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“INFINITY GOES UP ON TRIAL”: SANISM,
PRETEXTUALITY, AND THE REPRESENTATION
OF DEFENDANTS WITH MENTAL DISABILITIES
MICHAEL L PERLIN*
I INTRODUCTION
I begin by sharing a bit about my past. Before I became a professor, I spent 13 years as a lawyer
representing persons with mental disabilities, including three years in which my focus was
primarily on such individuals charged with crime. In this role, when I was Deputy Public Defender
in Mercer County (Trenton) NJ, I represented several hundred individuals at the maximum security
hospital for the criminally insane in New Jersey, both in individual cases, and in a class action
1
that implemented the then-recent US Supreme Court case of Jackson v Indiana,
2
that had declared
unconstitutional state policy that allowed for the indefinite commitment of pre-trial detainees in
maximum security forensic facilities if it were unlikely he would regain his capacity to stand trial
in the ‘foreseeable future.’
3
I continued to represent this population for a decade in my later positions as Director of the NJ
Division of Mental Health Advocacy and Special Counsel to the NJ Public Advocate. Also, as a
Public Defender, I represented at trial many defendants who were incompetent to stand trial, and
others who, although competent, pled not guilty by reason of insanity.
4
Finally, during the time
that I directed the Federal Litigation Clinic at New York Law School, I filed a brief on behalf of
appellant in Ake v Oklahoma,
5
on the right of an indigent defendant to an independent psychiatrist
to aid in the presentation of an insanity defence.
6
I have appeared in courts at every level from
police court to the US Supreme Court, in the latter ‘second-seating’ Strickland v Washington.
7
I
raise all this not to offer a short form of my biography, but to underscore that this article draws on
my experiences of years in trial courts and appellate courts as well as from decades of teaching
* Michael L Perlin AB (Rutgers University), JD (Columbia University School of Law), LLD (honorary) (John Jay
College of Criminal Justice), Professor Emeritus of Law; founding director, International Mental Disability Law
Reform Project; co-founder, New York Law School Mental Disability Law and Policy Associates.
1
Dixon v Cahill, No L30977/y-71 PW (NJ Super Ct Law Div 1973), reprinted in Michael L Perlin and Heather Ellis
Cucolo, Mental Disability Law: Civil and Criminal (Lexis Nexis, 3rd ed, 2016) § 19-8, 19-86 - 19-88, and discussed
in Michael L Perlin, ‘For the Misdemeanor Outlaw’: The Impact of the ADA on the Institutionalization of Criminal
Defendants with Mental Disabilities’ (2000) 52 Alabama Law Review 193, 20607.
2
406 US 715 (1972).
3
Ibid 738.
4
See eg, Michael L Perlin, ‘Mental Patient Advocacy by a Public Advocate’ (1982) 54 Psychiatric Quarterly 169.
5
470 US 68 (1986) (finding such a right).
6
Brief filed on behalf of amicus Committee on the Fundamental Rights and Equality of Ex-Patients (FREE)).
7
466 US 668 (1984), (establishing effectiveness of counsel standard in criminal cases; conduct so undermined the
proper function of the adversarial process that the trial court cannot be relied on as having produced a just result). In
this context, the term ‘second-seating’ is used to describe the person who sits at counsel table with – but does not
argue – the case in question.
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and of writing books and articles about the relationship between mental disability and the criminal
trial process.
8
And it was those experiences that have formed my opinions and my thoughts about
how society’s views of mental disability have poisoned the criminal justice system, all leading
directly to this paper, that will mostly be about what I call ‘sanism’ and what I call ‘pretextuality’.
The paper will also consider how these factors drive the behaviour of judges, jurors, prosecutors,
witnesses, and defence lawyers, whenever a person with a mental disability is charged with crime,
and about a potential remedy that might help eradicate this poison.
It is essential that lawyers representing criminal defendants with mental disabilities understand the
meanings and contexts of sanism and pretextuality
9
and to show how these two factors infect all
aspects of the criminal process, and offer some thoughts as to how they may be remediated.
10
I
believe – and I have been doing this work for over 40 years – that an understanding of these two
factors is absolutely essential to any understanding of how our criminal justice system works in
the context of this population, and how it is essential that criminal defence lawyers be in the front
lines of those seeking to eradicate the contamination of these poisons from our system.
11
I need to add: this is not all that is on the table. I believe that, in order to have any idea about why
our criminal justice system treats persons with mental disabilities the way it does, we also need to
understand the meaning of ‘heuristics’ and the meaning of (false) ‘ordinary common sense.’
12
I
believe that, if we do not come to grips with all of these factors, we are doomed to flail our arms,
swear colourfully and otherwise be stymied in our abilities to truly provide the most meaningful
representation for our clients that we can. In this article, I will then add some thoughts on these
two additional factors and why they need to be considered hand-in-glove with the rest of what I’m
explaining. I conclude by discussing the school of thought known as therapeutic jurisprudence
(‘TJ’),
13
and why – even though it has been criticised fairly severely by some criminal defence
lawyers
14
– I believe that it is the only way that we can strip the sanist and pretextual façade from
8
See, eg, Michael L Perlin, The Jurisprudence of the Insanity Defense (Carolina Academic Press, 1995); Michael L
Perlin, Mental Disability and the Death Penalty: the Shame of the States (Rowman and Littlefield, 2013); Michael L
Perlin, A Prescription for Dignity: Rethinking Criminal Justice and Mental Disability Law (Routledge, 2013); Michael
L Perlin and Heather Ellis Cucolo, Shaming the Constitution: the Detrimental Results of Sexualyl Violent Predator
Legislation (Temple University Press, 2017, forthcoming).
9
See infra text accompanying notes 3868. The word ‘sanism’ was, to the best of the author’s knowledge, coined by
Dr Morton Birnbaum. See also Morton Birnbaum, ‘The Right to Treatment: Some Comments on its Development, in
Medical, Moral and Legal Issues in Health Care’ in Frank J Ayd (ed), Medical, Moral and Legal Issues in Mental
Health Care (Williams and Wilkins, 1974) 97, 106-07; Koe v Califano 573 F 2d 761, 764 n12 (2d Cir 1978). The
word ‘pretextuality,’ in this context, was, to the best of the author’s knowledge, in his article Michael L Perlin,
‘Morality and Pretextuality, Psychiatry and Law: Of Ordinary Common Sense, Heuristic Reasoning, and Cognitive
Dissonance’ (1991) 19 The Bulletin of the American Academy of Psychiatry and the Law 131.
10
See, eg, Michael L Perlin, ‘Half-Wracked Prejudice Leaped Forth: Sanism, Pretextuality, and Why and How Mental
Disability Law Developed As It did’ (1999) 10 Journal of Contemporary Legal Issues 3; Michael L Perlin, ‘Pretexts
and Mental Disability Law: The Case of Competency’ (1993) 47 University of Miami Law Review 625.
11
Although the author is most familiar with the system in the US, his work ‘on the ground’ in other nations – including
Australia and New Zealand (and on all continents) – has made it clear to him that these observations are universal.
12
Perlin, ‘Half-Wracked Prejudice Leaped Forth’, above n 10, 320.
13
See infra test accompanying notes 114127; see generally, in this context, Perlin, A Prescription for Dignity, above
n 8.
14
See Mae C Quinn, ‘An RSVP to Professor Wexler’s Warm Therapeutic Jurisprudence Invitation to the Criminal
Defense Bar. Unable to Join You (Already (Somewhat Similarly) Engaged’ (2007) 48 Boston College Law Review
539.
“Infinity Goes Up On Trial”: Sanism, Pretextuality, and the Representation of Defendants with Mental
Disabilities
QUT Law Review 16 (3), December 2016 | 108
the criminal justice system and provide the best possible representation for criminal defendants
with mental disabilities.
My title comes, in part, from Nobel Prize-winner Bob Dylan’s brilliant song, Visions of Johanna,
as part of the verse that begins with these lines:
Inside the museums, infinity goes up on trial
Voices echo this is what salvation must be like after a while.
15
This song, ‘an undisputed masterpiece,’
16
is about, in part, nightmares and hallucinations.
17
Our
courtrooms – where contemporaneous understandings of mental illness and its relationship to
criminal behaviour are ignored, and where we repeat myths and shibboleths from the early 19th
century
18
are, in fact, museums of the past. There is no place for nuance; rather, the ‘infinite’
permutations that exist when people with mental disabilities commit inexplicable otherwise-
criminal acts is utterly ignored.
Writing some years ago about neonaticide cases, I said we ‘impose a dyadic straightjacket on
neonaticidal defendants. They are either crazy or they are evil.’
19
So it is with all defendants with
mental disabilities in the criminal process. Like ‘infinity’ in Dylan’s lyric, our entire criminal
justice system ‘goes up on trial.’
II ATTITUDES
20
To a great extent, my interest in sanism and pretextuality began at two separate points in time, both
in the 1970s, many years before I had heard of or thought of either word. As a ‘rookie’ Public
Defender in Trenton, New Jersey, I often filed motions to suppress evidence on behalf of my clients
in criminal cases, arguing that the police behaviour in seizing contraband (usually small amounts
of ‘street drugs’) violated the Fourth Amendment’s ban on ‘unreasonable searches and seizures.’
