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A Paragon for an Ethical Dilemma: the Mentally Ill and Justice



































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A human being is part of the whole, called by us Universe; a part limited in time and
space. He experiences himself, his thoughts and feelings as something separate from the
rest- a kind of optical delusion of his consciousness.
This delusion is a kind of prison for us, restricting us to our personal desires and affection
for a few persons nearest us.
Our task must be to free ourselves from this prison by widening our circle of compassion
to embrace all living creatures and the whole of nature in its beauty.
Nobody is able to achieve this completely but striving for such achievement is, in itself, a
part of the liberation and a foundation for inner security.
Albert Einstein (1905)
















A Paragon for an Ethical Dilemma: the Mentally Ill and Justice
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Ones mind being akin to a prison is not a notion that the layperson often
entertains. However, such a comparison can be readily understood when considering the
afflictions of the mentally ill. The delusions of our consciousness, such as obsessive,
irrational thinking, can induce a state of high stress. A stressful state can perpetuate ones
delusions leading to a downward spiral of self-imprisonment. Thankfully, the majority of
people have coping mechanisms in combination with reason to prevent delusional
thought from manifesting into unfounded action. Unfortunately, not all do. Mental
illness is complex, highly variable and only superficially understood. The delusions that
imprison the mentally ill implore compassion, but their actions unfortunately can lead to
fear and isolation from support systems and often society as a whole. Understanding
ones thoughts, feelings, and actions when they contradict our own or even invoke fear
and anger, can often prove to be a challenging, if not, impossible task. A lack of
understanding often leads to unfair judgment. The justice system attempts to eradicate
prejudice and provide an impartial, fair trial for all. However, how can one begin to fairly
judge the irrational actions of a person afflicted with a disorder that is only beginning to
be understood? Furthermore, is it morally right to judge these individuals in the same
manner that we judge an individual that commits a similar act in full consciousness
with malicious intent? This paper aims to examine a specific case that presents such a
predicament and relate said case to a broader ethical dilemma.
Ann and Craig McCain never could have predicted how difficult it was to raise
their son, Kenneth. Both parents loved Kenny desperately and had always agreed on
making parental decisions together in the best interest of their son. When Kenny was
thirteen, he began having trouble in school. His troubles were not academic, but rather
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behavioral. His parents began to notice severe social withdrawal not only at school, but
also at home. They rationalized the change in their son as a typically stage in adolescence
characterized by antisocial behavior, and rude, inappropriate responses and tones of
voice. At school, a young boy in Kennys class reported that he had not provoked Kenny
at all prior to Kenny punching him in his face and screaming, Stop following me! Leave
me alone! By the time Kenny was fourteen years old, several more similar violent
incidents had occurred. Craig had always been close to Kenny and confronted him about
his odd behavior and strange mannerisms. Kenny would not give his dad a
straightforward answer, but rather mocked Craig by repeating the end of his sentences
over and over again.
When Kenny was fifteen, Ann dragged her son to a psychologist. Within a few
months, the psychologist had diagnosed Kenny with undifferentiated schizophrenia. The
signs and symptoms of schizophrenia are diverse, but Kennys delusions, persecutory
behavior, disorganized thoughts, flat affected tone, as well as his mocking habit, known
as echolalia, are all common symptoms that present in schizophrenic patients (Andreasen
& Carpenter, 1993). The psychologist explained to Kennys parents that Kenny was
delusional. He had described to her non-bizarre and bizarre delusions that had been
occurring for a few years now. When his parents questioned the cause of the disorder, the
psychologist clarified that the cause and progression of the disease is not yet known
(Andreasen & Carpenter, 1993).
Clinical studies attempt to find heterogeneity in the physiology and anatomy of
patients brain structure. In fact, Kennys violent history could be related to his
neurophysiology. Studies have shown that male patients with schizophrenia that
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demonstrate a pattern of violent behavior perform poorly on assessments of orbitofrontal
functions as compared to schizophrenic males without a violent history. However, these
individuals also tend to perform better on neuropsychological tests targeting specific
executive functions (Naudts & Hodgins, 2005).
Anatomically, males with schizophrenia and a history of violent behavior have
large reductions in the volume of the amygdalae, structural abnormalities of the
orbitofrontal system, as well as slight reductions in volumes of the hippocampus.
