A man who dreamed of organising a military coup in Africa has been jailed for life for murdering a nurse after a trial which was punctuated by outbursts of foul-mouthed abuse from the defendant.
By Mario Cacciottolo
Stuart Harling claimed he suffered from mental health issues
What was never in doubt at the trial of Stuart Harling was that he stabbed nurse Cheryl Moss 72 times as she took a cigarette break outside St George's Hospital in Hornchurch, Essex.
The jury was simply asked to decide if he murdered her in cold blood or while suffering from a mental disorder.
In the end they did not believe his unstable behaviour in court, which included hurling papers from the dock and shouting threats - he was removed from court on one occasion for threatening to shoot the prosecution with a machine gun. They rejected his claims of innocence on the grounds of diminished responsibility.
But the case does highlight the massive difficulties surrounding the diagnosis of mental disorders.
Harling's barrister, Michael Wolkind, QC, called several psychiatrists to give evidence.
Dr Philip Joseph said Harling had either an Asperger's syndrome, which is a form of autism, or a personality disorder.
He disputed suggestions by prosecutor Brian Altman, QC, that Harling was feigning mental illness and added: "The suggestion of him pretending to be mad is completely opposed to what he is trying to do - to appear to be a normal person."
But is it possible for someone of sound mind to reach the age of 19, complete an accountancy course and be looking for jobs, before carrying out a brutal killing?
Equally is it possible to go without having mental health issues diagnosed - or even noticed - by family or doctors?
Cheryl Moss was stabbed 72 times by Stuart Harling
Mr Altman said Harling knew exactly what he was doing, right up to killing Mrs Moss. He pointed out Harling had bought a knife and a knife-fighting manual on eBay in advance and he argued that his actions were clearly premeditated.
Defence psychiatrist Professor Digby Tantam, was asked by the judge if it was rare for people with Asperger's to carry out physical assaults.
He replied: "No. Violence occurs with people with Asperger's no more than with the general population but when it does happen it tends to be directed at strangers."
The Mental Health Bill, which is currently going through Parliament, includes controversial plans to allow people with untreatable personality disorders to be detained even if they have not committed crimes.
Ministers have been trying to update mental health legislation for England and Wales since 1998.
The trial heard how Harling stabbed Mrs Moss in the hope of stealing her car keys. It was the start of a bizarre plan to travel to Equatorial Guinea in order to stage a coup, possibly following in the footsteps of British mercenary Simon Mann who was accused of hatching a similar plot in 2004.
Despite Harling's earlier disruptive behaviour, he later appeared calmer and gave evidence in the witness box.
He said he did not know why he had stabbed Mrs Moss but added: "It kinda ruined my day."
Michael Howlett, of mental health charity the Zito Trust, said the new bill would probably not have prevented Harling from killing Mrs Moss.
'Out of the blue'
He told the BBC News website: "It's an interesting case and not one that can easily be tied in with the Mental Health Bill.
"If there's nothing previous in his life in terms of mentally ill behaviour, if he's relatively intelligent with GCSEs, then maybe it's come out of the blue and it could be the first time that he's displayed problems.
"Up until that day perhaps nobody was any the wiser until the police got into his computer and saw that he was a disturbed human being.
"There's a question as to whether this guy should have been seen by somebody. But it's not a crime to be a loner and unpopular at school."
Mr Howlett said psychiatrists would be "falling over themselves to give opinions on this case" and they would probably all give differing ones, but crucially Harling must be dealt with in an appropriate manner following his sentencing.
'He could get worse'
He said: "The authorities are going to have to deal with him carefully and appropriately.
"If he just goes to prison then he could be out in 10 years, and where he could actually get substantially worse. If there's any issue with him then they need to work out what it is.
"He does seems highly disturbed. The question is why, and since when."
In October 2004, teenager Paul Smith was jailed for life for murdering a 10-year-old girl, Rosie May Storrie, at a Christmas party in Leicestershire.
Paul Smith, who has Asperger's is serving life for murder
Smith did suffer from Asperger's Syndrome but there was no suggestion that the killing was directly related to the condition.
A spokeswoman for the National Autistic Society said it could not comment on individual cases, but said Asperger syndrome was a developmental disability and "does not make a person more likely to intentionally commit a crime".
She said: "In many cases, individuals with autism are unusually concerned to keep the letter of the law, due to the nature of the disability.
"However, a person with autism may come to the attention of the police and other services through misunderstandings related to their social and communication difficulties, and through a lack of appropriate support."