The insanity defense is one of the toughest cases to make in US courts of law, especially when the crime is murder. Jeffrey Dahmer tried it, as did Jack Ruby and "Son of Sam" - all to no avail.
The fact is, juries are seldom willing to let someone skirt responsibility, even if that person has a history of mental illness.
But what if a medication intended to help someone stay on an even keel does the opposite?
That is the argument being considered by the lawyer of software tester Michael McDermott, charged with killing seven of his co-workers last week in Wakefield, Mass. An insanity defense would claim that Prozac and other antidepressants Mr. McDermott was taking produced rare violence-inducing side effects.
So far, few criminal cases have used the Prozac defense at trial, and only one has won. But the McDermott case, because of its high profile, could become a test of Americans' willingness to pin blame on mood-altering prescription drugs.
McDermott's exact diagnosis is
unclear, as is the number of antidepressants he was taking. But one thing is certain: If his lawyer argues that "prescription drugs made him do it," the case will renew concerns about the use of Prozac-type drugs in America.
Currently, millions of people in this country use Prozac, introduced in 1987, to treat everything from depression to gambling to nail-biting. Allegations have persisted for years that the drug can spark violent reactions in some patients, though maker Eli Lilly and Co. denies there is any credible evidence to support such accusations.
Experts agree that using the Prozac defense is fraught with difficulty and a long shot at best - especially in this case, where evidence seems to indicate that McDermott planned the killings and methodically carried them out.
"When a mental-disorder defense is effective, it almost always includes a psychotic element," says E. Fuller Torrey of the National Alliance for the Mentally Ill in Arlington, Va. Schizophrenia or manic depression fall into this category; mild depression does not.
"Someone on Prozac is not as persuasive," says Dr. Torrey. "Lots of people are depressed, but they don't go shooting the people they work with."
Indeed, about 38 million people worldwide have taken Prozac, and the vast majority have experienced no major side effects. Moreover, the medication's success stories are well documented in medical literature.
Adamant that the Prozac defense should not be considered in the McDermott case, Eli Lilly said "people who want to know why this tragedy occurred should focus on Mr. McDermott's illness rather than his medication." Said spokesman Blair Austin in an interview: "Our product did not in any way cause [him] to shoot his co-workers."
But critics say Eli Lilly has played down Prozac's more serious side effects for years.
Joseph Glenmullen, a psychiatrist at the Harvard Medical School, says the drug can increase the risk of suicide, and severe anxiety and agitation. In his book, "Prozac Backlash," Dr. Glenmullen describes the most dramatic case: that of Joseph Wesbecker, a Kentucky printing press operator who killed eight co-workers and himself with an AK-47.
Wesbecker began taking Prozac just weeks before the 1989 attack. His psychiatrist, worried about the drug's effects on him, tried to get him to stop using it.
Survivors of the rampage sued Eli Lilly. During the 1994 trial, a secret settlement was worked out in which the company avoided having to put a warning label on the bottle. Eventually, Eli Lilly was found not responsible. Glenmullen, though, says the settlement kept the drug's possible side effects under wraps for years.
Judges often throw out a Prozac defense before it ever reaches a jury. But the McDermott case could give lawyers incentive to try again, says John Williams, a defense lawyer who is the only one so far to win using a Prozac defense.
He argued that high dosages of Prozac played a role in causing a Connecticut man to rob a bank in 1997. In August, a judge acquitted the man of robbery after finding he was unable to appreciate the consequences of his actions. The defendant was committed to a state mental hospital for up to 10 years.
"I don't know of another case where the use of Prozac has been a successful defense," says Mr. Williams. He adds that his was not an "anti-Prozac case," but rather a case in which the drug was used inappropriately. His client, being treated for obsessive-compulsive disorder and depression, was taking two to three times what was prescribed.
Williams is preparing another case for trial involving Prozac, but he says it's not a favorite defense among lawyers. "You typically don't use a mental-disorder defense, except in the most horrific cases, because winning isn't that great," he says. "Your client can be put in a psychiatric facility for quite a while."
In addition, juries tend to react negatively to the argument that someone should not be held responsible for a crime they admit committing - even when that person has a long history of mental illness.
"There is a national repulsion against crime right now, and juries are more inclined to punish rather than to individualize people," says Martin Weinberg of the National Association of Criminal Defense Lawyers.
For instance, Andrew Goldstein - who pushed a woman into an oncoming subway in New York last year - was diagnosed with schizophrenia and was in and out of mental hospitals for 10 years. A jury convicted him of second-degree murder, finding that the attack was not related to his mental illness.
"It's not that juries don't buy the insanity defense; it's that they don't buy the consequences," Torrey says. "Juries don't trust the mental-health system."
(c) Copyright 2001. The Christian Science Publishing Society