21
In almost all of these cases, the arresting officer’s testimony was basically the same: he would
testify that, when my client saw him coming, my client made a ‘furtive gesture,’ and then reached
into his pocket, took out a glassine envelope (filled with the illegal drug), and threw it on the
ground, blurting out, ‘That’s heroin [or whatever], and it’s mine.’ My client not surprisingly
told a different story: that the policeman approached him, stuck his hands into my client’s pockets,
pulled out the glassine envelope, and then placed my client under arrest.
22
15
Bob Dylan, Visions of Johanna (1966) <http://www.bobdylan.com/us/songs/visions-johanna>.
16
Oliver Trager, Keys to the Rain: The Definitive Bob Dylan Encyclopedia (Billboard Books, 2004) 654.
17
Robert Shelton, No Direction Home: The Life and Music of Bob Dylan (Hal Leonard, 1997) 213.
18
See eg, Isaac Ray, A Treatise on the Medical Jurisprudence of Insanity (Little Brown & Co, 1838).
19
Michael L Perlin, ‘She Breaks Just Like a Little Girl: Neonaticide, The Insanity Defense, and the Irrelevance of
Ordinary Common Sense’ (2003) 10 William and Mary Journal of Women and the Law 1, 27.
20
I self-consciously begin with this auto-biographical information as I think it creates the mise en scene that is
necessary for this article to make sense to those unfamiliar with the underlying issues.
21
This body of law, in the US, flows from the US Supreme Court decision in Mapp v Ohio, 367 US 643 (1961),
mandating the suppression of illegally-seized evidence.
22
Perlin, ‘Half-Wracked Prejudice Leaped Forth’, above n 10, 6.
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I had no doubt that my client was telling the truth. I suspected that the judge and the prosecutor
had the same intuition. Yet, in such ‘dropsy’ cases, the judge invariably found the police officer to
be more credible and would thus rule that the search came within the ‘plain view’ exception of
search and seizure law, upholding the search. It was no surprise to me years later when I read
Myron Orfield’s article (studying ‘dropsy’ cases in Chicago), reporting that eighty-six per cent of
judges, public defenders and prosecutors questioned (including seventy-seven per cent of judges)
believed that police officers fabricate evidence in ca se reports at least ‘some of the time,’ and that
a staggering ninety-two per cent (including ninety-one per cent of judges) believe that police
officers lie in court to avoid suppression of evidence at least ‘some of the time.
23
Although I did
not know it at the time, this was my first introduction to pretextuality in law.
My second introduction followed soon after, and involved questions of mental disability law.
Again, as the ‘rookie’ Public Defender, I was assigned to represent individuals at the Vroom
Building, New Jersey’s maximum security facility for the ‘criminally insane,’ on their applications
for writs of habeas corpus (the reason I came to file the class action so as to implement Jackson v
Indiana). The cases were to be charitable charades. The attorney-general asked the hospital
doctor two questions: was the patient mentally ill, and did he need treatment? The answers always
were ‘yes,’ and the writs were denied.
24
Some years later, after I became Director of New Jersey’s Division of Mental Health Advocacy, I
read a story in the New York Times magazine section that summarised for me many of the
frustrations of my job.
25
The article dealt with an ex-patient, Gerald Kerrigan, who wandered the
streets of the Upper West Side of Manhattan. Kerrigan never threatened or harmed anybody, but
he was described as ‘different,’ ‘off,’ ‘not right,’ somehow. It made other residents of that
neighbourhood traditionally home to one of the nation’s most liberal voting blocs nervous
to have him in the vicinity, and the story focused on the response of a community block association
to his presence. The story hinted darkly that the social ‘experimentation’ of deinstitutionalisation
was somehow the villain. Soon after that, I read an excerpt from Elizabeth Ashley’s autobiography
in New York magazine (a magazine read by many of those same Upper West Siders). Ashley a
prominent (and not unimportantly) strikingly attractive actress told of her institutionalisation in
one of New York City’s most esteemed private psychiatric hospitals and of her subsequent release
from that hospital to live with the equally-prominent actor George Peppard, and to co-star with
Robert Redford on Broadway in Barefoot in the Park.
26
Ashley was praised for her courage.
Kerrigan was emblematic of a major ‘social problem.’ Both were persons who had been diagnosed
with mental illness. Both of their mental illnesses were serious enough to require hospitalisation.
Both were subsequently released. Yet their stories are presented and read in entirely different
ways.
27
23
Myron W Orfield, ‘Deterrence, Perjury, and the Heater Factor: An Exclusionary Rule in the Chicago Criminal
Courts’ (1992) 63 University of Colorado Law Review 75, 100107, discussed in this context in Perlin, Pretexts and
Mental Disability Law, above n 10, 627.
24
Perlin, ‘Half-Wracked Prejudice Leaped Forth’, above n 10, 7.
25
Ibid 8.
26
Ibid.
27
Ibid.
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Disabilities
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Gerald Kerrigan’s story reflected to many the ‘failures of deinstitutionalisation’ and demonstrated
why the application of civil libertarian concepts to the involuntary civil commitment process was
a failure. Elizabeth Ashley’s story reflected the fortitude of a talented and gritty woman who had
the courage to ‘come out’ and share her battle with mental illness. No one discussed Gerald
Kerrigan’s autonomy values (or the quality of life in the institution from which he was released).
No one (in discussing Ashley’s case) characterised George Peppard’s condo as a
‘deinstitutionalisation facility’ or labelled starring in a Broadway smash as participation in an
‘aftercare program.’ Ashley was beautiful, talented and wealthy. And thus she was different.
Kerrigan was ‘different,’ but in a troubling way. But the connection between Kerrigan and Ashley
was never made.
28
Again, at about the same time, I read a short article by Morton Birnbaum
29
in which he discussed
what he called ‘sanism,’ how ‘sanism’ was like racism, sexism and other stereotyping ‘isms,’ and,
mostly, how ‘sanism’ part of our social ‘pathology of oppression’ controlled mental disability
law policy.
30
I remember, about forty years ago, the moment when I read Birnbaum’s essay, and how,
immediately, something simply ‘clicked.’ At that point in time, I had already represented this
population for several years, and I had grown accustomed to asides, snickers, and comments from
judges, to ‘eyerolling’ from my adversaries, to running monologue commentaries by bailiffs and
court clerks (all about my clients’ ‘oddness’). But I had never before consciously identified what
Birnbaum had been writing about: that this was all sanist behaviour on the part of the other
participants in the mental disability law system.
31
From that moment on, I began to think about
mental disability law in different ways. I had already tried to come to grips with its pretexts (the
charade of the Vroom Building hearings in the era before Jackson v Indiana, the comments of the
prosecutor if I were to raise an issue of my client’s competency to stand trial or criminal
responsibility, the voir dire responses from jurors when I sought to question them about their
attitudes towards criminal defendants with mental disabilities.
32
But this explanation began to flesh
out the picture in ways that, finally, enabled me to make sense of what was going on around me.
And, once I left practice and started teaching and writing more, I started writing about sanism and
pretextuality, and how these two factors again, hand in glove with heuristics
33
and ‘ordinary
28
See Michael L Perlin, ‘The Deinstitutionalization Myths: Old Wine in New Bottles’ in Karl Menninger and Heather
Watts (eds), Conference Report: The Second National Conference on the Legal Rights of the Mentally Disabled
(Kansas Bar Association, 1979) 20.
29
Morton Birnbaum, ‘The Right to Treatment: Some Comments on its Development’ Frank J Ayd (ed), Medical,
Moral and Legal Issues in Health Care (Williams and Wilkins, 1974) 97, 10607.
30
Ibid 107.
31
Perlin, ‘Half-Wracked Prejudice Leaped Forth’, above n 10, 9.
32
In the American system, prior to trial, judges (in some jurisdictions, this is done by the lawyers themselves) question
jurors to determine if there are reasons they should be challenged for cause or via what are called ‘preemptory
challenges’ in which lawyers are allowed to challenge a specific number of jurors (often without having to state
reasons). See eg Nancy S Marder and Valerie P Hans, ‘Introduction to Juries and Lay Participation: American
Perspectives and Global Trends’ (2015) 90 Chicago-Kent Law Review 789.
33
By way of example, the vividness heuristic is the cognitive-simplifying device through which a ‘single vivid,
memorable case overwhelms mountains of abstract, colorless data upon which rational choices should be made.’
Michael L Perlin, ‘“The Borderline Which Separated You from Me”: The Insanity Defense, the Authoritarian Spirit,
the Fear of Faking, and the Culture of Punishment’ (1997) 82 Iowa Law Review 1375, 1417.
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common sense’
34
controlled the practice (and the jurisprudence) of mental disability law,
specifically in cases involving criminal law and procedure.
35
I have looked at these issues in the
context of competency, of insanity, of trial practice, of sentencing, of sex offender law, and of the
death penalty.
36
It is always the same: we cannot begin to understand why our law has developed
as it has until we come to grips with the pernicious power of these two factors.
These factors cause us to make, and to reinforce, biased and irrational judgments, and doom us to
repeat the errors that we continue to make in the way we deal with questions that relate to the
representation of criminal defendants with mental disabilities. They also diminish the likelihood
that we will treat this population with the level of dignity that the law (and authentic common
sense) should demand.
