Insanity of the Insanity Defense (Compilation)

Esteemed colleagues, the debate about the culpability of mentally ill or mentally challenged people. This debate is millennia old. In the Babylonian Talmud in the Mishna, the sacred writings of the Jews 2,500 years ago, we found we find the saying. It is an ill thing to knock against a deaf mute, an imbecile or a minor. He that wounds them is culpable. But if these people wound him, they are not culpable. If mental illness is culture dependent and if it mostly serves as a social organizing principle, what should we make of the insanity defense? What should we make of not guilty by reason of insanity NGRI? On the other hand, if mental illness is a viable uh series of clinical entities and these clinical entities are objective and neutral, the equivalent of shall we say tuberculosis or cancer in medicine, then again what are we to do with insanity defense? People like Jeffrey Dharma and Ted Bandi, vicious serial killers were declared sane by the courts. There is psychiatric insanity and legal insanity. And there's a gulf, there's an abyss between them. And the question is why? Why don't we have a universally agreed upon definition of insanity which is can be easily implemented in psychiatric or therapy therapeutic settings and in courts. A person is held not responsible for his criminal actions if he cannot tell right from wrong. To use the legal phrasiology, if a person lacks substantial capacity either to appreciate the criminality or wrongfulness of his conduct, then he has diminished capacity. And diminished capacity is only one element. The other element is that the person did not intend to act criminally, did not intend to act the way he did wrongfully. In other words, that he lacked men. And the third element is that the person could not control his behavior, that he had an irresistible impulse. These handicaps are often associated by laymen with mental disease or with mental defects or with mental disorders or with mental retardation. Mental health professionals prefer to talk about an impairment of a person's perception or understanding of reality. They talk mostly they discuss mostly the reality test and whether the reality test is impaired or intact. Mental health professionals hold or regard guilty but mentally ill verdicts to be contradictions in terms to be oxymorons. Either you're guilty or you're mentally ill. You can't be both. But in courts there's quite a few there are quite a few verdicts of guilty but mentally ill. All mentally ill people all of them operate within a usually coherent worldview with consistent internal logic and even with rules of right and wrong with a kind of personalized or customized form of ethics. Yet these rarely conform to the way most people perceive the world. The mentally ill therefore cannot be guilty because they have a tenuous grasp on the reality that the rest of us share. At least this is the view of psychiatry. Yet experience teaches us that a criminal may be mentally ill even as he maintains a perfect reality test and thus is or can be held criminally responsible. Again, Jeffrey Dharmmer for example, the perception and understanding of reality, in other words, can and does coexist with even with the severest forms of mental illness. The psychiatric limited test of reality or using the reality test is insufficient and life presents complicated nuanced cases which cannot be black and white. This makes it even more difficult to comprehend what is meant by mental disease. If some mentally ill people maintain a grasp on reality, if they know right from wrong, if they can anticipate the outcomes of their actions, if they are not subject to irresistible impulses, uh, which is the official position of the American Psychiatric Association, if they don't fulfill any of these conditions, in what way are they different to us, the so-called normal or healthy folk folks? If if we also share the same attributes, if we have a perfect reality test, if we perceive and understand reality um perfectly, if we um if we don't have irresistible impulses, if we know right from wrong, etc., etc., and yet we are not mentally ill, in which sense other people are mentally ill. And this is why the insanity defense often sits ill with mental health pathologies deemed socially acceptable and normal. Take for example love or take religion. Many would argue that they are mental health pathologies and yet because they are socially acceptable they are not deemed as such. Let's consider let's consider a case study. A mother bashes the skulls of her three young sons. Two of these kids die. She claims to have acted on instructions that she had received from God. And she is found not guilty by reason of insanity. The jury determines that she did not know right from wrong during the killings. But hold back. Why exactly was she judged or declared insane? Let's try to isolate the elements of her defense. First of all, she claims that she believes in God, in the existence of a God of God. Uh she claims to fully uphold the conviction that there is a being, supreme being, eternal being with inordinate and inhuman attributes. We can agree or disagree about the existence of such a being. We can deem her to be irrational. But is she really insane? It does not constitute insanity in the strictest in the strictest sense because it conforms to social and cultural mores, creeds and codes of conduct. In her millure, billions of people faithfully subscribe to the same irrational ideas, adhere to the same transcendental rules, observe the same mystical rituals, and claim to go through the same experiences. We can stand back and say, well, this is mass psychosis. This is a form of fia shared psychosis but it is so widespread that it can no longer be deemed pathological statistically speaking it falls within the spectrum of normaly. So this first element of her defense that God spoke to her in my view cannot be a part of the determination of her insanity. She claimed that God spoke to her as do numerous other people. Behavior that is considered psychotic, paranoid, schizophrenic in other contexts is actually laundered and admired in religious circles. Some people who claim to have spoken to God went on to found whole new religions. Jesus for example or Muhammad. hearing voices and seeing visions, auditory and visual hallucinations. These are considered rank manifestations of righteousness and sanctity in very wide circles to this very day. Perhaps but perhaps it was the content of her hallucinations that pro proved her insane. You could say, "Wait a minute. Okay, that she believes in God doesn't render her insane. that she spoke to God or God spoke to her doesn't mean that she's insane because so many millions maybe billions of people go through the same experiences. So what is normal is statistically defined and if billions through go through the same experience and she's normal but is the content of her hallucinations is what God told her what makes her insane. Um, she claimed that God instructed her to kill her boys. But surely God would not ordain such evil. Surely a true benevolent God would not instruct someone to kill his or her own children. Alas, the Old and New Testaments both contain examples of God's appetite for human sacrifice. Abraham, the patriarch Abraham was ordered by God to sacrifice his son Isaac, his beloved son. This savage command by God was rescinded at the very last second when the knife was already to Isaac's throat. Jesus the son of God himself and an integral part of the deity was crucified sacrificed to atone for the sins of humanity and it was at the direct behest and command of God when he was on the cross Jesus cried out why have have you forsaken me a divine injunction to slay one's offspring would sit well with precedent and with the holy scriptures in Apocrypha as well as with millennia old Judeo-Christian traditions of martyrdom and sacrifice. Some of these traditions are alive and well in Islam for example. Okay, you see maybe even the content of what she heard u can be reconciled with religious injunctions but her actions were wrong and they were in commenurate with both human and divine or even natural