Feix Jeff, Wolber Greg
Central State Hospital, Forensic Unit, 26317 Washington Street, Petersburg, VA 23803, USA.
J Am Acad Psychiatry Law. 2007;35(2):172-82.
This article presents a case of first-degree murder for which the defendant was acquitted as not guilty by reason of insanity, based on a defense involving the concept of "settled insanity." The literature on settled insanity is reviewed and discussed in the context of voluntary and involuntary intoxication. Statute and case law from those jurisdictions in which settled insanity is specifically allowed as an acceptable threshold condition for the insanity defense define the concept as a permanent condition resulting from substance abuse, rather than the effects of intoxication, no matter how severe. Also discussed are potential criteria for this defense, including evidence that psychotic symptoms thought to be responsible for the crime were, in some manner, separate and apart from symptoms caused solely by voluntary acute intoxication. Other factors that may assist evaluators in differentiating settled insanity from the effects of acute intoxication are presented. It is recommended that evaluators attempt to determine the timing of the onset of psychotic symptoms in relation to substance abuse, the persistence of such symptoms beyond detoxification, and whether ongoing psychiatric treatment is necessary to ameliorate the symptoms beyond intoxication. In the case described, psychotic symptoms persisted long after acute intoxication and beyond the time when drugs or alcohol were detected in the accused's body, requiring clinical intervention for psychosis. Also, before the crime, the defendant had exhibited significant psychological difficulty. The evaluating clinician must still determine, even when a threshold condition is considered to be present, whether statutory criteria for the insanity defense (for the jurisdiction in which the crime allegedly took place) are met.
本文介绍了一起一级谋杀案，被告基于“固定性精神错乱”概念的辩护，以精神错乱为由被宣告无罪。本文在自愿和非自愿醉酒的背景下，对有关固定性精神错乱的文献进行了回顾和讨论。在那些明确允许固定性精神错乱作为精神错乱辩护可接受门槛条件的司法管辖区，法规和判例法将这一概念定义为物质滥用导致的永久性状况，而非无论多么严重的醉酒影响。本文还讨论了这种辩护的潜在标准，包括表明被认为应对犯罪负责的精神病症状在某种程度上与仅由自愿急性醉酒引起的症状相分离的证据。还介绍了可能有助于评估人员区分固定性精神错乱和急性醉酒影响的其他因素。建议评估人员尝试确定精神病症状出现的时间与物质滥用的关系、这些症状在戒毒后持续的时间，以及是否需要持续的精神科治疗来缓解醉酒之外的症状。在所描述的案例中，精神病症状在急性醉酒后很长时间持续存在，且在被告体内检测到毒品或酒精之后仍存在，需要对精神病进行临床干预。此外，在犯罪之前，被告就已表现出严重的心理问题。即使认为存在门槛条件，评估临床医生仍必须确定是否符合（据称犯罪发生地司法管辖区的）精神错乱辩护的法定标准。
