(_a_) In _law_--sufficiently to understand what are considered by the
courts as characteristic marks of an insane mind, and what amount of
sanity the courts require to hold a culprit responsible for his crime or
a contract valid in its effects.
(_b_) In _psychology_--to such an extent that the expert witness can
speak analytically and correctly as to the properties and actions of the
human mind.
(_c_) In _medicine_--so far as concerns the treatment of the insane, and
the understanding of their peculiarities, so as to reason from them by
induction to the real condition of the client's or patient's mind.
But the main requisite for an expert witness is to understand clearly in
what insanity properly consists, and how far it ought to excuse an
insane man from bearing the consequences of his acts.
III. This two-fold knowledge is obtained by the psychological study of
insanity, on which study we are now to enter, and it is the principal
point in this whole matter.
Insanity means a want of soundness; he is insane whose mind is not
sound, but is deranged, and therefore, like a machine out of order, it
cannot properly perform its specific task, namely, to know the truth of
things. An insane man cannot judge rightly.
1. Insanity takes various forms, which may be reduced to two kinds, with
the doubtful addition of a third kind, namely, moral insanity, of which
we shall speak in our next lecture.
The first kind consists in the total want or gross torpor of mental
activity. When there is a total, or nearly total, eclipse of the
intellect, the disease is called _idiocy_, the state of an idiot. When
there is an abnormally low grade of the reasoning power, it is styled
_imbecility_. The failure or decay of reason in old age is called
_dotage_.
The second kind of insanity is called _illusional_ or _delusional_. In
it the intellect is not impotent; on the contrary, it is often unusually
active; but its action is abnormal, its conclusions are false. Not that
it reasons illogically or draws conclusions which are not contained in
the premises. Very keen logicians may be demented. Their unsoundness
arises from the fact that they reason from false premises; and they get
their false premises from their diseased imaginations, whose vagaries
they take for realities.
2. Here a difficulty presents itself, which we must explain at once,
namely, how can there be unsoundness of mind at all? Is not the
intellect of man a simple power, and his soul a simple being? How can a
simple being become deranged? Can that which has no parts become
disarranged, disorganized? I answer, the soul is a simple being, its
intellect is a spiritual faculty; and therefore we never say that the
_soul_ is insane, nor should we say that the _intellect_ is insane or
diseased; but we say that the _mind_ is deranged or insane; the mind
comprises more than the intellect; it designates the intellect together
with those lower powers that supply the materials for our thought, the
chief of which is the imagination. Now the imagination is an organic
faculty: it works in and by a bodily organism, which is the brain.
Therefore, when the brain is not in a normal condition, the action of
the imagination may be disordered. And the intellect or understanding of
the spiritual soul is so closely united in its action and its very being
with the organic body that the two ever act conjointly, like the two
wheels of a vehicle. If one wheel breaks down, the other is thrown out
of gear. Thus it is readily understood that mental unsoundness is an
affection of the brain, a bodily disease, which may often be relieved
and even cured by bodily remedies, by the use of drugs or wholesome
food, healthy exercise, fresh air, and all that benefits the nervous
system.
Pathologically considered, the nerves may be too excited or too sluggish
and torpid; and we have as the result two subdivisions of mental
insanity--_mania_ and _melancholia_. The differences between these two
are very striking; as they proceed from opposite causes they produce
opposite effects, and, therefore, they betray themselves by very
different manifestations; but in one point the two agree, and with this
point precisely we are concerned, because in it lies the essence of
mental insanity, namely, that both produce a disordered action of the
imagination.
3. The manner in which the imagination co-operates in mental action is
this. It presents to the intellect the materials from which that power
forms its ideas. When we see, feel, hear, taste, or smell anything by
our bodily senses, our imagination takes note of the object perceived by
forming a brain-picture of it which is called a _phantasm_. I do not
mean to say that it forms a photographic picture of the object; for
there can be no photographing taste or smell or feeling; but it forms an
image of some kind which it presents to the intellect. This power at
once proceeds to form, not a brain-picture, but an intellectual or
abstract image of the object presented. For instance, you see this book,
and at once you, in some mysterious way which has never yet been
explained, impress some image of it on your brain. That you do so is
clear from the fact that the image remains when the book is withdrawn.
That material image or brain-picture is the _phantasm_. It is not an
_idea_, though it is often improperly so called. But your intellect
forms to itself an idea of a book; that is, you know what is meant by a
book. You distinguish between the mere form of a book and the book
itself. Your idea of a book is a universal idea, which stands for any
book, no matter of what shape or size. Every phantasm, or brain-picture,
is a representation which presents its object as having a definite shape
or size, while your idea of a book ignores any shape or size. And yet,
when your intellect conceives a book, your imagination will picture some
particular form of book. If your brain became so affected by disease as
to be unfit for the formation and retention of the proper phantasms,
then your intellect either would not work at all or it would work
abnormally; your mind would then be insane.