37
III SANISM
Sanism infects both our jurisprudence and our lawyering practices. Sanism is largely invisible and
largely socially acceptable.
38
It is based predominantly upon stereotype, myth, superstition, and
deindividualisation,
39
and reflects the assumptions that are made by the legal system about persons
with mental disabilities — who they are, how they got that way, what makes them different, what
there is about them that lets society treat them differently, and whether their condition is
34
‘“[O]rdinary common sense” is a “prereflective attitude” exemplified by the attitude of “What I know is ‘self-
evident’”; it is “what everybody knows.”’ Keri K Gould and Michael L Perlin, ‘“Johnny’s in the Basement/Mixing
Up His Medicine”: Therapeutic Jurisprudence and Clinical Teaching’ (2000) 24 Seattle University Law Review 339,
357.
35
I continue to do this. See eg, Michael L Perlin, ‘God Said to Abraham/Kill Me a Son: Why the Insanity Defense
and the Incompetency Status Are Compatible with and Required by the Convention on the Rights of Persons with
Disabilities and Basic Principles of Therapeutic Jurisprudence’ (2016) American Criminal Law Review (forthcoming);
Michael L Perlin, ‘Your Corrupt Ways Had Finally Made You Blind’: Prosecutorial Misconduct and the Use of
‘Ethnic Adjustments’ in Death Penalty Cases of Defendants with Intellectual Disabilities’ (2016) 65 American
University Law Review 1437; Michael L Perlin, ‘Merchants and Thieves, Hungry for Power’: Prosecutorial
Misconduct and Passive Judicial Complicity in Death Penalty Trials of Defendants with Mental Disabilities’ (2016)
73 Washington and Lee Law Review 1501;Michael L Perlin and Alison J Lynch, ‘In the Wasteland of Your Mind:
Criminology, Scientific Discoveries and the Criminal Process’ (2016) 4 Virginia Journal of Criminal Law 304.
36
See generally, Perlin and Cucolo, ‘Shaming the Constitution’, above n 8; Perlin, A Prescription for Dignity, above
n 8; Michael L Perlin, The Hidden Prejudice: Mental Disability on Trial (APA, 2000). I have also looked at these in
the context of related civil law issues. See eg, Michael L Perlin and Alison J Lynch, Sexuality, Disability and the Law:
Beyond the Last Frontier? (Palgrave Macmillan, 2016); Michael L Perlin, ‘International Human Rights and
Institutional Forensic Psychiatry: The Core Issues’ in Birgit Völlm and Norbert Nedopil (eds), The Use of Coercive
Measures in Forensic Psychiatric Care: Legal, Ethical and Practical Challenges (Springer, 2016) 9; Michael L Perlin
and Naomi Weinstein, ‘Friend to the Martyr, a Friend to the Woman of Shame: Thinking About The Law, Shame and
Humiliation’ (2014) 24 Southern California Review of Law and Social Justice 1; Michael L Perlin, ‘The Ladder of
the Law Has No Top and No Bottom’: How Therapeutic Jurisprudence Can Give Life to International Human Rights
(2014) 37 International Journal of Law and Psychiatry 535.
37
Michael L Perlin, ‘A Law of Healing’ (2000) 68 University of Cincinnati Law Review 407; see also, Michael L
Perlin, ‘Understanding the Intersection between International Human Rights and Mental Disability Law: The Role of
Dignity’ in Bruce Arrigo and Heather Bersot (eds) in The Routledge Handbook of International Crime and Justice
Studies (Routledge, 2013) 191.
38
Michael L Perlin, ‘Everybody Is Making Love/Or Else Expecting Rain: Considering the Sexual Autonomy Rights
of Persons Institutionalized Because of Mental Disability in Forensic Hospitals and in Asia’ (2008) 83 University of
Washington Law Review 481, 486.
39
Ibid.
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immutable.
40
These assumptions — that reflect societal fears and apprehensions about mental
disability,
41
persons with mental disabilities,
42
and the possibility that any individual may become
mentally disabled
43
— ignore the most important question of all — why do we feel the way we do
about ‘these’ people (quotation marks understood)?
44
Decisionmaking in mental disability law cases is inspired by (and reflects) the same kinds of
irrational, unconscious, bias-driven stereotypes
45
and prejudices that are exhibited in racist, sexist,
homophobic, and religiously and ethnically bigoted decisionmaking.
46
Sanist decisionmaking
infects all branches of mental disability law – especially as it relates to questions of criminal law
and criminal procedure and distorts mental disability law jurisprudence.
47
Paradoxically, while
sanist decisions are frequently justified as being therapeutically based, sanism customarily results
in anti-therapeutic outcomes.
48
Significantly, we tend to ignore, subordinate, or trivialise behavioural research in this area,
especially when acknowledging that such research would be cognitively dissonant with our
intuitive (albeit empirically flawed) views. ‘Sensational media portrayals of mental illness’
exacerbate the underlying tensions. We believe that ‘[m]ental illness can be easily identified by
lay persons and matches up closely to popular media depictions.’ It is commonly assumed that
persons with mental illness cannot be trusted. Common stereotypes about people with mental
illness include the beliefs that they are invariably dangerous, unreliable, lazy, responsible for their
illness or otherwise blameworthy, faking or exaggerating their condition, or childlike and in need
of supervision or care.
Think about the sanist myths that dominate our legal system:
40
See eg, Martha Minow, Making All the Difference: Inclusion, Exclusion, and American Law (Cornell University
Press, 1990); Sander Gilman, Difference and Pathology: Stereotypes of Sexuality, Race and Madness (Cornell
University Press, 1985).
41
In US law, the phrase ‘mental disability’ generally includes both mental illness (psychosocial disability) and
intellectual disability.
42
See H Archibald Kaiser, ‘The Convention on the Rights of Persons with Disabilities: Beginning to Examine the
Implications for Canadian Lawyers’ Professional Responsibilities’ (2012) 20 Health Law Review 26.
43
See Michael L Perlin, ‘Competency, Deinstitutionalization, and Homelessness: A Story of Marginalization’ (1991)
28 Houston Law Review 63, 108 (on society’s fears of persons with mental disabilities), 93 (see n.174 (‘[W]hile race
and sex are immutable, we all can become mentally ill, homeless, or both. Perhaps this illuminates the level of
virulence we experience here’) (emphasis in original). Sex is immutable?
44
See eg, Marchell Goins, Kyneitres Good and Cori Harley, ‘Perceiving Others as Different: A Discussion on the
Stigmatization of the Mentally Ill’ (2010) 19 Annals of Health Law 441. On how sanism is more pernicious than other
stigmas, see Matthew Large and Christopher J Ryan, ‘Sanism, Stigma and the Belief in Dangerousness’ (2012) 46
Australian and New Zealand Journal of Psychiatry 1099.
45
See eg, Wim De Neys et al, ‘Biased but in Doubt: Conflict and Decision Confidence’ (2011) 6 Plos One 1. On
disability stereotypes in general, see Bradley A Areheart, ‘Disability Trouble’ (2011) 29 Yale Law and Policy Review
47.
46
See Perlin, ‘On Sanism’ (1992) 46 SMU Law Review 373, 37377.
47
On the ways that judges conceptualize mental disability professionals in forensic testimonial contexts, see Douglas
Mossman, ‘“Hired Guns,” “Whores,” and “Prostitutes”: Case Law References to Clinicians of Ill Repute’ (1999) 27
Journal of the American Academy of Psychiatry and Law 414.
48
See eg, David B Wexler, ‘Justice, Mental Health, and Therapeutic Jurisprudence, (1992) 40 Cleveland State Law
Review 517; David B Wexler (ed), Therapeutic Jurisprudence: The Law as a Therapeutic Agent (Carolina Academic
Press, 1990).
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1. Mentally ill individuals are ‘different,’ and, perhaps, less than human. They are erratic,
deviant, morally weak, sexually uncontrollable, emotionally unstable, superstitious, lazy,
ignorant and demonstrate a primitive morality. They lack the capacity to show love or
affection. They smell different from ‘normal’ individuals, and are somehow worth less.
2. Most mentally ill individuals are dangerous and frightening. They are invariably more
dangerous than non-mentally ill persons, and such dangerousness is easily and accurately
identified by experts. At best, people with mental disabilities are simple and content, like
children. Either parens patriae or police power supply a rationale for the institutionalisation
of all such individuals.
3. Mentally ill individuals are presumptively incompetent to participate in ‘normal’
activities, to make autonomous decisions about their lives (especially in areas involving
medical care), and to participate in the political arena.
4. If a person in treatment for mental illness declines to take prescribed antipsychotic
medication, that decision is an excellent predictor of (1) future dangerousness, and (2) need
for involuntary institutionalisation.
5. Mental illness can easily be identified by lay persons and matches up closely to popular
media depictions. It comports with our common sense notion of crazy behaviour.
6. It is, and should be, socially acceptable to use pejorative labels to describe and single
out people who are mentally ill; this singling out is not problematic in the way that the use
of pejorative labels to describe women, blacks, Jews or gays and lesbians might be.
7. Mentally ill individuals should be segregated in large, distant institutions because their
presence threatens the economic and social stability of residential communities.
