From a lay person (unfamiliar with this field), I always assumed that "criminal insanity" referred to a legal definition that meets certain criteria specified by statute (legislation) in the appropriate jurisdiction. On the other hand, "mental illness, exhibiting dangerous behavior" sounds like a clinical definition (DSM-V?). "Categories" of course are discrete (by definition) although it seems individual patients likely exhibit a continuum of "dangerousness" (or potential for injury to self and others). The 3 most simple categories would be minor injury, major injury (i.e., temporary or permanent "disability"), and fatal injury. I suppose to this simple framework you could overlay other categories such as "emotional injury" and "social injury" and "financial injury" etc. I look forward to how some of your knowledgeable colleagues respond to your interesting question!

Criminal insanity is the term used by mental health professionals when they do not want to face up to the fact that some patents commit crimes because of their illness, and do not want to stigmatize the majority of non-criminal mentally ill. The general public do not accept that mental illness is a reason for criminal acts, especially in high profile cases. Result -- we punish the mentally ill, and fill up our prisons with them.

Anthony,

Yes, in most states in the USA there are many more prison cells available than mental hospital beds. Only the most severe cases of mental disorders ever see the inside of a psychiatric hospital.

However, I have personally worked clinically with individuals in psychiatric hospitals who were very dangerous, and were on a locked unit for precisely that reason.

Absolutely. Mental Illness does not automatically indicate the inclusion of violent or dangerous behavior. "Criminally insane" indicates a pattern of behavior in which the person will use any means to accomplish what they want-which is usually escape from confinement and then rape/.torture/murder/ robbery or whatever the chosen crime of choice of the criminally insane person presents. Hannibal Lecter was criminally insane. Schizophrenic patients can be violent if they are not on their medication and hear voices or have auditory hallucinations. They are mentally ill at the time, but not criminally insane, Their behavior is sporadic and not purposeful. The criminally insane have consistent intent for their behavior, usually driven from severe child abuse.

So just for clarity, the concept in the justice system of "innocent by reason of insanity" is a legal term and not the same as "criminally insane", correct?

James,

I think your question strikes at the heart of the matter. Criminally insane, in the minds of many people, would be a person like a Hannibal Lecter - lucid, completely amoral, potentially deadly. Not Guilty by Reason of Insanity (NGRI) definitions differ by (USA) state, but NGRI implies that a person is so mentally impaired at the time of the crime (usually murder) as to be unaccountable (in a legal sense) for his/her actions. An NGRI verdict usually means that the accused is remanded to a mental health facility for treatment until such time as the person is deemed safe to return to the community. In practical terms, this NGRI finding often means an indefinite, if not permanent, stay in a psychiatric hospital.

To Respond to James Bowman: I believe the legal terminology is "Not Guilty by reason of Mental Disease or Defect"-which was the old term "Not guilty by reason of Insanity". In any case, the layman's translation is that the person was not responsible for their actions because they were not capable of premeditation, motive, using proper judgement, or acting independently to cause harm to another person. The true crux of the matter is " intent" and "motive". Those who are determined to be unable to make logical decisions are presumed incapable of maintaining the intent to harm or producing a motive to harm. Generally, persons with a functional IQ below 70 are presumed to be incapable of premeditated acts of violence. They may react violently to a situation that occurs in an instant, however, the complex thinking involved in planning a premeditated murder is not considered to be within their capabilities. Therefore, if another person or group of people were to manipulate a person of this functioning level to commit a crime; they would not be responsible for their actions because they do not have the ability to judge that what they are doing is wrong.

To James Brown: When you approach the category of emotional, social, and financial injury, you have entered the world of the Antisocial Personality Disorder. As for violence, it runs the gambit from Conduct Disorders to Spousal Abuse. Each case has it's own unique characteristics, although many fit within the constraints of the DSM- IV Diagnostic Categories.