laws. What she did proves that she is insane. Yes, her actions were uh horrific, but they were perfectly in accord with a literal interpretation of certain divinely inspired texts, with certain millennial scriptures, with certain apocalyptic thought systems and with fundamentalist religious ideologies such as the ones espousing the imminence of rapture or such as Shihada, multidom in more extreme strands of fundamentalist Islam such as Wahhabism. Unless one declares these doctrines and writings insane, her actions cannot be construed as insane. When you conform to an ideology or to a religion, then you are not insane. You may be considered radical, an extremist, fundamentalist. uh the whole ideology or religious creed can be condemned as irrational or as cruel but there's no hint of insanity in any of this. We as human beings are motivated by ideological and religious systems and rituals. We are forced to the conclusion that the murderous mother is actually perfectly same. Her frame of reference is different to ours. That's true. But she has a frame of reference. Hence, her definitions of right and wrong are idiosyncratic. That's also true. They are not like ours. To her, killing her babies was the right thing to do. and inconform conformity with value teachings and with her own epiphany. Her grasp of reality, the immediate and later consequences of her actions was never impaired. She knew what she was doing and she believed that she was obeying a higher authority as expressed by her auditory cues and via religious teachings. It would seem that sanity and insanity are relative terms dependent on frames of cultural and social reference and they are statistically defined. They are not objective immutable entities. There isn't and in principle can never be or can never emerge an objective medical scientific test to determine mental health or disease unequivocally. cultural context, societal background, and historical precedent are all crucial. Someone is considered mentally ill if he or she fulfills or meets four conditions. Uh, five conditions, I'm sorry. One, that his conduct rigidly and consistently deviates from the typical average behavior of all other people in his culture and society that fit his profile. So whether this convention this conventional behavior is moral or rational is not material. In Nazi Germany, someone who was not a psychopath and was not a narcissist would have been considered socially deviant and perhaps even insane. So what matters is the statistical aspect. There is no value judgment and there is no moral principle that can be that is applicable. what the majority of people do. This is the background against which we judge insanity. The second test is whether his judgment and grasp of objective physical reality is impaired or not. The third test is whether his conduct is not a matter of choice but whether it is innate and irresistible. The fourth test is whether the behavior causes him or others discomfort, whether there is egodist. And the fifth test whether this behavior is dysfunctional, self-defeating, self-destructive even by the person's own yalst sticks. That's it. These are the five tests of insanity. Descriptive criteria aside, what is the essence of mental disorders has just been described, but these are statistical tests and self-reporting tests. What is what are mental health disorders? What is insanity? Are they merely physiological disorders of the brain or brain chemistry? If so, can these disorders be cured by restoring the balance of substances and secretions in this mysterious organ? And once equilibrium and homeostasis are reinstated and restored, is the illness gone or is it still lurking there under wraps, so to speak? Is the whole thing reversible? Is it waiting to reerupt? Are psychiatric problems inherited? Are they rooted in faulty genes, though amplified by environmental factors? Or are they brought on by abusive and wrong nurturers? nature versus nurture. Even these most basic questions are far from determined. These questions are the domain of the medical school of mental health. Others cling to the spiritual view of the human psyche, whatever that is. They believe that mental ailments amount to the metaphysical discomposure of an unknown medium akin to ether in physics 100 years ago. And this medium is the soul. Spiritual healers, spiritual thinkers believe in a or adopt a holistic approach taking in the patient in his or her entirety as well as the media the environment within which the patient contextually operates. The members of the functional school of mental health regard mental health disorders as perturbations disturbances in the proper statistically normal behaviors and man manifestations of so-cal healthy individuals. So functional school uses dysfunctions as the framework within which to describe mental health disorders. The sick individual he at ease with himself equally stonic or making others unhappy deviant. The sick individual is mended or fixed when rendered functional again by the prevailing standards of his social and cultural frame of reference. It's a mechanical approach akin to a garage or garage where you bring the patient in and there's a mechanic and the mechanic works on the patient. Not all kinds of cogs and wheels and nuts flying in the air and then the patient emerges from the garage fully fixed, healed and cured. In a way, these three schools um are akin to the trio of blind men. These blind men render disperate descriptions of the very same elephant. Still they share not only the subject matter which is the elephant but to a counterintuitively large degree they share a faulty methodology as a renowned anti anti-csychiatrist thus sus of the state university of New York as he wrote in his article the lying truths of psychiatry mental health scholars regardless of academic predelection infair the ethology of mental disorders from [snorts] the success or failure of treatment modalities and medications. They apply some treatment. They they give some medication and then if the symptoms disappear, they say, "Well, now we know what the disease disease is." If we know which parts of the brain the medication modifies or interferes with or intervenes in, we know where the disorder is and we even know what the disorder is. But of course this form of reverse engineering is methodologically very wrong. Um it is unprecedented also. We don't do this in other areas of science um like physics or it is this form of reverse engineering of scientific models is uh sometimes used in other fields and it is sometimes uh acceptable if but only if the experiments meet the criteria of the scientific method. What I'm trying to say is that the faulty methodology is because we can never replicate the same situations. We can never repeat the experiments. The theory must be the theory we have must be allincclusive, must be anomnetic, must be consistent, must be falsifiable, must be logically compatible, must be monovalent and must be parimonious. psychological theories, even the medical ones, the role of serotonin and dopamine in mood disorders, for example, all psychological theories are usually none of these things or satisfy a few of these conditions, but not all of them. So when we compare psychological theories to for example theories in physics, in both cases we might engage in reverse engineering, we might we might go from the outcomes of experiments to a theory. But when we do this in physics, it's because the experiment is replicable. Because we can repeat the same experiments all over the globe. Thousands of of scholars and researchers and academics can repeat the same experiment and get the same result. Not so in psychology. The outcome is a bewildering array of evershifting mental mental health so-called diagnosis expressly centered around western civilization and its standards. Um neurosis a historically fundamental condition literally vanished after the 1980s. Um, homosexuality according to the American Psychiatric Association was a pathology prior to 1973. BDSM bondage and sudden mazocistic sex was a pathology prior to the fifth edition of the diagnostic and statistical manual. So until 2013, 5 years ago, if you engage in