What does the insanity defense mean in a court of law? And is there such a thing as temporary insanity? Is the twinkie defense a real thing? Can someone use premenstrual syndrome as a defense? And what does the legal wrestling around insanity tell us about the differences between brains: yours and other people’s, or even yours one day and yours the next day? How does law comport with science, and how are they sometimes like two people with quite different ways of looking at the world? Join to find out what happened to Andrea Yates, how the legal system deals with mental illness, and so much more.
Is there such a thing as temporary insanity? Is there such a thing as the twinkie defense, or using pre menstrual syndrome as a criminal defense? And what does this tell us about the differences between brains yours and other people's, or even between yours one day and yours the next day. How does the legal system wrestle with the science, and how are the law and the science like two different people with very different ways of looking at the world. Welcome to the inner Cosmos with me, David Eagleman. I'm a neuroscientist and author at Stanford, and in these episodes we sail deeply into our three pound universe to understand why we believe the things we do and behave in the ways that we do, and why there's such a variety in the ways that people see the world, and how we try to structure legal systems around that fact. Now, today we're picking up on the trial of Andrea Yates, who was a young woman in Houston, Texas, who had five beautiful children, and one day she murdered them one by one by drowning them in the bathtub. Now, if you haven't heard the previous episode, please go back to that one to get the full background on that story. Andrea was suffering from a psychosis, which is a mental disorder characterized by a disconnection from reality, and at her trial, her lawyers pled the insanity defense, or specifically, not guilty by reason of insanity. Now as a reminder, the prosecution hired on a psychiatrist who said, yes, Andrea clearly has mental troubles, but I think she did this particular act more purposefully because if she was unable to distinguish right from wrong, which is one of the prongs of the insanity defense, then she wouldn't have made sure she waited until her husband was gone before doing it, and she wouldn't have suffered regret. And Deet said, there was an episode of Law and Order, which is a show that Andrea watched regularly, in which a woman drowns her children in the bathtub so she can be free to be with her lover. So Andrea's case brings to the forefront some of the deep questions about the insanity defense. How do we know when we should judge someone's actions to stem from a mental disorder like a psychosis, versus judging the person to just be more devious? We can't really know what is happening inside someone's head. So how do we make these judgments as a society, and how do we canonize these decisions into law. I mentioned in the last episode that in eighteen forty three a Scottish man named Daniel McNaughton suffered from a deep psychosis and he shot and killed a man that he erroneously thought was the British Prime Minister, and a court of judges sat down and defined what came to be known as the McNaughton rules, which essentially said that if you want to establish an insanity defense, you have to clearly prove that at the time of committing the act you had a disease of the mind such that you didn't understand the nature and quality of the act, like if you pull a trigger a bullet comes out, or you didn't know that what you were doing was wrong. In other words, you were unable to distinguish between right and wrong. Okay, So these McNaughton rules caught on in England and America and around the world. But in the late nineteenth century, legal scholars began to worry that maybe the McNaughton rules were too narrow. Why because These rules only ask whether a person knows the difference between right and wrong and understands the nature and consequences of the actions, and that invited concerns for psychiatrists and lawyers. First, can a psychiatrists really testify to absolute knowledge of right versus wrong or about absolute freedom of choice? And even if they can in extreme cases, the rule only allows for total incapacity. But what if you're just a little confused about the difference between right and wrong? And what if you know the difference just fine, except for during a small window of time. So let's dig into that. On a February day in eighteen fifty nine, there was a United States congressman named Daniel Sickles who murdered the US attorney for the District of Columbia, a guy named Philip Barton Key. Sickles caught a glimpse of Key outside his house, and he furiously chased Key into Lafayette Square, across the street from the White House, and he shot him in the groin, reportedly yelling quote, you villain, you have dishonored my house and you must die. Sickles then fatally shot Key in the chest as he begged for his life, So what led up to that? Well, before these events in Lafayette Square, Sickles had been informed by a friend that his wife, Teresa was having an affair with Key Now. Sickles lawyer Edward Stayton, who went on to become Lincoln's Secretary of War, painted Sickles as a betrayed spouse driven crazy by grief and what he claimed was quote temporary insanity. For the first time in the United States history, this plea was successful, and Sickles was declared not guilty. In the United States, a