At Issue; 33; Innocent by Reason of Insanity: The Psychiatrist in Court

Add issue, the psychiatrist in court, take one. By what rule of infallibility does one human being decide that another human being is insane enough to live or sane enough to die? National educational television presents, at issue, a weekly commentary on events and people in the news. At issue this week, innocent by reason of insanity, an examination of the psychiatrist in court.

Jack Ruby's sanity is still in question. In courtroom psychiatry as in other social sciences, you can find an expert to suit your point of view, one for the defense, another for the prosecution. No one ever has been able to say, here is an expert who is 100% right. Tonight at issue seeks possible solutions. New York State deals with the problem at Madawon State Hospital for the criminally insane. Here Dr. John Lonsgren, assistant director at Madawon, begins taking an actual case history in a simulated sanity hearing. The patient is accused of manslaughter. Dr. Lonsgren's questions and the answers indicate the prisoner's sanity or insanity. In Dr. Lonsgren's hands rests the initial decision. I would like to know if you remember why you were sent here to this place.

This is a hospital? Yes, it's a hospital. Do you know where this hospital is? No. This is a hospital? Yes, it's a state hospital for the criminally insane. Do you know how you came here? Why you came here? No, I don't know. The prisoner, 30 years old, came from a middle-class rural community. Dr. Lonsgren learned that his childhood was very much the same, very similar to all his friends. The prisoner had four sisters, one brother, a mother, and father. After high school, he worked at almost a monthly variety of jobs and then entered the army. When did you get along with the army?

I got along a little bit. I used to drink with my friends and then I would drink with my friends. I had friends. How was your relationship with the women? I got married while I was in the army. Do you have any problems with your marriage? I don't remember my wife's name. We had a fight. I went back to the army. You went back to the camp? Yes, we had a fight and I went back to the army. Did you try to find your wife again?

Did you return? Dr. Lonsgren wants to learn why the prisoner was unable to hold a job. Why he drank excessively. I used to have blackouts and I was depressed. I didn't feel good and I used to be sad. I wanted to shoot myself once with a shotgun. How often did you have these suicidal preoccupations? A long time in one year. I tried to shoot myself and I went to a hospital. They took me to a hospital and I was there. Seven, eight, six months. Do you remember at what hospital you were sent? It was in New York.

In some place in New York. It was Marcy. Marcy hospital. Do you remember something about what happened before you came here? The events leading to your confinement here? I know the police. Policemen took me here. It was in a days and I think I had a breakdown or some kind of nervous breakdown or something. The policemen took me here because I did something. I think I did something at my grandfather's hospital. I don't know what it was. I was there talking to him. I went into his house and I was talking to him.

I heard men and women talking to me. I was talking to my grandfather and my face was all wet. I went home. I don't remember. I went home and I had to hide my jacket because my face was all full of blood. So you must have realized that you did something wrong when you hid this jacket. It was all bloody. Well, I thought that it needed to be cleaned. But I wasn't all bloody. Was it blood? That's what the authorities say. But I want to know what you remember about all of what happened.

That was a portion of a simulated sanity hearing. The patient remembered nothing about his crime except what the police had told him. It is on the basis of just such questions that a psychiatrist determines a man's sanity. Dr. Lansgren tells our reporter what he decided in this case. My first say that this patient was charged with manslaughter and sent to a referred to a state hospital for observation of his mental condition. It was then found by the examining psychiatrist that the patient was in such a state of insanity that he was unable to understand the charges to confirm his counsel or to help in his own defense. Then the court decided to commit him to marijuana state hospital for the criminally insane until such a time when his mental condition has approved sufficiently that he is able to stand trial.

The patient was judged insane. He will stay at this hospital for the criminally insane till he's cured if he's cured. Some patients have been at marijuana for more than 25 years. When this man is cured, whether it takes two months or 25 years, he will go back to court to stand trial for his crime. We all saw Jack Ruby shoot Lee Oswald. The only issue in the trial was his sanity. Sanity is a plea in crimes today from murder to passing a stop sign. And no matter what the psychiatric decision, there is inevitably a dissent. Melvin Belly fought and he lost. The jury, despite conflicting psychiatric testimony, said that Ruby was sane. In San Francisco, after the trial, we talked to Texas honorary deputy sheriff Belly about his problems as a defense attorney with the insanity plea. If an attorney were defending a man against murder and the plea were going to be innocent by reason of insanity.