BDSM, you were a deviant. You had a paraphilia, but afterwards you were totally normal. Seven years later, narcissism, seven years in 1918, narcissism was declared a personality disorder and that is almost seven decades after it was first described by Freud. It's a landscape of shifting values. Clinical entities don't behave this way. Tuberculosis was defined 200 years ago. It remained the same to this very to this very day. It wasn't taken in and out of medical manuals. And the situation is even much worse when we we try to deal when we deal with personality disorders. Personality disorders are an excellent example of the caladoscopic nature and landscape of objective psychiatry. The classification of axis 2 personality disorders deeply ingrained maladaptive lifelong behavior patterns all of them in the diagnostic and statistical manual. Um, this classification has come under sustained and serious criticism from its inception in 1952 in the first edition of the DSM. The DSM, the fourth edition, the fourth iteration and especially the text revision of the DSM adopted a categorical approach postulating that personality disorders are qualitatively distinct clinical syndromes. Page 689. And this is widely uh doubted and widely disputed and has been substantially modified in the fifth edition in 2013. Even the distinction made between normal and disordered personalities is increasingly being rejected. The diagnostic thresholds between normal and abnormal are neither absent are either absent or weakly supported. The polythetic form of the DSM's diagnostic criteria, the for the fact that only a subset of the criteria is adequate grounds for a diagnosis. This generates unacceptable diagnostic heterogeneity. In other words, people who are diagnosed with the same personality disorder may share only one criterion or even in extreme cases none. How is this possible? The diagnostic and statistical manual to this very day fails to clarify the exact relationship between axis 2 and axis one disorders and the way chronic childhood and developmental problems interact with personality disorders. The book contains little discussion of what distinguishes normal character or personality or personality traits or personality style according to Theod Millan. What distinguishes all these [clears throat] from personality disorders? Where is the threshold beyond which the personality is disordered? There's a death, a lack of documented clinical experience regarding both the disorders themselves and the utility of various treatment modalities. Numerous personality disorders are not otherwise specified. A catch all basket category. Cultural bias is evident in certain disorders such as borderline, antisocial, schizoypo. The emergence of dimensional alternatives to the categorical approach has been acknowledged even in the previous edition of the DSM. In page 689, it says, "An alternative to the categorical approach is a dimensional perspective that personality disorders represent maladaptive varants of personality traits that merge imperceptively into normality and into one another." Very helpful. But someone like Brian Leo received a a more lenient sentence for murdering his parents because he had narcissistic personality disorder. We don't even know what is a personality disorder. We don't even know whether Brian Blackwell was normal or not. And yet we have the audacity both as court as a court and as the psychiatric profession to claim that he he had diminished responsibility. The following issues are long neglected in the diagnostic and statistical man. Hopefully they will be tackled uh in future edition editions as well as in current research. But who knows their omission from official discourse hitherto is startling and telling the profession is avoiding its own shortcomings. There is an issue of the longitudinal course of the disorders the temporal stability from early childhood onwards. There is an issue of genetic and and biological underpinning of disorders. There is an issue of development of personality psychopathology during childhood and its emergence in adolescence. There is severe problem of coorbidity um of various disorders there. There's an issue of interactions between physical health and disease and personality disorders, effectiveness of various treatments, talk therapies, psychopharmarmacology etc etc. The field is utterly virgin I would say after decades of studies indeed the biochemistry and genetics of mental health is a very thorny issue. Certain mental health afflictions are either correlated with a statistically abnormal biochemical activity in the brain or they are ailerated with medication. Yet these two facts are not uh facets of the same underlying phenomena. In other words, that a given medicine reduces or abolishes certain symptoms does not necessarily mean that these symptoms were caused by the processes of substances affected by the drug administered. Causation is only one of many possible connections and chains of events. Correlation is another. A third event may have influenced both. To designate a pattern of behavior as a mental health disorder is a value judgment or at best a statistical observation. Such designation is affected is affected regardless of the facts or brain size. Moreover, as we just said, correlation is not causation. Deviant behav brain deviant uh body biochemistry u [clears throat] what used to be called in the 17th century polluted animal spirits. These exist but they are truly the but are they truly the roots of mental perversion. It is not clear what triggers what. Do the aarent neurochemistry or biochemistry, do they cause the mental illness or is it the other way around? Exactly. The mental illness causes the problems in biochemistry and and and neurochemistry. That psychoactive medication alters behavior and mood is indisputable of course but so do illicit and legal drugs. Uh certain foods food can be conceived as a form of medication but also interpersonal interactions. So there are changes in in uh behavior and mood. Environment affects behavior and mood incessantly. But that these changes were brought about by prescription and that this prescription is desirable. This is both debatable and total logical. Let me explain what I'm saying. What I'm saying is this. First you define mental illness, then you give a medication and then the medication works. You see you see medication is good but the medication is good because you started from a point that there is mental illness. You made a value judgment that me that the person is mentally ill and that mental illness is bad for the person and for his social media for his nearest and dearest for others. And it is because this value jud because of this value judgment that the medication is considered good or effective. Deviant um if a certain pattern of behavior is described as socially dysfunctional or psychologically sick. Clearly every change would be welcomed as healing and every agent of transformation would be called a cure. The same applies to the alleged heredity of mental illness. Uh you see the the the problem is that there is not enough information. Single genes or gene complexes are frequently and sensationally associated with mental health diagnosis, personality traits or with behavior patterns. But too little is known to establish irrefutable sequences of causes and effects. Even less is proven about the interaction of nature and nurture. genotype, infenotype, epigenetics, the plasticity of the brain, and the psychological impact of trauma, abuse, upbringing, role models, peers, and other environmental elements. We don't know enough. It's hubris and arrogance to claim otherwise. Nor is the distinction between psychotropic substances and talk therapy that clearcut. Words and interactions with the therapist also affect the brain, also change its chemistry, also change the re and rewire neural pathways, albeit more slowly perhaps, but but who knows? Maybe more profoundly, maybe more irreversibly. We simply don't know. Medicines as David Kaiser reminds us in against biological against biologic psychiatry medicines treat symptoms not the underlying processes that yield these symptoms. And there is the issue