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In the American criminal justice system, "insanity" enters into the equation in two separate ways. A defendant is constitutionally entitled to participate in his or her own defense. In certain situations, their competency to do so is obviously in question. So, a hearing is held to make that determination. Someone who is in a full blown catatonic state, for example, can't participate. Such a person goes into treatment, is suitably medicated, and then the process can hopefully begin.
Then there is the so called "insanity" defense. Certain specific standards have to be met. It's part of a defense attorney's job to make the case, but it almost never works, even in cases where I think it should work, and I'm the hanging prosecutor/judge type. That's because people don't understand or believe it. If the defendant knew the difference between right and wrong at the moment of the act, it doesn't apply, and very often juries don't find it. Also, the slightest indication of planning and rational thought destroys it.
One example where it should have applied was in a case where a woman in the throes of the worst postpartum depression ever recorded killed her young children. (It wasn't even postpartum depression; it was postpartum psychosis. Her crime so appalled the Texas jury that they just found her guilty. Ultimately, the case was retried as the medical evidence which had been ignored in the first trial showed that she was so ill she thought she was saving the children from some terrible state. The doctor who examined her after her arrest said he had never seen such a psychiatrically disassociated person. Of course, she'll probably never be free, nor does she seem to want to be, but at least she is in a humane psychiatric hospital. There are also cases, for example, where the person goes berserk,to use a very legal term, :) because of a brain tumor or something similar. You're not going to get cut any slack if you chose to take Meth and then commit some horrific crime.
I'm not saying that the rules should be so stringent. I do believe that some people have such diminished capacity that this should be a factor in charging, punishment etc. Sometimes juries also intervene. It's called jury nullification. A father whose child was raped planned to buy a shotgun and shoot the man, and he did it; no temporary insanity, nothing. The jury refused to convict and there was nothing to be done.
Non si fa il proprio dovere perchè qualcuno ci dica grazie, lo si fa per principio, per se stessi, per la propria dignità . Oriana Fallaci