4. Now, in an infant the brain is still too soft and imperfect to form
the proper phantasms from which the intellect is to elaborate its ideas.
A false school of psychology would say that the infant's brain cannot
yet _ideate_; but that is incorrect language. No brain can ideate or
form ideas; an idea is an intellectual or mind image, not a brain image;
it is an abstract and universal image, and matter cannot represent but
what is concrete and individual. Only a simple and spiritual being, the
rational soul, can form ideas. Nevertheless our soul, in its present
state of substantial union with our body, is extrinsically dependent on
the body; to form ideas it needs to have the sensible object presented
to it by a phantasm or brain-picture. Now, a child born blind and deaf,
and thus having its mind, as it were, cut off from communication with
the outer world, could scarcely form the necessary phantasms, because
the clogged senses could not supply proper materials for them; such a
child would, therefore, be apt to remain idiotic. And even in children
whose outer senses are sound the brain or the nervous system may be too
imperfect to allow of its forming proper phantasms. In this torpor of
the mind then consists the first kind of mental unsoundness, that of
_idiocy_, or its milder form _imbecility_. In old age, and in peculiar
diseases, the worn-out system may return to a second childhood, then
called _dementia_ or _dotage_. The existence of such species of insanity
is not difficult to discover.
5. The second and more common form of insanity, and that which it is
often difficult to discover and pronounce upon with certainty, is that
which I have called _delusional_ or _illusional_. Its characteristic
trait, its very essence, lies in this, that the insane man mistakes what
he imagines for what is real; and he cannot be made to distinguish
between imagination and reality, though the difference is obvious to an
intellect in its normal state.
In this connection, it is well to point out a distinction, not always
observed, but useful to explain the workings of an insane mind, between
_illusions_, _hallucinations_, and _delusions_.
(_a_) An _illusion_ is properly a deception arising from a mistake in
sense-perception; as when a half-drunken man sees two posts where there
is only one. He has a picture of the post in each eye, and his brain is
too much disturbed to refer the two pictures to the same object. In this
case the cause of the mistake is subjective. A _mirage_ offers another
instance of a sense-illusion; but in it the cause is objective.
(_b_) A _hallucination_ is a creation of the fancy mistaken for a
reality. The deception may be but momentary, as when Macbeth is stealing
on tiptoe to the chamber of his guest to murder him. His mind is
disturbed by the imagination of the horrid deed he is about to
perpetrate. He thinks he sees a dagger in the air, and he says: "Is this
a dagger that I see before me, its handle towards my hand? Come, let me
clutch thee. I hold thee not, and yet I see thee still; and on thy
dudgeon gouts of blood, which was not so before." But Macbeth, upon a
moment's reflection, sees it is all imagination. "There's no such
thing," he exclaims. He is not insane, though deceived for a while.
(_c_) A _delusion_, on the contrary, is a permanent deception, whether
it results from an illusion or a hallucination, it matters not; as a
fact, it almost always originates in hallucinations. The deluded man
clings to his imaginings; you cannot talk them out of his head. Such is
the case of an inebriate who suffers from _mania a potu_, or "the
horrors;" he sees snakes and demons, he thinks, and persists in his
error. Such also is a fixed idea not arrived at by faulty reasoning, but
come unbidden and proof against all reasoning and evidence. Thus an
insane man may be convinced, solely by his imagination, that he is
poisoned or pursued or conspired against.
6. This delusion constitutes the essence of mental insanity, which
therefore is often called delusional insanity. It may be chronic, i.e.,
of long continuance, or it may be temporary, acute. For the time being,
the effects are the same. Perhaps any man may, at times, be for a moment
thrown off his guard, and mistake a fancy for a reality; this does not
constitute lunacy. But when the error is so firmly held in the mind's
grasp that nothing can dislodge it thence, then the mind is deranged in
its special sphere of action, which consists in knowing the real from
the unreal; the mind is then insane.
You notice, gentlemen, that I speak of the mind as grasping the error,
and I suppose it to do so independently of the free will's command. But
when the error is voluntary; when a man clings to it simply because he
loves it; when he hugs a delusion to his heart, this shows not mental
but moral obliquity; it is not insanity but self-deception, and it is by
no means of rare occurrence. In a well-reasoned article on "The
Metaphysics of Insanity," written by Mr. James M. Wilcox and printed in
the "American Catholic Quarterly Review" for January, 1878, some very
severe and no less true strictures are made upon the readiness of a vast
multitude of people to practise this wilful self-deception. "Self," he
writes (p. 54), "is the prolific origin of such errors; and so indulgent
are we to its faults that we try secretly to hide them even from our own
eyes, mostly with success; and where success is not perfect, we make a
second effort to hide the imperfection. Repeated efforts of this kind,
from which we but half turn away, are crowned in the end, and we soon
forget what successful hypocrites we have been. Our numerous passions,
the complexities of our desires, the tenacity of their grasp, and the
pleasant gentleness of its touch explain an infinity of temptations
followed by wilful successes in blindness, all of which are nothing less
than guilty acts of self-deception."