of the variance of mental disease. If mental illnesses are bodily, if they are empirical, they should be invariant both temporarily and spatially. They should also be invariant across cultures and societies. And this to some degree is indeed the case. But psychological diseases are not uh context dependent. But the pathizing of of certain behaviors is context dependent. Suicides, substance abuse, narcissism, homosexuality, eating disorders, antisocial wins, schizotypical symptoms, depression, even psychosis are considered sick by some cultures and utterly normative or advantageous in other cultures. And this was only to be expected. The human mind and its dysfunctions they all it's it's alike all around the world. But values differ from time to time from period to period and from one place to another. Hence disagreements about the propriety and desiraability of human actions and inaction. These are about to arise in a in a symptombased diagnostic system. You cannot purge, purify and exclude value judgment, cultural judgment and social judgment from any system of systematic diagnosis. Again, psychological diseases should not be context dependent, but pathologizing certain behavior is always context dependent and behavior is a pillar in diagnosing psych psychological diseases. As long as the pseudomedical definitions of mental health disorders continue continues to rely exclusively on signs and symptoms, in other words, on reported and observed behaviors, they remain vulnerable to such discord and devoid of much sought, universality, and scientific rigor. The mentally sick receive the same treatment as carriers of AIDS or SARS or the Ebola virus or smallpox. They are sometimes guaranteed against their will. It's called mental asylum. And they are coerced into involuntary treatment by medication, psychosurgery or electrocombulsive therapy. This is done in the name of the greater good largely as preventive or preemptive policy. Prophylactic conspiracy theories notwithstanding, it is impossible to ignore the enormous interests vested in psychiatry and especially in psychopharmarmacology. The multi-billion dollar industries involving drug companies, hospitals, managed healthcare, private clinics, academic departments, and law enforcement agencies. All these gigantic industries rely for their continued and exponential growth on the propagation of the concept of mental illness and its coronaries, treatment and research. I'm not saying that schizophrenia paranoia does not exist. Psychotic disorders, they exist. Of course, I'm not saying that people are not depressed. They are depressed. Major depressive episodes. I'm not denying the the reality of bipolar disorder or pathonia. That's not what I'm saying. I'm saying that there's a whole gray area and it is about 70% of all psychiatry and psychology. There's a whole gray area where diagnosis are not real uniform, monovent, invariant, immutable clinical entities. They are socially and culturally motivated value judgments. Abstract concepts form the core of all branches of human knowledge. No one has ever seen a quark. No one has ever untangled a chemical bond by hand. No one has surfed an electromagnetic wave or visited the unconscious. These are useful metaphors, theoretical entities with explanatory or descriptive power. Mental health disorders are no different. They are shorthand for capturing the unsettling quidity of the other. They are useful as taxonomies. They are also tools of social coercion and conformity as Michelle Fuko and Louie Aler observed. But relegating both the dangerous and the idiosyncratic to the collective fringes although it's a vital technique of social engineering it is not science and it should ne definitely should not permeate the court system. We should not bring the shortcomings and deficiencies of psychiatry and psychology and convert them off-handedly by slate of hand into a science. And we should not convince laymen such as judges, prosecutors, and defense attorneys that we know what we're talking about. In in the vast majority of cases, we don't. It's too soon, too early. Everything is it in its inception. It's just starting. The aim is progress through social cohesion and the regulation of innovation and creative destruction. I agree. Psychiatry therefore raifies society's preference of evolution to revolution. But in the worst case um it is as I said a tool of social coercion. it regulating social behavior and relegating dangerous elements, criminal elements to enclaves where they cannot harm society and sometimes even themselves. This is a noble cause and it should be unscrupulously and dogmatically pursued. But we should not call this science and we should not get ourselves confused. We should not convince ourselves in our own confabulation. Mental illness is a very fuzzy concept open to debate and should be the subject of decades if not centuries of further study before we make arrogant grandiose claims in courts universities or elsewhere like mental asylum. Thank you for listening. and I hope I haven't been too eoclastic for your taste. I am not a member of the anti-csychiatry movement. I believe in the validity of some of the constructs. I believe in the benefits that humanity can derive from these fields of study. But I am dead set against pretending that we have all the answers. We hardly started to ask the right questions. Thank you again. I'm Sam Bagn and I'm the author of malignant self- loveve narcissism revisited. Is the narcissist legally insane? Well, narcissists are not prone to irresistible impulses. They are also not prone to dissociation. They don't blank out stressful events and actions. Narcissists more or less fully control their behavior and acts at all times. But exerting control over one's conduct requires the investment of resources, both mental and physical. And narcissists regard such an investment as a waste of their precious time or even a humiliating chore. Lacking empathy, narcissists don't care about other people's feelings, needs, priorities, wishes, preferences, and boundaries. As a result, narcissists are awkward, tuckless, painful, tacit, abrasive, and insensitive. True, narcissists often have rage attacks and grandio fantasies. Most narcissists are also obsessive compulsive. Yet all narcissists should be held accountable to the vast and overwhelming majority of their actions at all times, even during the worst explosive episode. The narcissist can tell right from wrong and can re in his impulses. The narcissist impulse control, contrary to prevailing myths, is unimpaired. The narcissist pretends that he is not in control of his rage or his impulses. And he does that in order to terrorize, to manipulate and coers his human environment into compliance. [clears throat] The only things the narcissist cannot control are his grandio fantasies. All the same, the narcissist knows that lying and confabulating are morally wrong and sometimes legally wrong, and he can choose to refrain from doing so. The narcissist is perfectly capable of anticipating the consequences of his actions and their influence on others. Actually, narcissists are X-ray machines. They are very perceptive and very sensitive to the subtlest nuances of human behavior and body language. But the narcissist does not care. For him, humans are dispensable, rechargeable, reusable and interchangeable. Humans, people are there to fulfill a function. Supply the narcissist with narcissistic supply. They should give him adoration, admiration, adulation, approval, affirmation, attention. As far as a narcissist is concerned, people don't have an existence apart from carrying out their duties to him. So, it sounds like a clear-cut case. Narciss narcissist knows and can tell right from wrong. He can control his actions and explosive character and rage. He simply doesn't care to do so. But it is not as clear-cut as it sounds. Some scholars note correctly that many narcissists have no criminal intent men even when they commit criminal acts act. The narcissist may victimize, plunder, intimidate, and abuse others, but not in the cold, calculating manner of the psychopath. The narcissist hurts people, but he does it off-handedly, carelessly, and