A just rule of law treats a person as an agent. When someone is accused of a crime, the law asks what was done, what was intended, what circumstances surrounded the act, and what the statute requires. Evidence can be examined. Witnesses can be questioned. Motive, accident, coercion, self-defense, and intent can all matter. Ideally, punishment is public, limited by law, and governed by principles that apply equally to people accused of the same offense.
The insanity defense complicates this model by introducing a psychiatric category into a question that is ultimately legal and moral. Some defendants are treated as responsible agents whose conduct must be judged under ordinary criminal law. Others may be declared not legally responsible because their thoughts, beliefs, perceptions, or behavior have been interpreted through a psychiatric framework. The central problem is not that a person’s mental state is irrelevant. Intent obviously matters. The problem is that a psychiatric diagnosis cannot, by itself, objectively establish whether a person possessed legal responsibility.
The Law Already Has a Language for Human Agency
Criminal law does not ordinarily punish bodily movement in isolation. It distinguishes an intentional assault from an accidental collision. It distinguishes murder from an unintended death. It considers whether someone acted knowingly, recklessly, under duress, in self-defense, or without the mental state required by a particular offense. These concepts may sometimes be difficult to apply, but they are recognizably legal questions about conduct, circumstances, and agency.
The insanity defense introduces another type of explanation. A defendant may have deliberately performed an act, yet the legal system can be asked to reinterpret that act through the language of psychiatric disorder. Attention can move away from the specific question of what the defendant intended and toward the broader question of whether an expert believes that the defendant’s experiences should be categorized as symptoms of mental disease.
That shift matters because responsibility is not a laboratory finding. There is no blood test, brain scan, tissue sample, or other medical measurement that directly reveals whether a person is legally responsible. Medicine can provide relevant evidence about neurological injury, intoxication, seizures, unconsciousness, cognitive impairment, or other bodily conditions. But the conclusion that a person should or should not be held responsible under law remains a normative judgment.
Szasz’s Epistemological Point
Thomas Szasz argued that psychiatry often confuses two different kinds of concepts: descriptions of bodily disease and judgments about human thought, conduct, conflict, and experience. Whatever disagreements one may have with other aspects of his work, this core epistemological distinction is sound. A diagnostic classification and a legal conclusion are not the same kind of claim.
A psychiatric diagnosis may classify patterns of reported experience and observed behavior. It may provide a vocabulary that clinicians use to communicate about distress, functioning, or behavior. What it cannot logically do by itself is establish the legal conclusion that an actor lacked responsibility for a particular act. That conclusion requires additional premises about agency, intention, knowledge, choice, and what the law ought to recognize as an excuse.
This is the crucial point. A diagnosis does not contain a finding of legal nonresponsibility hidden inside it. Moving from “this person satisfies the criteria for a psychiatric diagnosis” to “this person therefore should not be held responsible for an intentional act” requires a legal and philosophical judgment. Medical terminology cannot eliminate that step.
When Description Becomes Explanation
Problems arise when psychiatric labels are treated as though they provide a complete causal explanation for criminal behavior. A person may be described as having delusions, hallucinations, severe emotional distress, disorganized thinking, or another psychiatric condition. Those descriptions may be relevant to understanding what the person believed or perceived. But describing an experience is different from proving that a disease entity overrode the person’s agency.
This distinction can easily disappear in ordinary language. If an unlawful act is called a “symptom,” it may begin to sound as though the action was simply produced by an illness rather than performed by a person. The metaphor becomes increasingly literal. Eventually, the legal actor can seem to disappear behind the diagnosis.
Szasz objected strongly to this conceptual move. His argument does not require denying that people suffer, experience unusual perceptions, become profoundly confused, or behave in destructive ways. It requires recognizing that suffering and unusual behavior do not automatically answer the legal question of responsibility. That question still has to be argued rather than medically pronounced.
Different Labels for Similar Acts
The insanity defense therefore raises an important question about equality before the law. Two people may commit substantially similar acts. One defendant’s motives and intentions are examined through ordinary concepts of responsibility. The other defendant may be placed into a psychiatric category and treated as a fundamentally different kind of actor.
The distinction can have enormous consequences. One person becomes an offender who committed a crime. Another becomes a patient whose crime is interpreted as an expression of illness. Yet the difference may depend heavily on professional interpretations of speech, beliefs, emotional states, and reported experiences rather than upon an objective medical finding that independently answers the question of agency.
