The Line Between Mad and Bad

Psychiatric Times

August 2005

Vol. XXII

Issue 9

In his acclaimed biography of Justice Benjamin Cardozo, Harvard Law Professor Andrew Kaufman devotes part of a chapter to a lurid murder case in which Cardozo, then serving on New York's highest court, wrote an opinion interpreting the classic M'Naghten formulation of the insanity defense (Kaufman, 1998; People v Schmidt, 216 N.Y. 324). The case decided in 1915 is a classic cautionary tale for forensic psychiatrists and, with the wisdom of hindsight, one might even suggest that it is also a cautionary tale for the great justice.

Hans Schmidt, whose clerical credentials were never authenticated, was serving as a Roman Catholic priest in New York City. An immigrant from Germany, Schmidt was a charismatic figure in the German Catholic community. He was, however, something of a mountebank and apparently engaged in counterfeiting U.S. currency as well as having an affair with an unfortunate and uneducated woman, Anna Aumuller, who was a servant in the parish house of his New York church. Aumuller, also an immigrant, had at least one previous pregnancy by Schmidt and returned to Europe to obtain an abortion. It was a subsequent late trimester abortion in New York City that led to her death.

Parts of her dismembered body were discovered in the Hudson River and with them the manufacturers' tag on the pillowcase that had been used as wrapping. The tag led the police to a blood-stained apartment, to her identity and to the "priest" Hans Schmidt. Although the police did not at first suspect him, his reaction and their interrogation, unhindered in those days by any Miranda warning, led to a confession. The sordid details of the case reported in the New York newspapers of that time have been spelled out in Richard Polenberg's historical account The World of Benjamin Cardozo: Personal Values and the Judicial Process (1997). It suffices for our purposes to note that Schmidt at first took full responsibility for killing Aumuller and dismembering her body but claimed to be insane. God, he said, had appeared to him and ordered him to kill the poor woman as a sacrificial offering.

The trial would pit two teams of noted psychiatric experts against each other: the famous Smith Ely Jelliffe and William Alanson White for the defense and New York University/Bellevue Professors William Mabon and Carlos F. MacDonald for the prosecution. Both sides, according to Polenberg, claimed to have foolproof "objective" tests to support their forensic opinions. The New York newspapers gave the trial and the "battle of the experts" front page coverage. Headlines asked the crucial question, was Schmidt "shamming"? The defense psychiatrists in 30 hours of interviewing found "no signs of shamming." Jelliffe's expert pronouncement was, "A man cannot sham insanity such as [Schmidt] has ... It is a product of nature, not a product of artifice."

Schmidt, along with his supposed delusions and hallucinations, had told a strange and perverse story of being sexually aroused by blood all of his life. During their examination of him, Jelliffe and a colleague, who happened to have a blood blister on his finger, decided to test this part of the story. Pricking the blister with a pin, the finger with a drop of blood on it was presented to Schmidt who went appropriately berserk with what the psychiatrists considered physiological manifestations--dilated pupils and so forth--that could not possibly be faked. At trial, with total certitude, they advanced a diagnosis of the paranoid type of dementia praecox. The prosecution's experts had their own "objective" test set out 30 years before in the classic textbook Insanity, Its Classification, Diagnosis, and Treatment; a Manual for Students and Practitioners of Medicine (Spitzka, 1883). During their examinations they proposed "bogus symptoms" to Schmidt and when he claimed to have them he had fallen into their trap. They angrily confronted the defendant and berated him for pretending to be insane.

The judgment of history is that Schmidt was malingering and after he was condemned to death at his second trial (the first was a hung jury), Schmidt wanted everyone to know what had actually happened. He signed an affidavit stating that his confession was false and his insanity feigned. Aumuller, who was six months pregnant, died of a botched abortion, according to the new account, and several accomplices were involved.

