Abstract
Insanity acquittees are often (erroneously) believed to get away with murder. This article examines one possible cause of this view--that insanity acquittees may have, to various degrees, caused or exacerbated their own mental disorder in the first instance. Such a component of prior fault is illustrated with recourse to the putative insanity defense of Dr. Jekyll, who, while almost certainly not criminally responsible at the time he committed murder (in the guise of Mr. Hyde), was culpable for bringing about that nullification of responsibility (thereby causing the conditions of his own defense). Such culpability (also found in intoxication cases) is examined in relation to medication noncompliance in mentally disordered offenders, and possible solutions for dealing with "culpable madness" are presented.