AbstractThis article provides an overview of the historical development of the insanity defense, including a discussion of the standards which have been used to excuse someone from criminal responsibility. The legal issues raised pre‐trial and at trial are presented, along with a discussion of current proposals to modify or abolish the insanity defense. The article also focuses on the disposition of insanity acquittees, including both the case and statutory law in this area. Constitutional bases for challenges to differential procedures for insanity acquittees, along with proposals to change the law relating to them are include