Court Opinion

ID: 9489683
Source: CourtListenerOpinion
Date Created: 2023-08-05 13:21:24.403682+00
Date Added: 2024-06-11T17:53:39.565148
License: Public Domain

WILSON, District Judge,
concurring:
I agree with the majority in its conclusion that the fact that an insanity acquittee is largely asymptomatic does not mandate release under § 4243. Whether or not symptoms of the disease are manifested does not change the fact that the acquittee “suffers” from a mental disease or defect. I write separately, however, because I do not believe the appellant conceded that his condition could legally be considered a “mental disease or defect.”1 I conclude that his condition— personality disorder not otherwise specified (NOS) with passive/aggressive and narcissistic tendencies — is a mental disease or defect within the meaning of § 4243. Thus, I concur in the judgment as well.
As stated above, whether a person is suffering from a mental disease or defect is generally a question of fact. Deference is properly afforded to a district court’s weighing of the evidence and determinations of credibility. However, deference cannot be afforded, where — -viewing the evidence in the light most favorable to the court’s conclusion — the facts do not fall within the applicable legal standard. Generally, it will be readily apparent whether a mental condition is or is not a mental disease or defect (e.g. schizophrenia is, a head cold is not), the legal question is thus glossed over, and the only question which remains is a factual one— whether it was proper for a fact-finder to conclude that the defendant did or did not suffer from such a condition.
In this case, however, the appellant has specifically raised the legal question. Thus, although we must defer in this case to the *478district court’s conclusion that Appellant suffers from a continuing personality disorder— a descriptive question — the court must still review de novo whether that condition falls within § 4243 — the normative question. See United States v. Lyons, 731 F.2d 243 (5th Cir.), cert. denied, 469 U.S. 930, 105 S.Ct. 323, 83 L.Ed.2d 260 (1984) (issue of insanity cannot go to jury where evidence is only that defendant suffers from a narcotics addiction which does not, standing alone, fall within scope of mental disease or defect).
There is little guidance as to when a psychiatric condition falls within the scope of § 4243’s mental disease or defect. The courts have expressed reluctance in relying on medical categories and labels in determining the limits of legal insanity. United States v. Lyons, 731 F.2d 243 (5th Cir.), cert. denied, 469 U.S. 930, 105 S.Ct. 323, 83 L.Ed.2d 260 (1984); U.S. v. Torniero, 570 F.Supp. 721 (D.Conn.1983), aff'd, 735 F.2d 725, cert. denied, 469 U.S. 1110, 105 S.Ct. 788, 83 L.Ed.2d 782 (1985). Such reluctance is warranted. “[W]hat definition of ‘mental disease or defect’ is to be employed by courts enforcing the criminal law is, in the final analysis, a question of legal, moral and policy — not of medical — judgment. Among the most basic purposes of the criminal law is that of preventing a person from injuring others or, perhaps to a lesser degree, himself. This purpose and others appropriate to law enforcement are not necessarily served by an uncritical application of definitions developed with medical considerations of diagnosis and treatment foremost in mind.” Lyons at 246.2 Thus, it is not enough that Appellant suffers from a condition to which a psychiatric label has been attached. Likewise, it is of no significance that one witness, Dr. Saint Martin, testified that a personality disorder is not considered a mental disease or defect in the psychiatric literature.3
Nor can it he assumed that, as a matter of policy, a personality disorder is a mental disease or defect. To date, there is no federal law on whether a personality disorder qualifies as a mental disease or defect under § 424B.4 Among the states, there have been mixed results on the issue. At least two *479states have categorically excluded personality disorders from the definition of mental disease or defect. CaLPenal Code § 25.5; Or.Rev.Stat. § 161.295. Others exclude certain types of personality defects, disorders, or abnormalities, most commonly those of the antisocial subcategory. Ala.Code § 18A-3-1; Ariz.Rev.Stat.Ann. § 13-502; Ill.St. Ch. 720 § 5/6-2; Ind.St. 35-41-3-6; Me.Rev.Stat. Am.Tit., 17-A, § 39; Tenn.Code Ann. § 39-11-501; Utah Code Ann. § 76-2-305. At the opposite end of the spectrum, Alaska has adopted an extraordinarily broad definition of mental disease or defect which would seem to encompass all personality disorders. Alaska Stat. § 12.47.130(3) (mental disease or defect means a disorder of thought or mood that substantially impairs judgment, behavior, capacity to recognize reality, or ability to cope with the ordinary demands of life). In those states which have chosen to exclude personality disorders from serving as the basis for a verdict of not guilty by reason of insanity, there seems to be a desire to guard against turning every personality quirk into a “mental disease or defect” through the imprimatur of a psychiatric category. Criminal Procedure: Insanity Plea — Inadmissible Mental Conditions, 26 Pacific L.J. 254, 255 (1995).
Although I agree that mere personality quirks or characteristics cannot be construed as mental diseases or defects for purposes of determining legal sanity, I conclude that a personality disorder such as that suffered by Appellant is much more than a mere quirk. It is a systemic, enduring, and severe condition resulting in an extremely abnormal perception of and reaction to everyday events. In short, Appellant’s condition is so encompassing and impairing that it rises to the level of a disease or defect.
My conclusion is based, in large part, on interpreting what a diagnosis of personality disorder NOS signifies about a person’s mental state. That is, what does the psychiatric shorthand mean? To answer this question, I take judicial notice of the diagnostic standards in the American Psychiatric Association’s Diagnostic and Statistical Manual, (4th Ed.1994) (“DSM IV”). See U.S. v. Cantu, 12 F.3d 1506, 1509, n. 1 (9th Cir.1993) (taking judicial notice that a condition listed in the DSM is a recognized psychiatric condition); U.S. v. Johnson, 979 F.2d 396, 401 (6th Cir.1992) (taking judicial notice of an earlier edition of the DSM).5
The DSM IV defines a personality disorder as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture [which] is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.” DSM IV at 629. A personality disorder manifests itself in at least two of the following areas: 1. cognition, 2. affectivity, 3. interpersonal functioning, or 4. impulse control. Id. In addition, like all mental disorders classified in the DSM IV, a personality disorder must be a “clinically significant behavioral or psychological syndrome or pattern.” Id. at xxi. Finally, a personality disorder differs from mere personality traits. “Only when personality traits are inflexible and maladaptive and cause significant functional impairment or subjective distress do they constitute a personality disorder.” Id. at 630.
Of particular significance is the fact that a personality disorder is more than just a repeated pattern of behavior. It is an enduring pattern of behavior and inner experience which can affect cognition (i.e. ways of perceiving and understandings) and affeetivity (emotional reactions). Therefore, it can be said to be “mental.” In addition, it does not just manifest itself now and again in response to a particular set of circumstances; it is pervasive and inflexible. It is not just one part of a person’s personality which is annoying, distasteful, or rude; it is a trait or group of traits which dominates the person’s mental state to the point where they experience significant functional impairment or *480subjective distress. Thus, it comports with the general connotation of a “disease or defect” in that it is neither a temporary condition nor a chosen way of responding but rather a systemic, impairing psychiatric abnormality. Moreover, unlike narcotics addiction, antisocial, or compulsive gambling disorders, there is no fundamental criminal policy at odds with including a personality disorder NOS with passive-aggressive, narcissistic tendencies within the scope of § 4243. Therefore, the District Court correctly construed Appellant’s condition to be a mental disease or defect within the meaning of § 4243.