absent-mindedly. Narcissist is more like a force of nature or a beast of prey. Dangerous, but not purposeful, not evil. Psychopaths, on the other hand, on the other hand, are evil. They are sadistic. They usually enjoy what they are doing. Moreover, many narcissists don't feel responsible for their actions. They believe that they are victims of injustice, bias, prejudice, and discrimination. This is because they are shape shifters. They are actors. The narcissist is not one person, but two. The true self is as good as dead and buried. The force self changes so often in reactions in reaction to life circumstances that the narcissist has no sense of personal continuity. Therefore, a misdeed, a m misconduct, a [laughter] a felony, an aggressive act committed by the narcissist in one instance are disowned and disavowed by the narcissist in the next instance because he doesn't feel that he is the same person who has committed the act in the first place. I have written in my book malignant self- loveve narcissism revisited the narcissist's perception of his life and his existence is discontinuous. The narcissist is a walking compilation of personalities each with its own personal history. The narcissist does not feel that he is in any way related to his former selves. He therefore does not understand why he has to be punished for someone else's actions or inactions. This injustice surprises, hurts and enrages him. Pathological narcissism is on the border of dissociation. It's it resembles very much the old notion of multiple personality disorder. Only in this case there are two personalities. Brian Mark Blackle Blackwell is a British man. At the age of 18 years old, he killed his parents by stabbing and beating them with a carving knife and a claw hammer just to be on the safe side in their home near where else? Liverpool, England. That was in 2004. That's not someone you would like to spend a vacation with. [laughter] I assume his trial judge said that he would unlikely ever be safe enough to go free, but the judge has been repudiated because Blackwell was granted release on parole in 2016. Actually, the double murder charge was dropped after he pleaded guilty to the lesser charge of manslaughter and he was dropped because of diminished responsibility. Experts diagnosed him with narcissistic personality disorder and they said that he was not in his right mind to some extent. He was sentenced to life imprisonment in 2005. And this raises the question, should narcissistic personality disorder be considered a mitigating circumstance somehow [snorts] amilarate the crime committed or reduce the severity of a crime? Should narcissist, in other words, be held fully accountable for their actions? I will say with a suspense, my personal answer is yes. Absolutely. they should and without any absolutely any mitigation or amilaration of the charges. I will try to explain why in this relatively lengthy video. Otto Kernberg and many other scholars, myself included, claim that pathological narcissism is a form of psychosis or attenuated psychosis. That there is a confusion between internal objects and external objects. that there is hyperreflexivity, impaired reality testing, inability to tell apart reality from fantasy. And it's all very true. Add to this lack of impulse control, a totally inflated, fant fantastic, grandio self-concept, and these people are no longer with us. They're highly delusional. So why am I saying that they should be held accountable? Because as I've been telling you over many years, narcissists are responsive to their environments. They modify their behaviors. They're able to control their behaviors. They're able to turn their behaviors on and off depending on circumstances, on the presence of other people in their lives, on on social expectations, on goals, and so on and so forth. So for example, a narcissist in prison or in the army or in a hospital is very likely to suspend all narcissistic behaviors and to disable the expressions and manifestations of narcissistic traits. So this proves that narcissists have full control over their actions. They may not be aware and usually are not aware of their motivations and their psychonamics. They are completely at a loss regarding other people's emotions and social cues. They do have an impaired reality testing. But in total institutions and environments, the fear, the fear of being punished or assaulted breaks through and then they become pussycats. That means that narcissism, pathological narcissism or at least its behavioral expressions and manifestations are actually choices in my view. Okay. Narcissists are fully aware of behaviors not motivations but they have different valance. In other words, they attach different types of importance to certain behaviors. Whereas we for example could say that this behavior is seriously egregious. They are likely to not consider it as such. One of the reasons is that many narcissists are antisocial, but they also have aloplastic defenses. They tend to blame other people for their own misconduct or misbehavior and they often misjudge whether their actions are morally right or wrong. So yes, the narcissist is incapable of gauging or evaluating reality the way healthy normal people do. And yes, the narcissist is floating in space untethered and disconnected from reality. It's all true. And yet, as I said, narcissists are perfectly aware of their environment, their actions, the consequences of their actions, and therefore should be held legally accountable. They are not insane in the legal sense, though they are probably far um from sane from in the psychiatric point of view. So there's a legal sense of insanity um and there is a psychiatric sense of insanity. And whereas narcissists may be deemed insane psychiatrically speaking, they're definitely not insane legally speaking. And today I want to explore the legal argument for the narcissist insanity, reduced or diminished capacity, and consequently reduced or diminished responsibility for criminal acts. We start with self-awareness. Self-awareness is a self-focused attention which yields knowledge. It's a kind of exploratory attitude to oneself. I'm observing myself. I'm introspecting and I'm mining knowledge about myself. There's been a controversy which is still ongoing over whether non-human animals have self-awareness. But um there it's definitely true that most human beings are to some extent self-aware. Do not confuse self-awareness with insightfulness. Most people are not insightful. Insight simply means looking at yourself at a different from a different point of view regarding yourself not through yourself but through other people's eyes. And so insightfulness is closely linked to empathy whereas self-awareness is simply the awareness that you exist some basic things that are happening inside you and the lived experience the cumulative lived experience that give you the gives you the background for a cohesive theory of who you are. There's a theory of mind regarding other people, but there's a theory of your mind as well. An individual um uses a kind of internal mental mirror. I mentioned that self-awareness is predicated and premised on self focus. Self focus is the direction of conscious attention. When it is outwardly directed, it's one thing. And when it's inward inwardly directed directed [clears throat] at oneself, one's thoughts, needs, desires and emotions, that is what we call selffocus. [clears throat] Trait selffocus refers to a chronic habit or a pattern of self-consciousness. Whereas state selffocus refers to objective self-awareness. An excess of trait selffocus has been associated with the development of or with a heightened vulnerability to several mental health disorders such as alcohol use, depression, and anxiety disorders. So self-focused attention, it's the capacity of the individual to analyze and evaluate their own mental and emotional states. There is even a selfawareness theory or group of theories and these are theories that deal with the consequences of focusing attention on oneself. There are distinctions made between subjective self-awareness which arises directly from observation and experience of