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A 42-year-old woman is arrested for making terrorist threats. During the last 2 years, she had been repeatedly telephoning various physicians and health systems administrators to bitterly complain of negligent and abusive care and indifferent management. Numerous internal and external investigations could find no basis for her claims. Starting about 6 months ago, her calls became increasingly hostile and threatening, culminating in a voicemail that made veiled references to œtaking out the leaders of the cover-up. The woman's public defender enters a plea of not guilty by reason of insanity. Psychiatric testimony indicates that the woman suffers from delusional disorder, persecutory type. Which of the following facts is the most critical for the defense to establish to successfully pursue this course?

A: Her mental illness involved delusions that she was in danger.
B: Her mental illness makes it impossible for her to understand the charges.
C: Because of her mental illness, she could not recognize that she needed treatment.
D: Because of her mental illness, she did not have access to competent treatment.
E: Because of her mental illness, she could not have legally intended to commit the crime.

A: Her mental illness involved delusions that she was in danger.

A ?

nope

E , is it ?

yes

The insanity defense is based upon the legal principle that an individual commits a crime only when the action was intentional. The defense must prove that as a result of a mental illness, the defendant did not have an intention to commit the crime (choice E). There are three generally recognized ways a mental illness could interfere with intention: (1) it prevents the defendant from understanding that the action was illegal, (2) it prevents the defendant from being aware of his or her actions, and (3) it irresistibly forces the person to commit the crime. In this case, the defense would likely argue that the woman was irresistibly pushed by her delusions into making these threats.
Delusions (choice A) or other symptoms of mental illness alone do not establish lack of guilt. Inability to understand charges (choice B) may prevent an individual from standing trial but doesn't establish innocence. Ability to recognize the need for treatment (choice C) or not having access to treatment (choice D) might influence the severity of penalties but does not directly pertain to the issue of guilt.