The Matthew White Murder Case

     In 1979, Matthew White, a six-foot-eleven center from Bethesda, Maryland, led the University of Pennsylvania Quakers to the NCAA final four. Mr. White was picked that year in the fifth round of the NBA draft by the Portland Trailblazers. Instead of entering the NBA he earned a MBA from the Wharton School of Business. In 1984 Mr. White moved to Spain where, for the next twelve years, he played professional basketball. While in Spain the basketball player met and married Marie Reyes Garcia-Pellon.

     In 2010 after he suffered a stroke, Mr. White and Garcia-Pellon moved from Swarthmore, Pennsylvania to Nether Providence, a township near the eastern Pennsylvania town of Media. He, his wife and their 20-year-old son and teen-age daughter moved into a ranch-style home. Garcia-Pellon worked as a teacher's aide at the Nether Providence Elementary School.

     On February 10, 2013 the 55-year-old former Ivy League basketball star took his wife to an area hospital after her friends expressed concern about her mental health. Garcia-Pellon, no stranger to mental illness, had previously undergone psychiatric treatment. For some reason she was not admitted into the hospital that Sunday.

     On Monday afternoon, February 11, 2013, a friend of Garcia-Pellon's called the police department to report that Matthew White may have been murdered by his wife. At the Nether Providence house police officers found Matthew White sprawled out dead in the master bedroom. He had been stabbed in the neck.

     When questioned at the death scene Garcia-Pellon told the responders that sometime between midnight and one in the morning she got out of bed and walked into the kitchen where she picked up two knives. She returned to her husband, slipped the knives under her side of the bed and waited for him to fall asleep. When she was certain he was asleep she used one of the knives to stab him in the neck. The victim rose up, cried, "I'm dying, I'm dying" then fell back onto the bed and died.

     After killing her husband Garcia-Pellon got dressed and left the house. (Her son was no longer living at home and her daughter was attending college.) Later in the day she showed up at a friend's house. Garcia-Pellon told her friend that she had stabbed Matthew in the neck as he slept. The friend called the police.

     As a police officer handcuffed the 52-year-old murder suspect, Garcia-Pellon said, "I caught him looking at pornography, young girls. I love kids. I had to do it." (According to the police there was no evidence in White's computer that he had been viewing child pornography.)

     On Monday night the Delaware County district attorney charged Garcia-Pellon with first-degree murder, criminal homicide and possession of an instrument of crime. She was held without bail in the Delaware County Jail.

     Kathryn Labrum, Garcia-Pellon's Media, Pennsylvania attorney, on Wednesday, February 20, 2013 told reporters that her client was "so separated from reality right now." The lawyer described Garcia-Pellon's mental state as a "psychiatric crises." Attorney Labrum  said:  "He [Matthew White] knew that she needed help, tried to get her help and there you have it--a beautiful family ruined."

     In February 2015, after being found guilty of murder but mentally ill (a verdict that required mental health treatment while serving a 25-year prison term) the judge immediately probated Garcia-Pellon's sentence and ordered her transferred from the jail to the Norristown State Hospital. The judge did not believe the prison system was equipped to deal with someone so insane. The adjusted sentence meant that Garcia-Pellon, when declared sane, could be placed back into society. No one associated with this case seemed to object to this outcome.

Homeless Crime Victims

     During the early morning hours of July 3, 17 and 19 in 2012 someone in downtown Los Angeles, Santa Monica and Hollywood stabbed two homeless men and a women while they slept outdoors. The attacker fled the scenes leaving the wounded victims, all in their 50s, with large hunting knives stuck in their backs. None of the street people were robbed and they all survived their wounds. Beyond the similar MOs the assaults were linked by so-called "death warrant" notices left at each stabbing site. The typewritten documents were signed by a person using the name David Ben Keyes.

     Los Angeles detectives found a Facebook entry under the above name which included a photograph of a black man in his mid-30s. Police officers distributed copies of this photograph around the skid row neighborhoods where the homeless lived. Street people were advised to spend their nights in shelters until the stabber himself was identified and taken into custody. 

     At 8:40 in the evening on Friday July 20, 2012 a man who identified himself as Courtney Anthony Robinson called 911 and claimed responsibility for the three stabbings. The 37-year-old said he would surrender to the police at the Hong Kong Express Eatery in downtown Hollywood. When officers took Robinson into custody they noticed he matched the Facebook photograph of David Ben Keyes. When asked why he had stabbed the sleeping street people the arrestee assured his captors that this information would "come out in the court proceedings." There was no indication that Robinson knew his victims.

