The price we are willing to pay to curtail the insanity defense in the courtroom is death and destruction in the community.  As things stand, the state seems to require that a deposit in the form of injury or death be made before it can act to protect the community.

The criminal justice system and our lawmakers have gone so far afield in extricating medical science from a working definition of insanity in the courtroom, that society’s grasp on the meaning and consequences of severe psychotic illness has decomposed into utter abstraction.   Society at large, and even some advocates for people with SMI have become conditioned and acquiescent to a rejection of insanity by the criminal justice system.

Rarely does a day go by that is free and clear of another high-profile news story about an individual afflicted with acute psychosis being arrested, charged, or convicted for a gruesome crime.  Just days ago, the writer of this blog encountered another report of a defendant who was convicted on a guilty plea after an insanity defense was spurned by the prosecution and the court – the convicted woman still neurologically disconnected from reality (as evidenced by her utterings during proceedings) and profoundly anosognosic  – still under treatment for psychosis even as she is hauled away to prison.  If a defender believes that his or her client was insane, how can it be that the accused can be deprived of the right under the law to plead the truth?  How sayeth the prosecutor or the judge that insanity will not be permitted to exist in our courtroom?

A society that does not come to terms with the consequences of  particularly deadly strains of psychosis, deadly not because of guilty mind (mens rea) but because of malfunctioning brain, is cultivating risk – risk for the personal safety of the afflicted person, their families, and others.  A society that operates with a comprehension of the implications of insanity, as it would be defined by medical science, not the inauthentic definitions under the law, will behave very differently in the case management, housing, and treatment of people with serious mental illness.  The “sanitized” discussions that we are having in the community about “mental health issues” are going to need to change.  The advocacy community will have to change its messaging and its activism.  The medical and scientific communities will have to assume their rightful place in the forefront where their knowledge and expertise is respected.  Our lawmakers will have to change and begin to listen and lead instead of yielding to the pitchfork mob mentalities that have given us M’Naghten’s Rule.

Ultimately, we will never be able to prevent all natural disasters that are the consequence of untreated or persistent psychosis.  Because of this reality, we must make a stipulation of sorts about the tragedies that can happen when psychosis is either not diagnosed, is untreated, or refractory to treatment.  We will not be able to practice ad hoc justice when we come to terms with medical science.  We will be prepared to practice moral justice.