This does not mean that evidence concerning someone’s perceptions or beliefs should be excluded. Quite the opposite. If a defendant genuinely believed something that bears upon the required intent, the court should examine that evidence. If the prosecution cannot prove the mental state required by the statute, the defendant should not be convicted of that offense. The law already possesses concepts for examining what a person knew, intended, perceived, and chose.
Responsibility Is a Legal Judgment
A psychiatrist can provide information. A neurologist can provide information. A psychologist can provide information. Expert testimony may help a jury understand evidence that would otherwise be difficult to interpret. None of these professions, however, possesses an objective instrument that measures guilt, moral responsibility, or legal agency.
Those conclusions belong to another category. They involve rules about what human beings may justly be held accountable for and under what circumstances an excuse should apply. They are questions of jurisprudence, ethics, and public policy.
A legal system should therefore be cautious about allowing professional terminology to settle questions that the profession itself cannot empirically measure. Experts can testify about evidence. Courts and juries should remain responsible for deciding what that evidence means under law.
Not Guilty Does Not Necessarily Mean Free
There is also a significant irony in the insanity defense. A verdict of not guilty by reason of insanity sounds like an acquittal. In practice, it can lead directly to involuntary psychiatric confinement. The defendant may leave the conventional criminal justice system only to enter another system in which liberty depends upon continuing professional judgments about diagnosis, dangerousness, treatment, and readiness for release.
This matters because changing the terminology does not change the basic fact of state coercion. A person confined behind a locked door has lost liberty whether the confinement is officially called punishment, hospitalization, treatment, or something else. The justification may differ, and conditions may differ, but the restriction of freedom remains real.
Ordinary criminal punishment is at least supposed to be connected to a specified offense and bounded by rules governing sentencing. Psychiatric confinement can operate according to a different logic, potentially making the duration of confinement dependent upon continuing assessments rather than simply upon the punishment prescribed for the original act.
Judge the Act and the Required Intent
Abolishing the insanity defense would not require treating every act as equally culpable. It would not require ignoring evidence about cognition, perception, coercion, unconsciousness, neurological impairment, or intention. It would require keeping the inquiry focused on the elements of the offense and the traditional factual questions of agency.
Did the defendant perform the prohibited act? Did the defendant possess the mental state required by the statute? Was the act intentional, accidental, coerced, justified, or otherwise outside what the law prohibits? These are difficult questions, but they are the questions criminal law is supposed to answer.
If the prosecution cannot prove the required intent, the prosecution should fail on that ground. If neurological or other medical evidence demonstrates facts relevant to whether the required act or intent occurred, that evidence should be considered. But a psychiatric label should not operate as a separate mechanism that transforms an otherwise intentional criminal act into a medical event.
Equal Agency and Equal Law
The deeper issue is equal personhood before the law. Human beings should be treated as agents rather than divided into categories in which some people’s actions are attributed to them while other people’s actions are attributed to diagnostic abstractions. A coherent legal system can recognize differences in evidence and circumstance without abandoning the principle that responsibility is a legal judgment about persons.
People can be frightened, confused, distressed, mistaken, enraged, desperate, or convinced of things that others find extraordinary. Every one of those facts may matter in determining what occurred and what someone intended. None of them automatically converts a human action into a disease process or answers the legal question of responsibility.
This is where Szasz’s epistemological criticism remains especially strong. A description of behavior is not the same thing as a biological explanation of behavior, and neither is the same thing as a legal judgment about responsibility. Treating these different categories of claims as interchangeable gives psychiatric terminology authority that it cannot logically possess on its own.
A just legal order should judge acts through evidence, intent, circumstances, and law. It should protect the accused, demand proof from the state, recognize genuine defenses, and consider relevant medical evidence without pretending that responsibility itself is a medical condition. If the required act and intent are proven, the law should judge the case accordingly. If they are not proven, the defendant should not be convicted.
Equal law requires equal agency. The task of medicine is to provide medical knowledge where medical knowledge is relevant. The task of criminal law is to determine what happened, what was intended, what the law requires, and whether the state has proved its case. Keeping those categories distinct is not hostility toward medicine or toward people who experience profound distress. It is conceptual clarity, and conceptual clarity is essential when liberty and responsibility are at stake.
