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I think she was genuinely incompetent, but that doesn't necessarily equate to any kind of mental health defense. I think she's had episodes of being completely out of touch with reality in the past, too, but in my opinion none of it has anything to do with her guilt.
It reminds me of the competence determination of "David Mitchell", Elizabeth Smart's kidnapper. He seemed crazy to me. But, he was "crazy" on the continuum of "crazy", but that is separate from his ability to participate in his defense.
Psychologist: Mitchell has personality disorder, but competent
This is also not unlike the determination of competence for the Colorado Movie Shooter, who really seemed "crazy". But he was also found Competent.
Insights from a Psychiatrist Who Interviewed Mass Murderer James Holmes
There are so many criminals who do horrific crimes, how could anyone "normal" do a crime like killing children? But we need to differentiate an Anti Social Personality disorder from mental illness.
INMO, LVD is NOT in anyway "Mentally Ill". She does have a lot of issues though, stemming from her Personality disorders.
INMO. Not diagnosing LVD.