The Mickey Finn* Defense: involuntary Intoxication and Insanity Robert Lloyd Goldstein, MD, JD The legal context of voluntary and involuntary intoxication is delineated. The author reports a case of involuntary intoxication involving scopolamine toxic psy- chosis or delirium, in which he testified as a psychiatric expert witness. The specific psychological and physiological symptomatology produced by scopolamine intoxi- cation is outlined. The forensic psychiatrist should be alert to the involuntary intoxication defense in these cases and should familiarize himself with the specific toxicity of scopolamine, in view of the significant increase in the number of incidents in which it is utilized as "knockout" drops in certain jurisdictions. Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter." [classical de- scription of scopolamine poisoning12 It is a generally accepted rule of law that a defendant who is voluntarily un- der the influence of intoxicating sub- stances at the time a criminal act is committed will not be relieved of crim- inal responsibility. "Simply stated, a vol- untary intoxication or a voluntary drugged condition does not raise the de- fense of insanity, but. . .may be used to negate the existence of the mental state which is an element of the crime. A voluntary intoxication or voluntary Dr. Goldstein is associate professor of clinical psychia- try and director of the Legal Issues in the Practice of Psychiatry Program, Columbia University's College of Physicians and Surgeons, New York City. Address re- print requests to: Robert Lloyd Goldstein, M.D., J.D., The Apthorp, 390 West End Avenue, New York, NY 10024. *A drink of drugged liquor; a drink spiked with knock- out drops. drugged condition precludes the use of the insanity defenset. . ."3 While failing as a "complete defense" to eliminate culpability entirely, voluntary intoxica- tion nonetheless may be used as evi- dence to mitigate the seriousness of the offense by negativing an element of the crime charged. Thus, for example, a de- fendant charged with murder may be found guilty of the lesser included crime of manslaughter, if the factfinder deter- mines he was too intoxicated to form the requisite specific intent to cause death (i.e., the intoxication rendered the defendant incapable of forming the spe- cific intent constituting an element of the ~ r i r n e ) . ~ In contrast to voluntary intoxication, t A n exception to this rule may exist in the case of voluntary intoxication leading to a settled or fixed permanent type of insanity (e.g., alcoholic psychosis) or resulting in unforeseen temporary insanity (e.g., the LSD cases). Bull Am Acad Psychiatry Law, Vol. 20, No. 1, 1992 27 Goldstein involuntary intoxication is a "complete defense" to a criminal charge. Generally, the defendant must prove three ele- m e n t ~ : ~ 1) He was intoxicated at the time of the crim- inal act. 2) The intoxication was involuntarily created. 3) His mental state at the time met the juris- diction's test for insanity. The common law recognized invol- untary intoxication if it occurred under any of the following conditions: 1) coer- cion or d ~ r e s s ; ~ 2) "pathological intoxi- cation";' 3) prescription by a phy~ician;~ 4) resulting from an innocent m i ~ t a k e . ~ In the latter category, an individual makes an "innocent mistake" of fact, by innocently ingesting a substance without knowledge of the foreseeable intoxicat- ing potential of that substance. The "in- nocent mistake" can occur with or with- out the machinations, contrivance, trickery, or connivance of another indi- ~ i d u a l . ~ The prototype of involuntary intoxication is when the intoxicated state results from another person trick- ing the individual by slipping a potent intoxicating drug into his drink. The unsuspecting victim is said to have been given "knockout drops" or to have been slipped a "Mickey Finn."' The pleasing concoction then produces a state of stu- pefaction or confusion that was unfore- seeable to the victim and that sets him up for robbery, sexual assault, or other criminal acts. As far back as 1904, ex- Inspector Elliott, formerly of the Glas- gow police force, wrote: The use of drugs. . .or what is more familiarly known in criminal circles as "knockout" drops $A notorious saloon-keeper of Chicago, ca. 1896-1906. is common enough in most cities. What is known as "knockout" drops is chloral hydrate, and from 15 to 30 grains of it produces a sleep that lasts three hours." Eighty years later, in 1984, the New York City Police Department issued an Operations Order" on the subject of "Use of 'knockout' drops in certain crimes." The operations order described a significant increase in the number of robberies committed in which "knock- out" drops were used to render the vic- tim helpless. The perpetrator surrepti- tiously added the drug to the victim's drink and eventually, "while the victim is incapacitated. . .removes currency, credit