but I recall that it is unusual because the judge found

    “…that the defendant at the time of the commission of the acts constituting the offenses had the capacity to distinguish right from wrong, or to recognize his acts as being wrong…but because of mental illness or defect, he lacked sufficient capacity to conform his conduct to the requirements of the law.”

    The judge then accepted a plea of “guilty but mentally ill” and sentenced him to death.
    This ruling says to me that a person’s mental state is immaterial even if the court acknowledges that the individual is so incapacitated he can’t do anything to stop himself. As long as he admits that he did something wrong, he can be executed.
    How does this reasoning fit with the court’s decision to put a moratorium on executing persons who were found to be “mentally retrarded.”
    Thanks,
    Pete

  3. davealmeida says

    Pete-

    Unconscionably inconsistent are the only words I can find to descibe exempting people with mental retardation from the death penalty, while not doing the same for people with severe mental illnesses.

    Thanks for your reply, Pete.

    Dave

  4. richarnold says

    Pete, you are so right in your analysis. Thanks for your ability to put this argument so succinctly and forcefully. It's true that many delusional schizophrenic defendants in court do not actually want a ruling of innocent because insane, go figure. Even desperately ill defendants will protest to the judge that they are sane as anybody else, so much are they unable to have insight into their own condition.
    It's somehow tied in with the reason they don't want to accept medication. Kendra's law, I'm told, has been successful in New York State. Civil outpatient commitment just simply works. I've had a lot of first hand experience with these issues in my immediate family. Thanks again!

  5. richarnold says

    Pete, you are so right in your analysis. Thanks for your ability to put this argument so succinctly and forcefully. It's true that many delusional schizophrenic defendants in court do not actually want a ruling of innocent because insane, go figure. Even desperately ill defendants will protest to the judge that they are sane as anybody else, so much are they unable to have insight into their own condition.
    It's somehow tied in with the reason they don't want to accept medication. Kendra's law, I'm told, has been successful in New York State. Civil outpatient commitment just simply works. I've had a lot of first hand experience with these issues in my immediate family. Thanks again!