Abnormalities in the amygdalae have been linked to reduced ability to express emotions
as well as recognize emotions in others and respond appropriately. Normal development
of the amygdalae is necessary for normal development of the orbitofrontal cortex. The
orbitofrontal cortex is responsible for inhibiting impulsive decision-making and behavior
for physiological anticipation of negative events (Naudts & Hodgins, 2005). Although
there are these few consistencies in neurophysiology that may provide insight into the
irrational, illogical, and impulsive behavior of individuals with schizophrenia, more often
than not, results are inconsistent. These inconsistencies further highlight how little is
known and understood about this mental illness. Overall, studies agree that more
neurological soft signs, or neurological abnormalities, are being found in patients with
schizophrenia as compared to healthy people (Varambally, Venkatasubramanian, &
Gangadhar, 2012). However, when specifically looking at patients displaying a pattern of
aggression, fewer neurological soft signs are found. Additionally, more abnormalities are
found in the orbitofrontal system and the hippocampus as compared to schizophrenic
patients with no history of violence (Naudts & Hodgins, 2005).
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Chronic stress has also been linked the development of schizophrenia among
genetically predisposed youth (Walker & Diphorio, 1997). High levels of stress at a
young age leads to chronically elevated levels of cortisol in the brain that can prove to be
toxic in areas such as the hippocampus and other neural structures related to executing
brain functioning (Stein-Behrens et. al., 1994). People with schizophrenia that also
display a history of violence and antisocial behavior at a young age, such as Kenny,
symptomatically display lowered stress reactivity and lower levels of cortisol than other
children (Lorber, 2005). Some hypothesize that this lowered stress reactivity protects
neural structures in such individuals and could explain why men with schizophrenia and a
history of aggression perform better on neurophysiological tests targeting executive brain
functioning (Naudts & Hodgins, 2005).
At first, Ann and Craig were reluctant to believe the diagnosis. It did not seem
possible to them that a few fights at school and a distant teenage boy could translate into
a serious mental disorder. However, the diagnosis seemed to lift a burden off Kennys
shoulders. He admitted to his parents that at age twelve he had started hearing voices.
When he was fourteen, his mind had begun to manifest friendships with people that
Kenny later realized were not there. Kenny did not fully understand the dangers or
potential downward progress of his disorder, but rather felt that it was simply a coping
mechanism to handle his difficulties making friends at school. Schizophrenia often
begins to affect individuals at a relatively young age (Andreasen & Carpenter, 1993). It
often leads to social and economic impairment throughout an individuals lifetime. Many
individuals suffer from severe depression and the mortality rate of those suffering from
the mental disorder is high (Andreasen & Carpenter, 1993). Unfortunately, it is not only
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the individual that agonizes a great deal, but also the family as is demonstrated in the case
of Kenny and his parents.
At seventeen, Kennys disorder had progressed to a point that his psychologist
had recommended a psychiatrist to Kennys parents. The psychologist had been working
with Kenny for a few years and felt that he would benefit from medication. Ann felt that
medication was unnecessary and drastic. She believed that homeopathic remedies,
counseling, and close monitoring of her sons disorder were the best possible solution.
Ann feared that medication might overpower her sons personality and have even worse
social ramifications than the underlying disorder.
The psychologists pleaded with Ann informing her that the effectiveness of
antipsychotic medications has been studied thoroughly. She explained that double-blind
studies have been conducted comparing the effects of one of the main antipsychotic
drugs, chlorpromazine, to a placebo (Davis, et. al., 1980). Not only did three-fourths of
the patients given the anti-psychotic drug show drastic improvement in a relatively short
period, but also, no patients deteriorated from the treatment (Davis, et. al., 1980). The
psychologist also noted that antipsychotic drugs have normalizing effects that do not
uniformly sedate the individual taking them. In other words, only if a patient suffers from
excitatory schizophrenic episodes then the medication will slow them down. On the
other hand, if a patient more akin to Kenny, whose illness tends to cause symptoms of
psychotic depression will feel more elated and less despondent (Davis, et. al., 1980).