oneself. That is the source of perception on and behavior which is innate coming from the inside. And there is objective self-awareness which arises from comparison between oneself and the behaviors and attitudes and traits of others or some perceived standard for social correctness in any one of these areas. Internalized socialization, social mores, conventions and norms. Self-awareness therefore is triggered from the inside and can be triggered environmentally and socially. In the case of the narcissist, internal self-awareness is impaired. The narcissist is incapable of becoming fully self-aware of his or her own psychology. Uh the processes are in a way inaccessible to the narcissist. But narcissists are objectively self-aware. They are aware of the environment of society of expectations, norms, laws, regulations, mores, conventions etc. And they are definitely aware of the behaviors, traits and attitudes of others using cold empathy, a combination of cognitive and reflexive empathy. So their awareness while uh incomplete in the sense that subjective self-awareness is compromised is still sufficient to provide a feedback loop which would prove to be could prove to be or should prove to be regulatory. In other words, they can regulate their behaviors using cues from the outside, using information u from other people and society and the circumstances and the environment at large. This is a critical distinction. [clears throat] While introspection is very problematic in individuals with narcissistic personality disorder, the awareness of the outside world, the awareness of the external world is pretty heightened actually because narcissists are hypervigilant and they have paranoid ideiation. Introspection is a process of attempting to directly access one's own internal processes, judgments, perceptions or states. In the literature on attitudes, introspection is a process in which a person attempts to explain the reasons for holding a particular attitude, reaching a specific decisions, engaging in a particular behavior. All this is missing in nar in pathological narcissism. If you ask a narcissist, why did you do that? They're going to provide you with an external narrative or a narrative that involves the external world. That's why narcissists talk about themselves in third person singular. The narcissist would say, you know, Trump is doing this rather than I am Trump and I'm doing this. Okay. Introspectionism is a doctrine that the basic method of psychological investigation is or should be introspection. Historically, this approach was associated with the school of psychological structuralism. Structuralism is a movement and it's considered widely to have been the first school of psychology as a science or shall I say a pretention to science. Psychology used to be a part of philosophy and in many faculties throughout the world psychology is still uh a part of the department of philosophy. But Wilh Wilhelm Vunt the German in at the end of the 19th century tried to place psychology on a more scientific basis, more scientific grounds and it was later uh strongly uh influenced by Edward Bratford Titner um one of the founding fathers of psychology. So structuralism defines psychology as the study of mental experience and seeks to investigate the structure of such experience through a through a systematic program of experiments based on trained introspection and came to be known as structural psychology. And so the narcissist is incapable of a structural approach to his or her own experience. Narcissists in other words absent themselves. There's nobody there. There's no self. The self, the formation of the self has been disrupted in early childhood. And what's left is the interface. What people call the mask or the facade. What's left is the interface. And the main role of the interface. It is to self-enhance to butress and uphold and support and prove the veracity and extent and intensity of the self-concept. The self-concept which is inflated, fantastic, grandiose and unrealistic. This means that the narcissist excludes himself or herself from a [snorts] theory of the world and a theory of mind of the minds of other people. It's as if the narcissist is a disinterested machine-like observer, a device. And so whatever happens in reality, including the narcissist's own actions and the impacts these actions have on other people and on reality, all these are are perceived as a spectacle, something that is happening out there to be consumed by the narcissist as raw data. And this leads us to the issue of insanity. everything I've described many lay persons would say well he sounds or she sounds completely insane you know of their rockers and to a large extent that would be true there is a strong ingredient of component in pathological narcissism which renders a narcissist insane in many ways but not insane in the legal sense and so I would like to dwell now on the legal aspect of insanity. In the Mishna, the Babylonian Talmud, it says they say, "It is an ill thing to knock against a deaf mute, an imbecile reminder. He that wounds them is culpable. But if they wound him, they are not culpable." So [snorts] if mental illness is not an objective clinical entity, if mental illness is more culturally defined, it's a culture bound or culture dependent uh thing. If mental illness serves as an organizing social principle of inclusion and exclusion and social control, what should we make of the insanity defense? not guilty by reason of insanity and GRI. It is often lay persons often conflate and confuse insanity in psychiatry and insanity in law. They are not the same. They actually have very little in common. A person is held responsible for criminal actions if they cannot tell right from wrong or as the law says they lack substantial capacity either to appreciate the criminality wrongfulness of conduct then that is diminished capacity and or to appreciate that the conduct itself is criminal. So when a person is unable to realize that something they're doing is criminal, that's the first pillar of the insanity defense. And then the second pillar is that the person did not intend to act the way they did. There's an absent men. For example, a person who is in the throws of a compulsion, a person with a psychotic disorder who has been told by voices to do something. All the all these people not only did not appreciate the criminality of the act or the wrongfulness of the act, they were compelled to act. They there was no intentionality there and they could not control their behavior. Irresistible impulse. We'll come to it a bit later because modern legal systems dispensed with the irresistible impulse pillar altogether. The these handicaps are often associated with mental disease or mental defect or mental disorder or mental retardation. But this association is not relevant in the law that that these tests because these are tests that these tests these legal tests are statistically often associated with mental illness doesn't mean that mental illness automatically excuses culpability or creates uh ex excalpation or acquitt. Mental health professionals professionals talk about an impairment of a person's perception or understanding of reality. They hold a guilty but mentally ill verdict to be contradiction in terms. That's how psychiatrist see it, but not how lawyers and judges see this. All mentally ill people operate within a usually coherent worldview with consistent internal logic and rules of right and wrong. And yet these rarely conform to the way most people perceive the world. The mentally ill therefore cannot be guilty because they have a tenuous grasp on reality. So whereas a psychiatrist would say every seriously mentally ill person is not guilty by definition, the legal system imposes very strict tests and criteria that exceedingly few people can meet even when they are mentally ill. To a large extent this does not apply to intellectually challenged people but I will not deal with this now. So experience teaches us that a criminal may be mentally ill even as they commit a crime. We know this from experience. And yet they maintain a perfect reality test. This kind of person, however mentally ill, will