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The mental health and criminal justice systems are two of the major control mechanisms in American society that often function together through related and interdependent structures to identify and control deviant behavior. Both systems employ coercive control. In addition, regardless of the specific form of the deviance, these control institutions also use informal social control to reinforce role behaviors appropriate to the individual’s age, sex, race/ethnicity, and other social statuses. This paper investigates the effects of gender and gender role incongruence on the determination of criminal responsibility. Data for this study came from the Insanity Defense Reform Project, a National Institute of Mental Health-funded study of eight states. The sample for this study consists of 4842 cases in which insanity was raised as a defense. The findings suggest that how and the degree to which courtroom personnel rely on common stereotypes and gender expectations in decision making is complicated and may reflect a weighing of factors related to blameworthiness and dangerousness—both physical and symbolic.