Meghan Musselman, MD

Today, 25 years after the Lorena Bobbitt trial, the case has gained a renewed interest. The #MeToo and Time’s Up movements have begun to identify the widespread problem of sexually abusive behaviors in both social and occupational arenas. In light of these crusades, filmmaker and producer Jordan Peele (

) has created a four-part docuseries reexamining the Lorena Bobbitt case.

 A look back at the case is a reflection of how far we have-and haven’t-come in conceptualizing sexual violence, including gender bias in the determination of culpability as examined in Bobbitt’s not guilty by reason of insanity (NGRI) acquittal.

Twenty-five years ago, after she took a knife to her husband’s genitals, Lorena Bobbitt became a household name. At her trial, she and others testified that she had been trapped in an abusive marriage with a husband who raped, beat, and belittled her. The media, at that time, adopted comedic commentaries and headline puns in covering the story, depicting Lorena as a crazed woman who falsely claimed rape.

After the trial, Lorena’s popularity dissipated, and she faded into a quiet life in Manassas, Virginia. Her ex-husband, John Wayne Bobbitt, remained in the spotlight, starring in adult films, giving interviews on talk shows, and getting paid to appear at events around the country. He was subsequently charged, on more than one occasion, with battery.

The not guilty by reason of insanity plea

On the evening of June 23, 1993, Lorena Bobbitt cut off her husband’s penis with a kitchen knife as he slept. She left the house, appendage in hand, and subsequently threw the penis out of her car window, near a 7-Eleven, and called 911. Lorena later told police that John was sexually, physically, and emotionally abusive. She reported that just before she cut her husband, he raped her. John’s version of events was that he had come home after an evening of drinking with a friend and went to sleep. He stated that Lorena attempted to make sexual advances toward him and that there was “some petting,” but they did not have sex. Lorena was charged with malicious wounding, and John was charged with marital sexual assault.

At Lorena’s trial, she testified to the years of abuse that occurred in her marriage, including being forced by her husband to undergo an abortion. She discussed in detail the rape on the evening of the incident for which she was charged. She testified that following the rape, she went to the kitchen to get a glass of water and attempt to calm down. While there, she had memories of the traumatic events she had undergone at the hands of her husband. Lorena said she did not remember cutting her husband. Both the defense and prosecution offered psychiatric testimony. While both psychiatrists agreed that Lorena suffered from a mental illness, their opinions differed regarding Lorena’s criminal responsibility.

Dr Susan Fiester, the defense expert, made a diagnosis of MDD, PTSD, and panic disorder. She described Lorena as a classic example of a “battered wife,” weakened by years of abuse and fearful of leaving her husband. She testified that John’s assault on Lorena on the evening of June 23 led to “an acute deterioration of her mental state,” and she “became psychotic.” Dr Fiester further opined that Lorena did not have control over her actions when she assaulted her husband.

Dr Miller Ryans, the prosecution expert, testified that although he did not doubt Lorena was raped, he did not detect any evidence that she was “out of touch with reality or experiencing any delusions” at the time of the assault on her husband. He concluded that Lorena’s actions were not an “irresistible impulse” but rather “an impulse she did not resist.” The defense prevailed, and Lorena was found NGRI.

The insanity defense is a legal construct, which in some circumstances can allow for an individual to be found not legally responsible for his or her criminal behavior due to mental illness. The standard for insanity, or criminal responsibility, varies by jurisdiction, and some states do not recognize an insanity defense.

Legal standards are categorized by the presence of a cognitive or a volitional prong. The cognitive prong refers to whether mental illness prevents an individual from appreciating the wrongfulness of the act. The volitional prong, often used interchangeably with the “irresistible impulse test,” focuses on whether the mental disease or defect prevented the individual from controlling his or her behavior at the time of the offense. While the standard in most states includes a cognitive prong, 16 states and the District of Columbia recognize a volitional prong for the insanity defense.