7. It oftens happens in real insanity that mental derangement manifests
itself upon one error or one group of errors only, while for all the
rest the patient appears to be quite rational. Such a man is called a
_monomaniac_. But he is truly an insane man; for the essence of insanity
is in him. It is usually found that a monomaniac will, sooner or later,
exhibit signs of mental unsoundness on other matters as well; and even
while he has given no such signs, it still remains true that a mind
cannot be trusted, but has something radically unsound about it, if it
is really unhinged at any point at all.
But then you must be very careful not to confound monomania with
eccentricity. The distinction is as important as it is real.
_Eccentricity_ is a conscious aberration from the common course of life;
it consists in peculiarities in reasoning, words, and actions, which are
wilfully indulged, in defiance of popular sentiment. The eccentric man
knows that he is eccentric; he is willing to be so, and to take the
consequences; but he is not insane.
As this matter is of frequent occurrence before the courts of justice,
and the validity of last wills in particular often depends on the view
that judges and expert witnesses take of it, I think it well to refer
the earnest student for further information to Wharton's and Stillé's
"Medical Jurisprudence," in the volume on "Mental Unsoundness and
Psychological Law;" in particular to secs. 29, 38, 39, 40.
8. We must now return to the consideration of the manner in which the
disturbance of the brain may affect the mind. The brain is a storehouse
of records of things formerly noted there by the imagination, either as
the results of sense perception or of arbitrary combinations of
phantasms; it is a library of facts and fancies. And these are not
single, but grouped together, so that when one is stirred it will arouse
others as well. When the brain is affected, whether by an acute or a
chronic derangement, its images may become so disordered that records of
mere imaginations get mixed up with records of real perceptions in
inextricable confusion. You may have had occasion to notice the process
in the case of a man who is becoming intoxicated and then passes on to
_mania_ or _delirium tremens_: he gradually proceeds to mix up
brain-pictures with realities, and after a while he speaks and acts like
a very crazy man. He is in a kind of dream; his imaginations are wild
and disconnected, his language is incoherent.
The delirium arising from violent fevers, for instance from typhoid
fever, is very similar to that arising from the excessive use of
intoxicants and narcotics; similar in these respects; that the mania is
only temporary, and that the exciting cause is not altogether unknown.
The _bacilli_ of the infection, like the alcohol, the opium, the
morphine, or other drugs, are accountable for the disordered action of
the brain. But I do not pretend to know, nor do medical writers
generally pretend to understand, _how_ the poison, or whatever causes
the disease, gets to affect the brain. Does it do so directly, or by
means of the alteration it causes in the whole nervous system or in the
blood? We do not know; nor does it matter for the purposes of Medical
Jurisprudence.
IV. The questions with which the courts of justice, the lawyers, and the
expert witnesses are concerned are these: Is the man really insane? Or
was he insane at a given time when he performed a certain civil or
criminal act? Is he now, or was he then, so far controlled by his mental
unsoundness as to be incapable of acting like a rational being
accountable for his actions? Even if he is now, or was then, a
monomaniac, can the deed in question be traceable to his monomania as to
its real cause?
1. When we know that a man is suffering from a fever, or has been
drinking to excess, or has been addicted to the use of morphine, opium,
cocaine or to similar deplorable practices, it is then easy enough to
conclude from this that he is not in his right senses; knowing the
cause, we can fairly estimate the effect. But in many cases of
delusional insanity the cause is hidden; neither pulse nor other medical
test betrays it. Whether the mind is sane or not is then to be found out
from the man's words and actions; and these may be affected for a
purpose: he may play the fool to escape punishment.
2. Phrenologists have pretended that the peculiarities of a person's
mind could be known by the conformation of his brain, and even by the
elevations and depressions of the skull. But brain and skull do not
always correspond with sufficient closeness; and besides, Sir William
Hamilton has shown conclusively, I believe, that phrenology is quackery;
its principles are not scientific and its observations not reliable. He
points out, among other errors, that while women as a class are more
religiously inclined than men, what phrenologists call the bump of
reverence, an important element in religious sentiment, is generally
more developed in men than in women, and is often most conspicuous in
reckless criminals.
