When a Psychiatrist or Psychologist Diagnoses an Offender with a Serious

When a psychiatrist or psychologist diagnoses an offender with a serious mental illness that prevents the person from appreciating the difference between "right" and "wrong," we classify that person as legally insane. This means

A) We then excuse what might otherwise constitute criminal conduct on this basis of insanity and excuse criminal punishment for it.
B) We still hold them accountable for their actions and punish them.
C) We still hold them accountable for their actions, but excuse criminal punishment.
D) All of the above.