The admission by a US Mafia boss that he duped experts into believing he was mentally unfit for trial has put forensic psychiatry in the dock, writes Stephen Phillips.

It was like night and day. The man on the tape lucidly discussed the relative merits of two medications administered by the prison dentist vis-a-vis his allergy to penicillin. Cognisant of visiting hours, he wound up the conversation with his daughter, telling her he needed to confer with his lawyer. It sounded like somebody calling the shots - much as you'd expect from the man credited with ruling America's most powerful Mafia crime syndicate during the 1980s, and perhaps beyond.

Yet five years earlier, Vincent "the Chin" Gigante was demented and deranged, according to the sworn testaments of scores of eminent US forensic psychiatrists who declared him unfit to stand trial.

"In 1997, he didn't even know the names of his children. It's a miracle - the only man ever cured of Alzheimer's," proclaims New York University psychiatry professor Jonathan Brodie, who testified against Gigante's mental incompetence defence back then. Of course, Brodie - called in by US prosecutors earlier this year to review recordings of Gigante, in connection with charges that he was still running illicit operations from behind bars - has his tongue firmly lodged in his cheek.

ÖйúAƬ

Gigante's case seemingly belongs to that exclusive class of miraculous medical remissions reserved for wealthy defendants seeking a way out of lengthy jail time. As in the case of imprisoned former Guinness chairman Ernest Saunders - released ten months into a five-year sentence for malfeasance after doctors attested he was suffering from Alzheimer's disease (he subsequently recovered his faculties to carve out a lucrative consulting niche) - this anomaly is unlikely to wind up in the annals of medical research any time soon.

For 75-year-old Gigante, already serving 12 years for murder conspiracy and racketeering, last month confessed to feigning mental illness during his trial. In return, charges of running dockside extortion rackets in New York, New Jersey and Miami while he was incarcerated were dropped.

ÖйúAƬ

The admission, which also secured more lenient sentences for family members facing other charges, ended an epic legal saga. But it now raises uncomfortable questions of the illustrious cast of experts from the US academy who had testified that Gigante was in the grip of Alzheimer's and schizophrenia. Those who appear to have been duped include a respected Harvard psychiatrist and several former presidents of the American Academy of Psychiatry and the Law (AAPL).

Brodie says his colleagues "blew it", missing glaring red flags. "There was a disservice done to forensic psychiatry... we need to be very humble."

But Thomas Gutheil, a Harvard Medical School psychiatry professor, and William Reid, an adjunct forensic psychiatry professor at the University of Texas medical school and a past president of the AAPL, do not believe their discipline is on trial. Both stand by their original diagnosis of Gigante's incapacity, arguing that since his admission to malingering was part of a plea bargain, this undermines its credibility.

All of this promises a lively debate in October, when the former legal adversaries square off in a discussion of the case at the AAPL conference.

Gigante's legal wrangles captivated US tabloids during the 1990s, prompting the depiction of neurotic gangsters in the hit TV series The Sopranos and the movie Analyze This (in which Robert De Niro stars as a mobster released from jail after a nervous breakdown).

Veteran New York crime reporter Jerry Capreci gives Gigante top billing among recent US mobsters. As alleged head of New York's Genovese family, the don controlled a sprawling crime empire, Capreci says. "He was the boss of bosses - the Ivy League of organised crime."

But Gigante took to the media glare in a markedly different role from arch-rival John Gotti, boss of the rival Gambino family, whom he stood accused of plotting to kill. Whereas Gotti was christened the Dapper Don for his snappy designer suits, immaculately coiffeured hair and urbane courtroom manner, Gigante (dubbed Chin for his jutting jaw) took the stand in ratty clothes and with dishevelled hair, by turns mumbling incoherently and catatonic.

Gotti was eventually convicted of murder and racketeering, and in 1992 he began a life sentence in prison, where he died last year. Gigante proved more slippery. For eight years from 1989, his defence team kept the US legal system at bay, portraying him as a victim of dementia. His shambling gait became a familiar sight in interminable competency hearings. "He was mumbling, stumbling, staring off into space; all of the things you'd think someone who was non compos mentis would do," Capreci recalls.

ÖйúAƬ

Then there were the nocturnal sojourns in Manhattan's Little Italy, when Gigante would pad around in dressing gown and slippers, chaperoned by his brother Father Louis Gigante while muttering "God is my lawyer". The antics earned him soubriquets such as "The Oddfather" or "Daffy Don".