     According to David Ben Keyes' Facebook page he was a musician and writer from Santa Barbara California. In his Facebook profile, laden with schizophrenic sounding nonsense about his intent to restructure the "Holy Roman Catholic Church and Empire," Keyes-Robinson claimed to be the CEO of a $250 billion Beverly Hills entertainment corporation. In reality he was homeless like the people he had stabbed.

     On the day of his arrest Mr. Robinson was charged with three counts of attempted murder. He was held under $500,000 bond at the Metropolitan Detention Center in Los Angeles.

     In February 2015 a jury found Mr. Robinson guilty as charged. In the second phase of the trial to determine if the stabber had been sane at the time of the attacks the same jury found the defendant legally insane and therefore not criminally culpable for the crimes. The judge ordered him to be sent to the Patton State Hospital where he would stay until the psychiatrists deemed him sane enough to be released back to the streets.

     Most crimes against the homeless are committed by mentally ill street people off their anti-psychotic medication. At one time insane people who were dangerous were held in mental institutions. Thanks to do-gooders who fought to set them free they now live on the streets. Some spend their nights in shelters but many prefer to remain outdoors around the clock. These are the people most vulnerable to assault and murder committed by offenders like Mr. Robinson.   

Homicidal Schizophrenics: Individual Rights Versus Public Safety

     In February 2009 Joseph Hagerman III, a diagnosed paranoid schizophrenic, stopped taking his antipsychotic medication. He had stopped taking his medicine twice in the past and had experienced psychotic episodes. This time, however, he decapitated his 5-year-old son and injured his wife who tried in vain to protect the boy.

     Following his arrest Mr. Hagerman in a jailhouse interview with a local TV reporter said he had killed his son because he believed the boy had become the antichrist.

     A few months after the homicide, a jury in Virginia Beach Virginia found the defendant not guilty by reason of insanity. Under Virginia law this meant that Mr. Hagerman would be sent to a mental institution instead of prison. He would remain at the hospital until his doctors and a judge declared him sane enough to rejoin society.

     In late 2016 doctors at the Eastern State Hospital in Williamsburg Virginia recommended to the court that Joseph Hagerman be granted conditional release from the institution. According to the psychiatrist, this patient, over the past few years had been given 48-hour passes that had not caused any problems. He had been, according to the hospital staff, a model patient.

     A Virginia circuit judge acting upon the psychiatric recommendation ordered that Mr. Hagerman be given two independent mental health evaluations.

     On May 9, 2017, following the testimony of two psychiatrists and Mr. Hagerman's father, the judge ordered the patient's conditional release from the mental hospital. Pursuant to this decree Mr. Hagerman was required to live at an adult foster care facility during the week. On weekends he would reside with his parents.

     Under the judge's order Mr. Hagerman would also receive periodic visits from social workers and psychiatrists who would check to make sure he was still taking his antipsychotic medication.

    At the conclusion of the sanity hearing Mr. Hagerman's sister told a local television correspondent that, "I just want to let the community know that my brother is a very loving, generous, Christian man. He had a wonderful family, and it was an unfortunate incident. [Italics mine.] Everyone needs to get educated on mental illness."

     The fact that a child died because his mentally ill father, for the third time, had stopped taking his medication was perhaps cause for concern. Compassion for the mentally ill is well and good but so is the need to protect people who cross this man's path. One doesn't need to be highly educated on the subject of mental illness to know that the behavior of a homicidal schizophrenic is extremely unpredictable. 

The Christian Jose Gomez Murder Case

      Marua Suarez Cassange, 48, lived with her two sons in a house in Oldsmar, Florida, a town of 13,000 not far from Tampa Bay on the Gulf Coast. At seven-thirty on New Year's Eve 2014, Cassange's older son, Mario Gomez, called 911 after the 26-year-old made a shocking and gruesome discovery in the yard outside his house.

     Lying near the trash can in the side yard, Mario Gomez discovered his mother's decapitated body. Inside the trash can, in a garbage bag, he found her head. Mr. Gomez informed the 911 dispatcher that his younger mentally ill brother, 23-year-old Christian Jose Gomez, had murdered their mother just a few minutes earlier. He had left the house on his bicycle.

