UNTIL NOW, the psychiatric profession has not spoken as a group on the question of the insanity defense in criminal trials. The considerable uproar that followed the Hinckley trial, however, produced a flood of proposed legislation to curtail or abolish the defense and highlighted public confusion about the psychiatrist's role in a trial. The doctors themselves decided that it was time for a reexamination of their role and a statement to the public on what they take to be their responsibility in the criminal justice system. Just such a report, approved by the board of trustees of the 27,000-member American Psychiatric Association, was issued this week, and it is reassuring in its humane and sensible approach to this controversial subject.
Initially, the doctors state their belief that some kind of insanity defense must remain available to prevent the conviction of those who are really not responsible for their crimes. The defense, however, should be available only in restricted circumstances where, for example, the accused had a "severely abnormal mental condition that grossly and demonstrably impaired (his) perception or understanding of reality." Persons who manifest primarily personality disorders, say the doctors, should be held accountable for their behavior.
The report emphasizes that psychiatrists are medical, not legal, experts, and that it is neither their desire nor their responsibility to assess guilt or to predict future behavior. They can present medical information and opinion about the defendant's mental state and motivation, but it is the function of the jury to determine the ultimate fact of legal insanity. And on the question of the treatment and possible release of persons acquitted by reason of insanity, the psychiatrists rightly refuse to accept the whole burden of predicting behavior.
The doctors warn that persons who have already committed acts of violence can be presumed to be dangerous for quite some time, and should not be treated in the same manner as persons who have been civilly committed to mental institutions. Decisions to release them from custody should not be made solely on the basis of psychiatric testimony, but rather by boards composed of persons from a variety of disciplines, including psychiatry, who are "not naive about the nature of violent behavior committed by mental patients." Under no circumstances should conditional release be granted unless there are sufficient resources in the community for treatment and supervision.
It is difficult to read this report without nodding in agreement at one sensible suggestion after another. Anyone who thought, at the time of the Hinckley trial, that psychiatrists were necessarily eager to find excuses for criminal behavior or resigned to setting the criminally insane free on the streets will be reassured by these practical and helpful suggestions. The writers have cleared away a lot of cobwebs and provided guidelines for their profession. Courts and legislatures should pay attention.