And one of the defense attorney's own psychiatric witnesses came over and said this man is he was sane at the time. Would that mean a change of plea or would that mean a search for other psychiatrists? Depends on your appreciation of the psychiatrist ability. If a gutmaker or a shaffer or a brown bird or a toddler or a menager came to me, and told me that Jack Ruby didn't have the psychomotor epilepsy variant or that he wasn't insane, how to immediately change the plea. In Dallas, Henry Wade is glad to return to the smaller controversies of a district attorney's daily routine. The Ruby case was far from the first time he encountered an insanity plea. He gets it all the time. Mr. Wade, would you say that the insanity plea is abused by defense attorneys?

Well, I think it's abused. It's a kind of figment of imagination of most defense lawyers when they have no other defense they come up with insanity. Or you can prove that it was an unmitigated killing and you have proof on it. They first will defend it on the theory that you can't prove them guilty. You know, but if they know you can prove them guilty and they end up with either temporary insanity or permanent insanity. And unfortunately, you can nearly always get psychiatrists to testify to nearly anyone who's insane and it's been my experience. Mr. Bell, I, despite the general acceptance of mental disease as a mitigating factor in court cases, there are many who say that pleas of insanity are frequently used because there is no other defense. Is the insanity plea abused? Yes, it is abused. It's abused both ways, but it's abused more the other way than you put it to me.

The jury has been so tuned in on some of the TV shows that they're inclined to disregard the plea of mental illness. They're not abusing it. The jurors are abusing it. They don't understand it. This case that we tried down in Dallas, Jack Ruby, they not only didn't understand it, they didn't want to understand it. And the district attorney said with reference to psychomotor epilepsy, he said something as hideous as, oh, that's a psychomotor pool. Now, in an enlightened city with the hospitals that they have and claim to have in Dallas, let us in that they profess to have in Texas. Isn't it a little bit short of a served or beyond being absurd to refer to psychomotor epilepsy in a courtroom, the Temple of Justice, where all of this is brought into focus as psychomotor pool? I wonder who's abusing what here? Author of Law, Liberty and Psychiatry. Professor of Psychiatry at the Upstate Medical Center in Syracuse.

Dr. Thomas Suss argues that psychiatry has no place in the courtroom at all. We asked him if he thought the insanity play is abused. The whole insanity defense is, in a sense, a hoax. I say this, since I don't believe that there is such a thing as insanity, the whole notion is a mythical one. To my mind, it's a modern equivalent of witch trials. Now, there are no witches and there is no, it doesn't matter how many experts testify on the one hand that John Doe was a witch and the other testify that he was not a witch, both certainly subscribes the proposition that some people are witches and some are not. And we have the same kind of a nonsense here that by testifying that someone is insane and conversely that someone is not insane, the whole testimony corroborates the perfectly silly idea that some people are in fact insane. It's only a question of finding out who it is, who is and who is not. And the whole thing is nonsense. The whole insanity defense is utter nonsense.

Mr. Wade, how does a jury or how do individual jurors decide which experts to believe? You had X number of experts on the stand. Mr. Bell, I had a number of experts on the stand. How do I know as a juror? Who's right? I think your usually ends up with medical testimony both ways and the jury throwing them both out and going back to their common sense of what the man said or did at the time as to whether or not he knew it. He's presumed to be sane to defend that there's a presumption of sanity just like the presumption of innocence. And the burden is on the defendant to prove him insane rather than us. And if they end up just throwing all the testimony out, of course they find him sane. I say don't throw it out. They just say, well, we're confusing here. Some say he isn't. Some say he isn't. The law of presumption is sane. That's what we'll find. Are you saying in the fact that in most of the cases where psychiatric experts are brought in to testify, those cases might have been decided exactly as they were decided without those experts having been there?

I make so. If you have experts on both sides. How do the people who are sitting on a jury who have been exposed to all kinds of conflicting psychiatric testimony decide which psychiatrists know what they're talking about? The point of fact, I don't know how the jury determines this, but my assumption is, and the people have studied this question, my assumption is that the jury goes partly by the reputation of the psychiatrist. Partly, perhaps by the evidence, but largely probably by their own feelings about the case and what sort of thing should happen to the defendant. And I assume they largely disregard the psychiatric arguments. Now, my own view about psychiatric testimony is, in a sense, radical. I believe that psychiatrists as professionals have no business in the courtroom.

