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This article provides a psychiatric perspective on the problems Atkins raises for courts that handle death penalty cases. In contrast to the overarching aim of the majority's opinion in Atkins - making the administration of capital punishment more equitable - the Supreme Court's latest prescription of psychiatric help may only add a new layer of complexity and confusion to the already capricious process through which the U.S. criminal justice system imposes death sentences. The article briefly review's the Supreme Court's 1989 Penry decision, focusing on the role that evidence of mental retardation played in death penalty cases before Atkins was decided. The article then looks at how the Supreme Court majority in Atkins characterized the appellant's mental condition and the diagnostic process. Subsequent sections discuss: the process of diagnosing mental retardation, the ambiguities in that process, and the way that courts and legislatures may distort clinical diagnosis for use in legal proceedings; the contradiction between professional organizations' treatment of, and response to, Atkins and these organizations' customary stance on the use of diagnoses for non-clinical purposes; potential implications for capital defendants with psychiatric problems as incapacitating as, or more disabling than, mental retardation; the potential effect of Atkins on testimony by mental health experts; the effect of such testimony in future death-sentencing determinations.