temporary insanity defense can be raised to argue that a defendant is not responsible for their actions because a severe mental disease or defect prevented them from appreciating the wrongness of their acts at the time. So different jurisdictions treat this differently, but the standard from the Supreme Court of Iowa states that quote in order to be an excuse and defense for a criminal act, the person accused and who claims temporary insanity as a defense must prove that the crime charged was caused by mental disease or unsoundness which dethroned, overcame, or swayed her reason and judgment. With respect to that act which destroyed her power rationally to comprehend the nature and consequences of that act end quote. So the temporary insanity defense often gets linked with intoxication, and in certain jurisdictions, intoxication can be grounds for a reduced penalty because of temporary insanity. Now, Sickles act as an example of what we commonly refer to today as a crime of passion. Under this kind of interpretation, Sickles would have been said to have been experiencing extreme emotional disturbance, and his crime would likely be reduced from murder to voluntary manslaughter. Why because crimes of passion are not punished to the same degree. Because there are certain circumstances under which we think it's reasonable for someone in extreme emotional distress to lose their self control. While we don't condone the crime, we intuitively think that a person acting during a moment of extreme emotional distress is less culpable than the cool headed and calculating criminal. Unlike the insanity defense, extreme emotional distress doesn't absolve the defendant of all culpability, but it can lessen the degree of the crime. Now, you may have heard the term twinkie defense, and this is used to describe a seemingly absurd, yet somehow successful legal defense, and what this originates from is the nineteen seventy nine trial of Dan White for the deaths of the San Francisco Mayor George Moscone and supervisor Harvey Milk, and the term twinkie defense refers to this commonly held but actually inaccurate belief that White's lawyers successfully argued that his consumption of Twinkies put enough sugar into his body to send him into a murderous state. In actuality, White's lawyers argued diminished capacity from depression and his sugary diet only played a small role in explaining his mental decline. Nevertheless, the term twinkie defense continues to be applied to legal defenses that seem ludicrous. Now there are many kinds of defenses that people try, and sometimes they're successful. A woman in Virginia in nineteen ninety one argued that pre menstrual syndrome caused her erratic behavior, and she was able to avoid being found guilty of driving under the influence this way, and a decade before that, two women in England were similarly able to reduce their criminal responsibility from murder to manslaughter based on a pre menstrual syndrome defense. Okay, so these are the concerns that people have about whether insanity can be temporary or not. But let's zoom back out to the really big picture about the McNaughton rules and what the problems are. The bigger problem with the mcnotton rule is that it's too narrowly cognitive. You might know the difference between right and wrong, and you might know the nature and consequences of your action. But what if that's not the problem. What if the real problem is one of the In other words, your cognitive reasoning is fine, but you can't stop yourself. In later episodes, we'll see a lot of examples of impaired volition. For example, there's a disease known as frontotemporal lowbar degeneration, where people can know perfectly well the difference between right and wrong, but they are totally unable to stop their impulsive behavior. They'll expose themselves in public, they'll urinate in public, they'll touch people inappropriately. They'll shoplift, they'll reach into garbage cans and eat food out of it. They'll run red lights, they'll curse in public. They just do whatever they want. If you ask such a person is shoplifting right or wrong, they're perfectly capable of verifying that they're not supposed to do it. If you ask you understand when you steal it costs someone else money, they'll genuinely agree that. They understand. They can discriminate right from wrong, and they understand the nature and consequences of their actions. They just can't do anything about it. This comes up not only in cases of degenerative brain disease, but also in cases of traumatic brain injury or from brain disorders that people are sometimes born with. In all these cases, a person can understand the difference between right and wrong, and they simply don't have the proper brain function to stop their transgressions. So by the eighteen eighties, scholars wondered whether the legal definition of insanity would need to evolve, and to that end, an additional prong was added to the insanity defense in some jurisdictions, and this was the concept of an irresistible impulse. Was the defendant able to control his behavior at the time of the offense. I'll give you an example of this from eighteen eighty five, a woman named Nancy Parsons believed that she knew why she had been sick and in bad health for a long time, and her assessment was that her husband, Bennett possessed supernatural powers that caused her illness and put her at risk of death. So she encouraged her daughter to shoot and kill Bennett. Now, both Nancy and her daughter