be held criminally responsible. Consider Jeffrey Dharmmer for example. It's a perfect example. The perception and understanding of reality, in other words, can and does coexist even with the severest forms of mental illness. Where reality testing is compromised, for example, in narcissistic personality disorder, other tests should be applied. For example, were they aware of what they were doing? Uh did they anticipate the consequences of of their actions? Did they know right from wrong? They didn't know what they were doing was wrong. Even if someone is delusional, hallucinating under the influence of alcohol, for example, when they commit a crime, these are the critical questions, not how what was their state of mind, not whether they're mentally ill, not whether their mind was compromised by some substance. These are not relevant tests in in uh in in the legal framework with the exception of consent. There's an issue with consent but again I will not go into it. What and this makes it very difficult for lay persons to comprehend. I said but Jeffrey Dber is completely crazy and yet the courts decided he's not. I mean he's not he's not u legally insane. Psychiatrist said that he is insane. The courts decided he's not insane. It's very difficult to comprehend what is meant when we use the phrase mental disease or mental illness. If some people who are mentally ill maintain a grasp on reality, they know right from wrong. They can anticipate the outcomes of their actions. They're not subject to irresistible impulses. Um in what way do they differ from normal people, healthy people? This is why the insanity defense often sits ill with mental health pathologies deemed socially acceptable and normal. We have for example religion which is a delusional disorder. We have love which is addiction and addiction and yet these are considered to be perfectly okay socially. So do not confuse mental health and mental illness in psychiatry with mental health and mental illness in the legal system. Not guilty by reason of insanity with mental illness and mental health in culture and society where even mental illness can be legitimized as culturally acceptable behavior. And this leads us to the issue of criminal responsibility. A defendant's ability to formulate criminal intent menray at the time of the crime with which they are charged is a critical component of criminal responsibility. It must be proved in court before the person can be convicted. Criminal responsibility may be excluded for reasons of insanity, but it's again very rare. And it's not enough. You can't prove criminal intent by pointing to a general attitude or proclamations about general behavior. You need to link it to the specific crime. And if it is proven that the person is compromised somehow there is legal insanity there we then move to the territory Blackwell's territory of diminished capacity. The mage capacity is a legal defense in which a mental abnormality due for example to in intoxication or mental defect is claimed to have limited the defendant's ability to form the the requisite criminal intent men for a crime that they are charged. So diminished capacity simply means the person could not have formed the intent because for example they are completely divorced from reality or they cannot appreciate actions and reactions or they're intoxicated or they're under influence of substances or therefore could not make the connection. Menria is malicious requires malice. It's a blameworthy state of mind. Mensia means in Latin guilty mind. It must be proved in addition to the act the criminal act in order to establish criminal responsibility and secure a conviction and it must be proved in relation to a specific act not generally speaking. someone can be can make statements or be considered generally a bad person that doesn't enter the legal the legal argument or the legal system except in highly specific crimes. So men involves a conscious disregard for the law which is presumed to be known by the defendant. For some crimes, men swear may be recklessness or negligence rather than a deliberate intention to bring about certain consequences. And this is criminal intent. And it is distinct from the illegal act itself, the actus, the guilty act that combined with the criminal intent in committing it constitutes a crime. Where does insanity fits in in law? Insanity is a condition of the mind that renders a person incapable of being responsible for their criminal acts. Defendants who are found not guilty by reason of insanity lack criminal responsibility for their conduct. Whether a person is insane in this legal sense is determined by judges and juries, not by psychologist or psychiatrists. There are numerous legal standards for determining criminal responsibility. And the central issue in an insanity defense uh is that these legal standards are not aminable to the ministrations and diagnosis of psychiatrists and psychologists and they include the Durham rule, the American law institute model, penal code, insanity test and mcnotton rule. I will dwell upon all these shortly. Let's retrace. Not guilty by reason of insanity. A final judgment made in a court of law that a defendant has been found to lack the mental capacity to be held criminal criminally responsible for their actions. It's a plea usually entered by a defendant in a criminal trial indicating that they are non-composantes and so they are not responsible for the crime that they're charged with committing. I mentioned that earlier in the 19th century, big part of the 20th century, there was a test of irresistible impulse. The irresistible impulse rule, it's the in the United States, for example, this rule was commonly used for determining insanity. Defendants were judged to be insane and absorbed of criminal responsibility if there were unable to control their conduct even if and when they were aware that the conduct is wrong or criminal. Today this is no longer used as a test because the critical element is did you know what you were doing was wrong and despite knowing that it's wrong did you choose deliberately men with criminal intent did you choose this criminal conduct these are the these are the key the key tests were you capable of evaluating the rightness and wrongness And then was your action motivated by a choice that involved a pre an appreciation of reality, your place in it, your actions, the consequences of your actions, a reality, a view of reality. Diminish responsibility is a form of affirmative defense in which evidence of mental abnormality is presented. The idea is to mitigate or reduce a defendant's accountability for an act. It's not the same as insanity defense because insanity defense is a all orno perspectives regarding criminal responsibility whereas diminished responsibility or limited responsibility is a kind of halfway halfway house. The insanity defense in criminal law is a defense plea that an individual lacks criminal responsibility for their conduct. Now let's investigate how is this established in a court of law. Start with the McNorton rule. Um [snorts] it's a rule for defining insanity that focuses on the cognitive state of the defendant at the time of committing the act with which they are charged. It states that to plead insanity, the accused must be laboring under such a defect of reason, I'm quoting, from disease of the mind as not to know the nature and quality of the act he was doing, or if he did know it, he did not know that what he was doing was wrong. The Royal was established in 1843 by judges in England after the trial of Daniel McNorton who believed the government was persecuting him and killed Prime Minister Robert Peele's secretary Edward Drummond after mistaking him for Pill. The Durham rule is much later in time about 100 years later. The Durham rule was established in 1954. There was a ruling by the US Court of Appeals in a case involving a defendant uh whose name was Dirham. It stated that I'm quoting an accused is not criminally responsible if his unlawful act was the product of mental disease or mental defect. This rule was too expansive and opened the gates for multiple unsubstantiated claims. And so it was minimized or reframed