     That evening, a few blocks from the murder scene police officers, after a brief foot-chase, took Christian Gomez into custody. This arrest was not the suspect's first contact with the police. In 2013 officers took Gomez into custody for a variety of minor offenses such as loitering, prowling, resisting arrest without violence and disorderly conduct.

     In addition to his troubles with the law, Christian Gomez had recently been committed for psychiatric evaluation. The psychiatrist who diagnosed him as a schizophrenic prescribed anti-psychotic medication. Mr. Gomez had quit taking his medication.

     At the police station Christian Gomez calmly and matter-of-factly told his interrogators that he had been planning to kill his mother for two days. Why? asked one of the detectives. The suspect explained that the victim had infuriated him with her constant nagging about putting some boxes away in the attic. He said he just couldn't take it anymore.

     That evening, in the garage, Gomez used an axe to behead his mother then dispose of her head in the trash can. Because she was too heavy for him to lift he dragged her torso into the side yard. After a futile effort to scrub up the blood in the garage he rode off on his bicycle. His brother was in the house at the time of the murder but had no idea what was going on.

     A local prosecutor charged Christian Gomez with first-degree murder. After officers booked the mentally disturbed man into the Pinellas County Jail the judge denied him bond.

     Gomez, after being incarcerated in a state mental hospital for three years was declared mentally competent to stand trial. In July 2018, facing life in prison, he pleaded guilty in return for a sentence of 25 years behind bars.

The M'Naghten Case

     On Friday, January 20, 1843, in a shot heard around the world, Scottish woodcutter and conspiracy theorist Daniel M'Naghten fired at and killed Edward Drummond, private secretary of Sir Robert Peel. M'Naghten was under the impression that he was shooting at Sir Robert, then Prime Minister of Great Britain. He was further under the delusion that Sir Robert Peel, the founder of the first London Police force was part of a cabal, along with the Pope and the Society of Jesus, that plotted to abridge the rights of British subjects and that had deliberately set out to spy on and persecute him.

     That M'Naghten was insane there was no doubt; nine medical experts testified for the defense, and none for the prosecution. That insanity was accepted as a defense came as a surprise, and that M'Naghten was acquitted "by reason of insanity" came as a shock. [In many states the insanity defense doctrine is called The M'Naghten Rule.]

Michael Kurland, How To Try a Murder, 1997

The Mentally Ill in Prison

     According to Brown University Medical School psychiatrist Dr. Christine Montross: "Police officers, sometimes in an attempt to provide mentally ill people with treatment, have said things to me: 'We know if we take them to jail, they will at least get three hots and a cot. They will at least get their psychiatric medications.' And so taking them to jail feels like an act of compassion."

     "So this idea of a 'compassionate arrest' struck me so deeply, because we would never do something like that for someone to make sure that he or she received their treatment for diabetes. We would never arrest someone to make sure that they received treatment for cancer. We only do that in this situation of the mentally ill, and that, to me, seems like a travesty."

     "When you are in the prison system, the expectations are very clear. You're given a set of rules; you're meant to follow those rules. If you don't follow the rules, there are consequences, and the consequences result in greater punishment, greater control. When a person with mental illness enters into that system, there is a misalignment between the straightforward system and their ability to comply with that system. So if someone is not thinking clearly, if they're feeling extremely paranoid, they are not going to trust the rules that are being told to them or the people who are enforcing those rules."

In David Davies, "Psychiatrist: America's Extremely Punitive Prisons Make Mental Illness Worse," NPR, July 16, 2020

Violence and Mental Illness

It is possible to argue that some people are violent and mentally ill, but it is no longer defensible to argue that people are violent because they are mentally ill.

Richard Rhodes, Why They Kill, 1998

Rethinking Mental Illness

     What if mental disorders like anxiety, depression or post-traumatic stress disorder aren't mental disorders at all? In a compelling new paper, biological anthropologists call on the scientific community to rethink mental illness. With a thorough review of the evidence, they show good reasons to think of depression or PTSD as responses to adversity rather than chemical imbalances...

     Mental disorders are routinely treated by medication under the medical model. So why are the anthropologists who wrote this study claiming that these disorders might not be medical at all? They point to key points. First, that medical science has never been able to prove that anxiety, depression or post-traumatic stress disorder are inherited conditions.

     Second, the study authors note that despite widespread and increasing use of antidepressants, rates of anxiety and depression do not seem to be improving...

     Third, worldwide rates of these disorders remain stable in 1 in 14 people. Yet "in conflict affected countries, an estimated one in five people suffers from depression, PTSD, anxiety disorders, and other disorders" they write.