cards, jewelry, and/or other prop- erty."" Although "knockout" drops were originally considered to be mainly chloral hydrate, the 1984 operations or- der noted that the police laboratory and medical examiner's office have identi- fied one of the most commonly used "knockout" drops to be scopolamine hy- drobromide, commonly diluted in water, "resulting in a colorless, odorless, and tasteless liquid. Prostitutes have been known to carry the diluted solution in eye dropper bottles and/or small plas- tic squeeze bottles. . . . " l l In some cases, the intended victim may become delirious and perpetrate an act of violence, with the result that he himself is charged with a criminal of- fense. Such a case is described in the following case report, which illustrates a recent successful involuntary intoxica- tion defense in New York City involving scopolamine. 28 Bull Am Acad Psychiatry Law, Vol. 20, No. 1, 1992 The Mickey Finn Defense Case Report An off-duty police officer met a few colleagues after work and consumed two beers. Later in the evening, he stopped off at a topless bar, a known underworld haunt, for one more beer. After ordering the drink and taking a few sips, he went to the men's room. He returned to the bar and finished his drink. Within fifteen or twenty minutes, he suddenly felt as though his head was spinning. He felt hot, flushed, and dizzy. His throat was exceedingly dry and he had difficulty swallowing. His heart was beating fu- riously and his vision was blurred. He remembers staggering back from the bar, feeling that his mouth was burning, and then he blacked out completely. He is amnesic for the events that followed. Other observers in the bar noted that he seemed to be confused and delirious. He staggered and strutted around the bar, shouting (at times incoherently). He yelled that he was a policeman and was going to "take care of troublemakers." He waved his gun in a menacing fashion and pointed it at several patrons, causing them to duck under tables and scramble to safety as best they could. He shot one of the patrons at point-blank range, causing serious injuries, for no rational reason. Then he wandered around the nearly deserted bar for 10 or 1 5 minutes in a confused and agitated state, appar- ently unable to find the exit. The police finally amved and placed him under arrest for attempted murder. Although he appeared to be intoxicated according to police reports, no blood tests or urine screening was camed out for alcohol or drugs after his arrest. Prior to the incident described above, the officer had an unblemished record, had recently received a promotion, and had no history of psychiatric disorder or substance abuse. The psychiatric expert retained by the defense (the author) con- cluded that the defendant appeared to have suffered an acute confusional state, most probably a reaction to scopolamine intoxication, in view of the constellation of psychological and physiological symptoms he experienced at the time of the incident. These included confusion, disorientation, amnesia, delirium, agi- tation and aggressiveness, as well as flushed skin, dry and burning mouth, palpitations, blurred vision, and difi- culty focusing. He testified that the spe- cific combination of such symptoms, both psychological and physiological, was pathognomonic for scopolamine in- toxication. Because the officer was not taking any prescribed medications con- taining scopolamine or related sub- stances, and because scopolamine is not usually a drug of choice for abuse, the expert opined that the most likely route of administration involved surreptitious addition of the substance to the unsus- pecting officer's drink. The expert's clin- ical inferences were based on the offi- cer's subjective account and the objec- tive observations of third party witnesses, who confirmed that he had been highly confused, disoriented, and irrational at the time of the incident. The police had camed out a cursory investigation and failed to seek any in- dependent corroboration of the officer's account of the incident. Blood or urine samples were not collected for labora- Bull Am Acad Psychiatry Law, Vol. 20, No. 1, 1992 29 Goldstein tory analysis, and no attempt was made to explore the possibility that his drink had been drugged (e.g., by subjecting his glass to forensic analysis or by identify- ing the perpetrator who allegedly drugged him [which itself would have constituted a criminal act]). The prosecution's expert argued that, in the absence of any physical corrobo- ration (e.g., finding scopolamine in the officer's blood or urine), the defense had to rely on the officer's self-serving sub- jective account of the symptoms he had experienced, which might have been fab- ricated in order to convey the false impression that he was the victim of scopolamine poisoning, rather than ad- mitting to voluntary intoxication with alcohol. He testified that although sco- polamine is readily absorbed from the gastrointestinal