8. The mentally disabled person charged with crime is presumptively the most dangerous
potential offender, as well as the most morally repugnant one. The insanity defence is used
frequently and improperly as a way for such individuals to beat the rap; insanity tests are
so lenient that virtually any mentally ill offender gets a free ticket through which to evade
criminal and personal responsibility. The insanity defence should be considered only when
the mentally ill person demonstrates objective evidence of mental illness.
9. Mentally disabled individuals simply don’t try hard enough. They give in too easily to
their basest instincts, and do not exercise appropriate self-restraint.
10. If ‘do-gooder,’ activist attorneys had not meddled in the lives of people with mental
disabilities, such individuals would be where they belong (in institutions), and all of us
would be better off. In fact, there’s no reason for courts to involve themselves in all mental
disability cases.
49
49
Michael L Perlin, ‘“Where the Winds Hit Heavy on the Borderline”: Mental Disability Law, Theory and Practice,
Us and Them’ (1998) 31 Loyola of Los Angeles Law Review 775, 78687.
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Disabilities
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Social science research confirms that mental illness is ‘one of the most if not the most
stigmatised of social conditions.’
50
Historically, individuals with psycho-social disabilities ‘have
been among the most excluded members of society... Research firmly establishes that people with
mental disabilities are subjected to greater prejudice than are people with physical disabilities.’
51
One might optimistically expect, though, that this gloomy picture should be subject to change
because of a renewed interest in the integration of social science and law, and greater public
awareness of defendants with mental disabilities…One might also expect that litigation and
legislation in these areas would draw on social science data in attempting to answer such questions
as the actual impact that deinstitutionalisation has had on homelessness, or whether experts can
knowledgeably testify about criminal responsibility in so-called ‘volitional prong’ insanity cases.
52
And yet, any attempt to place mental disability law jurisprudence in context results in confrontation
with a discordant reality: social science is rarely a coherent influence on mental disability law
doctrine.
53
Rather, the legal system selectively — teleologically either accepts or rejects social
science data depending on whether or not the use of that data meets the a priori needs of the legal
system. In other words, social science data is privileged when it supports the conclusion the fact
finder wishes to reach, but it is subordinated when it questions such a conclusion.
54
As discussed above, these ends are sanist. Further, judges are not immune from sanism.
‘[E]mbedded in the cultural presuppositions that engulf us all,’
55
judges reflect and project the
conventional morality of the community; judicial decisions in all areas of civil and criminal mental
disability law continue to reflect and perpetuate sanist stereotypes,
56
a global error that is most
critical in criminal law and procedure cases. Judges’ refusals to consider the meaning and realities
of mental illness cause them to act in what appears, at first blush, to be contradictory and
inconsistent ways. Teleologically, they privilege evidence of mental illness (where that privileging
50
Susan Stefan, Unequal Rights: Discrimination Against People with Mental Disabilities and the Americans with
Disabilities Act (APA, 2001) 45.
51
Michael E Waterstone and Michael Ashley Stein, ‘Disabling Prejudice’ (2008) 102 Northwestern University Law
Review 1351, 136364.
52
See, eg, Norman Finkel, ‘The Insanity Defense: A Comparison of Verdict Schemas’ (1991) 15 Law and Human
Behavior 533, 535; Richard Rogers, ‘APA’s Position on the Insanity Defense: Empiricism Versus Emotionalism’
(1987) 42 American Psychologist 840; Richard Rogers, ‘Assessment of Criminal Responsibility: Empirical Advances
and Unanswered Questions’ (1987) 17 Journal of Psychiatry and the Law 73.
53
See eg, Michael L Perlin, ‘Unpacking the Myths: The Symbolism Mythology of Insanity Defense Jurisprudence’
(198990) 40 Case Western Reserve Law Review 599, 658, n 256 (federal legislators ignored empirical evidence about
the insanity defense in the debate leading to the passage of the Insanity Defense Reform Act of 1984).
54
Michael L Perlin, ‘Baby, Look inside Your Mirror’: The Legal Profession’s Willful and Sanist Blindness to Lawyers
with Mental Disabilities (2008) 69 University of Pittsburgh Law Review 589, 599600. See eg, John Q La Fond and
Mary L Durham, Back to the Asylum: The Future of Mental Health Law and Policy in the United States (Oxford
University Press, 1992) 156: ‘Neoconservative insanity defense and civil commitment reforms value psychiatric
expertise when it contributes to the social control function of law and disparage it when it does not. In the criminal
justice system, psychiatrists are now viewed skeptically as accomplices of defense lawyers who get criminals “off the
hook” of responsibility. In the commitment system, however, they are more confidently seen as therapeutic helpers
who get patients “on the hook” of treatment and control. The result will be increased institutionalization of the mentally
ill and greater use of psychiatrists and other mental health professionals as powerful agents of social control.’
55
Anthony D’Amato, ‘Harmful Speech and the Culture of Indeterminacy’ (1991) 32 William and Mary Law Review
329, 332.
56
See Perlin, above n 406, 400404.
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serves what they perceive as a socially-beneficial value) or subordinate it (where that subordination
serves what they perceive as a similar value).
57
Judges are not the only sanist actors. Lawyers, legislators, jurors, and witnesses (both lay and
expert) all exhibit sanist traits and characteristics.
58
Until system ‘players’ confront the ways that
sanist biases (selectively incorporating or mis-incorporating social science data) inspire such
pretextual decision-making, mental disability jurisprudence will remain incoherent.
59
IV PRETEXTUALITY
Sanist attitudes lead to pretextual decisions. ‘Pretextuality’ means that courts accept (either
implicitly or explicitly) testimonial dishonesty and engage similarly in dishonest (and frequently
meretricious) decision-making, specifically where witnesses, especially expert witnesses, show a
high propensity to purposely distort their testimony in order to achieve desired ends.
60
This
pretextuality is poisonous; it infects all participants in the judicial system, breeds cynicism and
disrespect for the law, demeans participants, and reinforces shoddy lawyering, blasé judging, and,
at times, perjurious and/or corrupt testifying.
61
Pretextual devices such as condoning perjured testimony, distorting appellate readings of trial
testimony, subordinating statistically significant social science data, and enacting purportedly
prophylactic civil rights laws that have little or no ‘real world’ impact dominate the mental
disability law landscape.
62
Judges in mental disability law cases often take relevant literature out
of context,
63
misconstrue the data or evidence being offered,
64
and/or read such data selectively,
65
and/or inconsistently.
66
Other times, courts choose to flatly reject this data or ignore its existence.
67
In other circumstances, courts simply ‘rewrite’ factual records so as to avoid having to deal with
social science data that is cognitively dissonant with their view of how the world ‘ought to be.’
68
57
See La Fond and Durham, above n 54, 156.
58
Michael L Perlin and Keri K Gould, ‘Rashomon and the Criminal Law: Mental Disability and the Federal Sentencing
Guidelines’ (1995) 22 American Journal of Criminal Law 431, 443.
59
See Perlin, above n 53, 599–600.
60
See eg, ibid 602.
61
See Michael L Perlin, ‘“Through the Wild Cathedral Evening”: Barriers, Attitudes, Participatory Democracy,
Professor tenBroek, and the Rights of Persons with Mental Disabilities’ (2008) 13 Texas Journal on Civil Liberties
and Civil Rights 413, 41617.
62
Michael L Perlin, ‘“There’s No Success like Failure/and Failure’s No Success at All”: Exposing the Pretextuality
of Kansas v. Hendricks’ (1998) 92 Northwestern University Law Review 1247, 1257.
63
David Faigman, ‘Normative Constitutional Fact-Finding’: Exploring the Empirical Component of Constitutional
Interpretation (1991) 139 University of Pennsylvania Law Review 541, 577.
64
Ibid 581.
65
J Alexander Tanford, ‘The Limits of a Scientific Jurisprudence: The Supreme Court and Psychology’ (1990) 66
Indiana Law Journal 137, 153–54.
66
See, eg, Thomas Hafemeister and Gary Melton, ‘The Impact of Social Science Research on the Judiciary’ in Gary
Melton (ed) Reforming the Law: Impact of Child Development Research (Guilford Press, 1987) 27.
67
See, eg, Barefoot v Estelle, 463 US 880, 897–902 (1983), discussed in this context in Perlin and Cucolo, ‘Shaming
the Consitution’, above n 8.
68
The classic example is Chief Justice Burger’s opinion for the court in Parham v JR, 442 US 584, 605–10 (1979)
(approving more relaxed involuntary civil commitment procedures for juveniles than for adults). See, eg, Gail Perry
and Gary Melton, ‘Precedential Value of Judicial Notice of Social Facts: Parham as an Example’ (1984) 22 Journal
of Family Law 633 (critiquing Parham).
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Disabilities
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V HEURISTICS
Heuristics is a cognitive psychology construct that refers to the implicit thinking devices that
individuals use to simplify complex, information-processing tasks,
69
the use of which frequently
leads to distorted and systematically erroneous decisions,
70
and causes decision-makers to ‘ignore
or misuse items of rationally useful information.’
71
One single vivid, memorable case overwhelms
mountains of abstract, colourless data upon which rational choices should be made.
72
Empirical
studies reveal jurors’ susceptibility to the use of these devices.