     Taken together, the authors posit that anxiety, depression and PTSD may be adaptive responses to adversity...

Alison Escalante, Forbes, August 11, 2020

Genetics and Schizophrenia

There is no question that psychiatric problems can be inherited--we know this from studies comparing identical twins with fraternal twins. Identical twins are genetically the same, meaning that they share 100 percent of their DNA, whereas nonidentical (fraternal) twins share only 50 percent of their genes. Studies looking at the concordance rate of schizophrenia--that is, how commonly both siblings develop the same disorder--have found a concordance rate of 10 percent in nonidentical twins, versus 40 percent in identical twins. This implies that genetics plays a significant role in schizophrenia. But what is that role? Answering that question has been devilishly hard, and the latest landmark study found that we are much further away from identifying such genes than we ever thought.

Dr. Daniel J. Carlat, Unhinged: The Trouble With Psychiatry, 2010

Misunderstanding Schizophrenia

The medical community's long misunderstanding of schizophrenia is largely a story of relentless failure, every theory proving more misguided than the last. Some experts championed shock therapy, others called for institutionalization; some psychotherapists saw madness as a metaphor and some doctors prescribed catatonia by tranquilizers. Perhaps most troubling of all, a generation of psychotherapists blamed the mother for causing the disease by either over-parenting or under-parenting.

Sam Dolnick, The New York Times Book Review, April 5, 2020

Living On The Street

One-fifth of America's 1.7 homeless population suffer from untreated schizophrenia or manic depressive disorder. That amounts to 385,000 people. There are more seriously mentally ill individuals living on the street than the 90,000 receiving care in psychiatric facilities. 

Psychopharmacology And the Mystery of Mental Illness

Over the last thirty years, [psychiatrists] have constructed a reliable system for diagnosing mental disorders, and we have created medications that work well to treat a range of psychological symptoms. But these very successes have had unpredictable consequences. As psychiatrists have become enthralled with diagnosis and medication, we have given up the essence of our profession--understanding the mind. We have become obsessed with psychopharmacology and its endless process of tinkering with medications, adjusting dosages, and piling on more medications to treat the side effects of the drugs we started with. We have convinced ourselves that we have developed cures for mental illness...when in fact we know so little about the underlying neurobiology of their causes that our treatments are often a series of trials and errors.

Dr. David J. Carlat, Unhinged: The Trouble With Psychiatry, 2010

Problems in Adjudicating The Insanity Defense

Insanity defense cases should be tried not by juries but by specially trained and credentialed judges. I have seen firsthand the debacle of naive and inexperienced judges struggling with complicated psychological testimony, ineptly charging juries, and generally remaining clueless throughout the proceedings. These judges should be given on-the-job training and assistance to become proficient in the application of psychological principles.

Dr. Barbara R. Kirwin, The Mad, the Bad, and the Innocent, 1997

Kleptomania: Illness Or Theft?

Shoplifting is…misunderstood because the line between crime and disease has blurred. Although most estimates put the number of kleptomaniacs among shoplifters at between 0 and 8 percent, some experts believe that the disease is far more prevalent. Others contend that so-called shopping addiction has replaced kleptomania altogether.

Rachel Shteir, The Steal, 2011

What To Do With the Mentally Ill

      In the 1950's, more than half million people lived in U.S. mental institutions--one in 300 Americans. By the late 1970s, only 160,000 did, due to efforts by psychiatrists, philanthropists, and politicians to deinstitutionalize the mentally ill.

     Today there's one public psychiatric care bed for 7,100 Americans--the same ratio as in 1850. The motives behind this trend were varied. Emptying the asylums was going to save money. And who needed hospitals with all the antipsychotic drugs on the market? Deinstitutionalization was going to restore citizens' rights and protect them from deplorable conditions like those portrayed in movies like "One Flew Over the Cuckoo's Nest," conditions in which an insane person was unlikely to be cured. Wouldn't it be better if the mentally ill were treated at home, given support, therapy, and medication via community clinics? It sounded good, but the reality was quite different.