Intent and motive may well be absent or indeterminate in those with low IQ, but this is certainly not the case in the mentally ill. Here is a Table from my article in J Am Acad Psych Law 1998;26:683 where I rated an old series of homicides in Britain for premeditation/intent :

Incidence of Intentional Killing (True

Murder) in Relation to Medicolegal Verdicts

in Those Indicted for Murder

Legal Outcome Cases "Willful" Murder

Murder and failed suicide 70 56 (80%)

Unfit to plead 70 45 (64%)

Guilty but insane 48 24 (50%)

Manslaughter 320 103 (31%)

Murder, not executed 187 42 (22%)

Executed for murder 25 4 (16%)

Every week in the UK I read of yet another schizophrenic convicted of murder and sent to prison since (s)he had shown intent, eg buying a knife, when it is perfectly clear that intent is a much more characteristic of mental illness than the often impulsive homicides of the non-mentally ill.

So maybe drifting too much into the legal arena here, but it seems there are at least two medical categories of individuals who might be Not Guilty because incapable of comprehending "right from wrong" (against the law) or lacking cognitive processing capacity for premeditation to commit crime: (1) neurologically impaired , i.e., developmental mental retardation, acquired brain disorder (e.g. surgery, trauma, stroke, degenerative disease); and (2) severe mental/psychological type of impairment/derangement (i.e., psychosis, schizophrenia, etc). Most of us non-experts have no difficulty accepting the first category. However, when an individual in the second category can somehow make the necessary plans to acquire a weapon, take the compicated steps needed to inflict harm/violence on another individual, then the "not guilty by reason of insanity" tends to come up shallow. Thanks to all for your careful explanations and your patience with my nagging questions.

Responding to Mr. Anthony Gordon,

I totally agree with your assessment that many mentally ill individuals possess the knowledge, skills, and capability to commit heinous crimes. We have seen this in the recent mass killings here in the U.S. by diagnosed Schizophrenics. While all the politicians are running around calling for a change in gun laws, they should realize that these mass killings are committed by less than 4% of the population. Identifying intervening, and preventing this 4% from harming the general society is like finding a needle in a hay stack with the current mental health law restrictions that are in place.

Our efforts would be better served by proving means for friends and family of these 4% to have them evaluated and if necessary; detained until it is determined they are no longer a threat to themselves or others. I am fully supportive of individual rights and freedom however, we must draw the line when it comes at the expense of the lives of innocent bystanders for the mentally ill to be able to refuse treatment.

So, again veering maybe off topic, we are really talking about those fringe individuals in our society who, for whatever reason, do not conform to the norms of behavior that our society deems acceptable. If they happen to exhibit violent behavior, we label them with DSM diagmoses and the most violent as ".criminally insane" and send to prison. If they happen to be nonviolent, but still atypical, we might give them a label if they can't hold a job or have significant interpersonal relationship difficulties, but as long as they relatively harmless, keep a job, pay their bills, and otherwise just a bit recluse, or bizarre, we might call them avante gard artists, creative writers, progressive musicians, or philosophers! So Samuel Beckett was right: "We are all born mad. Some remain so."

yes, there is a difference. "In sanity" is a legal term. It is not used in mental health. "Mental illness" is, of course, a mental health term; it is not used (technically), in the courtroom. "exhibiting dangerous behavior" is used neither place. There are various diagnoses in mental health that include violence or criminal behavior, and the legal system has several venues for dealing with people that have been adjudicated dangerous. The key difference, in the legal arena, is that persons adjudicated insane are absolved of blame for crimes they have committed, while persons who may commit dangerous behavior in the future must be dealt with in some way.

"Criminal insanity" is a legal terminology and " mental illness, exhibiting dangerous behavior" is a clinical description. I do not think that insanity is a clinical term but belongs to the legal and colloquial arena

" I do not think that insanity is a clinical term but belongs to the legal and colloquial arena"

Many with clear mental illness are judged sane by courts and punished accordingly, since a very restrictive and nonsensical definition of insanity is used.

I accept that the definition of insanity maybe too restrictive. I can see how it varies across the English speaking jurisdictions. Insanity is a legal term and is not a clinical one . the definition depends on the local law.