Tarrah Casey L'26, a third-year student at Elon Law who researches neurodivergence and the law, reflects on the stigmas that mentally ill defendants face in legal proceedings.
During my first week of Elon Law’s Residency-in-Practice program, I walked into a South Carolina courtroom expecting a routine introduction to trial practice — jury selection, opening statements, the familiar choreography of witness examinations. Instead, I encountered a murder trial with an insanity defense that forced me to confront the volatile intersection of mental illness, violent conduct and the law’s attempt to impose rational order on human behavior. It was a rare case of a murder defendant claiming an insanity defense before a South Carolina jury.
Criminal doctrine claims to distinguish morally culpable action from conduct driven by severe mental disease or defect. Yet in practice, society remains deeply resistant to extending even minimal grace when punishment is at stake. We love to punish, and we distrust anything that resembles an excuse. The defendant before me needed treatment; he needed help. But within a system oriented toward retribution, illness collapses into guilt. The institutional response becomes predictable: contain, control and confine the beast.
Nothing in a casebook prepared me for the raw immediacy of a mind splintered long before the law judged him.
His delusions dominated the evidence. I listened to voicemails he left after beating his mother beyond recognition with the leg of a table. He referred to himself as a Navy SEAL and carried on a conversation with someone who existed only in his mind. The forensic psychiatrist explained how his inward and outward projections tethered him to an alternate reality. In that reality, CIA agents listened through devices in his teeth and loved ones were replaced by alien spies.
The murder scene reflected this fractured world: He believed he had killed the alien inhabiting his mother’s body and attempted to give her a new one. He called his family and described the event in a chilling voice that even his social worker said didn’t sound like him.
As the psychiatrist detailed the defendant’s psychosis, the voices that commanded him and the delusional system shaping his actions, I felt the weight of the law’s expectations pressing against the limits of human cognition. We ask jurors — ordinary people with no psychiatric training — to translate hallucinations and delusions into legal categories.
Mental illness exists on a scientific spectrum. Insanity, by contrast, is a legal term of art. South Carolina, like many states moving away from the insanity defense, is taking a giant leap in the wrong direction.
A finding of “not criminally responsible” due to paranoid schizophrenia should carry substantial moral and legal weight, yet it rarely moves a modern jury. Cultural narratives about personal responsibility and dangerousness prime jurors to distrust the very concept. To compound the problem, South Carolina provides no instruction about the consequences of a verdict. Courts warn that “focusing on outcomes could prejudice the jury,” leaving jurors to choose among vague constructs like “Guilty but Mentally Ill” (GBMI), a verdict functionally indistinguishable from guilty. GBMI reflects a deeper cultural shift: Mental illness itself is becoming morally blameworthy.
That trial stayed with me. It revealed the limits of our current system and the urgency of reform. It pushed me to study GBMI, juror misunderstanding and the consequences of sanism in criminal adjudication. If justice is to mean anything for defendants whose minds break from reality, the law must bridge the gap between doctrine and science.
Tarrah Casey L’26 is a third-year student at Elon Law and presented her research on how courts evaluate remorse in sentencing autistic defendants at the 2025 Autism Law Summit. She completed her Residency-in-Practice, Elon Law’s signature experiential learning program in which students learn the law by praticing it, at Sarratt & Horta Vorse, P.A., in Spartanburg, South Carolina.