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This chapter reviews decision-making in insanity defense trials. The chapter begins with an overview of the variety of legal definitions of insanity in the United States, discussing how these rules provide parameters and shape (or fail to shape) insanity decisions. Various factors related to decision-making in insanity defense cases are discussed, including attitudes toward the insanity defense itself (and how these reflect myths about the insanity defense and its implications), prototypes of insanity, and individual differences of both jurors and defendants. The chapter examines misconceptions of mental disorder and how these might relate to decision-making in these cases and considers the role of decision-makers’ perceptions of punishment in this context. The chapter also reflects on the role of intersecting identities in insanity judgments, provides an overview and synthesis of the current body of research on legal decision-making in insanity cases, discusses limitations to the current literature, provides future directions, and considers legal and policy implications.
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