The Insanity Defense, The World Over

As a forensic clinician, I welcomed the opportunity to review this book; the title aroused my curiosity. I looked forward to the prospect of reading about how the insanity defense has evolved and is applied in different countries around the world.

The Insanity Defense, The World Over is part of Lexington Books’ series, Global Perspectives on Social Issues. The book will appeal to readers who are interested in criminology, sociology, and international relations; it is not a forensic mental health or legal text.

The authors’ stated goal was to examine and compare insanity defense criteria and procedures across 22 countries. The countries are divided into eight geographic regions: North America (Canada and the United States), South America (Argentina and Brazil), Western Europe (France, Germany, Great Britain, Italy, The Netherlands, and Sweden), Eastern Europe (Bulgaria, Hungary, Poland, and Russia), Middle East (Israel and Turkey), Asia (China, India, and Japan), Africa (Nigeria and South Africa), and the Pacific (Australia). In addition to describing the criteria for the insanity defense in each country, the authors proposed to report the burden and degree of proof required, whether the trier of fact is a judge or a jury, the role that experts play in the proceedings, the disposition of insanity acquittees, and how often insanity is proffered as a defense.

The chapters are well organized and follow a consistent format. A general introduction to each country is followed by an outline of the history of its legal system and a review of the current criminal code. The authors report the mental health laws of some, but not all, countries. When present, it is a useful resource. The chapters also contain a detailed review of how each country defines and interprets the insanity defense.

Although one of the book's strengths lies in its contribution to comparative social and international studies, I was surprised by the presence of minimal commentary on the social and cultural aspects of the insanity defense. An unaddressed reality is that mental health systems differ among countries and that the various degrees of adequacy and organization of the systems determine the level of care received by defendants and offenders who have mental disorders. In the chapter on China, the authors attempt to examine the connection between the insanity defense and the psychiatric abuse of political dissidents, but such analyses are notably absent in other sections of the book.

The authors meet all of their stated goals when they describe the laws and practices of countries that have well-developed forensic mental health systems (such as Great Britain, the United States, Canada, and Australia). The other chapters are unevenly handled.

I read this book hoping that I might be able to rely on the authors’ scholarship as a springboard for identifying and locating mental health law references for countries that have scant forensic psychiatric literature, such as Japan and India. It was disappointing, therefore, to find that more diligent research was not undertaken by the authors. In Chapter 13, which describes practices and laws in Hungary, a source is cited entitled the “History of Shock Therapy in Psychiatry,” taken from an Internet magazine called Brain and Mind. The citation in Chapter 20 of a newspaper article from the Japan Times that describes changes in that country's mental health system made me wonder about the accuracy of some of the book's contents. More thorough research among peer-reviewed sources would have enhanced the scholarship of the book.

The authors’ failure to determine the degree of proof necessary to meet insanity defense criteria in several countries, such as Italy and The Netherlands, is a major shortcoming of their book. From my perspective, such information could have been found in legal sources.

Although the authors proposed to help readers navigate the stormy waters of the criteria for the insanity defense from an explicitly comparative perspective, they failed to bring the reader home to port. Nevertheless, this is a relatively inexpensive volume that can fill a unique niche in a forensic mental health library. The major advantage of the book is that it summarizes the insanity defense in a format similar to that of a government briefing that provides a summary of psychiatric services rendered in a certain jurisdiction. Readers with broader expectations will be left wishing for more.

• American Academy of Psychiatry and the Law