Denouement of an execution competency case: is Perry pyrrhic?
Bull. Amer. Acad. Psychiatry & the Law
23(2): 269-84, 1995.
In October 1992, the Louisiana Supreme Court ruled that that state could not forcibly medicate
condemned, mentally ill prisoners to make them competent to be executed. State v. Perry has been
seen as a victory for psychiatrists, but the decision contains bad news as well as good: although the
Court extricated psychiatrists from having to medicate convicts involuntarily in preparation for their
execution, the Court justified its decision by invoking a distortion-filled, highly critical interpretation
of standard psychiatric treatment for psychoses. This article summarizes the Perry case and the
Court's opinion, describes the perceptions of antipsychotic medication that animated the majority's
legal conclusions, and reviews subsequent decisions in which Perry has been influential. The article
suggests that Perry's description of pharmacotherapy may not have been motivated by a reasoned
view of neuroleptic therapy so much as the Court's desire to uphold the institution of capital
punishment. By studying the Perry majority's opinion, psychiatrists can appreciate how certain
characterizations or descriptions of psychotic symptoms and antipsychotic therapy lend themselves
to distortion and misunderstanding by legal decisionmakers. Recently developed conceptions of
schizophrenic symptoms and pharmacological therapy may provide psychiatrists with sophisticated
modes of explanation that courts will find more difficult to misconstrue or misrepresent.