Insane acquittees and insane convicts: the rationalization of policy in nineteenth-century Connecticut.

A current situation in Connecticut of whether a violent insane acquittee should be held in a state prison or psychiatric facility raises difficult issues in jurisprudence and medical ethics. Overlooked is that the present case of Francis Anderson reiterates much of the debate over rationalization of policy during the formative nineteenth century. Contrary to theories of social control and state absolutism, governance in Connecticut was largely episodic, indecisive and dilatory over much of the century. The extraordinary urban and industrial transformation at the end of the Gilded Age finally forced a coherent response in keeping with longstanding legal and medical perspectives.

[Differences in psychiatric expertise of responsibility: Assessment and initial hypotheses through a review of literature]. / Divergences dans l'expertise psychiatrique de responsabilité : bilan et premières hypothèses à travers une revue de la littérature.

INTRODUCTION: Forensic psychiatric assessment regarding liability ensures a balance between justice and psychiatry. In France, criminal assessment is not contradictory. The psychiatric expert is commissioned by judges to determine whether or not the accused has a mental disorder and specify whether it affects discernment and control of actions at the time of offense. Its mission focuses on the mental element required to constitute an offense, and is structured around Article 122-1 of the Criminal Code. This article, composed of two paragraphs, distinguishes the framework of the abolition of discernment ­ a cause of non-imputability and therefore of a statement of lack of criminal responsibility due to mental disorder ­ and the framework of the alteration of discernment. Nowadays expertise seems to meet discomfort, with criticism focusing on possible differences among psychiatric experts, without specific studies having been conducted to confirm it. OBJECTIVES: Our objective was to identify the main points of disagreement between psychiatric experts and to propose explicative hypotheses. MATERIALS AND METHODS: For this, we carried out a literature review on PubMed, Science Direct and Cairn, and studied the report of the 2007 public hearing on forensic psychiatric assessment with contributions from different authors. The keywords were: forensic psychiatry, psychiatric court report, psychiatric expertise, differences among experts, legal responsibility, and discernment. We defined differences as disagreements between experts, or as a mismatch in conclusions and approaches of experts. RESULTS: The differences among experts concerned mainly forensic interpretation, i.e. the discussion of the relationship between pathology and offense, particularly in contexts that involve a larger forensic discussion, including interruption of medication, use of drugs, association with antisocial personality, premeditation, denial of facts, especially when the accused suffers from a mental illness (especially schizophrenia). For a finding of abolition of discernment, an expert must consider two requirements, one temporal (the mental disease must be active during offense) and the other causal that involves seeking a direct and exclusive relationship between the offence and the mental state, according to expert jurisprudence. Some experts do not comply with these two requirements or this jurisprudence, whence differences. There were also diagnostic differences and disputes relating to the concept of "alteration of discernment". Disagreements appeared to be related primarily to personal ideologies or different schools of thought that influenced interpretations and conclusions of experts, e.g. accountability as a therapeutic response for the psychotic person. Then, the lack of clarity of expert mission regarding necessary causal relationship ­ between any disease and crime ­ to demonstrate to conclude an abolition of discernment, could also contribute to differences. Moreover, time available to achieve the mission is too short and the expert would not devote enough time to an expert examination, which could lead to less good expertise and differences; especially as observed clinical examination in expertise is sometimes difficult, misleading, due to pathological reticence of accused mentally ill but also sometimes due to possible simulations. Finally, the low quality of some expert reports ­ due in part to the less well-trained experts, but also the particular conditions of achievement of expertise, especially in prisons ­ were mentioned by some authors as causes of differences. DISCUSSION: It appears from this review of literature that differences mainly concern forensic interpretation and are mainly explained by ideologies. This synthesis is a preliminary work prior to a study among psychiatric experts.

Criminal insanity in Bulgaria and Norway: Analysing the prospect of a common approach.

This article raises the question of the prospect of a common approach to mentally ill offenders in Europe, through a comparative discussion of the criminal insanity rules and systems in Norway and Bulgaria. The underlying motivation is to fill a gap in current legal research where the insanity discourse is still to a certain extent nationally oriented. Bulgaria is to date not represented at all in the international discussion of criminal insanity. Starting out from recognizing the different history, rules, culture and welfare of Norway and Bulgaria, the authors argue that these countries have a similar practical understanding of insanity and how it is associated with mental disorders as well as common challenges in their forensic and legal systems. These insights can provide a basis for further comparative explorations concerning a possible harmonization of insanity law in Europe.

Identifying deficits in Ukrainian law: Forensic psychiatry misuse in proceedings of administrative offenses.