His doting mother, Yolanda, told the New York Post in 1996: "Every day I care for him... feed him... wash him... cry over him."

Batteries of psychiatric tests administered by academic experts vouched that Gigante was indeed losing his marbles. He was unresponsive in psychological evaluations, the simplest questions baffled him in IQ tests, while an examination to detect malingering seemed to absolve him of faking it. Most compellingly, brain scans appeared to crystallise abnormalities consistent with neurological deterioration.

Gigante's malaise seemed plausible to Brodie too, at first. "When I examined him I was taken aback, I thought 'my God, he really is demented'... for about 30 minutes." Eventually, hubris proved Gigante's undoing. "He said he didn't know his children's names, but said they held 'legitimate jobs'. That shows a high level of abstraction for someone who can't recall their names," Brodie says.

ÖйúAƬ

Gigante's mask also slipped when he was asked who the US president was.

Brodie recalls: "He didn't know, but three minutes and ten questions later he said: 'George Bush Senior'. This was a terrible mistake. It was Clinton at the time, but he remembered the question; now you know he's faking it."

To trip Gigante up further, Brodie calculatedly expressed his desire to take a coffee break, wondering aloud what time it was. Gigante motioned to a clock not directly visible from his chair, betraying a recollection that if you moved your head, you could see it. Picking more holes in the incompetence defence, Brodie, an acknowledged authority on neuro-imaging, says the abnormal brain scans by which Gigante's lawyers set so much store were, in many cases, of murky quality and could have reflected the powerful psychotropic medication he'd been prescribed at the time.

Tests for malingering hardly rule out deception, either. Questions posed to Gigante offered two multiple-choice answers; getting substantially more than half wrong is considered a marker for feigned memory impairment. But such tests are flawed, says University of North Texas psychiatrist Richard Rogers, author of The Clinical Assessment of Malingering and Deception.

"They demonstrate when a person is almost definitely lying, but not that they are telling the truth," explains Rogers, whose research shows a 17 per cent malingering rate among people pleading incompetence to stand trial.

More incriminating than such psychiatric debunking were the fruits of FBI surveillance. Wary of the wire taps, Gigante's criminal cohorts discreetly referred to him as "that guy" while stroking their chins. But those outside his immediate circle were less guarded. For example, "Fat" Tony Salerno's observation that "if Chin gets pinched, all those years in that ****in' asylum would be for nothing", did the crime boss no favours.

Remorseless monitoring of Gigante himself also picked up "off-duty" moments. In jail on remand, he made his bed, shadow-boxed to keep in trim, discussed his fondness for tomatoes with one warder, and declared to another that "nobody ****s with me". His fate was ultimately sealed by several turncoat mobsters who testified that he headed the Genovese family.

Despite these developments, Gutheil and Reid are sticking to their guns. Neither retracted his previous testimonies about Gigante's incapacity when played tapes by federal prosecutors of him waxing lucid.

"They were snippets of minutes obviously chosen from many," says Reid, who holds that Gigante was merely a Mafia figurehead. And Gutheil says: "They ignore the likelihood that he was reading (what he was saying)." Besides, he adds, "He was mostly schmoozing." He casts Gigante's "fantastic plea bargain" as the altruistic act of a beneficent patriarch to save his kin from stiffer sentences. "People pretend this is a revelation of his duplicity, but it's the price tag of his plea."

But all this is beside the point, Gutheil argues. "It's all about whether [Gigante] met the criteria [of competence to stand trial]. No one ever demonstrated that he understood the nature of the court proceedings or of the offence committed... this is the law, it doesn't matter that he can do some things well."

To Capreci, this smacks of legal sophistry. "It's self-serving drivel.

Harvard professors can do self-serving drivel with the best of them," he says. "If they (the criminal fraternity) thought he was nuts, they would have killed him," he adds, referring to the Mafia practice of "mercy killing" unhinged gangsters deemed to be a security risk.

Brodie, who says the tapes he heard were not edited excerpts, seems nonplussed by his colleagues' argument. "Alzheimer's is a progressive illness with a six to 11-year life span. How the hell is he still around in 2003, schmoozing?"

It all boils down to whether Gigante was "crazy as a loon" as the tabloids of the time screamed - or, as Joe "Black" Gorgone put it in an eavesdropped conversation, "crazy like a fox". As the 2002 sequel to Analyze This puts it: "Analyze that".

ÖйúAƬ