Irresistible impulse or impulse not resisted

No state relies on irresistible impulse as the only test of insanity, largely because of the difficulty in distinguishing an “irresistible impulse” from an “impulse not resisted.” This means that those individuals, such as Lorena Bobbitt, who are found NGRI based on the volitional prong would have been found guilty in most other states.

The irresistible impulse test was first used successfully in the English case of Regina v Oxford in 1840. In this case, Edward Oxford was indicted for treason for attempting to shoot Queen Victoria. His defense was on the grounds of insanity, largely relying on a family history of insanity and his own prior “insane acts.”

 At the trial, Justice Denman charged, “If some controlling disease was . . . the acting power within him which he could not resist, then he will not be responsible.”

The idea of an “irresistible impulse” was raised in the 1843 trial of Daniel M’Naghten, who shot and killed the secretary of Sir Robert Peel, while believing that he was being persecuted by Sir Robert Peel and the Tory Party. In his successful defense of M’Naghten, defense attorney Alexander Cockburn described M’Naghten’s murderous act as an “irresistible impulse.” Following this trial, multiple states added an irresistible impulse rule to their insanity standards, and by 1944, 17 states included an irresistible impulse rule.

 Practically, the difficulty in applying this defense is in establishing the difference between an irresistible impulse and an impulse not resisted. This proved to be a key issue in the Bobbitt trial, and where Dr Fiester and Dr Ryans differed in their opinions.

The question of whether Lorena Bobbitt sufficiently met the criteria for an NGRI defense can be answered by examining the two necessary components of a successful insanity defense, the presence of a mental disease or defect at the commission of the criminal act and whether the disease or defect impaired cognition or volition. All three clinicians who evaluated Bobbitt concluded that she was a “battered woman,” a psychological diagnostic shorthand that persisted throughout the trial and associated media coverage.

 Based on the pioneering work of Dr Lenore Walker, battered woman syndrome provided a rubric for understanding the complex, often counter-intuitive, responses of domestic violence victims.

The battered woman syndrome has been used as a defensive strategy to justify a broad array of behavior, ranging from self-defense and provocation, to insanity and diminished capacity. The 1977 case of Francine Hughes marked one of the earliest high-profile criminal cases to use battered woman syndrome as a defensive strategy. At the time of the trial, Hughes was a 29-year-old housewife, married to a man who had violently and repeatedly abused her over 13 years. On March 29, 1977, after being humiliated, raped, and beaten, Francine set her sleeping husband’s bed on fire and was subsequently charged with first-degree murder. Following a trial by jury that included expert witness testimony, Hughes was found not guilty by reason of temporary insanity.

. . . the basic premise of such a defense [temporary insanity] would be that the defendant, at the time of the killing, suffered from severe stress and an impaired mental state as a result of the battering relationship, and that this impaired mental state caused her to kill the batterer. The causal link between the woman’s impaired mental state and the killing can be established by showing that the woman viewed her predicament from a psychologically distorted perspective and thus was unable to perceive her options accurately, or by showing that the “woman was driven to the breaking point by the circumstances of her situation and therefore was substantially unable” to conform [her] conduct to the requirements of law.

In contrast to the successful use of battered woman syndrome in the Hughes’ defense, the case 

 in 1979 highlighted early conflict about the validity of the diagnosis.

 Following years of spousal abuse, Beverly Tamas shot her husband and was charged with second-degree murder while armed. After a guilty verdict, the case was taken to appeal, claiming the court had erred in excluding the expert testimony by Dr Lenore Walker on battered woman syndrome. Following appeal, the case was remanded to a lower court for reconsideration. The trial court concluded that the “defendant failed to establish a general acceptance by the expert’s colleagues of the methodology used in the expert’s study of battered women.”

 In doing so, the court proceedings highlighted concerns that Dr Walker’s reports, while compelling and relevant, were limited by a paucity of supporting scientific data.