Ukraine is actively denouncing and abandoning its Soviet legacy, with the legal process of decommunization being at the forefront of this process.1 However, despite Ukraine's ongoing judiciary reformation process amplified by the signing of the Association Agreement between Ukraine and the European Union, Ukraine's legal system still contains inherited Soviet legal deficiencies that allow for human rights violations. Some of the most glaring deficiencies relate to the rules and regulations for assigning and conducting forensic psychiatric examinations in cases of administrative offenses. With an aim to aid Ukraine in eliminating present legal deficiencies that allow for violations of human rights, here we discuss current definitions, rules, and regulations concerning appointment and execution of forensic psychiatric examinations in cases of administrative law violations. We place particular emphasis in our discussion on the European Court for Human Rights case "Zaichenko v Ukraine, No 2", and the reform bill that followed this case. This case is an 'in vivo' illustration of how Ukraine's legal deficiencies have created grounds for the violation of individual human rights. Our assessment of the current rules and regulations for assigning and conducting forensic psychiatric examinations in proceedings of administrative offenses reveals that the legal deficiencies persist. The proposed reform bill is thus a highly warranted initiative, which however has several issues in its formulations and fails to address a few of the worst existing deficiencies. Ukraine's legislators must do further work to put through reforms that will safeguard individuals from unjustified forensic psychiatric examinations.

Remodelling criminal insanity: Exploring philosophical, legal, and medical premises of the medical model used in Norwegian law.

This paper clarifies the conceptual space of discussion of legal insanity by considering the virtues of the 'medical model' model that has been used in Norway for almost a century. The medical model identifies insanity exclusively with mental disorder, and especially with psychosis, without any requirement that the disorder causally influenced the commission of the crime. We explore the medical model from a transdisciplinary perspective and show how it can be utilised to systematise and reconsider the central philosophical, legal and medical premises involved in the insanity debate. A key concern is how recent transdiagnostic and dimensional approaches to psychosis can illuminate the law's understanding of insanity and its relation to mental disorder. The authors eventually raise the question whether the medical model can be reconstructed into a unified insanity model that is valid across the related disciplinary perspectives, and that moves beyond current insanity models.

Psychiatric and Forensic Differences Between Men Charged with Sex Offences and Men Charged with Other Offences.

Studies on differences between individuals convicted of sexual offences and nonsexual offences are sparse and there is an on-going debate as to whether sexual offenders differ from other offenders. The primary aim of this study was to determine demographic characteristics, prevalence of mental disorders, alcohol and drug use at the time of the crime and the criminal responsibility of individuals charged with sexual offences, compared to nonsexual crimes, with the aim of bringing awareness to the similarities and differences between men charged with sex offences and those charged with other crimes. This is a single-institution retrospective study of subjects charged with sexual offences and sent for institutional psychiatric evaluation to a Forensic Psychiatric Centre in an urban, academic, tertiary-care center. The control group consisted of individuals charged with nonsexual offences referred to the same center. Results showed significant differences between individuals charged with sexual offences and nonsexual offences. Men charged with sex offences more frequently committed their crimes alone and victimized children equally as often as adults. They also less frequently pleaded guilty in court. They were more likely to be abused in childhood and more often had antisocial personality disorder and paraphilias and less often substance-related disorders. The majority were considered criminally responsible. Our results show that sex offenders are different from nonsex offenders in many characteristics of their personal history, offence characteristics and forensic evaluations and these particular differences warrant different approaches to the prevention of future re-offending, compared to nonsex offenders.

Assessing NGRI and dangerousness: Perspectives from forensic reports in Portugal.

In Portugal the expert whose report supports the criminal defence of not guilty by reason of insanity (NGRI) must also consider the defendant's dangerousness. Nevertheless, the concept of dangerousness has received little attention in the Portuguese critical literature. Moreover, there is concern that the concept is often used improperly. We endeavoured to evaluate a sample of Portuguese forensic reports in order to discuss: 1) the prevalence of defendants who were considered guilty, NGRI, and dangerous; 2) which treatments were proposed; and 3) the frequency of technical errors found. We analysed 124 case folders from the year 2006, from both mainland Portugal and the archipelagos of Madeira and the Azores, which included an evaluation of dangerousness of the defendants. These 124 cases were analysed using frequencies, correlations and multiple logistic regressions. The majority of the defendants were male and single. Thirty-nine percent (39%) were considered NGRI. A total of 34% of the defendants were considered dangerous or no dangerousness could be excluded. In 66% of cases treatment was recommended but in only 9% was admission to a forensic hospital recommended. Technical errors in the forensic reports, both of format and content, were identified in 26% of the 124 cases, the incidence of errors being high in reports from certain institutions. The majority of the forensic reports did not discuss the educational background of the defendants or their criminal history/records. We conclude that the experience of the expert is crucial in producing an appropriate report. The establishment of uniform criteria for the preparation of forensic reports and enhanced training of psychiatrists in forensic psychiatry should be considered as possible strategies to improve the accuracy of forensic reporting, particularly when assessing dangerousness.

Delusions and Responsibility for Action: Insights from the Breivik Case.

What factors should be taken into account when attributing criminal responsibility to perpetrators of severe crimes? We discuss the Breivik case, and the considerations which led to holding Breivik accountable for his criminal acts. We put some pressure on the view that experiencing certain psychiatric symptoms or receiving a certain psychiatric diagnosis is sufficient to establish criminal insanity. We also argue that the presence of delusional beliefs, often regarded as a key factor in determining responsibility, is neither necessary nor sufficient for criminal insanity.