The insanity defense in Illinois -- a psychiatric perspective.

The insanity defense has come under increasingly strong attack by both lawyers! and psychiatrists,2 at least in part, because of its lack of clarity in relating mental illness to criminal responsibility. Recent scholarly publications3.4 have exhaustively reviewed the pertinent medical-legal, social, and philosophical issues surrounding the contemporary debate regarding retention or abolition of the affirmative defense of insanity. Supporters insist that there is a societal need for the continuation of the insanity defense in order to protect from conviction and punishment the mentally ill offender who is unable to form a criminal intent because of absence of mens rea. In contrast, abolitionists attack the psychiatrist's role in court as primarily financially motivated, 6 criticize inadequate follow-up care for defendants acquitted as not guilty by reason of insanity,7 cite the confusion of insanity defense standards,8 and deplore the inefficient use of psychiatric time in an adversarial role where physicians are forced into arbitrary discriminations between" mad" and "bad."9 Some states have already achieved significant modifications in their insanity defense standards. IO Illinois lawmakers in 1978 introduced the first legislative bill (not passed) which would have totally eliminated the insanity defense replacing it with a "guilty but mentally ill" plea. While the conceptual issues surrounding the insanity defense have been heatedly debated, there have been few attempts to systematically assess: ( 1) perceptions of the insanity defense by professionals (attorneys, judges, psychiatrists, etc.) involved in the criminal justice process or, (2) to gather data concerning the demography and treatability of the not guilty by reason of insanity (NGRI) patient. One notable exception is the recent report from the New York Department of Mental Hygiene!! which systematically details characteristics of insanity defense acquittees under the state's former McN aughton standard and also evaluates perceptions