Furthermore, two commonly observable symptoms of schizophrenia, including
disorganized thought processes and over-inclusive thinking that generates random,
inappropriate responses, were significantly decreased in medicated patients (Shimkunas,
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Gynther, and Smith 1966). Kennys psychologist argued that a decease in these
observable symptoms of schizophrenia would allow Kenny to interact with his peers in a
healthier manner and ultimately prevent further social ostracization. Unfortunately,
Kenny was not placed on medication to control his delusions and his disorder eventually
lead to a tragic event.
One hot Florida night, a young girl named Zoe Prewitt drove to a friends house
to stay the night. Zoe had recently moved to Florida to begin studying at the University of
Miami. Having grown up in Texas, Zoe did not know many people in Miami and was
currently living alone. Her father had suggested Zoe purchase a gun for safety purposes.
Zoe had researched the laws in Florida and found it fairly easy to obtain a concealed-
firearm permit. On the drive over to her friends house, Zoe noted that she felt uneasy
with the weapon in her purse, but agreed with her father that the gun would give her a
sense of safety and more likely than not, would never be fired.
On that same hot Florida night, Kenny had been having a particularly bad day
both real and imagined. Kenny began to walk for no particular reason. Paranoia was
making him anxious and delusional thoughts were taking control. No one can explain
Kennys decision to break into the house on the corner or the events that followed. Upon
breaking into the house, Kenny found Zoe and her friend and attempted to rape both girls.
His disorganized thought patterns and uncontrolled behavior was no match for Zoes
healthy brain. Zoe quickly grabbed the gun in her purse and ordered Kenny to stop.
Kenny stopped and stumbled toward the door. Zoe, petrified of the empty look in
Kennys eyes and his erratic, unpredictable behavior, shot Kenny before he reached the
exit. The wound was fatal. Kenny died within a few minutes.
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The story of Kenny McCain depicts a tragedy that is often seen with the
mentally ill. Zoe was a victim. Her actions are understandable and justifiable within the
scope of the law. However, Kenny was also a victim; a victim of his disorder that is still
struggling to be understood. Kenneths parents later filed a wrongful death suit in civil
court. However, Floridas castle doctrine laws state that defensive force is justifiable if
there is a reasonable fear of imminent peril to oneself or another. Zoe won the case, but
lost her sense of safety, and Kennys parents lost their son. When reviewing a case such
as this, one must consider an alternative ending. Ponder an alternative in which Kenny
reaches the exit before being shot and is later brought to court as the defendant. In this
version, should Kenny be punished for his actions? How should the justice system deal
with a defendant that did not only have no control of his or her actions, but also did not
truly understanding the reality of the situation at the time of the event?
The evolution of the laws concerning the mentally ill began in 1843 in Scotland
with a man named Daniel MNaghten (Bartol & Bartol, 2011). MNaghten shot a man he
believed to be the prime minister of a group that he believed was persecuting him. There
was not only no doubt that MNaghten had committed the crime, but also, no doubt that
he was delusional and mentally ill. Due to the MNaghten case, a cascade of laws
concerning the mentally ill began to evolve. The MNaghten Rule stated that one must
prove at the time of the crime one was affected by his mental illness to a point that there
was little to no connection between the action and mental cognition of said action.
Furthermore, if the defense did comprehend the action, then mental illness could be
utilized as a plea bargain if a fundamental understanding of right and wrong, in relation to
the action, was not present (Bartol & Bartol, 2011).
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The MNaghten rule was later questioned and revised. The complexity of mental
illness was not reflected in the simplicity of this law. For some mental disorders, an
understanding of right versus wrong is present, but the ability to control their actions is
not due to the characteristic impulsivity of their disorder and the lack of neurological
mechanisms to control such impulses. The Brawner Law, proposed in 1972, attempted to
expound on the previous laws and account for the impulsive nature characteristic of many
mental disorders (Bartol & Bartol, 2011). This law emphasized that anyone pleading not
guilty due to insanity must demonstrate that the disease directly influenced the
defendants mental and emotional processes or impaired his or her ability to control the
behavior. The ability to control the behavior allowed for admission of partial
responsibility, yet still exonerated the defense on the basis of lack of impulse control
despite cognition of right and wrong. However, in 1984, the insanity defense was once
again reformed. The Reform Act put more restrictions on the insanity plea and
specifically stated that certain personality disorders did not qualify as a mental disorder
applicable to the insanity plea. The Insanity Defense Reform Act abolished the idea that
the inability to control ones actions due to impulsivity is a sound excuse for ones
actions. It focused the law on a total lack of understanding of right and wrong as well as a
severe inability to comprehend the actions due to the mental illness at the time of the
event (Bartol & Bartol, 2011). Today, insanity standards are based primarily on two
criteria: irrationality and compulsivity. Irrationality refers to the defendants inability to
control his mental processes where as, compulsivity, refers to an inability to control ones
actions (Morse, 1986).