sought to employ the insanity defense. Nancy was experiencing a quote insane delusion and the daughter quote was at the time of said killing and always had been an idiot. Now, applying the McNaught rules, the jury initially found Nancy and her daughter guilty of murder in the second degree. On appeal, however, the state Supreme Court reversed the decision and added a component to the insanity defense. Someone is not guilty if she was subject to quote the dress of such mental disease that she had lost the power to choose between right and wrong, and her free agency was at the time to destroyed. So this was not about knowing the difference between right and wrong. Instead, it was about losing the power to choose between right and wrong. A person has an impulse to act that cannot be resisted. In this way, the additional prong makes the McNaughton test slightly broader, although the legal defense still has to demonstrate that the crime was connected with a mental disease and was directly the product of it. So to understand this notion of an irresistible impulse, consider a case that you probably remember. LORRAINA. Bobbitt. In the wee hours of June twenty third, nineteen ninety three, she pulled back the covers on her sleeping husband, John Wayne Bobbitt, and cut off his penis with an eight inch kitchen knife. She fled from their apartment in her car, and she tossed the severed organ into a field. Now what led to this moment? At trial, her defence team alleged that she had spent the years of their marriage being repeatedly raped and beaten and sodomized by her husband, and this was verified by expert witnesses on both the prosecution and the defense, who validated that she quote lived in constant fear of him. In light of this, her lawyers argued that she had an irresistible impulse. After many hours of deliberation, the jury found lorrain and Bobbitt not guilty by reason of temporary insanity based on their conclusion that she was unable to resist her impulse to wound John. In this way, she was not held liable for her assault. Instead, she was sent for a forty five day evaluation at a local state hospital. So by the end of the nineteenth century it seemed that bases were covered with the McNaughton rules plus the notion of an irresistible impulse, But legal experts agonized that this version of insanity might still be too narrow because the rules only allowed for total incapacity, they were insensitive to partial problems, and many people on trial were seen to be in a gray area in between, not completely unaware of right and wrong, or maybe they were subject to impulses that might not be one hundred percent irresistible. In the late nineteen forties, there was a young man named Monty Durham who had years of petty crimes and mental illness, and this familiarized Durham with both the criminal justice system and the state asylum. So in July of nineteen fifty one, Durham was convicted of housebreaking in Washington, d c. And he appealed his case and as a result, a new test emerged in nineteen fifty four, which is called the Durham rule, and the idea was to broaden the mcnot rules such that now the task was merely to conclude whether a defendant's criminal act was quote the product of mental disease or mental defect. If it was, then he would not be criminally responsible. But there was a problem here. How do you ever prove that some act was the product of a disease or a defect. One might claim the disease was related to the act, But what portion of the disease came from you? And what portion from the disease? But that wasn't even the big problem. The big problem was who gets to decide if an act was the product of a disease. So the Durham rule shifted the power to psychiatrists who gave expert testimony. A psychiatrist would testify whether the act was the product of a mental disease, and the jury, instead of making decisions on their own, was in a position of just having to accept the psychiatrist's testimony. In other words, starting in nineteen fifty four, the power was in the physician's expert testimony instead of in the juror's hands. Now, at first blush, that doesn't seem like a problem, because, after all, the psychiatrists are the experts. But the problem was that their testimony could be ambiguous and two experts could contradict one another. Imagine the defense pulls up their favorite psychiatrists who asserts that mister Smith has clear evidence of a mental illness, and then the prosecution puts up their psychiatrists who says the opposite. Suddenly, the fact finding job of the jury becomes complexified. Relying on expert witness testimony turned out to be much more problematic than they had originally envisioned. So the Durham rule held sway in US Corps for eighteen years. But then one night at a party, a man named Archie Brauner got into a fight. He left bleeding and returned with a gun, and after shooting and killing a man, Bronner was arrested. The court tested for insanity using a standard that's now known as the Bronner rule, and the rule states a person is not responsible for criminal conduct if, at the time of the action, as a result of mental disease or defect, he or she lacks the substantial capacity either to appreciate the criminality of his conduct, or to conform his conduct to the requirements of the law. The key thing about the Bronner rule is that expert witnesses no longer decided whether the crime resulted from a mental defect. Instead, that was now up to the jurors. If a defendant wanted to claim that he wasn't