As part of the 1994 Violence Against Women Act,

 the federal government released a report reviewing the medical and psychological evidence for battered woman syndrome. The report noted that Dr Walker’s cycle of violence was not universally replicable throughout battering relationships and, as such, should not be used to define the psychology of those within the relationship. In addition, the report stated that available data contradict the theory’s proposal that abused women are universally helpless and passive. However, “expert testimony on battering and its effects can be based on and supported by an extensive body of scientific and clinical knowledge on the dynamics of domestic violence and traumatic stress reactions.” In doing so, the construct of battered woman syndrome was viewed as being limited and overly simplistic, but the overarching body of trauma literature was an invaluable resource in expert testimony.

While Dr Walker has referred to battered woman syndrome as a sub-type of PTSD, it is important to note that this view is not supported by the American Psychiatric Association, as evidenced by the exclusion of battered woman syndrome from multiple subsequent iterations of DSM. While it is certainly likely that a woman with a history of intimate partner violence could meet criteria for PTSD, the experience of a traumatic event is necessary but not sufficient for a PTSD diagnosis. Dr Walker’s battered woman syndrome overlaps with PTSD criteria by including intrusion symptoms [re-experiencing the trauma], high levels of anxiety and arousal, and high levels of avoidance behaviors. Unlike PTSD, the syndrome shifts to include disrupted interpersonal relationships because of the isolation, power and control by the batterer, distorted body image, and physical health and sexual issues.

The experts who evaluated Lorena Bobbitt agreed that she suffered from a mental illness at the time of the criminal offense. However, the use of the battered wife syndrome as a diagnosis was questionable in 1993 and remains so today. Although the definition of a mental illness or defect for the purpose of an insanity defense does not specifically reference DSM, most experts rely on DSM. The use of diagnoses not described in DSM raises questions about the scientific validity and acceptability of such diagnoses. The relevance of battered wife syndrome to the outcome of the Bobbitt case is unclear. Those who doubt the disorder speculate that battered wife syndrome was a way to recognize Lorena’s abuse and generate a narrative to address female victimhood and gender stereotypes.

At the request of Lorena’s defense team, the judge instructed the jurors on irresistible impulse, requiring only that they find that Lorena’s mind was “so impaired by disease that she was unable to resist the impulse to commit the crime.”

 The jury found that Lorena met criteria for the volitional prong-namely that she cut off her husband’s penis because of an irresistible impulse fueled by her traumatic experiences.

Whether Lorena met criteria for an insanity defense may not be the most significant analysis of the case. Perhaps more important, and undeniably interwoven, is the impact this case has had on American society. Coverage of the Bobbitt case stimulated a discussion about whether describing women as “battered” fuels the stereotype of women as weak, helpless, or pathetic. Although some herald Lorena as “fighting back” against male aggression, her overall demeanor, including witness accounts, portrayed her as a fragile, “beaten” woman. Others identified Lorena as a symbol of female empowerment, resisting gender suppression.

Lorena’s acquittal may resonate with another societal misperception, that women are not perpetrators of violence, but rather victims. Women in general receive lighter sentences in the judicial system than their male counterparts. Models of sanity are gendered, and female sanity, or proper femininity, revolves around the belief that violent women are either seen as not sane or not women, because sane women are never violent.

 What is clear from this case is America’s irresistible impulse to view women as victims and men as perpetrators.

Does this cultural perception permeate society today? Are the #MeToo and Time’s Up movements evidence of a less gendered perception of violence? Although such progress has provided support to many victims, a closer look yields the same heterosexual script of violence-women are victimized by strong men. Revisiting Bobbitt 25 years later reminds us how little progress we’ve made in abandoning gender disparities especially as they relate to violence, sex, and criminal conduct.

Dr Sorrentino is Assistant Professor, Harvard Medical School and Associate Psychiatrist, Massachusetts General Hospital (MGH), Boston, MA; Dr Musselman is an MGH/Mclean Psychiatry Resident; Dr Broderick is an MGH/Mclean Psychiatry Resident. The authors report no conflicts of interest concerning the subject matter of this article.

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