I believe that they only obscure the administration of the justice. The determination, now this is not to say that the state of mind of a defendant is not relevant. It has always been relevant. But the state of mind of a defendant is a common sense psychological matter. It is supposed to be determined by the defendant's peers in Anglo-Saxon law. It is therefore something for the jury to determine by a kind of common sense explanation on the part of defense and prosecution witnesses of what happened. But to illustrate, there is an obvious difference from a psychological point of view between an accidental homicide, such as one might commit with a car on a dark street by accidentally hitting someone and killing him, and premarited in murder of a professional gangster who shoots a man down with a machine gun and has been hired for it. You don't bring in psychiatrists to explain to the jury the mental state of these two people. This is part and parcel of the nature of the circumstance of the act.

Now my view is that these are the models by which we should go. And psychiatry as a quasi-technical discipline has no place in the courtroom. It obscures and degrades the administration of the justice and I think it degrades the defendant. Now how does a jury decide which expert to believe? That's with one of the jurors trying at the outset of the case to do the impossible being fair on their four-dire. Ask me who do I believe Mr. Belly if they bring experts and you bring experts? I answered that in my argument to the jury. Perhaps it's not a great answer or a complete solution, but we as human beings don't do the greatest we do the best we can or as human. We do the best we can and I said if you want to know who to believe then think which one you would take as your family doctor. Which one if you had a mental illness to whom would you go with your sick child?

Suppose you had some intercranial problems. Suppose you were faced with psychomotor epilepsy, petite malgran mal, jacksonian. Suppose you had some of those problems to whom would you go? You'd go to the greatest man in electroencephalography in the world to Dr. Gibbs. And I say to you that's the man that I would believe them if he's good enough for your child. He's good enough for someone who's not near and dear to you, but upon whose faith you're called to decide. They can put this all together if they will, if they'll understand, and if they won't when you stand up to argue to them, Yon and say as two jurors did on this Dallas jury, I missed all of Mr. Ballet's experts. Could we have it read back to us and it never was read back? They also said we were asleep when the defense medical went in. If you don't run into roadblocks to human understanding like that, then a jury is perfectly confident to understand medical testimony, the most scientific testimony, psychiatric testimony.

Most psychiatrists feel that a person can commit a crime without knowing what he's doing, as some maintained about Jack Ruby. Dr. Soss has a different point of view. I commit a crime. I kill someone. And I really honestly don't know what I've done at the moment I did it. What, you know, how would you classify my behavior? I would classify your behavior as something that exists only in textbooks. I simply do not believe that such things exist. I see. So you are saying that everyone is always aware of every act he commits. More or less. I would say that no one is capable of committing a more or less complex anti-social criminal act without knowing what he's doing. I do believe that some people are sometimes unconscious or in a rather disorganized state, but in proportion as they are unconscious or disorganized, they are also incapable of acting in a complex way.

Again, it takes a ruby case. After all, he killed Oswald. He didn't kill one of the other policemen. If he was in some kind of a seizure so that he didn't know what he was doing, how come he shot this particular man? How come he went to the police station? How come he didn't leave his gun in the car? Did things like high interests who testified for the defense answer any of those questions in their tests? Mr. Ferrell, this is one of the reasons why I and people who think like me don't appear in courtrooms. No one is interested in asking these questions. The psychiatric argument in a courtroom is extremely well, I am tempted to say very silly one. No one is interested in the truth. No one is interested in anything that is half-ereasonable. The defense is interested in getting an acquittal by any means possible, and in this case obviously no other means where possible. And the prosecution is interested in foiling the acquittal. So no one is interested in psychiatry.

That's no place to study psychiatry or to think about human behavior. Wouldn't the prosecution have asked those questions that you just asked? The prosecution, in my opinion, has no interest in asking those questions because a V from now the prosecution may be interested in incriminating another defendant who wants to strangle a mental ale so that they can send into a mental hospital. Since this mental illness game, if I may call it that metaphorically, is something that everybody in our society, virtually everybody is using as best they can. It's a gimmick that virtually everybody has gotten on to. Defense, prosecution, courts, judges, psychiatrists, the public at large. We are all in this, most of us, and we are all responsible for using it. Dr. Sash, what you're saying is that anyone who commits a crime knows right from wrong. Yes, I would say that I don't like the way it is put because it is a terminology of the McNaughton rule which was already devised to make some sense out of the concept of insanity, which makes no sense. I would put it this way. Anyone in a civilized society who commits a crime and who is an adult must be treated as a responsible person.

