by Lucy Puryear, M.D.You may be surprised by my title and use of the work "crazy." That's not exactly a politically correct medical term, but when you listen to a psychiatrist's private conversations it's one that's used frequently. It's shorthand for, "Boy, did I just see someone who was really sick." What is meant by that is that the person in front of us is either acting bizarrely (standing in the middle of the street gesticulating wildly and talking to the sky) . . . listening to voices in his head or responding to visions you and I can't see (if you've ever had a really high fever you might have experienced this; it's called
delirium) . . . believes something entirely off the wall (the CIA has planted a bug in my head--remember you have to be careful with delusions, one day the CIA may indeed be capable of that!) . . . or his speech is so unintelligible he doesn't make sense to anyone (the technical term is "word salad," a little of this, a little of that . . .) .S
o when I'm speaking with a group of psychiatrists I'm pretty sure we all know the shorthand. But when you are trying to translate "crazy" to a courtroom it becomes much more complicated. The medical and legal definitions are entirely different.
In the Andrea Yates trial I was asked to determine if Yates (pictured above) was legally insane at the moment she drowned her children. So I had to put my medical definition through the lens of a legal one: Was Andrea Yates legally insane at the time she killed her children?There is no standard psychiatric definition of the word insane and it's not one we use in regular conversation. In a courtroom in Texas insane means the following: does the person know at the time the crime was committed the difference between right and wrong? From a medical understanding of psychotic illness (crazy) that definition is hard to interpret. Obviously the jury found it difficult as well. In the first trial she was found guilty, in the second trial, not guilty by reason of insanity.
To make matters more confusing, the legal definition of insanity changes depending on which state you live in. You can commit the same heinous crime and be insane in Texas, but by definition not insane in Connecticut. Excuse me for saying so, but that's CRAZY. Whereas Texas uses a much older and more constricted definition of insanity (McNaughton Rule), Connecticut uses a more modern definition (American Law Institute). The advocates who worked so tirelessly for the defense in the Andrea Yates trial have been working to have the legal definition of insanity changed in Texas to a more modern standard. Good luck getting that passed in a state that still struggles over the execution of those with mental retardation.
There's a new case getting the attention of the media here in Houston that will test the stomachs of those chosen to sit on the jury. Joshua Royce Mauldin (pictured left) is currently on trial for putting his two-month-old baby daughter in a microwave for ten seconds. She suffered second- and third-degree burns over parts of her body and currently is living with relatives. Mr. Mauldin has pled not guilty by reason of insanity. According to the Houston Chronicle, he has a history of mental illness and claims to have heard voices. He felt a "weird sensation" come over him right before he put her in the oven.I have not interviewed Mr. Mauldin or consulted with any of the psychiatrists who have. Is he legally insane? I don't know. That's going to be for the jury to decide. The jury will have to make sense of a complicated psychiatric history and conflicting testimony from mental health professionals. Is he crazy? No doubt. Is he sick? Absolutely. There's something seriously wrong with someone who can do that to another human being. But in the state of Texas the defense will have to prove that at the time of the crime he didn't know what he was doing was wrong. In this instance, I bet that will be a hard case to make.