. As stated in the majority opinion, Appellant conceded that a personality disorder could — under certain circumstances — be a mental disease or defect. I do not understand that concession to have eliminated one of the principal arguments set out in the briefs, namely, whether Appellant's personality disorder is a mental disease or defect.

. Indeed, this case is unique in that the review panel specifically refused to say either way whether a personality disorder is a mental disease or defect. Cf. U.S. v. Bilyk, 949 F.2d 259 (8th Cir.1991) (experts distinguished personality disorder from mental illness); United States v. Bilyk, 29 F.3d 459 (8th Cir.1994) (review panel distinguishes personality disorder from mental illness).

. Then District Judge Cabranes lays out a thorough and provocative discussion on the definition of mental illness and the pitfalls of merging the definitions of illness and criminal conduct in U.S. v. Torniero, 570 F.Supp. 721 (D.Conn.1983) (concluding that insanity is, for purposes of criminal law, a state of mind which is incomprehensible to the jury).

. The two Bilyk cases cited by both parties are unhelpful. In the first case, a denial of release was upheld where two experts testified that the defendant only had a personality disorder but a third testified that he suffered from schizophrenia. U.S. v. Bilyk, 949 F.2d 259 (8th Cir.1991). Thus, the first Bilyk case merely upheld the trial court’s weighing of competing expert opinions. The second case, U.S. v. Bilyk, 29 F.3d 459 (8th Cir.1994) did cite a review panel's report distinguishing personality disorders from mental diseases, but decided nothing more than that the case had to be remanded to allow the court to examine the review panel's report. Cases touching on the issue in the context of an insanity plea under 18 U.S.C. § 17 imply a split. Some have implied that personality disorders are mental diseases, though not severe enough to serve as the basis for an insanity plea. See U.S. v. Salava, 978 F.2d 320 (non-psychotic behaviors or neuroses such as "inadequate personality” are not severe mental diseases or defects); U.S. v. Shlater, 85 F.3d 1251 (7th Cir.1996) (rejecting insanity plea based on mild to moderate personality disorder because not severe personality disorder). In contrast, in U.S. v. Rosenheimer, 807 F.2d 107 (7th Cir.1986), the court upheld, with no explanation, the trial court's distinction between personality disorders and mental diseases or defects for purposes of an insanity plea. See also U.S. v. Prescott, 920 F.2d 139 (2d Cir.1990) (upholding finding of no mental disease .or defect where experts testified that personality disorder was not considered a mental disease or defect in the mental health community). In dicta, the Supreme Court has implied that a personality disorder standing alone would not be sufficient to warrant continued commitment of an insanity acquittee. Foucha v. Louisiana, 504 U.S. 71, 83, 112 S.Ct. 1780, 1787, 118 L.Ed.2d 437 (1992) (state cannot hold indefinitely an insanity acquit-tee not mentally ill who could be shown to have a personality disorder that may lead to criminal conduct). The dicta in Foucha, while striking, is of no precedential value since the state had conceded in that case that the acquittee's anti-social personality disorder was not a mental disease.

. My reliance on the DSM IV is not in contradiction with the position taken earlier that the definition of mental disease or defect is a matter of legal and not medical judgment. The law must ultimately be applied to the facts, but the facts can only be determined by trying to understand what the evaluating doctors saw when they examined Appellant. Those observations were recorded in the diagnosis which can only be understood through reference to the DSM IV.