by the American Law Institute model penal code insanity test. The Durham decision dur Durham test product rule were not very useful. The American Law Institute model penal code insanity tests is a legal standard for establishing criminal responsibility adopted in 1962. It combined elements of the McNorton rule and the irresistible impulse rule. According to this standard, individuals are not responsible for criminal conduct if mental illness or or defect rendered them either unable to understand at the time that what they were doing was against the law or unable to control their behavior enough to keep from breaking the law. This was also called the American Law Institute guidelines, ALI, ALI guidelines, the broader decision of the Broner rule. That was 1962. But again, it included the element of impulsivity or inability, lack of impulse control, in inability to resist an impulse. And that created a major issue because you could be according to this, you could be aware of your actions fully and their consequences. You could you would be able to tell that what you're doing is wrong or criminal. And yet, there was this nebulous test. I couldn't control myself and it opened the gates again to many to litigation which was criminal litigation which was problematic. So in 1984 the US Congress stepped in and formulated the insanity defense reform act or IDRA ID and it modified existing laws relating to insanity defense cases. A major modification involved removing the volitional component of the penal of the penal model the American law institute model penal code insanity test. So the voluitional component was removed so that the inability to conform one's conduct to the requirements of the law was no longer a factor in judging insanity. Another modification involved shifting the burden of proof, responsibility for convincing the court beyond reasonable doubt of the truth of an allegation in such cases from the prosecution to the defense. You're claiming you're crazy. You're claiming you're insane, legally insane. You have to prove it. This gave rise to a variety of partial midway solutions. Partial insanity. Marshall insanity is a borderline condition in which mental impairment or illness is present but is not sufficiently severe to render the individual completely irresponsible for their acts. In legal proceedings, a conclusion of partial insanity may arise when there is evidence that a mental disorder was probably a contributing cause to a defendant's criminal actions or that the disorder rendered the individual incapable of deliberation, premeditation, malice, or another mental state usually requisite for firstderee offenses. In such circumstances, partial insanity may lead to a conviction of for a lesser offense. And that was basically the argument uh in the case of Blackwell. I don't think the insanity defense should apply to people with narcissistic personality disorder, but there may be a case to argue that people with narcissistic personality disorder are partially insane. In other words, maybe a case, a legal case, case in law to argue that narcissists are not 100% sane. They're not 100% insane. They don't satisfy the the test for not guilty by reason of insanity, but they are also not sane. They're also not sane. So partial insanity the offenses should be lesser than first degree. And so this is an overview of the of the uh situation. I would like now to apply everything we have just learned. I would like now to apply this to a specific case and to show you how counterintuitive how counterintuitive the idea of insanity defense is when it comes to real life applications. And let's take the case of a mother. a mother who bashes the skulls of her three sons. She just caves the skulls in. Two of her sons die. She's arrested and she claims that she she has she claims to have acted on the instructions that she had received from God himself. God told me to do it. She is found not guilty by reason of insanity. The jury determined that she did not know right from wrong during the killings. I disagree with this. I think she should not have been exonerated or acquitted essentially based on NGRI. In other words, I think she did not satisfy the legal test for the insanity defense. While she is definitely insane, psychiatrically speaking, she she is not insane legally speaking. Let's examine my argument. Why exactly was she judged, adjudicated by her peers and the judge to be insane? Why did they decide that she's insane? Let's start with her belief in the existence of God. God is a being with inordinate and inhuman attributes. Clearly believing in God is both irrational and delusional. But does it constitute insanity in the strictest sense? It conforms to social and cultural creeds and codes of conduct in her millure. Billions of people faithfully subscribe to the same ideas, adhere to the same transcendental rules, observe the same mystical rituals, and claim to go through the same experiences. If it is psychosis, it is shared psychosis. It's so widespread that it can no longer be deemed pathological. Statistically speaking, it's kind of normatively validated. So, this could not be a reason to judge her insane. Okay, let's escalate. She spoke to God or actually she claimed that God has spoken to her. Has spoken to her. Numerous people claim this behavior that is considered psychotic. What used to be called paranoid schizophrenic behavior in other contexts is lorded and admired in religious circles. Hearing voices and seeing visions, auditory and visual hallucinations and delusions are considered rank manifestations of righteousness and sanctity in these circles. She was a religious person within a highly religious community. So the fact that God she claimed that God has spoken to her is insufficient to substantiate her insanity, her legal insanity. Next, perhaps it was the content of her hallucinations that proved her insane. She claimed that God had instructed her to kill her boys. Surely God could not ordain such evil. Would never give such an instruction. Alas, the Old and New Testaments both contain examples of God's appetite for human sacrifice, directly and indirectly. Abraham was ordered by God to sacrifice Isaac. his beloved son. Though this savage command was rescinded at the last moment, luckily for Isaac, Jesus, the son of God himself, was crucified to atone for the sins of humanity. God instructs Moses to kill everyone in Cananan and many Israelites who have sinned. A divine injunction to slay one's offspring actually sits well with the holy scriptures and the apocrypha as well as a millennia old Judeo-Christian traditions of martyrdom and sacrifice that in itself is insufficient to establish insanity because it is culturally congruent. It conforms to the culture. Okay. But her actions, we say, were wrong and incommensurate with both human and divine or natural laws. Yes, she her misconduct misconduct is is shocking, shattering, incredibly egregious. But her actions were perfectly in accord with a literal interpretation of certain divinely inspired texts, millennial scriptures, apocalyptic thought systems, and fundamentalist religious ideologies such as the ones espousing the imminence of rapture. Unless one declares these doctrines and these writings insane, which they are in my view, her actions are not insane. we are forced to the conclusion that the murderous mother is murderous but perfectly same. Her frame of reference is simply different to ours. Hence her definitions of right and wrong are idiosyncratic but valid within her ambiance within her millure within her circle. To her killing her babies was the right thing to do. and inconformity with valued teachings and her own epiphany. Her grasp of reality, the immediate and later consequences of of her actions was never impaired. It's just that her reality was different to ours. It would seem that sanity and insanity are relative terms, dependent on frames of cultural and social reference and statistically defined. There isn't and in principle can never emerge an objective medical scientific text test to determine mental health or disease unequivocally and definitely not to retroactively divine the state of mind of a criminal.