8 The Rorschach Test and Forensic Psychological Evaluation: Psychosis and the Insanity Defense

No area of the legal system and mental health law is more controversial than the question of criminal responsibility and the insanity defense. Societies have wrestled with how to hold individuals responsible for actions who have committed crimes when they were “out of their mind. ” The commission of a criminal act, particularly a heinous crime that out-rages the sensibilities of the community, generates demands for retribution. Neverthe-less, legal systems since antiquity have made allowances for individuals who were “insane, ” by whatever definition was culturally relevant and current at the time. Because the majority of criminal defendants acquitted by reason of insanity are diagnosed as psy-chotic (Melton, Petrila, Poythress, & Slobogin, 1997), the chief focus here is on “psycho-sis. ” It needs to be emphasized that psychosis is not simply tantamount to insanity, as will be seen in the discussion of criteria for the insanity defense. This chapter reviews fundamental legal constructs concerning criminal responsibil-ity, describes psychosis as a clinical and forensically relevant phenomenon, reviews clin-ical and theoretical constructs relevant to understanding psychosis, reviews the utility of the Rorschach test in the assessment of psychotic mental states, and provides tactical an