Nor is it at all certain that a lunatic's brain, if it could be examined
with a microscope while he is alive, would exhibit the marks of any
disorder to the eye of the observer. It is stated by Dr. Storer that
the results show that "insanity may exist without structural changes of
the brain, and that structural changes in the brain may exist without
insanity." Dr. Bell, of the Somerville Asylum, says that "the autopsies
of the insane generally present no lesion of the brain." Dr. Bucknil
maintains that "the brains of the insane appear to be certainly not more
liable than those of others to various incidental affections." Nor has
the microscope discovered in the demented any exudation or addition to
the stroma of the brain, or any change in size, shape, or proportional
number of its cells. Dr. Storer concludes: "It is thus seen not merely
that there is no direct correspondence between the exterior of the skull
and mental integrity, any more than between the exterior of the skull
and the shape and consistence of its contents" (Wharton and Stillé,
"Mental Unsoundness," sec. 323). In the cases of insanity among women,
the causes are largely to be found in derangement of their productive
organs, and are to be met by special local treatment (ib.).
It does happen, however, at times, that the brain itself is diseased,
_idiopathically_ diseased, as it is technically called; but at other
times it is merely affected by _sympathy_ with some other organ that is
physically deranged. A physical cause there is for all mental insanity,
and that physical cause determines its kind of mania or melancholia, its
duration, its chances of a perfect cure. But what that cause is in a
given case is often very hard if not impossible to determine. Besides
natural and inherited predispositions--some taint of derangement in the
family, often betrayed by fits of epilepsy, hysterics, etc.--exciting
causes are usually traceable. Every form of disease may bring on
sympathetic affection of the brain when the circumstances for such
affection are favorable.
But while affirming that the disease usually arises in the body, and
even frequently in parts far removed from the brain, we must not deny
nor ignore the fact that intellectual and protracted worry, or sudden
and violent grief, can also be the direct cause of disturbance in the
brain. For the brain is the organ not of the imagination alone, which is
put to an unhealthy strain by excessive mental labor, but probably also
of the passions, whose emotions when excessive may cause even permanent
lesion. Hence mental insanity may and does often arise from ill-subdued
passions.
The knowledge of all this may enable the physician to remove the
exciting cause or to mitigate its influence; it may also aid expert
witnesses, judges, lawyers, and jurymen to ascertain the main fact with
which the courts are concerned, namely, the presence or absence of
mental insanity at the time of a given civil or criminal action.
V. Supposing then that, in the case before the court, the fact of
insanity is established, the next question of Jurisprudence to determine
is this: How far and why ought such unsoundness of mind to exclude
responsibility for deliberate acts?
It is a clear principle of reason that no man can justly be blamed or
punished for doing what he cannot help doing; now an insane man cannot
help judging wrong at times; he cannot then justly be blamed for acting
on his mistaken judgments. If he invincibly judges an act to be morally
good whereas it is morally bad, no matter how criminal the act may
be--say the killing of his own father or child--if he commits the deed
with the full conviction that he is doing right, he cannot be blamed or
punished for committing that awful crime.
The principle then is clear that an insane man is not to be held
responsible to God or man for his insane acts. For the root and reason
of our responsibility for an act lies in the fact that we do the deed of
our own free choice; knowing its moral nature, being masters of our own
free will, so that, if we do one act in preference to another, we
wilfully take upon ourselves the consequences of this preference as far
as we can know or suspect them.
If we do what we are firmly convinced is right, just, worthy of a man,
we deserve praise; if we do what we are convinced or suspect is wrong,
unjust, unworthy of a man, we deserve blame and punishment. But an
insane man may do the most unjust act, and yet feel invincibly convinced
that it is just; he cannot then be held responsible for doing it,
because the root of responsibility is then wanting.
I do not, however, maintain that one who is insane on any one point is
thereby made irresponsible for all his actions. If he does what he
thinks to be wrong, he acts against the dictates of his conscience, he
deserves punishment from God; and if he violates a just law of the land,
and it can be proved that his deed proceeded from a bad will, he may be
punished by the civil courts as well, even though he is insane on other
points. For instance, if a young man were to have a crazy notion that
his father disliked him, that he is often in various ways unjust to him,
and if, in consequence of this insane conviction, he were to attempt his
father's life, he should be punished for the criminal act; because, even
according to the way he views the matter, he could not be justified in
killing his father for such a reason. It were different if he insanely
imagined that his father was in the act of killing him, and that he
could not escape death but by killing his father first; for then he
could plead the right of self-defence against an unjust aggressor, as he
foolishly imagines his father to be.
The conclusion then from all this explanation is that an insane man
should not be held responsible for a deed which he insanely thinks to be
right; but he is responsible for all his other acts.
In our next lecture we shall consider more fully the treatment of the
insane by the civil and criminal tribunals.