73
Similarly, legal scholars are
notoriously slow to understand the way that the use of these devices affects the way individuals
think.
74
The use of heuristics ‘allows us to wilfully blind ourselves to the ‘grey areas’ of human
behaviour,’
75
and predispose ‘people to beliefs that accord with, or are heavily influenced by, their
prior experiences.’
76
Experts are similarly susceptible to heuristic biases,
77
specifically the seductive allure of
simplifying cognitive devices in their thinking; further, they frequently employ such heuristic
gambits as the vividness effect or attribution theory in their testimony.
78
Also, biases are more
likely to be negative; individuals retain and process negative information as opposed to positive
information.
79
Judges’ predispositions to employ the same sorts of heuristics as do expert witnesses
further contaminate the process.
80
By way of example, the vividness heuristic is ‘a cognitive-simplifying device through which a
‘single vivid, memorable case overwhelms mountains of abstract, colourless data upon which
rational choices should be made.’
81
Through the ‘availability’ heuristic, we judge the probability
or frequency of an event based upon the ease with which we recall it. Through the ‘typification’
heuristic, we characterise a current experience via reference to past stereotypic behaviour; through
the ‘attribution’ heuristic, we interpret a wide variety of additional information to reinforce pre-
69
See Michael L Perlin, ‘Psychodynamics and the Insanity Defense: Ordinary Common Sense and Heuristic
Reasoning’ (1990) 69 Nebraska Law Review 3, 1217.
70
See Michael J Saks and Robert F Kidd, ‘Human Information Processing and Adjudication: Trial by Heuristics’
(1980-81) 15 Law and Society Review 123.
71
John S Carroll and John W Payne, ‘The Psychology of the Parole Decision Process: A Joint Application of
Attribution Theory and Information-Processing Psychology’ in John S Carroll and John W Payne (eds) Cognition and
Social Behavior (Psychology Press, 1976) 13, 21.
72
David Rosenhan, ‘Psychological Realities and Judicial Policy’ (1984) 19 Stanford Law Review 10, 13.
73
Jonathan Koehler and Daniel Shaviro, ‘Veridical Verdicts: Increasing Verdict Accuracy Through the Use of Overtly
Probabilistic Evidence and Methods’ (1990) 75 Cornell Law Review 247, 264–65.
74
Thomas Tomlinson, ‘Pattern-Based Memory and the Writing Used to Refresh’ (1995) 73 Texas Law Review 1461,
1461–62.
75
Perlin, above n 19, 27.
76
Russell Covey, ‘Criminal Madness: Cultural Iconography and Insanity’ (2009) 61 Stanford Law Review 1375, 1381.
77
See Oren Perez, ‘Can Experts Be Trusted and What Can Be Done About It? Insights from the Biases and Heuristics
Literature’ in Alberto Alemanno and Anne-Lise Sibony (eds), Nudge and the Law: A European Perspective
(Bloomsbury, 2015).
78
Perlin, ‘Pretexts and Mental Disability Law’, above n 10, 60203: Michael L Perlin, ‘They Keep It All Hid’: The
Ghettoization of Mental Disability Law and its Implications for Legal Education (2010) 54 Saint Louis University
Law Journal 857, 87475.
79
Kenneth D Chestek, ‘Of Reptiles and Velcro: The Brain’s ‘Negative Bias’ and Persuasion’ (2015) 15 Nevada Law
Journal 605.
80
Perlin, ‘Pretexts and Mental Disability Law’, above n 10, 60203: Perlin, above n 78, 87475.
81
See Perlin, above n 33, 1417.
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existing stereotypes. Through the ‘hindsight bias,’ we exaggerate how easily we could have
predicted an event beforehand. Through the ‘outcome bias,’ we base our evaluation of a decision
on our evaluation of an outcome.
82
Through the ‘representative heuristic,’ we extrapolate
overconfidently based upon a small sample size of which they happen to be aware.
83
Through the
heuristic of ‘confirmation bias,’ people tend to favour ‘information that confirms their theory over
disconfirming information.’
84
It is impossible to understand the thrall in which the media portrayal of criminal defendants has
captured the public without understanding the pernicious power of these cognitive-simplifying
heuristics.
VI ‘ORDINARY COMMON SENSE’
‘Ordinary common sense’ (‘OCS’) is a ‘powerful unconscious animator of legal decision making.’
It is a psychological construct that reflects the level of the disparity between perception and reality
that regularly pervades the judiciary in deciding cases involving individuals with mental
disabilities .
85
OCS is self-referential and non-reflective: ‘I see it that way, therefore everyone sees
it that way; I see it that way, therefore that’s the way it is.’
86
It is supported by our reliance on a
series of heuristics-cognitive-simplifying devices that distort our abilities to rationally consider
information.
87
The positions frequently taken by former Chief Justice Rehnquist, Justice Scalia and Justice
Thomas in criminal procedure cases best highlight the power of OCS as an unconscious animator
of legal decision-making.
88
Such positions frequently demonstrate a total lack of awareness of the
underlying psychological issues and focus on such superficial issues as whether a putatively
mentally disabled criminal defendant bears a ‘normal appearance.’
89
These are not the first jurists to exhibit this sort of closed-mindedness. Trial judges will typically
say, ‘he (the defendant) doesn’t look sick to me,’ or, even more revealingly, ‘he is as healthy as
82
Michael L Perlin, ‘The Sanist Lives of Jurors in Death Penalty Cases: The Puzzling Role of Mitigating Mental
Disability Evidence’ (1994) 8 Notre Dame Journal of Law, Ethics and Public Policy 239, 256; see also n 86 of this
article (citing research sources).
83
See, eg, Amos Tversky and Daniel Kahneman, ‘Belief in the Law of Small Numbers’ (1971) 76 Psychological
Bulletin 105 , as discussed in Michael L Perlin, ‘“His Brain Has Been Mismanaged with Great Skill”: How Will
Jurors Respond to Neuroimaging Testimony in Insanity Defense Cases?’ (2009) 42 Akron Law Review 885, 898, n
89.
84
Alafair S Burke, Improving Prosecutorial Decision Making: Some Lessons of Cognitive Science (2006) 47 William
and Mary Law Review 1587, 1594, as discussed in Covey, above n 76, 1381, n 22.
85
Michael L Perlin, ‘Wisdom Is Thrown into Jail’: Using Therapeutic Jurisprudence to Remediate the Criminalization
of Persons with Mental Illness’ (2013) 17 Michigan State University Journal of Medicine and Law 343, 365, n 127.
86
Perlin, above n 18, 8.
87
Michael L Perlin, ‘“Simplify You, Classify You”: Stigma, Stereotypes and Civil Rights in Disability Classification
Systems’ (2009) 25 Georgia State University Law Review 607, 622.
88
Perlin, above n 19, 25.
89
Perlin, above n 78, 1418. See, eg, State Farm Fire & Cas Ltd v Wicka, 474 NW 2d 324, 327 (Minn, 1991), (stating
that both law and society are always more skeptical about a putatively mentally ill person who has a ‘normal
appearance’ or ‘doesn’t look sick’).
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you or me.’
90
In short, advocates of OCS believe that simply by using their OCS, jurists can
determine whether defendants conform to ‘popular images of “craziness.”’
91
If they do not, the
notion of a handicapping mental disability condition is flatly, and unthinkingly, rejected.
92
Such
views reflecting a false OCS are made even more pernicious by the fact that we ‘believe most
easily what [we] most fear and most desire.’
93
Thus, OCS presupposes two ‘self-evident’ truths:
‘First, everyone knows how to assess an individual’s behaviour. Second, everyone knows when to
blame someone for doing wrong.’
94
Reliance on OCS is one of the keys to an understanding of why and how, by way of example,
insanity defence jurisprudence has developed.
95
Not only is it prereflexive and self-evident, it is
also susceptible to precisely the type of idiosyncratic, reactive decision making that has
traditionally typified insanity defence legislation and litigation. Paradoxically, the insanity defence
is necessary precisely because it rebuts ‘common-sense everyday inferences about the meaning of
conduct.’
96
Empirical investigations corroborate the inappropriate application of OCS to insanity defence
decision-making. Judges ‘unconsciously express public feelings…reflect[ing] community
attitudes and biases because they are “close” to the community.’
97
Virtually no members of the
public can actually articulate what the substantive insanity defence test is. The public is seriously
misinformed about both the ‘extensiveness and consequences’ of an insanity defence plea.
98
And,
the public explicitly and consistently rejects any such defence substantively broader than the ‘wild
beast’ test.
99
Elsewhere, in discussing the insanity defence, I have stated,
Not only [are our insanity defence attitudes] ‘prereflexive’ and ‘self-evident,’ it is susceptible to
precisely the type of idiosyncratic, reactive decisionmaking that has traditionally typified insanity
defence legislation and litigation. It also ignores our rich, cultural, heterogenic fabric that makes
futile any attempt to establish a unitary level of OCS to govern decisionmaking in an area where
90
Perlin, above n 33, 147. By way of example, the trial judge in the US must seek a competency evaluation if s/he
believes there is a ‘bona fide’ question as to the defendant’s incompetency. See eg, Perlin, above n 85, 35859. Cases
are collected in Perlin and Cucolo, above n 1, § 13-1.2.2.
