William Reid's posting draws out issues which underline legal/psychological differences between the USA and the UK. In the UK murder trials can not end in a death penalty, as I believe the law allows for this in the state of Texas. However the wider issue returns us to the mad/bad debate that continues here and in the USA.

It seems to me at the core of the legal argument, both in the USA and here in the UK, is one of choice. That is, if you are deemed legally insane you are not making a choice, whereas if you are deemed legally sane you are making a choice. However the definition of insanity remains dependant on geography and the belief's of those geographical areas. Therefore one might suggest that if you live in the Bible Belt for instance, where Christianity is the dominant belief, the legal system would be more likely to support the death sentence and be less likely to take a sympathetic view to mental health issues. This would also be true where any religious belief dominates, Saudi Arabia would be another example of this where crimes we would consider less heinous can also lead to the death penalty.

I have to confess that the complexity of the arguments on both sides can lead me to an indecisive state. Most models describing the human condition can argue for both. Example, if we have evolved by states of fitness, then humans are by definition killing machines in terms of one species over another. We can use examples of other species to illustrate this. If we use the medical model we can argue that any abnormal behaviour can be attributed to an abnormal development or physical condition. Example, alcoholism is likely the outcome of a genetic precondition. Of course here we would have to define what is abnormal. Too often what is considered abnormal behaviour is measured in the sociological rather than anthropological.

Beyond this there well always be tension between legalised murder and illegal murder. The state chooses to take the life of an individual, this is called legal execution. A man shots another and this can be called murder, manslaughter and sometimes self defence. The State, (I'm using the term State to include all governments), meets all the criteria we would normally use to describe a premeditation of murder, yet the State remains immune to the laws we apply to individuals...it can be a curious state of duality.

I'm not suggesting that either stance is right or wrong, only that in the final analysis if we are to medicalise peoples behaviour we have to accept the notion that any socially destructive behaviour is mad. Also that agency and self determination is a political construct and has little to do with the individual, who in the medical model responds to their cognitive and sociobiochemical balances. On the other hand, if we take the legal stance, depending on the political masters concerned, e.g. democratic, socialist ect. we are answerable for our actions because we do have agency and the ability to self determine, therefore the perpetrator of a crime is simply bad.

At first glance this presentation may appear too simplistic. However the UK prisons hold very high levels of mentally ill and developmentally restricted inmates. I believe, (though I am unable to quote the statistics accurately the same applies to the USA). This suggests that either there are insufficient facilities to deal with the mentally ill or the state does not fully accept the mad side of the argument. Either way as it is the State that supports these facilities, it illustrates a reluctance to allow a fully inclusive approach to the law.

Saying, the question should have been asked is only saying, if we asked the questions then it's not our fault. This does nothing to advance our understanding, it just covers our backside. This view is as common on this side of the Atlantic as it is in the USA.

Returning to the thread and it's point relating to specific trials. If Mrs. X kills her children, can we really rely on any current model to tell us whether it was predictable or preventable?

Here in the UK we have recently had a mother accused of just this. She was tried, found guilty and sent to prison. While there were no witnesses to the crime the damning evidence came from an expert witness. The expert explained that the woman was likely suffering Munchoussen by Proxy, and she killed these children to get attention. Later in an appeal this same woman was released on new genetic evidence that infant mortality was a statistically significant visitor throughout her distant family. Since then, here in the UK at least, this theory Munchoussen by Proxy has been discredited. It seems that the woman concerned was one of those very unfortunate people that has lost her children through Sudden Infant Death Syndrome, something we still know very little about. In spite of all the evidence presented in her defence including that of her MD (referred to as GP here, General Practitioner), family, friends other expert witnesses one questionable theory condemned her to a prison cell for 3 years, and would have been no less that 15years had her appeal failed.

Sadly these types of events are all too frequent, so when we say that somebody, usually a main stream mental health worker, psychologist, psychiatrist, should have asked the right questions, it's worth remembering that the 'questions' sometimes themselves condemn the innocent. Questions can be loaded and framed in such a way that the person being questioned is left with a Catch 22.