Critics of the insanity defense and the separation of the mad and the bad in correctional facilities have contended that there are other offenders who because of environmental conditions have as little control over their behavior as those classified as mentally ill. This paper first outlines current legal views of criminal responsibility and then addresses the rehabilitation theory of punishment as well as arguments that it has been simply a rationalization for maltreatment. The current trend in criminal law theory toward a harm model which focuses on the social harm caused by an offender and effective dispositions rather than personal responsibility is discussed. Contemporary definitions of mental illness are explored from sociological, anthropological, and psychiatric perspectives and theories which defend the concept of mental illness against those who consider it mythological are summarized. In order to evaluate treatment of the criminally insane and the role of responsibility in everyday criminal dispositions, clinical services offered in Wisconsin's maximum security prison are described. Patient confidentiality, staff experience, caseloads, therapy objectives, and criteria for transfer to security hospitals are covered. The clinicians did not practice coercive therapy, but concentrated on helping inmates adjust to harsh prison life. Data are lacking on the therapeutic effectiveness of both prison and security hospitals, but effectiveness should not be measured solely by recidivism rates. The survey of Wisconsin's correctional facilities indicates that the environment of the maximum security hospital is more benign than prison for offenders judged as criminally insane or mentally ill. Better mental health services are needed in all prison facilities, but are unlikely to be implemented because of funding constraints. The insanity defense and related categories should be reserved for those cases where offenders on their own volition raise such a defense successfully. The appendix contains a description of other prisons and the maximum security hospital in Wisconsin. Tables, footnotes, and 86 references are provided.