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Discontent with the special insanity defense has resulted in pressure on legislatures and courts to change or abolish it. Most reformers urge modifications that they hope will rectify obvious abuses. This article examines the most frequently advanced moderate reforms and compares them to a more radical reform, the so-called abolition of the special insanity defense, which involves the use of the mens rea—or intent—approach as a vehicle for exculpating offenders who are seriously mentally ill, together with a greater emphasis on the dispositional stage of the process. It is argued that abolition of the insanity defense is neither immoral nor inhumane, as is often charged, if it is accompanied by such dispositional reforms. Rather, the elimination of an expanded insanity defense would result in restoring confidence in the criminal justice system and in psychiatry, would eliminate show trials, and would provide a more rational allocation of scarce mental health resources, with ultimate benefit both to the individual offender and to society.

Discontent with the special insanity defense has resulted in pressure on legislatures & courts to modify it. The most frequently advanced moderate reforms are examined & compared with a more radical approach -- the so-called abolition of the special insanity defense, which involves the use of the mens rea -- or intent -- concept as a vehicle for exculpating offenders who are seriously mentally ill, together with a greater emphasis on the dispositional stage of the process. It is argued that abolition of the insanity defense is neither immoral nor inhumane, if it is accompanied by such reforms. Rather, the elimination of an expanded insanity defense would: result in restoring confidence in the criminal justice system & in psychiatry; eliminate show trial; & provide a more rational allocation of scarce mental health resources, with ultimate benefit to both the individual offender & society. Modified HA

AbstractPsychiatrists should recognize that involuntary civil commitment is not exclusively a medical matter. The decision to hospitalize is primarily a social decision that incorporates medical considerations.