BY REASON OF INSANITY

In this book, a clinical psychologist uses examples from case histories to unravel the mysteries and dramas of patients whose crimes have resulted in their incarceration in a psychiatric hospital.

During the latter half of the 1990s, Sternberg served on the staff of the Kirby Forensic Psychiatric Center in New York City. Kirby, a maximum security hospital that opened in 1985, consolidated about 160 patients from a number of other New York facilities, all of them forcibly committed. Some of Kirby’s residents were placed there because they had been found incompetent to stand trial. These inmates generally only remained a short time, receiving counseling and medication to render them capable of participating in their own defense. The author’s main focus is on the other category of Kirby inmates, those who pled “not guilty by reason of insanity.” These patients avoided prison terms in favor of commitment to a high-security mental facility like Kirby. Some, Sternberg points out, may have, often unwittingly, exchanged fairly short prison sentences for what could ultimately be a lifetime of psychiatric incarceration. Changing the names and recognizable details, the author uses the case histories of four long-term patients to explore the basic questions at the foundation of the text: “Who are these people? What are they like? How did they come to be that way? What have they done? And why?” The resulting narrative is an intriguing and informative examination of not only the lives and progressive disintegration of those deemed criminally insane, but also the legal system that led to their incarceration and the ironies and absurdities that permeated their treatments. Sternberg’s writing is lucid and his stories absorbing. Most of the book will be highly comprehensible to lay readers. But the text occasionally slips into academic verbiage that slows its momentum, such as a description of a patient’s damaged sense of self as “to one degree or another adequate or lacking in cohesion and integration based largely on the contingencies within his interpersonal world.”

An illuminating look at the dangerously unstable and the systems that control them.