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Book Review   |    
The Mad, the Bad, and the Innocent: The Criminal Mind on Trial
Mary O'Regan, Ph.D.
Psychiatric Services 1999; doi:
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by Barbara R. Kirwin, Ph.D.; New York City, Little, Brown & Company, 1997, 306 pages, $23.95

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For this book Barbara Kirwin has chosen a timely and controversial topic, the insanity defense. She relies on her 20 years of experience as a forensic psychologist to argue that there are numerous abuses of the insanity defense.

The author approaches the subject with an overview of the insanity defense. The following chapters focus on aspects of the defense that Kirwin identifies as problematic, including the belief that individuals who are truly insane are being found responsible for their actions, while individuals without mental illness are being found not responsible; the use of "designer defenses"; dispositional issues for those found insane; the impact of the media in the courtroom; and differentiation of the mentally ill from the malingerer. The final chapter contains Kirwin's "manifesto" for recommended changes.

The issues covered are of interest to professionals as well as to the general public. Kirwin addresses these challenging topics by using case material to illustrate specific issues. Unfortunately, she relies almost exclusively on personal experience to support her arguments, making this book of little utility to professionals. Kirwin includes information that has some general level of acceptance as well as opinions that are based on her personal perspective. However, she intermingles these statements without indicating which are supported fact and which are personal opinion. Readers are left minimizing the importance of well-founded opinions or giving credence to opinions with no foundation.

Some information is blatantly incorrect. The statement that "more people are winning insanity verdicts for crimes they knowingly committed, and more truly insane people are being convicted of crimes they are not responsible for" is not supported by reliable data. The statement that an individual who is psychotic cannot be creative or organized is just wrong. At other times, Kirwin's comments serve to fuel a public fear, such as the assertion that it is a "myth" that the criminally insane can be successfully treated. The topics chosen by Kirwin are hotly contested, and her use of extreme case material serves to further inflame the controversy rather than to provide any clarity.

Not only does the book fail to provide readers with an accurate understanding of the controversies surrounding the insanity defense, but it perpetuates myths and misunderstandings. Kirwin vacillates between using professional terms, sometimes inaccurately, and using colloquial language that is histrionic and misleading—for example, describing a forensic hospital as "a decaying, substandard, poorly staffed Devil's Island" and civil psychiatric hospitals as "the snake-pit asylum." Her frequent reference to using her "intuition" perpetuates the image of we psychologists as mystics and undermines our role as experts based on solid scientific training and experience.

A final, but major, issue is Kirwin's depiction of individuals with serious mental illnesses. Despite acknowledging the impact of stereotyping and stigma, the author is guilty of both, as in referring to the mentally ill as "mad" and "crazy." Kirwin's description of her forensic evaluations as being "a good deal more intensive than that of most other forensic psychologists" suggests a thoroughness and accuracy of information not apparent in this book.

The Mad, the Bad, and the Innocent offers little to the informed reader and presents the serious risk of misdirecting the uninformed. Furthermore, it does a disservice to those of us who practice forensic psychology and, more important, continues to stigmatize those of us with a serious mental illness.

Dr. O'Regan is assistant professor of psychiatry at the University of Massachusetts Medical School in Worcester.




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