liable for a crime, his argument had to meet two prongs. He has to lack the capacity to appreciate that his conduct was wrongful, and he has to lack the capacity to conform his conduct. So why have I told you this whole history of the insanity defense. It's because this illustrates a really key point, which is that it's not easy to take something as complex as mental life and reduce it cleanly into a yes or no decision in the courtroom. The endeavor to build the right definition relies on a collaboration of psychiatry and legal scholarship and the public, and because of the inherently diversified goals, the road to definitive rules didn't even end with the Broader rule. Over a century after McNaughton committed his homicide, there was a troubled twenty five year old American named John who was developing an increasing obsession with the actress Jody Foster, and so he repeatedly watched this movie Taxi Driver, in which the young Foster played a twelve year old prostitute. And in the movie, the protagonist Travis Bickle, who is played by Robert de Niro, hatches a plot to assassinate a politician for public admiration. So John, with his unshakable love for Jody Foster, began to send letters to her and stalk her, and he somehow got a hold of her phone number, and he rang her several times, and every time she hung up. And he wrote in his final letter to her, quote, as you very well know by now, I love you very much. The past seven months, I have left you dozens of poems, letters, and messages in the faint hope that you would develop an interest in me. Although we talked on the phone a couple of times, I never had the nerve to simply approach you and introduce myself. Desides my shyness, I honestly did not wish to bother you with my constant presence. I know that many messages left at your door and in your mailbox were a nuisance, but I felt it was the most painless way for me to express my love to you. I will admit to you that the reason I'm going ahead with this attempt now is because I just cannot wait any longer to impress you. End quote. Now. The attempt he's referring to there was the assassination of President Ronald Reagan. So on March thirtieth, nineteen eighty one, John Hinckley fired six shots as the president and his entourage exited the Hilton Hotel in Washington, d c. None of Hinckley's bullets directly hit Reagan, but one ricochet off the limousine and hit the president under his left armpit, and three other people in the party were wounded, including the Press secretary James Brady, who spent the rest of his life partially paralyzed on the left side of his body. Now, this act of senseless violence led to a national uproar, people thirsted for a swift and effective punishment for Hinckley. The federal trial was quickly set into motion, and at the end the jury gathered in their room with their coffee cups and spent a long time deliberating over everything they had seen, and they agreed that Hinckley was indeed deeply psychotic. He was disconnected from reality and was unable to conform to the requirements of the law. So on June twenty first, eighty two, Hinckley was declared not guilty by reason of insanity. But this pill was a jagged one for the public to swallow, just as in Queen Victoria's Day, which I talked about in the last episode, the air was filled with outcries and citizens had just witnessed an assassination attempt on their president, and they were enraged. They felt that they were being denied their right to see punishment. After all, people asked, how do we know if Hinckley truly had an impulse that was irresistible or simply an impulse not resisted. All this national anger sparked action at the congressional level. Lawmakers, responding to all this ire came together to pass the Insanity Defense Reform Act of nineteen eighty four. The act stripped the insanity defense back to a simpler version. A defendant could now escape criminalizability only if he was unable to appreciate the nature and quality, or the wrongfulness of the Act. In other words, it got rid of the irresistible impulse prong. It brought it back to the McNaughton rules. It got rid of the consideration of whether you were able to appropriately conform your behavior. All that mattered now is whether a defendant could appreciate right from wrong. If there was some reason he couldn't help himself, from frontal low problems to psychosis, he was out of luck and surfing. On top of this wave of national anger, Congress went even further beyond removing this volitional component. They also added conditions to raise the bar for the insanity defense. They specified that the defendant has to suffer from a severe mental illness, and the defendant has to prove by clear and convincing evidence the alleged insanity, which was higher than before which was just a preponderance of evidence. So, in addition to raising the standard of proof, the Act further complicated things by shifting the burden of proof from the prosecution to the defense. In other words, before Hankley, the prosecution had to prove that the defendant was not insane, but now the defendant had to prove that he was insane. And part of the difficulty here is that a. The central feature of psychosis is a lack of insight. So consider the unibomber ted Kaczynski, who killed three people and injured twenty three others by sending them explosives in the mail. Although he clearly had paranoid schizophrenia, he took offense to any suggestions or implications that he was mentally ill. He wouldn't follow