Now, in some cases of political crime, of course we take this for granted. No one pleaded during the Nurember trials that Nazis were insane. Before the event on trial, there was widespread speculation. During the war, there was no shortage of psychiatrists to claim that Nazis and anti-Semitism were the form of insanity. Even today, you hear this view that, to be anti-Semitic, to be anti-negro, to have prejudiced, this is a form of mental illness. When some of these people commit crimes, most psychiatrists come to their defense, which illustrates that this is a purely ethical matter. That when the crime is sufficiently repulsive ethically, then the psychiatrists don't show up. When it's ethically more defensible, when someone like Ruby kills someone who allegedly kills a president, well, the implication is really, you know, this man should be treated with a little bit more consideration. And then psychiatric testimony is marshaled for his defense. It is this kind of a phenomenon that we are dealing with.

Let me ask you a question about kleptomania. Now, they say that this is a psychological behavior. A force is a person to steal. He must steal. He's a kleptomania. Does such a thing exist? No. There's not exist. Now, by this, I do not mean that compressive behavior in the sense that some people are driven, feel impaled to steal or to drink or to smoke, to drink Coca-Cola, more than other people. The phenomenon is very real, but it's widespread. But we don't, why don't we speak of compressive Coca-Cola drinking, compressive news paper reading, compressive television watching? We bring up this kind of phenomenon, again, in a very devious and peculiar way, we might want to excuse someone from a criminal act. But if stealing is a criminal act, it makes no difference how impaled a person is. And whether he's impaled because of what happened to him when he was five years old, or whether he's impaled because of hunger, because his children are starving.

This is pure ethics. And this kind of a psychiatric explanation, which is in a psychological theoretical sense, sometimes valid. Has no place in the courtroom, in my opinion. Mr. Wade, a very respected psychiatrist, Dr. Thomas Saas, on the faculty of a medical school, publisher of many books in his field, says that there is no such thing as insanity in relation to crime, that every crime is a purposeful act, and that the person who committed is fully aware of what he's done. By and large, what would you have to say about that? I probably wouldn't go as far. I've read some of his articles. I think they're running some of the newspapers. I've read some of his articles and trying to agree with him that under our right and wrong test that there are very few crimes that the defendant doesn't know what he's doing. However, there are many crimes committed by people who are actually insane that don't know right from wrong. We recognize that.

My theory is that, and that this is not shared by very many, my theory has always been that the insanity has overplayed a great deal. And that the man should be tried to see whether he committed to crime and his punishment set. And then, if you have neutral people examining the term where they ought to be treated in an institution or in the penitentiaries, what I think. Because Mr. Wade, as a district attorney, is involved in criminal cases every day, he makes frequent use of psychiatric testimony. Mr. Wade, how do you decide what psychiatric experts to call as witnesses for the prosecution? Well, you need one competent psychiatrist, two you need competent witnesses. There's lots of very competent people both professionally that can't explain it in language that a jury can understand. We're interested in one having a competent psychiatrist and two one that can explain his theories of the case and every day language where a jury can understand it.

And we've used about ten different psychiatrists and this, a matter of fact, you know, we called four or five other psychiatrists here and this. Most of them didn't want to get involved in the case of this magnitude. Many of them said they already had their opinion made up one way or another and didn't think it's right from do. We also had Dr. Arietti from New York down here to examining who is a real outstanding psychiatrist. Really wouldn't talk to him because his lawyers are totally not to talk to him. But we try to find one we want a competent psychiatrist. We also want another one that can ask your question that he can explain is there is the word jury will understand. Among those who labor with the law, dissatisfaction with the uses of psychiatry in court is rampant. There's no estimating the number of prisoners who pleading insanity were found sane by a lay jury and sent to their deaths.

Wouldn't it be reasonable then if we cannot find experts to agree on a man's sanity that we find jury is more competent to evaluate the experts. In cases where insanity is an issue, should not the jury be 12 psychiatrists or if a defendant pleads insanity thereby admitting he committed the crime, eliminate the jury completely and leave the decision to psychiatric experts or if even one psychiatrist descends from the majority opinion admit that this constitutes reasonable doubt and accept the defendant's plea. This is NET, National Educational Television.