Severe Mental Illness Does Not Preclude Legal "Sanity"

The underlying personality structure is critical.

Posted Nov 20, 2017

Because a person is mentally ill, it is imperative that he or she not be viewed solely in terms of the symptoms of his or her disorder. Put another way, there is far more to that human being than what is readily visible. An underlying personality continues to exist but it may be overshadowed or masked by symptoms of a mental disorder.

A person who is confused and hallucinating may have difficulty holding a job. But before the psychosis developed, they may have been ambitious and diligent and worked at every opportunity. They still may desire to live a productive life and return to work. Taking prescribed medication may result in a subsiding of psychotic symptoms and allow them to be more rational and hold a job. This is very different from a person who had similar symptoms of a mental illness and took medication but who never had a work ethic and, in fact, regarded work as for other people, not for them.

In evaluating the totality of a person’s psychological functioning, it is critically important to identify and describe the underlying personality structure.

As far back as anyone could recall, Steven had contempt for work. Although he had considerable intellectual potential and did reasonably well in school (he was a college graduate), he put minimal effort into studying and often skipped classes. His parents wanted him to earn money during summers by working—any job was fine. But Steven held work in disdain, especial if it was menial. Confident that he was superior in intelligence to most people, he considered demeaning even a suggestion that he labor among what he termed “the common people.” Arrogant and judgmental, he refused throughout his adult life to take a full-time job. Briefly, he worked at a restaurant, then a hotel, growing bored and disgruntled with each. He did not get along with co-workers and sought relief from the jobs’ tedium by using drugs.

For nearly two decades, Steven lived at home, expecting to continue the lifestyle to which he had become accustomed and thought he was entitled. His psychotic symptoms first emerged in his early twenties, precipitated by drug use. Numerous psychotic episodes came later. However, when he took medication, he was rational and capable of holding a job. He preferred to stay home writing poetry and reading. He bristled with indignation whenever he was asked to help at home by cleaning, raking leaves, or do other chores. His anger was so intense that requests for his assistance ceased.

Underlying his psychotic disorder was a disorder of personality. A person can have cancer and a cold. One does not cause the other. And so it is that an individual can have a personality disorder as well as a significant mental illness. One does not cause the other. In some instances, medication alleviates the psychotic condition and the personality disorder becomes more visible.

When such an individual commits a crime, a judge or jury is faced with a dilemma. Unless a thorough psychological evaluation of the defendant has been conducted and collateral information is available, it is nearly impossible to assess that person’s mental state at the time they committed the crime.

After Steven’s father died, he continued living with his mother. Over the years, he was diagnosed variously as “schizophrenic” and “schizoaffective.” Although his mother was kind and understanding, she found him extremely difficult to deal with. Steven became increasingly resentful of his dependency on her especially when it came to asking for money. He found himself competing for her attention once she had grandchildren. One night he brutally murdered her but claimed that demons took over his personality and that his mother not his mother because she no longer had a soul. Nonetheless, Steven was able to tell police officers at the crime scene the identity of the deceased, what he had done, and where the body was located. Interviewed by detectives immediately thereafter, he provided a detailed account as to how he committed the homicide, then discussed with them the insanity plea and its repercussions. When the detectives questioned him closely about his mental disorder, he quickly invoked his right to consult an attorney. After its deliberation, the jury concluded that Steven was legally sane. The issue here was not malingering. Rather, the jury reasoned that, regardless of his mental illness, Steven still knew right from wrong.

Thousands of human beings suffer from mental illness. Many of them have interpersonal conflicts with others, especially with people upon whom they depend. Very few of these individuals kill family members, other caretakers, or anyone else. How they resolve their conflicts is likely to be determined by their underlying personality rather than a mental illness.