his lawyer's suggestion to take the insanity plea because he was angered that anyone would be suggesting that something was wrong with his thinking. So a lack of insight is a hallmark characteristic of people with psychosis. They have no discernment that something is strange about their behavior. Instead, they believe they're seeing the world correctly while others are not. So it's no surprise that many defendants have a mental illness but will not take an insanity plea because they see a full justification for their actions, whether that was divine commandment or revenge for imagined political wrongdoings, or other fantastical reasons. So I'm telling you all this to make it clear that the legal definition of insanity is more complicated than the road which began with Daniel McNaughton. In America, if a defendant suffers from a mental disease, you might have four different tests used in different places, and cases can conclude very differently depending on which test is employed. Some jurisdictions still use the McNaughton rule. One still uses the Durham rule almost half free line on the broader rule. The Federal Core and several other jurisdictions employ the Insanity Defense Reform Act, and the state by state bespoke nature doesn't even end there. In nineteen ninety five, Kansas abolished the affirmative insanity defense and established what's known as the mensrea approach. Under this approach, mental illness is only considered to the extent that it prevents the defendant from having the required mensrea or guilty mind. For example, if a defendant knowingly commits a crime but couldn't know what she was doing because of her mental illness, that would satisfy the mens rea approach. The defendants act to judge the wrongfulness of her acts just doesn't matter. So Kansas's decision rose to the US Supreme Court in twenty twenty after a guy named James Craig Kaylor killed his wife and two teenage daughters, and his wife's grandmother. He had a major depression an obsessive personality disorder, but he was not allowed to use an affirmative insanity defense and he was given a death sentence. So his team appealed to the Kansas Supreme Court, and they argued that the prosecution had violated his right to a fair trial by denying him the right to leverage the insanity defense. But Kansas said that they were within their rights to craft their insanity defense however they chose. So this went all the way up to the US Supreme Court, and his council argued that a state government shouldn't be able to impose cruel and unusual punishment, and a lack of insanity defense fit this description. Additionally, they argued that Kansas's approach violated his due process, which calls for the fair treatment by the judicial system. They argued that ignoring this question of could you distinguish right from wrong equated to an unfair system. So the US Supreme Court affirmed that Kansas was not required to take on in the sanity defense that depended on a defendant's ability to recognize that their crime was morally wrong. In other words, the court concluded that it was the state's decision and that decisions surrounding criminal liability and mental illness were left to them. So, as of twenty twenty, there are four states that have committed to the men's rea approach rather than a traditional insanity defense. Here's the thing, there's no single right answer that everyone should use, and this underscores the difficulty, both legal and psychiatric, of deciding who is criminally liable and who is not. And this is not just a current challenge. It's not as though in another few decades scientists are going to announce that we've got it all worked out. Why not because humans are complex and mental life varies along many axes. Some people suffer deep mental illnesses, and most thinkers believe that they should be treated differently. But how do we draw a bright line in the sand of a very complex landscape. The legal system, after all, is forced to be categorical. The judge and jury are tasked with deciding whether a defendant is or is not insane. And the fact is that science and the law are strange bedfellows because science does not see things in binary categories like that. So the legal system has been wrestling for many decades about how a person's cognition and volition matter in their culpability. But every time a famous person gets attacked, society's generous interest in this issue gets scaled back. Why because many people, perhaps most have little to know experience with mental illness, and therefore they see the insanity plea as simply an excuse that people people are trying for bad behavior. After all, how would you know with certainty whether lorraina Bobbits act was an irresistible impulse or justin urge that had not been repelled. So with the intersection of neuroscience and law, there is not always a clear solution. But we know enough about human variation to know that the search has to continue, and so, as it stands, different jurisdictions make individualized choices about how they think insanity should be handled. So what happened to Andrea Yates, the woman who drowned her children in the bathtub. Her council pled the insanity defense. They argued that she had suffered from severe mental illness, that she'd attempted suicide many times, that she'd shuttled in and out of psychiatric hospitals, and that she had this belief that she was saving her children from hell by killing them. Her plea was unsuccessful. On the one year anniversary of her father's