The Supreme Court ruled in July that states can significantly restrict the
insanity defense, counter to the position APA supported in its amicus curiae
brief in the case.
The ruling came in Clark v. Arizona, which concerned whether a
teenager convicted of killing an Arizona police officer had a fair chance to
argue that he was insane when he committed the crime. Arizona amended is laws
in 1993 to bar a defense based only on the presence of mental illness. The
change limited criminal defendants with mental illness to a defense based on
whether a mental defect kept them from knowing right from wrong.
The court ruled 6-3 that the state's more restrictive insanity defense law
did not deny the defendant his due process. The court's ruling was in part
based on the right of states to define the insanity defense as long as they
meet certain standards, which the court ruled Arizona law meets.
The court also decided that judges do not have to allow testimony from
mental health experts about the characteristics of a mental illness because of
frequent disagreements within the mental health profession.
"Though mental-disease evidence is certainly not condemned wholesale,
the consequence of this professional ferment is a general caution in treating
psychological classifications as predicates for excusing otherwise criminal
conduct," Justice David Souter wrote for the majority.
It was that second part of the ruling—that allowed states to bar
psychiatrist testimony—that most disturbed those who follow psychiatric
"Ultimately they seemed to rest the justification on the grounds that
there is something about expert testimony on psychiatric issues that is
inherently less reliable and more confusing than other sorts of testimony, and
therefore it was not unreasonable for the state to seek to exclude it in these
circumstances," Paul Appelbaum, M.D., chair of APA's Council on
Psychiatry and Law, told Psychiatric News.
Appelbaum pointed out that the Supreme Court previously approved the use of
psychiatric testimony in a wide variety of cases—such as capital
punishment cases. The court never suggested that there was anything in such
expert testimony that a jury could not understand and apply to a case. Thus,
the justices "seemed to be inconsistent at best in terms of their
response to an issue regarding the admissibility of psychiatric
testimony," he said.
The case was the first Supreme Court consideration of the more restricted
insanity defenses that several states created after John Hinckley's acquittal
by reason of insanity in the March 1981 shooting of President Ronald Reagan
and three others.
Some psychiatrists raised the concern that the decision may influence
additional states in efforts to restrict the insanity defense.
"I suspect states will look to this Supreme Court decision for
justification if a state wants to have a more narrow insanity defense,"
said Stuart Anfang, M.D., a member of APA's Council on Psychiatry and Law."
If state courts are asked to review the constitutionality of a state's
insanity defense, they will probably also look to this as guidance in favor of
a more narrow insanity definition."
In the case at issue, defendant Eric Michael Clark had been diagnosed with
paranoid schizophrenia and civilly committed after he killed Officer Jeff
Moritz during a traffic stop in Flagstaff, Ariz., in 2000. Psychiatric
treatment eventually improved his condition enough that a court decided he was
competent to be tried for the shooting. His defense maintained that Clark
believed his town was under alien control and that he was held captive and
tortured before the killing.
The state, joined by the Bush administration, argued that Clark knew what
he was doing and knew it was wrong because he ran away from police and spoke
of trapping and killing police before the shooting.
APA filed an amicus curiae brief in which it was joined by the American
Psychological Association and the American Academy of Psychiatry and the Law.
The brief urged the court to require states to allow consideration of evidence
of mental health problems when determining a defendant's criminal intent
(Psychiatric News, June 16).
The majority decision cited APA's brief in noting that psychiatrists may be
justifiably reluctant to reach legal conclusions regarding a defendant's
In a dissenting opinion, Justice Anthony Kennedy wrote that the majority
was mistaken to interpret APA's position this way.
"In this very case, the American Psychiatric Association made clear
that psychiatric evidence plays a crucial role regardless of whether the
psychiatrist testifies on the ultimate issue" of legal insanity, Kennedy
Kennedy wrote that an expert psychiatrist's explanation of Clark's
condition was essential to understanding how Clark processed sensory data and
therefore to deciding what information was in his mind at the time of the
"Simply put, knowledge relies on cognition, and cognition can be
affected by schizophrenia," he wrote.
The majority decision also cited a cautionary statement from
DSM-IV that its definitions of psychiatric conditions are intended
only for clinical purposes and were subject to change.
One of the authors of that statement, Steven Hoge, M.D., director of the
division of forensic psychiatry at Bellevue Hospital Center in New York and a
member of APA's Council on Psychiatry and Law, said the statement aimed to
remind readers that all science is a moving target.
"It is important to set the framework for the Supreme Court and legal
policymakers that they understand that science is not a cut-and-dried `we know
everything and here it is,' " Hoge said.
The court ruling and dissents in Clark v. Arizona are