<p>This article critically examines the proposed use of the psychiatric distinction between delusions and extreme overvalued beliefs as a tool for distinguishing criminal insanity from (mere) violent extremism. The analysis contrasts this distinction with a wholly normative one that we designed to better fulfill the same purpose. This normative distinction, based on concepts from John Rawls’ political philosophy, highlights and depends upon a host of political considerations relevant to the ideals of the criminal justice system and the rights and freedoms fundamental to the political systems in which it is situated. These considerations challenge the psychiatric distinction between delusions and extreme overvalued beliefs, suggesting that criminal responsibility cannot be adequately explained or justified by psychiatric factors alone. The article further explores the case of criminal accountability for psychopaths and concludes that neither the psychiatric diagnosis of psychopathy nor the empirical findings that one may lack the capacity for empathy is determinative in such cases. Evaluations of criminal responsibility involve a host of other moral and political considerations, and the weight one gives to those considerations ultimately provides the basis for a legitimate determination of responsibility within the criminal law.</p>