     In 1961, a joint commission of the American Medical and American Psychiatric Associations recommended integrating the mentally ill into society. This plan depended on the establishment of local facilities where mentally ill people could receive outpatient care. In 1963,Congress passed a law providing funding for these "community mental health centers". States, under pressure from the patients' rights movement, downsized their psychiatric hospitals faster than anyone had anticipated…

     As of 2006, 1.3 million of America's mentally ill were housed where they used to be until the late 1800s: in prisons. Between 1998 and 2006, the number of mentally ill people behind bars more than quadrupled. In some county jails, rates of inmates with mental illness have increased by nearly 50 percent in the past five years. It's not uncommon for individual jails to report that 25 to 30 percent of their inmates are mentally ill or that their mentally ill populations rises year after year…[Today, because politicians don't want the mentally ill in jail, tens of thousands of them live in squalor on the streets.]

Mac McClelland, "Schizophrenic Killer My Cousin," Reader's Digest, February 2014 

Greyhound Bus Therapy: Losing Your Mind in Las Vegas

     According to mental health experts, the city of Las Vegas not only drives people crazy, it attracts unbalanced folks from around the country.  Dr. Lorin Scher, an emergency room psychiatrist with the University of California at Davis Medical Center explains why so many mentally ill people end up in Las Vegas: "As the whole country knows, Las Vegas is a pretty unique place. Many bipolar patients impulsively fly across the country to Vegas during their manic phases and go on gambling binges. Vegas also attracts wandering schizophrenics, people who are drawn to the warm weather, lights, and action."

     Nevada, in 2009, began cutting its mental health service budget. By 2012, the funds for this form of health care had been cut by 28 percent. The reduced spending occurred during the period Las Vegas experienced the surge in psychiatric admissions. Something had to be done to hold down the state's health care costs.

     In March 2013, James Flavy, a 48-year-old schizophrenic living in a complex in Sacramento, California for the homeless, told the authorities a rather disturbing story. A month earlier, when discharged from the Rawson-Neal Psychiatric Hospital in Las Vegas, a mental health worker drove him to the Main Street bus station and put him on a Greyhound bus destined for Sacramento. Following a 15-hour bus ride, Mr. Flavy rolled into Sacramento with a two-day supply of medication and instructions to follow-up his care with a doctor in California. Someone suggested that upon his arrival in the Golden State he call 911. Flavy got off the bus without any identification or access to his Social Security benefits. He wound up in a University of California at Davis Medical Center emergency room where he lived for three days before someone arranged temporary housing.

     Mr. Flavy's story led to the remarkable revelation that from 2008 to 2014, more than 1,500 Las Vegas mental patients had been shipped via Greyhound bus to more than 200 cities in every state in the continental United States.

     The Southern Nevada Adult Mental Health Services, between July 2008 and December 2014, spent $205,000 on mental patient bus tickets. (The agency had a special arrangement with Greyhound.) The busing program has saved the state of Nevada millions of health care dollars.

     One-third of the Greyhound therapy recipients were bused to California, 200 of whom were sent to Los Angeles County. In 2012, Greyhound buses rolled out of Las Vegas carrying 400 mental cases destined for 176 cities in 45 states.

     Health care administrators in Nevada defended their mental ward on wheels program as sort of a revolving door operation. If unbalanced folks from all over the nation can roll into Las Vegas, they ought to be able, following emergency mental health treatment, to roll them back out of town.

Escaping Los Angeles

     Gold's Gym has become synonymous with the Hollywood dream. Set just a few hundred yards from the ocean in sun-kissed Venice Beach, Los Angeles, Gold's was the backdrop for "Pumping Iron," the 1977 documentary which followed a young unknown Austrian bodybuilder named Arnold Schwarzenegger as he prepared for the Mr. Universe contest...

     Yet today Gold's sits amid post-apocalyptic scenes which have consumed much of LA, turning the City of Dreams into an urban nightmare from which people are fleeing in droves. A makeshift tent city made up of flapping tarpaulins and cardboard boxes surrounds the gym on all sides.

     Junkies and the homeless, many of whom are clearly mentally ill, walk the palm-lined streets like zombies--all just three blocks from multi-million dollar homes. Stolen bicycles are piled high on pavements littered with broken syringes.

     TV bulletins are filled with horror stories from across the city; of women being attacked during their morning job or residents returning home to find strangers defecating in their front gardens.

     Today, Los Angels is a city on the brink. "For Sale" signs are seemingly dotted on every suburban street as the middle classes, particularly those with families, flee for the safer suburbs, with many leaving LA altogether...