death, Andrea Yates was found guilty of murder, but Andrea's defense counsel found reason to hope for a mistrial. Remember, the prosecutor mentioned an episode of Law and Order in which a woman drowned her children in the bathtub. As it turned out, there was no episode with that plot. Whether this was by deception or just misremembering, Dietz's claim had been totally false. In two thousand and five, Andrea's conviction was reversed because of Dietz's false testimony. A four week retrial ensued, and this time the jury found Andrea not guilty by reason of insanity. Andrea is locked away for life, but in a psychiatric institution where she has a roommate, she gets care, she's on medications, the public is safe, she presents no danger to anybody, and she can obtain the help that she needs. So why is there a public resistance to the insanity defense. Well, first, there's often this misunderstanding about the not guilty part of the plea, and the public is often horrified by the notion that some person, whether that's McNaughton or Hinckley, is not culpable for a horrific crime. There's a feeling that they're not appropriately punished for their actions if they're simply sent to a cushy hospital. And also a lot of people, especially those with no direct connection to someone with mental illness, they think that everyone is the same on the inside, and that the insanity defense is just an invitation to deceive. Now, one thing to note here is that only one percent of felony cases in the US involve the insanity defense. It's not generally a part of public knowledge that this is such a very rare plea. Instead, a lot of people have the opinion that everyone who murderers is simply going to plead insanity to try to get away with that, and of those who plead the insanity defense, only about thirty cases or successful each year. Even in these successful cases, the sentences are often longer because a person can be sentenced to a prison hospital for a long time, and it's not uncommon that those sentences end up being worse than prison itself. What worse means depends on the decade you're in, but sometimes In these prison hospitals, a person is kept in a drug induced stupor for the remaining years of their life. So, in the same way that prisons can often lead to more crime, some mental health institutions are thought to actually worsen a psychosis. For this reason, there was a push for the institutionalization in nineteen sixties America. The country used to run a large mental health care system of what were called insane asylums, but these asylums proved less than perfect. In many instances, men and women in hospital gowns led meaningless lives. They were just bodies being kept alive. So these mental institutions were shut down with plans to have a network of halfway houses and other mechanisms to help people back into productive society, but that part was never fully implemented, and so the shutdown led to a large homeless population and to many of the former inhabitants of the asylums flowing into the prison system. So some people argue that the insanity defense is not often invoked, in part because prison hospitalizations can be worse and lasts longer than prison sentences. And there's another problem that some scholars point to about the not guilty by reason of insanity plea, which is that jurors find themselves in a tough spot when they have to deal with the words not guilty. After all, the person did commit the crime, right. It turns out that when juries are given other options, they come to more nuanced decisions. So to this end, some states have adopted the term guilty but mentally ill, and that gives an option to root someone to mental health care while not making the jury feel as though they're letting someone off scot free. So, in this way, when a defendant with a psychosis shoots somebody in the back, we can come to the slightly more satisfying conclusion that he is guilty of the crime. But there's another issue that requires consideration of the best root forward. So how we phrase things matters. So where is Andrea Yates today? Well, she still resides at the Kerville State Hospital in Texas. Her husband, Rusty, went to law school with the aim of improving the societal response to the criminal behavior of mentally ill defendants and improving the healthcare system for the mentally ill. Part of Andrea's time in Kerville is devoted to craftmaking, the fruits of which she sells anonymously at craft shows. Andrea donates the majority of her earnings from the sales to the Yates Children Memorial Fund. So to wrap up, we've been seeing throughout these episodes how different people's internal models can be, and therefore how different their realities can be. We've talked elsewhere about synesthesia or a fantasia, or different levels of empathy, or a hundred other ways that people can see the world differently on some sort of spectrum. And for Andrea, her internal model told her I believe quite genuinely that her children were going to hell, and so she did what she believed was the right thing given her reality. And all of this emphasizes the complexity of putting together billions of brains to work and live together in a massive collaboration that we call society. Go to Eagleman dot com slash podcast for more information and to find further reading. Send me an email at podcasts at Eagleman dot com with questions or discussions, and then making episodes in which I address those until next time. I'm David Eagleman, and this is Inner Cosmos.