tract, the onset of psy- chiatric symptoms would not have been so immediate, but would have taken 30 to 60 minutes to appear. In New York, a finding of involuntary intoxication is not treated as a variant of the insanity defense, but leads to an outright acquit- tal. In such a case, the defendant had drugs administered to him against his will or by deception, thereby depriving him "of the ability to act consciously and to exercise his own independent judgment and volition. . . ."I2 Because his conduct was involuntary, he could not be found guilty of a criminal act. As one New York court said on the issue: . . . criminal liability requires at the very least a voluntary act.13 The jury acquitted the defendant po- lice officer of any criminal wrongdoing, on the basis of involuntary scopolamine intoxication. Note on Scopolamine Intoxication Scopolamine is one of the belladonna alkaloids related to atropine. An anti- cholinergic drug, it is a primary central nervous system depressant with marked sedative and tranquilizing properties. It dilates the pupils, causes blurred vision, dryness of the skin, accelerated heart action, flushing, dryness and burning of the mouth and throat, and difficulty ~wallowing.'~ Scopolamine has a well- recognized amnesia-producing quality and induces a transient, memory-erasing effect, which has "led to its use as a preanesthetic medication for surgical and obstetrical procedure^"'^ ["twilight sleep"]. Although primarily a sedative- tranquilizing drug, scopolamine may cause a paradoxical delirium in as many as 10 percent of patients premedicated with it in the pre- or postoperative period.I5 A striking effect of large doses is the total amnesia that develops for events that occurred while the individual is under the influence of the drug.14 For those who are excessively susceptible to scopolamine, alarming toxic symptoms may include "marked disturbances of the intellect, ranging from complete di- sorientation to an active delirium resem- bling that encountered in atropine poi- soning."14 Anticholinergic intoxication has been described by Homer in The Odyssey, by Omar Khayyam, Henry David Thoreau, and others,with ac- counts of poisoning causing confusion, stupor, and even death.2 The intoxica- tion syndrome induced by anticholiner- 30 Bull Am Acad Psychiatry Law, Vol. 20, No. 1, 1992 The Mickey Finn Defense gic agents has been reported for drugs used to treat colds, allegeries, motion sickness, peptic ulcer, ophthalmological conditions, and Parkinson's d i ~ e a s e . ' ~ - ' ~ A number of articles have described the anticholinergic intoxication syndrome, scopolamine psychosis, and scopola- mine dissociative-delirium. ' ', 19-21 References 1. Partridge E: A Dictionary of the Underworld. Hertfordshire, U.K., Wordsworth Editions, 1989, p. 437 2. Johnson AL, Hollister LE, Berger PA: The anticholinergic intoxication syndrome: diag- nosis and treatment. J Clin Psychiatry 42:313-7, 1981 3. People v. Free, 94 Ill. 2d 378 474 N.E. 2d 218 (1983) 4. Lafave W, Scott A: Criminal Law (ed 2). St. Paul, West Publishing, 1986 5. Bidwill MJ, Katz DL: Injecting new life into an old defense: anabolic steroid-induced psy- chosis as a paradigm of involuntary intoxi- cation. U Miami Ent and Sports L Rev 7: 1- 63. 1989 6. State v. Bunn, 283 N.C. 444, 196 S.E. 2d 777 (1973) 7. Comment: Pathological intoxication and the voluntarily intoxicated criminal defendant. Utah L Rev 96:419-42, 1969 8. Saldiveri v. State, 2 17 Md. 4 12 143 A. 2d 70 ( 1958); City of Minneapolis v. Altimus, 306 Minn. 462 238 N.W. 2d 85 1 (1976) (en banc) 9. Special Project: Drugs and criminal respon- sibility. Vanderbilt L Rev 33:1145-234, 1980 10. Partridge E: supra, note 1 at 39 1 11. New York City Police Department: Opera- tions Order, No. 47, May 10, 1984 12. New York State Consolidated Jury Instruc- tions, Involuntary Intoxication, 9.45 ($15.25) 13. People v. Carlo, 46 A.D. 2d 764, 361 NYS 2d 168 (1974) 14. Gilman AG, Goodman LA, Gilman A (Eds): The Pharmacological Basis of Therapeutics (ed 6). New York, Macmillan, 1980 15. Good MI: Substance-induced dissociative disorders and psychiatric nosology. J Clin Psychopharmacol9:88-93, 1989 16. Berger PA, Tinklenberg JR: Medical man- agement of the drug abuser, in Psychiatry for the Primary Care Physician. Edited by Free- man A, Sack R. Berger P. Baltimore, Wil- liams and Wilkins, 1979 17. Shader RI (Ed): Manual of Psychiatric Ther- apeutics. Boston, Little, Brown, and Com- pany, 1975 18. Rodysill K, Warren JB: Transdermal scopol- amine and toxic psychosis. Ann Intern Med 98561-70, 1983 19. Dysken MW, Merry W, Davis JM: Anticho- linergic psychosis. Psychiatric Ann 8:452-6, 1978 20. MacEwan GW, Remick RA, Noone JA: Psy- chosis due to transdermally administered scopolamine. Can Med Assoc J 133:431-2, 1985 21. Macvicar K: Abuse of antiparkinsonian drugs by psychiatric patients. Am J Psychia- try 134:809-ll, 1977 Bull Am Acad Psychiatry Law, Vol. 20, No. 1,1992