Much of the second half of this post is taken from a book chapter I co-authored with William Hirstein and Ty Fagan titled “Legal Insanity and Executive Function,” to appear in The Insanity Defense: Multidisciplinary Views on Its History, Trends, and Controversies, Palgrave Macmillan (White, M. Ed.). If you are interested in seeing citations for some of the claims made here, or in reading the chapter, please email me: firstname.lastname@example.org.
I had been in London trying to find a place to live for five days when I got an email from my mom’s best friend with the subject line “Emergency. Call home.” I planned to start my MPhil at King’s College London in a few weeks. I had an odd background for a student starting graduate work in philosophy – an undergraduate degree in psychology, and a JD – but I felt philosophy would allow me to do the research and writing I was unable to do as a government cog. After law school I worked as a criminal research analyst for the U.S. government. I wanted to study philosophy of mind and responsibility.
I called home from a payphone on busy Edgware Road. Cell phones weren’t so common in 2001, and I didn’t have one. I could barely hear my mom as she told me to put my friend on the phone over the traffic noise. My best friend Jeff had come with me to London to help me find a place. He listened, looked stricken, choked a bit, and then with the phone still in his hands, said “Your brother is dead. He was hit by a car. Scott is gone.”
We walked back to the roach-infested studio apartment we had found only the day before. I pulled out pictures of my brother – my only sibling, my playmate and confidant because we had moved so often – and looked at them. He had stopped on the way up to our lake house in the north woods of Wisconsin to help another motorist who had hit a dear and whose windshield had cracked. On the dark and hilly forest road a local dentist had struck him and killed him instantly. I felt so sad for him. He was only 24.
The hallucination started on the plane as I was flying back home to Chicago. I looked out the plane window and there he was, my brother, sitting gently on the wing of the plane. Clear as day. He didn’t look at me. He looked ahead, smiling. I didn’t tell Jeff what I had seen.
During the days before and after the funeral Scott often appeared. Sometimes I held the door open for him or held his hand when I thought nobody would notice. I saw him for about a year. He never spoke, or even looked at me directly. But he was there.
Or so part of my overwhelmed brain told me. But at the same time, I very clearly knew that he wasn’t there, and that I was having a hallucination due to the shock. As soon as I heard the news, I felt strongly that when Scott’s body stopped functioning, nothing of him was left: here, or anywhere else. I felt the banal truth of life and death very keenly straightaway – we are here one minute, and then poof. We are gone.
Maybe it was because of my psychology degree that I never felt afraid that my brain was malfunctioning. I figured it was, under the circumstances, a somewhat normal reaction. Although I was clearly seeing something that was not there, I knew it was not there, even though I sometimes acted like it was. In general, I had control over my behavior despite my false perception. I went to student orientation a week after the funeral, and then to lectures and tutorials like any normal student. I asked questions and studied for exams. I don’t think anyone in the department knew I was having mental problems. I didn’t act in a way that was embarrassing in public, except for the few times I had panic attacks on a busy street after a long day acting normal. The top-down control I had to execute all day long to act normal was exhausting, and walking home from school I often broke down. When I got home I went to bed.
The hallucination went away after about a year. I never took any medication, although when I was home over Christmas I saw a psychiatrist who diagnosed me with PTSD and said medication might help. I was almost sorry when I realized it had gone.
My experience with my brother’s death and my hallucination has profoundly shaped my philosophical study and views. After Scott’s death and under the influence of my Ph.D. supervisor I became a militant physicalist, and a non-eliminative reductionist. I came to believe that science is relevant to some of our most important philosophical questions, especially the question of who we should hold responsible. In my Ph.D. I began to explore the way in which scientific accounts of cognitive capacities might inform folk notions of who ought to be excused from criminal culpability.
My experience with my own mental illness taught me that false beliefs, or hallucinations or delusions, are not enough to excuse. A person like me, who knows they are having a false belief, and who can act in accordance with this knowledge, is fully culpable for her actions, hallucination or not.
It is a mistake to think that persons with serious mental illness, such as schizophrenia, are excused because they have persistent, even very intense hallucinations or delusions. Although legal insanity excuses are very rarely offered, and even less often successful, it is the case that schizophrenia is the mental illness most likely to ground a plea of incompetency or legal insanity. But schizophrenics have deficits not just in perception or representational systems; they often have deficits falling across almost all areas of executive function, including planning, attention, task shifting, and sequencing. Such deficits have been found not to track the severity of positive psychotic symptoms in schizophrenics; they persist even during periods of remission. Studies have found that patients with schizophrenia, compared to healthy controls and even to patients with bipolar disorder, evince significant and specific cortical inhibition deficits in the dorsolateral prefrontal cortex. These deficits include decreased cognitive processing speed, easily depleted sequencing capacity, difficulty multitasking, and decreased working memory – all of which indicate executive dysfunction.
The brain’s executive processes normally have the power to reject spurious perceptions and memories. Executive processes can correct for defects in perception and prevent distorted perceptions from being coined into beliefs, as mine did. I saw my brother, but I did not believe he was there. This distinction is crucial to mental competence. A person who is experiencing hallucinations is only mentally incompetent if she mistakes them for reality.
We all experience strange thoughts on occasion, such as the feeling that someone is watching us; or the odd notion that we had a causal influence on something where no reasonable physical explanation is available (for example, I flip a light switch and a car horn honks outside). The formation of a delusional belief, however, has at least two levels. First a spurious representation or thought is created, typically due to compromised perceptual or mnemonic faculties, but sometimes also traceable to the emotional systems. Secondly, there is an executive failure to properly assess the thought and reject it.
My case shows that even after rejection the false perception can persist. But my realization that the perception was false helped ensure I did not hurt myself or others by acting on the false representation when doing so would be odd or harmful.
I do not think there is something special about the way mental illness excuses. The presence of an illness or symptoms are not inherently exculpatory. Only a mental illness of the sort and severity that substantially degrades one’s executive function is exculpatory.