For example, he joined Justice Stephens' majority in striking down capital punishment for persons with mental retardation in Atkins v Virginia. In almost all these cases, Souter joined the Justices who took positions closest to those supported by the APA. There have been numerous other cases in the Supreme Court during the years of Justice Souter's tenure that to a significant extent turned on our psychiatric diagnoses and scientific expertise. In what follows, I shall try to present the Clark case in a historical context, explain in somewhat oversimplified terms the complex legal issues surrounding it, and suggest what I believe Justice Souter was attempting to accomplish by his decision. Both issues are complicated, but they are basic to the understanding of the role of modern psychiatry in determining criminal responsibility and deserve the attention of every psychiatrist. This was the first time in the history of the Supreme Court that the Justices have dealt directly with both the insanity defense and the admissibility of psychiatric testimony on criminal intent. However, I think it would be a mistake to conclude that Justice Souter is somehow biased against psychiatry, or that this disappointing decision constituted a major setback for psychiatry.
Justice Souter rejected all of the carefully crafted arguments therefore, a certain amount of disappointment and disgruntlement was to be expected. A great deal of careful thought and collaborative effort had gone into an impressive brief in which forensic psychiatrists and psychologists had been able to work out a professional consensus with their lawyers on the difficult legal, constitutional, and scientific issues. 4 Paul Appelbaum, now chair of the committee that prepared the APA briefs and an expert on law and psychiatry, worried that the legacy of the Clark opinion might be "to exert unfortunate influences involving mental health issues far removed from criminal law." Justice Souter's decision was certainly a kick in the stomach to the drafters of this amicus brief, which was submitted to the Court on behalf of the APA, together with the American Academy of Psychiatry and Law and the American Psychological Association. Leading forensic practitioners read the opinion as hostile to the insanity defense, dismissive of psychiatric expertise in the courtroom, and "skeptical about the evidence of mental disorders." 2,3 And let it be said that legal scholars agreed with the forensic psychiatrists and thought that Justice Souter's decision was wrongly decided and poorly reasoned. Justice Souter, who wrote for the majority, ruled that Arizona's vanishingly narrow insanity defense was not unconstitutional and, more troubling to forensic psychiatrists, he decided that on the issues of intent or premeditation (the mental elements of the crime), Arizona could prohibit expert psychiatric testimony on the grounds that it was unreliable and confusing to jurors.
The Supreme Court's 2006 decision in Clark v Arizona 1 was one of the most unexpected defeats the American Psychiatric Association (APA) has had since it began regularly submitting amicus briefs to the Court 35 years ago.
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