Psychopathic disorders and criminal responsibility in the USA.

The insanity defense in the United States is available to provide a legal excuse for those whose criminal acts were due to serious mental illness. To an underappreciated extent, the evolution of the insanity defense is integrally related to the evolution of conceptions of psychopathic disorders and their relevance, or determined lack thereof, to the insanity defense. As legal and mental health professionals discuss the ideal insanity defense and whether psychopathic disorders should be qualifying or disqualifying conditions, any practical outcome of such discussions must take into account the politics of the insanity defense. When this is done, it becomes apparent that the insanity defense itself, even for serious, psychotic mental disorders, is withering under relentless attack and must be advanced and defended without diluting its salient importance by including psychopathic disorders.