Schmidt apparently was so confident of his powers of persuasion that he had assured his confederates that he would be found insane and shipped back to Germany. To protect them from the legal consequences of the criminal abortion he had proposed to take sole responsibility. Although the confederates never confessed, the evidence emphasized by Polenberg (1997) seems to support this new confession. For example, pathologists testified that Aumuller's body had been dismembered by someone with surgical knowledge and the findings at autopsy were more compatible with a hemorrhaging uterus than the throat-slitting murder to which Schmidt had originally confessed.

If the famous defense psychiatrists Jelliffe and White had been wrong, there can be no question (at least in my mind) that they fully believed every word of their testimony. They spoke honestly, they thought they had "objective" evidence, and no lawyer twisted their words or their testimony. They, of course, had no specialized training in forensic psychiatry, but their certitude was not unlike what one encounters in the testimony of fully trained forensic psychiatrists in cases like Sirhan Sirhan, John Hinckley and the recent Texas trial of Andrea Yates. In the glare of the public spotlight and the pressures of the adversarial system, forensic experts seem to become more dogmatic and more convinced about their own clinical judgments; direct contradiction by the forensic experts for the other side only seems to strengthen their certitude. This in my view is what has often happened in notorious forensic cases that come to public attention (see Stone, 1984). The ethical guidelines developed for forensic psychiatrists that emphasize honesty will not protect trained practitioners from the pitfall of their own hubris.

If the distinguished experts were chagrined, one can imagine how Schmidt felt when he was condemned to death. His lawyers, of course, appealed the verdict on two grounds that are relevant to this account. As one might expect, they argued that the affidavit and evidence about the botched abortion, newly brought to light, required a new trial. And although this argument acknowledged that Schmidt had been "shamming" insanity, in their other grounds for appeal his lawyers asserted that the trial judge had given the jury mistaken instructions on the last clause of the M'Naghten rule: that the accused did not "know that the act was wrong." This is a subject that has vexed law and psychiatry scholars for decades. Does wrong mean legally wrong or morally wrong? Killing on order from God might be legally wrong but the accused person might believe it was not morally wrong. It was this broader moral reading that Schmidt's lawyer faulted the judge for not including in his instructions to the jury and that would be the issue about which Cardozo memorably wrote.

It may sound strange to the modern reader that Cardozo would send Schmidt to his death for first-degree murder despite what he himself considered plausible evidence of a botched abortion that a jury had not heard. His opinion is written so as to suggest that the applicable law of New York's criminal procedures, and the traditional legal maxim that "no man shall be permitted to profit by his own wrong," left Cardozo no other choice. Those who know Cardozo's reputation as a judge adept at getting beyond the strict letter of the law may wonder at his judicial restraint in this case. But Cardozo was intransigent. Schmidt had tried to commit "fraud" on the law and now he wanted a second chance in the halls of justice. Schmidt's lawyers had not produced new evidence, they were now offering information that the defendant had knowingly concealed at trial. Cardozo saw nothing wrong in rejecting that ground for the appeal and upholding the death penalty. If, as many legal scholars would like to believe, justice is a search for the truth, it seems a particular injustice to order the execution of a man who, though a charlatan and a mountebank, might not be guilty of a capital offense.

As to the second ground for appeal, Cardozo concluded that since Schmidt and his lawyers now conceded that he was sane, the jury had in fact reached the right decision on the insanity defense. Although the issue was moot, he nonetheless seized the opportunity to opine in dicta about the moral significance of M'Naghten, its legal history and how judges should understand it. Polenberg wrote:

Cardozo offered an emotionally charged hypothetical, a mother kills her infant child to whom she has been devotedly attached. She knows the nature and quality of the act, she knows the law condemns it; but she is inspired by an insane delusion that God has appeared to her and ordained the sacrifice.

Cardozo continued, "It would be a mockery to say she knew her act was wrong." A mockery perhaps to Cardozo but not to the states that in recent decades have either abolished the insanity defense or given the narrowest possible reading to the right/wrong language.

There are many reasons why in recent years the insanity defense has been given a narrow construction in the United States. Part of it is a reaction to the verdict in the historic Hinckley trial and the consensus among lawyers and psychiatrists that a carefully worded and limited rule would be less likely to produce conflicting expert testimony and controversial verdicts (American Psychiatric Association, 1985). There is reason to believe that these reforms have been effective. Psychiatric diagnosis certainly has greater reliability since the development of DSM-III and its successors. But expert testimony goes beyond diagnosis, and disagreement can and still occur on the crucial questions.