Caroline Graham, "Hollywood's Apocalypse Now," Daily Mail. com, August 15, 2020 

Mentally Ill, Violent, and Living on the Streets

     Riverside Park, situated along the Hudson River, stretches four miles from 72nd Street to 158th Street on Manhattan's Upper West Side. Just before eight o'clock on Tuesday morning, October 1, 2013, New Yorkers enjoying this beautiful place were jogging, walking, biking, and sitting on benches.  This was a spot in the city, especially at this time of day, where people felt safe. But on this morning a mentally disturbed man who bounced between homeless shelters in Manhattan and the Bronx, showed up at the park with a vacant stare and a threatening posture.

     Julius Graham, who had spent most of his life in Texas, used a pair of scissors to stab a 32-year-old women in the neck as she jogged near 65th Street and Riverside Park South. Seconds later, the 43-year-old homeless man stabbed another female jogger with the bloody scissors. The silent attacker next stabbed 36-year-old Ben Loehnen in the stomach as the book editor walked his dog. At first Mr. Loehnen thought he'd been punched in the stomach.

     As the scissor wielding man's fourth victim, Julius Graham randomly selected James L. Fayette, a former principal dancer with the New York City Ballet. When Mr. Fayette came face to face with the man and his bloody scissors, he picked his 2-year-old son up out of his stroller and ran. Graham caught up with the father who tried to fight him off while holding onto his boy. When slashed in the chest with the scissors, Fayette put his son on the ground and covered him with his body.

     A bystander, Thomas Ciriacks came to Fayette's rescue by pushing Graham off the victim and wrestling him to the ground. Ciriacks held the attacker down until the arrival of police officers a few minutes later. The man who bravely took the assailant down not only saved others from being slashed or stabbed, he saved the lives of Mr. Fayette and his son. It was possible that Mr. Ciriacks also saved the attacker's life. No police officer would wrestle with a man armed with a pair of bloody scissors. He'd shoot him first.

     Except for the boy who was treated and released for a minor cut on his arm, the other victims of this Tuesday morning attack received injuries serious enough to keep them at St. Luke's-Roosevelt Hospital in Midtown Manhattan. Ben Loehnen, the man stabbed in the stomach, underwent emergency surgery.

     Police officers transported Julius Graham to the Bellevue Hospital Center where a team of mental health experts concluded the obvious--Mr. Graham was dangerous.

     Julius Graham was charged with five counts of assault, criminal possession of a weapon, and resisting arrest. He had been spending his nights at the Willow Avenue shelter in an industrial section of the Bronx. According to people who know him there, Graham did not like spending time in the shelter.

     In speaking to a reporter with The New York Times, D. J. Jaffe, executive director of the Mental Illness Policy Organization, said that in the 1950s, people suffering from serious mental illness were cared for in institutions designed for long term treatment. In New York City, mentally ill people either lived on the street, or were temporarily housed at Rikers Island--the city's massive jail complex. As a result, there was no place in the city that was completely safe from the random attacks of violent people who were out of touch with reality. In most instances, these people, with long histories of mental illness, stop taking their anti-psychotic medication. To get people like this off the street, required a court order. And even then, following a ten day drug regimen, they were usually released back into society.

     In April 2015, Julius Graham pleaded guilty to six counts of assault. The prosecutor agreed to drop the attempted murder charges against him. In May 2015, Judge Charles H. Solomon sentenced Graham to 23 years in prison.

The Role of the Forensic Psychiatrist

     When John Hinckley was found "not guilty by reason of insanity" after having shot President Ronald Reagan and two of his aides [in 1981] in full view of the national press corps, public furor brought the controversy concerning the use of psychiatric testimony in criminal trials to a boil.

     Critics [of psychiatrists in the courtroom], most of whom demand that psychiatrists be banished from all criminal trials, possess either a minimal or distorted understanding of just what a forensic psychiatrist does....[The critics] have forgotten that well before a psychiatrist ever entered an American courtroom, our legal system was already greatly concerned not only with what a man did wrong, but why he did it--what was going on in his head at the moment of his offense.

     It is a cornerstone of our system of justice that if a man perceives himself as innocent at the time of his offense, if he had not intended a wrongful outcome, then he is less culpable than someone whose crime was deliberate and committed with malice aforethought. Because of the preeminence of the principle that there are degrees of criminal liability, criminal trials necessarily go beyond the black-and-white issue of whether or not the accused pulled the trigger, and into the murky labyrinth of his intentions and motivations--his state of mind.

Dr. Martin Blinder, Lovers, Killers, Husbands and Wives, 1985