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The application of an insanity plea is based primarily on the mental diagnosis of
the defendant and secondarily on the severity of and repetition of the crime (Cochrane,
Grisso, & Frederick, 2001). Not all mental disorders are treated similarly in a court of
law. Historically, psychotic disorder, affective disorder, and mental retardation are more
likely to receive exoneration than other mental disorders (Cochrane, Grisso, & Frederick,
2001). Antisocial personality disorder, as seen in many psychopaths and sociopaths,
although a significant mental illness, is not viable when pleading not guilty by reason of
insanity (Warren, Rosenfeld, Fitch, & Hawk, 1997). This discrepancy is often due to the
repetitive nature of criminal behavior that is characteristic of psychopaths and sociopaths
as well as the severity and brutality of the crimes committed by this distinct
subpopulation. This exclusion, known as the caveat paragraph was recognized in 1972
in the Brawner Rule (Bartol & Bartol, 2011).
Once the defendant has successfully won a plea of not guilty due to reasons of
insanity, he or she is typically institutionalized for a period as long as, if not longer, than
the alternative sentencing to a general prison (Golding, Skeem, Roesch & Zapf, 1999). If
the defendant does not qualify for a plea of not guilty due to mental illness, then they are
judged in the same manner as a healthy person who commits a similar act in full
consciousness and placed in a jail or prison system. In 2004, it was reported that 10 to 15
percent of persons in jails and prisons have severe mental illnesses (Lamb, Weinberger,
& Gross, 2004). Unfortunately, the prison systems do not have the means or training to
identify or deal with the mentally ill.
The increasing number of mentally ill in jails and prisons is becoming an urgent
concern to the prison systems themselves, as well as the mental health professionals and
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the general public. Several explanations have been proposed for the latter trend. One of
the leading issues, relating to the increase of the mentally ill in the criminal justice
system, is the overcrowding of state mental hospitals leading to deinstitutionalization of
chronically and severely mentally ill persons (Lamb, Weinberger, & Gross, 2004). State
hospitals do not have the resources to hold mentally ill individuals for a long period of
time. The inadequate resources of the psychiatric facilities may directly result in more
mentally ill individuals being incarcerated. Another leading cause of the mentally ill
being incarcerated is a lack of community and familial support systems. People tend to
fear the unknown. The trend seen with the mentally ill is no different. Many individuals
are abandoned by their families and friends resulting in homelessness and/or
incarceration. Unfortunately, many persons coming into the criminal justice system have
never before had any type of mental health treatment. Furthermore, when released
mentally ill persons have trouble gaining access to mental health treatment within the
community (Lamb, Weinberger, & Gross, 2004).
The treatment of the mentally ill within the justice system is a complicated issue
with no clear-cut solution. Realistically, reforms to the justice system and the psychiatric
state hospitals would require a substantial financial investment. However, reform is
possible and increasingly necessary. There is an overwhelming obligation to increase
public education about the mentally ill which would lead to greater understanding and
compassion for those suffering from a mental disorder. With the implementation of
widespread education, the mentally ill and the families of the mentally ill would have
communal support. Police would be better equipped to recognize signs of mental illness
and could potentially prevent so many from ending up in jail or prison. Furthermore,
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more money and resources should be allocated to mental health facilities. If mental health
facilities were better equipped to deal with an increasing number of severely and
chronically mentally ill patients then less individuals would be incarcerated and the
burden of and resources required to house the mentally ill in the prison systems would be
decreased.
In conclusion, the story of Kenny McCain tragically is not an isolated case. Many
people are suffering from mental illness and are not receiving proper care or medications
to alleviate their signs and symptoms. Ultimately, we must widen our circle of
compassion. Although mental illness is only superficial understood, increasing public
awareness and education of what is currently understood would increase communal and
familial support and compassion. Increasing communal and familial support may directly
decrease the number of mentally ill individuals on the streets, leading to less violent
crimes committed by the mentally ill, and ultimately, a decrease of mentally ill
individuals in the justice system.









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