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The Rorschach Test and Forensic Psychological Evaluation: Psychosis and the Insanity Defense
Marvin W. Acklin
Private Practice, Honolulu, HI

No area of the legal system and mental health law is more controversial than the question of criminal responsibility and the insanity defense. Societies have wrestled with how to hold individuals responsible for actions who have committed crimes whenthey were “out of their mind.” The commission of a criminal act, particularly a heinous crime that outrages the sensibilities of the community, generates demands for retribution. Nevertheless, legal systems since antiquity have made allowances for individuals who were “insane,” by whatever definition was culturally relevant and current at the time. Because the majority of criminal defendantsacquitted by reason of insanity are diagnosed as psychotic (Melton, Petrila, Poythress, & Slobogin, 1997), the chief focus here is on “psychosis.” It needs to be emphasized that psychosis is not simply tantamount to insanity, as will be seen in the discussion of criteria for the insanity defense. This chapter reviews fundamental legal constructs concerning criminal responsibility, describes psychosisas a clinical and forensically relevant phenomenon, reviews clinical and theoretical constructs relevant to understanding psychosis, reviews the utility of the Rorschach test in the assessment of psychotic mental states, and provides tactical and strategic issues in the forensic assessment of psychosis when the question of criminal responsibility is raised.
THE INSANITY DEFENSE

Historically,societies have developed a variety of “tests” for determining basic principles of rationality and moral responsibility. Criminal codes from the ancient Middle East, Greek and Roman antiquity, medieval Europe, pre-Norman England, and more recently, in Anglo-American law have defined the basic parameters of what constitutes sanity and definitional criteria for excusing individuals of criminalresponsibility when their actions were manifestly irrational (Robinson, 1996).
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ACKLIN

Modern jurisprudence on the insanity defense can be traced at least as far back as a 1505 case, which recorded a jury verdict of insanity (Perlin, 1989, p. 285). Since that time, judicial systems have struggled to define and refine standards of criminal responsibility necessary to exculpateindividuals from guilt in the commission of a criminal act when they were “not in their right mind.” In the early 18th-century, English judges began attempting to define for juries mental conditions that would excuse, as a matter of law, otherwise criminal behavior (Perlin, 1989, p. 286). The most significant case in the history of the insanity defense in England (1843) arose out of the shooting by DanielM’Naghten of Robert Drummond, the secretary of Prime Minister Robert Peel, M’Naghten’s intended victim. Based on his delusion that he had been persecuted by Peel and the Tory party, the jury found M’Naghten not guilty by reason of insanity. The M’Naghten decision established the fundamental conceptual basis for most subsequent insanity defense formulations, including the necessity of a threshold“mental disease or defect,” questions about the defendant’s knowledge or appreciation of the “nature and quality of the act,” and later, whether the individual was capable of fundamental selfcontrol. Bonnie (1983) asserts the foundational moral basis of the insanity defense and the centrality of the cognitive/rational impairment: “It is fundamentally wrong to condemn and punish a person whose rationalcontrol over his or her behavior was impaired by the incapacitating effects of severe mental illness” (pp. 194–195). Forensic mental health evaluations where there is a question of an insanity defense “require an investigation of the defendant’s mental state at the time of the offense (MSO)—a reconstruction of the defendant’s thought processes and behavior before and during the alleged crime...