Variation in the insanity defense among the 50 states and the federal court reflects the breadth of public attitudes about mental illness and the degree to which it should exonerate criminal behavior, Zonana said. On one end of the spectrum, some jurisdictions allow consideration of volitional aspects of brain diseases. They consider whether mentally ill individuals not only appreciated the difference between right and wrong but also whether they were able to conform their conduct to the requirements of law. Others have, in effect, abolished the insanity defense.
The practice guidelines, Zonana said, will at least help assure some consistency in the way that forensic experts handle cases when criminal defendants assert the insanity defense. At the same time, Zonana said that he hoped the guidelines would also help still some of the misperceptions -- at times advanced by the media -- that arise during high profile cases.
"I think psychiatry takes a beating in the press all the time. All you need is one bad testimony and that's what people remember and think about psychiatry," Zonana said. "Even though the statistics show that most people who get insanity defenses are really very ill and psychotic, [the public] tends to focus on people getting away with something. So I hope [the practice guidelines] will upgrade more the quality of evaluations and testimony and give some sense that these are hard issues but that there are reasonable ways to do these evaluations."
The Yates case had its moment of what the defense will claim on appeal was "bad" testimony. During the trial, for example, Park Dietz, M.D., a forensic psychiatrist from Newport Beach, Calif., who is nationally recognized for his participation in many high profile cases, testified that Yates' conduct bore a resemblance to an episode of the television show Law and Order. In that episode, a woman who killed her children was exonerated by the insanity defense. The prosecution used Dietz's testimony to subsequently argue that Yates followed the model created by the show.
The trouble was that no such episode ever aired, a fact disclosed only after the jury rendered its guilty verdict. No one has accused Dietz, who has acted as a consultant during the show's production, of lying to jurors, and the trial judge refused to declare a mistrial, but an appeal based on the error is likely.
"I would give him the benefit of the doubt and see it as an honest error," said Phillip J. Resnick, M.D., professor of psychiatry at Case Western Reserve University School of Medicine in Cleveland and a past president of AAPL who testified as a defense expert in the Yates case. Resnick further told PT, "I certainly don't see it as malicious. I think it was just a simple error. It turns out since it was used in closing argument it may be problematic with respect to an appeal."
Resnick said that he read Dietz's "103-page, single-spaced report" and didn't recall seeing any reference to the Law and Order episode, adding that he would have asked Yates about it had he known. Dietz was unavailable for comment.
Resnick told PT that in two discussions with psychiatric professional audiences regarding the verdict of the Yates case, sentiments ran three-to-one in favor of Mrs. Yates, with attendees tending to be "disturbed by the outcome." Nevertheless, it is doubtful that this opinion will result in any changes to the standards used in the insanity defense. "The general public is a bit more mixed, with some people feeling that a mother who killed her children is the ultimate betrayal, but psychiatric audiences tend to be sympathetic to her," Resnick said.