At the trial of Yates, recently overturned on other grounds, forensic psychiatrists were dealing with a fact situation much like the "highly charged hypothetical" that Cardozo had imagined (Yates v State of Texas, 2005 WL 20416). Yates was obviously psychotic. The forensic psychiatrists on both sides agreed that she was not "shamming." Although God had not appeared to her, it was her religious "delusions" that led her to drown her five children in the bathtub. She may well have believed that what she was doing was not morally wrong. But the state of Texas had no interest in the moral considerations that Cardozo advocated. They wanted forensic psychiatrists to go beyond the diagnosis and offer expert opinion on whether Yates knew right from wrong. It was on that narrow issue that the new generation of trained and eminent forensic psychiatrists disagreed. The prosecution's expert was convinced that Yates knew right from wrong. The defense expert was equally convinced she did not.

When the law asks psychiatrists such narrow questions, it does so on the commonsense assumption that there is a common reality, a world of black and white, right and wrong. But is that assumption correct and did Yates' psychotic experience of reality correspond in any meaningful way to that assumed legal reality? My own belief is that no forensic psychiatrist can objectively answer the law's narrow question yes or no. There is no "truth" of the matter. Our science cannot yet map the psychotic experience of reality or measure its correspondence to the reality of the law's simplifying assumptions. The narrow right-from-wrong question may seem clear and obvious, but it is premised on assumptions that neither science nor philosophy can verify.

Cardozo, famous for the eloquence of his opinions, was like many other jurists, eager to clarify the meaning and scope of the insanity defense. But as one recent law review student note pointed out, with the wisdom of hindsight, the opinion in Schmidt no longer makes sense legally or psychiatrically (Hawthorne, 2000).

One might conclude that Cardozo, like Jelliffe and White, suffered from his own hubris. Perhaps, but I would suggest that there is also a larger lesson to be learned. I believe that the law's effort to formulate the right question about criminal responsibility and psychiatry's efforts to answer it are equally misguided. After centuries of efforts on the part of great legal scholars, jurists and philosophers to define the precise question they want answered, might it be time to acknowledge that such a definition is beyond the reach of legal reason? And if the legal question is unaskable, psychiatrists, even the best trained forensic psychiatrists, should recognize that it may be unanswerable.

Neither law nor psychiatry has yet found a way to draw a bright line between mad and bad. There is now great interest in the possibility that new neuroscience will answer the law's questions. This new enthusiasm is based on the assumption that law and science speak the same language. I believe that anyone who has thought seriously about either law or science would suggest that there is no good reason to believe that such an assumption is true.

Dr. Stone is the Touroff-Glueck Professor of Law and Psychiatry in the faculty of law and the faculty of medicine at Harvard University.

References

American Psychiatric Association (1985), Insanity Defense Position Statement. Available at: www.psych.org/public_info/libr_publ/position.cfm. Accessed July 1, 2005.

Hawthorne C (2000), "Deific Decree": The Short, Happy Life of a Pseudo-Doctrine. Loyola of Los Angeles Law Review 33(4):1755-1810.

Kaufman AL (1998), Cardozo. Cambridge, Mass.: Harvard University Press.

People v. Schmidt, Court of Appeals of New York, 216 N.Y. 324 (1915).

Polenberg R (1997), The World of Benjamin Cardozo: Personal Values and the Judicial Process. Cambridge, Mass.: Harvard University Press.

Spitzka EC (1883), Insanity: Its Classification, Diagnosis, and Treatment; a Manual for Students and Practitioners of Medicine. New York: Bermingham & Co.

Stone AA (1984), Law, Psychiatry, and Morality: Essays and Analysis. Washington, D.C.: American Psychiatric Press.

Yates v State of Texas WL 20416 (Tex.App.-Hous. [1 Dist.]) (2005).