The insanity defense debate has come full circle, again. The current round began when John Hinckley opened fire; in 1843, it was Daniel M'Naghten who pulled the trigger; the "acts" of both would-be "insanity acquittees" provoked the press, the populace, a President, and a Queen to expressions of outrage, and triggered Congress, the House of Lords, judges, jurists, psychologists, and psychiatrists to debate this most maddening matter. "Insanity" -which has historically been surrounded by defenses, defen­ ders, and detractors-found itself once again under siege, on trial, and undergoing rigorous cross-examination. Treatises were written on the sub­ ject, testimony was taken, and new rules and laws were adopted. The dust has settled, but it has not cleared. What is clear to me is that we have got it wrong, once again. The "full circle" analogy and historical parallel to M'Naghten (1843) warrant some elaboration. Hinckley's firing at the President, captured by television and rerun again and again, rekindled an old debate regarding the allegedly insane and punishment (Caplan, 1984; Maeder, 1985; Szasz, 1987), a debate in which the "insanity defense" is centrally situated. The smolderings ignited anew when the Hinckley (1981) jury brought in its verdict-"not guilty by reason of insanity" (NGRI).

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I. Historical Development of Anglo-American Insanity Perspectives.- 1. An Historical Look at Insanity Defenses: From King Aethelred to Queen Victoria.- Secular Shortcomings and Ecclesiastical Entwinings.- Partial Insanity-The Emerging Gray Area.- Beyond the Beast.- Hadfield Fires, but Erskine Hits the Mark.- M'Naghten.- 2. From M'Naghten to Hinckley: Yesterday's Answers Breed Today's Questions.- The Rules Run Afoul.- The Dust Settles, but Does Not Clear.- To Know the Nature and Quality of the Act.- Wrong.- Disease of Mind.- Irresistible Impulses.- Isaac Ray and the Durham Rule.- The ALI Fallback.- Diminished Responsibility.- Abolishing the Insanity Defense.- 3. The Courtship of Law and Psychology.- The First Profession.- Medicine and Morality.- Punishment, Treatment, and the Presumption of Expertise.- Medicine's Insecurities and Inroads.- Divestment.- Blind Justice Sees a Wolf in Sheep's Clothing.- The Psychological Age.- A Medico-Psychological Retreat.- Healer Heal Thyself, or Else.- II. Background Issues-Basic Concepts, False Hopes, and Erroneous Beliefs.- 4. The Concept of Mental Illness (Disease).- The Problem of Defining Mental Disorder.- Mental Illness: A Medical or Cross-Dimensional Concept?.- Schizophrenia.- Demedicalizing Mental Illness.- The Hypothesized Relationship Between Mental Illness and Insanity.- A Mental Illness Threshold for Legal Insanity.- A Judgment-Capacity Connection?.- A Consciousness -Mens Rea Connection?.- A Rent in the Self.- Some Conclusions about the Mental Illness-Insanity Relationship.- 5. Therapeutics for the Insane, Dilemmas for Therapists.- The Reach of the Therapeutic Hand...and the Surety of Its Grasp.- Therapy at Its Best.- Therapeutic Dilemmas.- Therapy as an Ethical-Moral Undertaking.- In Search of Ethical Precepts...and Effective Therapy.- Contracts.- Confidentiality.- Consent.- Therapeutic Limits.- 6. Punishment and the Insane.- Popular, but Erroneous, Assumptions.- When May We Punish?.- Harm.- A Moral Wrong.- A Criminal Act.- Mens rea-Intent.- A Capacity.- Why Punish?.- Retribution.- Deterrence.- Rehabilitation.- The Problem of Having Only Two Choices.- Revenge and "Wild Justice".- Future Directions and Dead Ends.- III. Prevailing Currents, Unsettling Consequences.- 7. The Layman's (Juror's) Perspective on Insanity.- The Jurors Stand Accused.- Empirical Evidence.- Insanity Test Instructions.- Case-by-Case Discriminations.- Subject Variables.- A Swayed or Independent Jury?.- Construing.- Framing the Case.- Juror's Sentiments.- The Law's vs. the Jurors' Constructs.- Suggested Directions for an Insanity Test.- 8. Neuropsychological Perspectives on Insanity.- Split-Brain Background Facts.- Split-Brain Madness.- The Issue of Responsibility.- Where Personal Responsibility Ends and Brain Processes Begin.- "What Sort of Persons Are Hemispheres?".- Split Psyches.- Closing Summary, Deliberations, and a Verdict.- A Disquieting Epilogue.- 9. The Patient's Perspective: Involuntary Treatment.- A Preliminary Issue-Competence to Stand Trial.- Pragmatic and Political Concerns.- Lang, Jackson, and Most Grievous Abuses.- Confusions over Competency.- Assessing Competency.- Unequal Protection.- NGRI Consequences.- Retribution.- Deterrence.- Rehabilitation.- Release.- The APA Position.- IV. Future Directions and Recommendations.- 10. The Essence of Insanity.- A Dogged Dilemma.- In Defense of an Insanity Defense.- Justifications for Excusing.- No mens.- The Need for a Unifying Doctrine.- Strict Liability.- Abolishing the Insanity Defense.- Mens Rea Proposals.- Lady Wootton's Proposal.- H. L. A. Hart's Proposal.- Fine-Tuning the NGRI.- Partial Insanity.- Diminished Responsibility and Diminished Capacity.- GBMI.- An Unasked Question and Conclusion.- 11. Toward a New Test for Insanity.- Culpability Reconsidered.- The DOM Doctrine.- An Expanding Contextual Universe.- Closing an Escape Hatch.- A New Schema for Insanity.- DOM as an Affirmative Defense.- Redefining Actus Reus Behaviorally.- The Mens Phase.- Culpability for the DOM.- Sentences and Consequences.- Instructions to the Jury.- General Remarks.- Instructions.- The Behavioral Decision.- The Mens Decision.- Culpability Decision.- Mens Rea Decision.- A Concluding Comment to the Jury.- 12. Law and Psychology-the Courtship Reconsidered.- Remaining Matters.- A Passionate Ambivalence.- A Withering and Widening Courtship.- Unveiling Values.- Science (and Facts) vs. Morality (and Values).- Free Will vs. Determinism.- Paternalism vs. Autonomy.- Unveiling the Law.- Final Recommendations.- A Concluding Moral.- References.