91
Perlin, ‘Pretexts and Mental Disability Law’, above n 10, a24.
92
Ibid.
93
Thomas D Barton, ‘Violence and the Collapse of Imagination’ (1996) 81 Iowa Law Review 1249, 1249 (book review
of Wendy Kaminer, It’s All the Rage: Crime and Culture (Basic Books, 1995)).
94
Michael L Perlin, ‘Myths, Realities, and the Political World: The Anthropology of Insanity Defense Attitudes’
(1996) 24 Bulletin of the American Academy of Psychiatry and the Law 5, 1617.
95
See generally, Perlin, The Jurisprudence of the Insanity Defense, above n 8.
96
Benjamin Sendor, ‘Crime as Communication: An Interpretative Theory of the Insanity Defense and the Mental
Elements of Crime’ (1986) 74 Georgetown Law Journal 1371, 1372. On the need for the retention of the insanity
defense, see Perlin, ‘God Said to Abraham/Kill Me a Son’, above n 35.
97
Perlin, above n 33, 1420.
98
Valerie Hans and Dan Slater, ‘“Plain Crazy”: Lay Definitions for Legal Insanity’ (1984) 7 International Journal of
Law and Psychiatry 105, 10506.
99
Caton F Roberts et al, ‘Implicit Theories of Criminal Responsibility: Decision Making and the Insanity Defense’
(1987) 11 Law and Human Behavior 207, 226.
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we have traditionally been willing to base substantive criminal law doctrine on medieval
conceptions of sin, redemption, and religiosity.
100
VII AS APPLIED IN THE CRIMINAL JUSTICE SYSTEM
This example of the relationship between OCS and the insanity defence is just the tip of the iceberg.
I have previously considered just about every aspect of the criminal trial and appellate process
from these perspectives, and in each instance, my conclusions are the same: these factors dominate
and contaminate the way the criminal trial system works, and it is absolutely essential that those
representing criminal defendants ‘get this’ so as to seek to revere and remediate this behaviour.
Here are some illustrative examples.
Sanism infects incompetency-to-stand-trial jurisprudence in at least four critical ways: (1) courts
resolutely adhere to the conviction that defendants regularly malinger and feign incompetency; (2)
courts stubbornly refuse to understand the distinction between incompetency to stand trial and
insanity, even though the two statuses involve different concepts, different standards, and different
points on the ‘time line’; (3) courts misunderstand the relationship between incompetency and
subsequent commitment, and fail to consider the lack of a necessary connection between post-
determination institutionalisation and appropriate treatment; and (4) courts regularly accept
patently inadequate expert testimony in incompetency to stand trial case.
101
Consider sanism’s impact on jurors in insanity cases: Juror attitudes consistently reflect ‘sanist’
thinking;
102
in insanity cases, jurors demonstrate what I have characterised as ‘irrational brutality,
prejudice, hostility, and hatred toward insanity pleaders.’
103
Think of some of the sanist myths
upon which jurors rely:
reliance on a fixed vision of popular, concrete, visual images of craziness;
an obsessive fear of feigned mental states;
a presumed absolute linkage between mental illness and dangerousness;
sanctioning of the death penalty in the case of mentally retarded defendants, some
defendants who are ‘substantially mentally impaired,’ or defendants who have been
found guilty but mentally ill (‘GBMI’);
the incessant confusion and conflation of substantive mental status tests; and
the regularity of sanist appeals by prosecutors in insanity defence summations,
arguing that insanity defences are easily faked, that insanity acquittees are often
immediately released, and that expert witnesses are readily duped.
104
Also consider how pretextuality relates to the insanity defence:
(T)he fear that defendants will fake the insanity defence to escape punishment continues to
paralyze the legal system in spite of an impressive array of empirical evidence that reveals (1) the
100
Perlin, ‘Pretexts and Mental Disability Law’, above n 10, 29.
101
Perlin, above n 1, 23536.
102
Perlin, above n 82, 257.
103
Perlin, The Jurisprudence of the Insanity Defense, above n 8, 317.
104
Perlin, above n 33, 1422; Perlin, above n 53, 64851.
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minuscule number of such cases, (2) the ease with which trained clinicians are usually able to
catch malingering in such cases, (3) the inverse greater likelihood that defendants, even at grave
peril to their life, will be more likely to try to convince examiners that they're not crazy, (4) the
high risk in pleading the insanity defence (leading to statistically significant greater prison terms
meted out to unsuccessful insanity pleaders), and (5) that most successful insanity pleaders remain
in maximum security facilities for a far greater length of time than they would have had they been
convicted on the underlying criminal indictment. In short, pretextuality dominates insanity defence
decisionmaking. The inability of judges to disregard public opinion and inquire into whether
defendants have had fair trials is both the root and the cause of pretextuality in insanity defence
jurisprudence.
105
Sentencing decisions are often pretextual. One example: In the case of a chronically depressed,
compulsive gambler under threats of violence to pay off his debts (apparently from organised
crime figures), the Sixth Circuit justified its rejection of a downward departure on the grounds that
the defendant could have ‘just said no.’ The court moralised: ‘He had the option of reporting the
threats he received to the authorities, of course, but he chose instead to engage in serious violations
of the law.’
106
And decision-making at the penalty phase of a death penalty trial bespeaks both sanism and
pretextuality.
107
Consider, for one notorious example, the improper use of mental disorders as an
aggravating factor at the punishment phase; is there any example more vivid than Dr James
Grigson’s typical performance as an example of pretextual testimony?
108
Elsewhere, I have said
this about sanism and the death penalty:
Sanism in the death penalty decision-making process mirrors sanism in the context of insanity
defence decision-making. Such decision-making is often irrational, rejecting empiricism, science,
psychology, and philosophy, and substituting in its place myth, stereotype, bias, and distortion. It
resists educational correction, demands punishment regardless of responsibility, and reifies
medievalist concepts based on fixed and absolute notions of good and evil and of right and
wrong.
109
And all of this must be contextualised with what we know about how heuristics and OCS similarly
contaminate these areas of practice. False OCS drives insanity defence practice; the vividness
heuristic leads to death penalty decisions and to incompetency determinations. One example:
Research reveals that, in determining the likely future dangerousness of defendants found
incompetent to stand trial, and thus in need of institutionalisation, ‘expert’ evaluations frequently
105
Perlin, above n 33, 1423.
106
United States v Hamilton, 949 F2d 190, 193 (6th Cir 1991). See generally, Michael L Perlin, ‘I Expected It to
Happen/I Knew He’d Lost Control’: The Impact of PTSD on Criminal Sentencing after the Promulgation of DSM-5’
(2015) Utah Law Review 881, 90607 (discussing Hamilton in this context).
107
Perlin and Cucolo, Shaming the Constitution, above n 8.
108
Michael L Perlin, ‘Therapeutic Jurisprudence: Understanding the Sanist and Pretextual Bases of Mental Disability
Law’ (1994) 20 New England Journal of Criminal and Civil Confinement 369, 37980. The author discusses the
‘scandalous’ story of Dr Grigson in, inter alia, Perlin, above n 35, 1440, 144748. Dr Grigson was known universally
in the US as ‘Dr Death.’ See, eg, Ron Rosenbaum, Travels with Dr Death and Other Unusual Investigations, (Penguin
Books, 1st ed, 1991) 206, (profiling Dr Grigson and referring to him as ‘the legendary forensic psychiatrist known as
“Dr. Death”’).
109
Michael L Perlin, ‘The Executioner’s Face Is Always Well-Hidden: The Role of Counsel and the Courts in
Determining Who Dies’ (1996) 41 New York Law School Law Review 201, 227.
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rely not on the examiners’ experience or knowledge but on the facts of the act upon which the
defendant was originally indicted (a blunder that, of course, ignores the fact that an incompetent
defendant may be factually innocent of the underlying charge).
110
Also, the valid and reliable
evidence informs us of discrepancies between the criteria actually employed by the examiners,
such as seriousness of the crime, and the criteria that the examiners reported as informing their
decisions, such as presence of impaired or delusional thinking.
111
I have written often about the impact of these factors on the representation of persons with mental
disabilities. Thirty years ago, in a survey of the role of counsel in cases involving individuals with
mental disabilities, Dr Robert L Sadoff and I observed:
Traditional, sporadically-appointed counsel … were unwilling to pursue necessary investigations,
lacked … expertise in mental health problems, and suffered from ‘rolelessness’, stemming from
near total capitulation to experts, hazily defined concepts of success/failure, inability to generate
professional or personal interest in the patient's dilemma, and lack of a clear definition of the
proper advocacy function. As a result, counsel … functioned ‘as no more than a clerk, ratifying
the events that transpired, rather than influencing them.’
112
The availability of adequate and effective counsel to represent this population both in criminal
and civil matters is largely illusory; in many jurisdictions, the level of representation remains
almost uniformly substandard, and, even within the same jurisdiction, the provision of counsel can
be ‘wildly inconsistent.’
113
Without the presence of effective counsel, substantive mental disability
law reform recommendations may turn into ‘an empty shell.’ Representation of mentally disabled
individuals falls far short of even the most minimal model of ‘client-centred counselling.’ What is
worse, few courts even seem to notice.
