It would seem it would be an advantage to pretend to be insane to avoid being found guilty so how do they determine if someone is truly insane or just pretending to be?
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Folks have explained the court process very well. Specifically to your question of how psychiatrists, psychologists, neuropsychologists and other mental health and neurological professionals determine whether someone is actually insane or is manufacturing symptoms to appear insane, the answer is that the diagnosis of many mental health disorders relies on patient observation as well as psychological and possibly neuropsychological testing.
The major psychological diagnostic tests are similar to the standardized tests that you may have taken in school – they have a lot of questions with multiple choice answers or answers on a scale. For example, a question might be, “From a scale of 0 (not at all) to 5 (all the time) how much of the time do you feel worthless.” Diagnostic tests such as the MMPI (Minnesota Multiphasic Personality Inventory) provide a scale that rates the reliability of the patient’s answers – the questions are asked in such a way that it’s possible to score how consistently the patient answers the same question asked in different ways. If there’s a lot of deception on the exam that could mean different things, but one possibility is that a patient is trying to game the test.
The same thing is true of in person interactions. Mental health practitioners are trained in evaluating a person’s behavior, and part of that evaluation is determining whether they’re being truthful in their responses. Deception or answers that deflect from the truth doesn’t automatically mean they’re being malicious, for example it’s pretty common for trauma survivors to understate their trauma (“I know my parents loved me, they just didn’t know how to show it.”). But a professional is not going to just blindly accept symptoms of psychopathy or sociopathy as valid without some backup diagnostic testing. Also, anyone other than a patient who took time to educate themselves very well would likely counterfeit symptoms incorrectly, because the psychiatric symptoms portrayed on TV and in movies are almost universally wrong.
Lastly, as others have said, it’s not like being found incompetent to stand trial or not guilty by reason of insanity allow you to escape punishment. I’ve spent a fair amount of time in inpatient psychiatric settings due to chronic mental illness, and I guarantee that no one will find the experience pleasing. There are many similarities to prison – lack of freedom to schedule your own day, inability to freely leave the facility, folks who tell you what to do, etc. It’s likely safer than some prisons, but it’s profoundly mentally taxing to see folks actively in the midst of a psychotic break, determined to harm themselves, or otherwise socially scary.
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