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This column describes a recent Supreme Court case, Clark v. Arizona, in which an adolescent who had schizophrenia was convicted of first-degree murder of a police officer who he believed was a hostile space alien. The Arizona courts had rejected his insanity defense as well as a second defense that he lacked the required intent to commit the crime (mens rea) because his delusions interfered with his knowing that the victim was a police officer. The Court ultimately declined to overturn Arizona's rules regarding the insanity defense and mens rea. However, the column highlights the points in Justice Sou-ter's decision that may have implications for any case involving mental health issues.