114
In short, we cannot begin to understand what happens in court in cases involving criminal
defendants with mental disabilities until we confront these poisons. I turn next to what I believe is
the only potential path to redemption.
VIII THERAPEUTIC JURISPRUDENCE
115
One of the most important legal theoretical developments of the past two decades has been the
creation and dynamic growth of therapeutic jurisprudence (‘TJ’).
116
Therapeutic jurisprudence
110
Perlin, ‘Pretexts and Mental Disability Law’, above n 10, 663.
111
Ibid 66364.
112
Michael L Perlin and Robert L Sadoff, ‘Ethical Issues in the Representation of Individuals in the Commitment
Process’ (1982) 45 Law and Contemporary Problems 161, 164.
113
Michael L Perlin, ‘“You Have Discussed Lepers and Crooks”: Sanism in Clinical Teaching’ (2003) 9 Clinical Law
Review 683, 690.
114
Ibid.
115
This section is generally adapted from Michael L Perlin, ‘Yonder Stands Your Orphan with His Gun’: The
International Human Rights and Therapeutic Jurisprudence Implications of Juvenile Punishment Schemes’ (2013) 46
Texas Tech Law Review 301 (2013); Michael L Perlin and Alison J Lynch, ‘All His Sexless Patients’: Persons with
Mental Disabilities and the Competence to Have Sex (2014) 89 Washington Law Review 257, and Perlin and Lynch,
above n 35. Further, it distills the author’s work over the past two decades, beginning with Michael L Perlin, What is
Therapeutic Jurisprudence? (1993) 10 New York Law School Journal of Human Rights 623.
116
See, eg, David B Wexler, Therapeutic Jurisprudence: The Law as a Therapeutic Agent (Carolina Academic Press,
1990); David B Wexler and Bruce J Winick, Law in a Therapeutic Key: Recent Developments in Therapeutic
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Disabilities
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recognises that the law potentially a therapeutic agent can have therapeutic or anti-therapeutic
consequences for individuals involved in both the civil and criminal justice systems.
117
It asks this
question: can or should legal rules, procedures, and lawyer roles be reshaped to enhance their
therapeutic potential while, at the same time not subordinating principles of due process?
118
From
the outset, one of the creators of this field of scholarship/theory has been clear: ‘the law’s use of
“mental health information to improve therapeutic functioning [cannot] impinge upon justice
concerns.”’
119
‘An inquiry into therapeutic outcomes does not mean that therapeutic concerns
trump’ civil rights and civil liberties.’
120
Therapeutic jurisprudence utilises socio-psychological insights into the law and its applications,
121
and is also part of a growing comprehensive movement in the law towards establishing more
humane and psychologically optimal ways of handling legal issues collaboratively, creatively, and
respectfully.
122
TJ has thus been described as ‘a sea-change in ethical thinking about the role of
lawa movement towards a more distinctly relational approach to the practice of lawwhich
emphasises psychological wellness over adversarial triumphalism’.
123
That is, therapeutic
jurisprudence supports an ethic of care.
124
Therapeutic jurisprudence and its practitioners place
great importance on the principle of a commitment to dignity.
125
Professor Amy Ronner describes
the ‘three Vs’: voice, validation and voluntariness,
126
arguing:
Jurisprudence (North Carolina Academic Press, 1996); Bruce J Winick, Civil Commitment: A Therapeutic
Jurisprudence Model (Carolina Academic Press, 2005); David B Wexler, ‘Two Decades of Therapeutic
Jurisprudence’ (2008) 24 Touro Law Review 17; Perlin and Cucolo, above n 1, § 26.
117
See Perlin, above n 83, 912; Kate Diesfeld and Ian Freckelton, ‘Mental Health Law and Therapeutic Jurisprudence’
in Ian Freckelton and Kate Peterson (eds) Disputes and Dilemmas in Health Law 91 (Federation Press, 2006) 91 (for
a transnational perspective).
118
Perlin, The Hidden Prejudice, above n 36; Perlin, above n 113.
119
David B Wexler, ‘Therapeutic Jurisprudence and Changing Concepts of Legal Scholarship’ (1993) 11 Behavioral
Sciences and the Law 17, 21. See also, eg, David Wexler, ‘Applying the Law Therapeutically’ (1996) 5 Applied and
Preventative Psychology 179.
120
Perlin, The Hidden Prejudice, above n 36, 412; Perlin, above n 49, 782.
121
Ian Freckelton, ‘Therapeutic Jurisprudence Misunderstood and Misrepresented: The Price and Risks of Influence’
(2008) 30 Thomas Jefferson Law Review 575, 582.
122
Susan Daicoff, ‘The Role of Therapeutic Jurisprudence Within The Comprehensive Law Movement’ in Daniel P
Stolle, David B Wexler and Bruce J Winick (eds), Practicing Therapeutic Jurisprudence: Law as a Helping
Profession’ (Carolina Academic Press, 2006) 365. On the relationship between therapeutic jurisprudence, procedural
justice and restorative justice, see generally, Perlin, A Prescription for Dignity, above n 8.
123
Warren Brookbanks, Therapeutic Jurisprudence: Conceiving an Ethical Framework (2001) 8 Journal of Law and
Medicine 328, 32930.
124
See eg, Bruce J Winick and David B Wexler, ‘The Use of Therapeutic Jurisprudence in Law School Clinical
Education: Transforming the Criminal Law Clinic (2006) 13 Clinical Law Review 605, 60507; David B Wexler, Not
Such a Party Pooper: An Attempt to Accommodate (Many of) Professor Quinn’s Concerns about Therapeutic
Jurisprudence Criminal Defense Lawyering (2007) 48 Boston College Law Review 597, 599; Brookbanks, above n
123. The use of the phrase dates to Carol Gilligan, In a Different Voice (Harvard University Press, 1982).
125
See Bruce J Winick, Civil Commitment: A Therapeutic Jurisprudence Model (Carolina Academic Press, 2005)
161. See generally, Perlin, A Prescription for Dignity, above n 8; Michael L Perlin, ‘There Are No Trials Inside the
Gates of Eden’: Mental Health Courts, the Convention on the Rights of Persons with Disabilities, Dignity, and the
Promise of Therapeutic Jurisprudence’ in Bernadette McSherry and Ian Freckelton (eds) Coercive Care: Law and
Policy (Routledge, 2013) 193.
126
Amy D Ronner, ‘The Learned-Helpless Lawyer: Clinical Legal Education and Therapeutic Jurisprudence as
Antidotes to Bartleby Syndrome’ (2008) 24 Touro Law Review 601, 627. On the importance of ‘voice,’ see also,
Freckelton, above n 121, 588.
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What ‘the three Vs’ commend is pretty basic: litigants must have a sense of voice or a chance to
tell their story to a decision maker. If that litigant feels that the tribunal has genuinely listened to,
heard, and taken seriously the litigant’s story, the litigant feels a sense of validation. When litigants
emerge from a legal proceeding with a sense of voice and validation, they are more at peace with
the outcome. Voice and validation create a sense of voluntary participation, one in which the
litigant experiences the proceeding as less coercive. Specifically, the feeling on the part of litigants
that they voluntarily partook in the very process that engendered the end result or the very judicial
pronunciation that affects their own lives can initiate healing and bring about improved behaviour
in the future. In general, human beings prosper when they feel that they are making, or at least
participating in, their own decisions.
127
A The Significance of Dignity
128
It is also necessary to focus more closely on TJ’s commitment to dignity, and to consider the
meaning of dignity in the legal process.
129
Treating people with dignity and respect makes them
more likely to view procedures as fair and the motives behind law enforcement’s actions as well-
meaning.
130
What individuals want most ‘is a process that allows them to participate, seeks to merit
their trust, and treats them with dignity and respect.’
131
The right to dignity is memorialised in
many state constitutions,
132
in multiple international human rights documents,
133
and in judicial
opinions.
134
It is important to note that, in several landmark decisions, the US Supreme Court has struck down
both criminal and civil statutes that humiliate and shame.
135
With these cases, the Court has
acknowledged the importance of the role of dignity.
136
Elsewhere, the Court has specifically
recognised the shame that can result when dignity is not present. In Indiana v Edwards, the Court
held that ‘a right of self-representation at trial will not ‘affirm the dignity’ of a defendant who lacks
the mental capacity to conduct his defence without the assistance of counsel.’
137
The Court stated
that ‘to the contrary, given that defendant's uncertain mental state, the spectacle that could well
127
Amy D Ronner, Songs of Validation, Voice, and Voluntary Participation: Therapeutic Jurisprudence, Miranda and
Juveniles’ (2002) 71 University of Cincinnati Law Review 89, 9495; See generally, Amy D Ronner, Law, Literature
and Therapeutic Jurisprudence (Carolina Academic Press, 2010).
128
This section is partially adapted from. Perlin and Lynch, above n 36, 14749.
129
See generally, Perlin, A Prescription for Dignity, above n 8.
130
See eg, Tamar Birckhead, ‘Toward a Theory of Procedural Justice for Juveniles’ (2009) 57 Buffalo Law Review
1147.
131
Luther T Munford, ‘The Peacemaker Test: Designing Legal Rights To Reduce Legal Warfare’ (2007) 12 Harvard
Negotiation Law Review 377.
