Denouement of an execution competency case: is Perry pyrrhic?

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.