132
See John D Castiglione, ‘Human Dignity under the Fourth Amendment’ (2008) 4 Wisconsin Law Review 655.
133
See Astrid Birgden and Michael L Perlin, ‘Where the Home in the Valley Meets the Damp Dirty Prison’: A Human
Rights Perspective on Therapeutic Jurisprudence and the Role of Forensic Psychologists in Correctional Settings’
(2009) 14 Aggression & Violent Behavior 256.
134
See Erin Daly, ‘Human Dignity in the Roberts Court: A Story of Inchoate Institutions, Autonomous Individuals,
and the Reluctant Recognition of a Right’ (2011) 37 Ohio Northern University Law Review 381.
135
Perlin and Weinstein, above n 36, 1619.
136
See, eg, Lawrence v Texas, 539 US 558, 57879 (2003).
137
Indiana v Edwards, 554 US 164, 176 (2008) (citing McKaskle v Wiggins, 465 US 168, 17677 (1984) (finding a
pro se defendant's Sixth Amendment right to conduct his own defense was not violated by unsolicited participation of
standby counsel)).
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result from his self-representation at trial is at least as likely to prove humiliating as ennobling.’
138
So, what is the value of TJ in this context? I have argued in the past that it can be used as a
‘redemptive tool in efforts to combat sanism, as a means of strip[ping] bare the law’s sanist
façade.’
139
The founders of therapeutic jurisprudence – David Wexler and Bruce Winick – have
written about how the current insanity acquittee retention system and the entire incompetency
system violate basic TJ tenets.
140
Let me consider these issues in more depth solely from the
perspective of the insanity defence to make my points more clearly.
I have been critical (and remain critical) of the ways that insanity acquittee release/ recommitment
hearings have been conducted (on issues ranging from the lack of adequate counsel to the
perfunctory ways judges treat these matters to the sanism and pretextuality reflected in the
positions of prosecutors in their efforts to oppose lessening of restraints or changes of conditions
of confinement or release).
141
On the question of whether the defence is consonant with TJ
principles, I draw on the words of my hero, the late Judge David Bazelon: ‘By declaring a small
number not responsible, we emphasize the responsibility of others,’
142
concluding that ‘the
existence of the defence gives coherence to the entire fabric of criminal sentencing.’
143
By
punishing nonresponsible defendants, ‘we diminish all the rationales of punishment of the others
whom we believe to be responsible for their crimes.’
144
Indeed, in Clark v Arizona,
145
holding that a state’s insanity test that was couched solely in terms
of capacity to tell whether an act is right or wrong did not violate due process,
146
the Supreme
Court came perilously close to condoning the punishment of such nonresponsible defendants. In
criticising that decision, I have said:
Almost 25 years ago, Judge David Bazelon, writing in the American Psychologist, argued that the
courts should ‘open the courthouse doors’ to mental health professionals, warning that they should
‘never hand over the keys.’
147
They may now not be slammed shut, but it is fair to say that after
Clark, Judge Bazelon’s dreams have now been, for the foreseeable future, dashed.
148
138
Indiana v Edwards, 554 US 164, 176 (2008). See Perlin and Cucolo, above n 1, §2-6.3.2 (The Supreme Court’s
focus on dignity and the perceptions of justice are, perhaps, its first implicit endorsement of important principles of
therapeutic jurisprudence in a criminal procedure context); see generally, Perlin and Weinstein, above n 135, 1118.
See also, Helen L v DiDario, 46 F3d 325, 335 (3d Cir 1995), cert den, 516 US 813 (1995): ‘[t]he [Americans with
Disabilities Act] is intended to ensure that qualified individuals receive services in a manner consistent with basic
human dignity rather than a manner that shunts them aside, hides, and ignores them.’
139
Perlin, above n 34, 591, quoting, in part, Perlin, above n 36, The Hidden Prejudice, 301.
140
David B Wexler, ‘Health Care Compliance Principles and the Insanity Acquittee Conditional Release Process’, in
David B Wexler & Bruce J Winick (eds), Essays in Therapeutic Jurisprudence (Carolina Academic Press, 1991) 199;
Bruce Winick, ‘Ambiguities in the Legal Meaning and Significance of Mental Illness’ in Bruce J Winick (ed)
Therapeutic Jurisprudence Applied: Essays on Mental Health Law (Carolina Academic Press, 1997) 93.
141
See eg, Perlin, above n 1, 236; see generally, Perlin, above n 33.
142
Perlin, above n 36, The Hidden Prejudice, 293, quoting David L Bazelon, Questioning Authority: Justice and the
Criminal Law (Knopf, 1988) 2.
143
Perlin, above n 36, The Hidden Prejudice, 293.
144
Ibid 29394.
145
548 US 735 (2006).
146
Ibid 742.
147
David Bazelon, ‘Veils, Values, and Social Responsibility’ (1982) 37 American Psychologist 115.
148
Perlin and Cucolo, above n 1, §14-1.2.8.
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In an article about the role of counsel in insanity and incompetency cases, I listed multiple issues
that, from a TJ perspective, needed additional focus. Consider this list:
If a defendant is, in fact, incompetent to stand trial, that means that he does not have
sufficient present ability to consult with his lawyer with a reasonable degree of
‘rational understanding’ and or a ‘rational as well as factual understanding of the
proceedings against him;’ how can TJ principles be invoked in such a case?
If a defendant is initially found to be incompetent to stand trial, will the lawyer act as
most lawyers and consider him to be de facto incompetent for the entire proceeding
(as a significant percentage of lawyers do act for any client who is institutionalised)?
If a defendant is found to be incompetent to stand trial, will the lawyer assume that he
is also guilty of the underlying criminal charge?
What are the issues that a lawyer must consider in addition to the client’s mental state
in assessing whether or not to invoke an incompetency determination?
What are the TJ implications for a case in which the incompetency status is not raised
by the defendant, but, rather, by the prosecutor or the judge?
Are there times when TJ principles might mandate not raising the incompetency status
(for example, in a case in which the maximum sentence to which the defendant is
exposed is six months in a county workhouse but is in a jurisdiction in which
defendants who are incompetent to stand trial are regularly housed in maximum
security forensic facilities for far longer periods of time than the maximum to which
they could be sentenced)?
What are the TJ implications of counselling a defendant to plead or not to plead the
insanity defence?
Can a defendant who pleads NGRI ever, truly, take responsibility?
Does the fact that the insanity-pleading defendant must concede that he committed the
actus reus distort the ongoing lawyer-client relationship?
To what extent do the ample bodies of case law construing the ineffectiveness
assistance of counsel standard established by the US Supreme Court in Strickland v
Washington
149
even consider the implications of TJ lawyering?
To what extent does the pervasiveness of sanism make it obligatory for lawyers in such
cases to educate jurors about both sanism and why sanism may be driving their
decisionmaking, and to what extent should lawyers in such cases embark on this
educational process using TJ principles?
150
I believe that TJ requires a robust and expansive insanity defence,
151
and demands a
reconsideration of the policies that punish defendants for raising the defence, that reject testimony
as to the causal relation between mental disability and the commission of otherwise-criminal acts,
and that incarcerate ‘successful’ insanity pleaders in maximum security forensic institutions for
149
466 US 668, 689 (1984) (‘whether counsel’s conduct so undermined the proper function of the adversarial process
that the trial court cannot be relied on as having produced a just result’).
150
Michael L Perlin, ‘Too Stubborn To Ever Be Governed By Enforced Insanity’: Some Therapeutic Jurisprudence
Dilemmas in the Representation of Criminal Defendants in Incompetency and Insanity Cases’ (2010) 33 International
Journal of Law & Psychiatry 475, 47778.
151
See Perlin, The Jurisprudence of the Insanity Defense, above n 8, 417, 41937, discussing how therapeutic
jurisprudence can be employed to ‘make the incoherent [insanity defense] coherent.’
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Disabilities
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far longer than the maximum sentence for the underlying crime, often (in the US, at least) a trivial
one.
152
I am convinced, after spending over 40 years representing and working closely with persons
with serious mental disabilities in the criminal justice system, it is the only way that we can begin
to eradicate the poison of sanism that contaminates our criminal justice system.
IX CONCLUSION
Nothing in this paper should be much of a surprise, especially to veteran criminal defence lawyers.
Or even to those who may not be that veteran. My son has been a PD for six years (first in Trenton,
now in Brooklyn). When we discuss his cases, the judges, the DAs, the court personnel, all is
deadeningly familiar to me. I have been thinking about these issues for over 40 years now, and am
hoping that these observations and suggestions will be of some help to those who care about these
issues.
Visions of Johanna – from which I drew the start of my title – ‘teeter[s] on the brink of lucidity.’
153
Many of the court proceedings in which I was involved in my career representing this population
teetered on that exact brink. I am again hoping that, as our clients, like ‘infinity,’ ‘go up on trial,’
we can help provide some of what Dylan sought in the next line of the verse: what ‘salvation must
be like after a while.’
152
TJ is also, in my view, the best and only option for changing the culture that condones the brutal treatment of
mentally ill defendants in prison settings. See Perlin, ‘God Said to Abraham/Kill Me a Son’, above n 35.
153
Trager, above n 16, 654.
