evidence, in order to impress and satisfy the tribunal before which
his testimony is given, should not merely pronounce the party to be
insane, but ought to adduce sufficient reasons as the foundation of
his opinion. For this purpose it behoves him to have investigated
accurately the collateral circumstances. It should be enquired if
he had experienced an attack at any former period of his life?—if
insanity had prevailed in his family?—If any of those circumstances
which are generally acknowledged to be causes of this disease had
occurred? as injuries of the head, mercurial preparations largely
or injudiciously administered—attacks of paralysis—suppression of
customary evacuations, &c. It should likewise be ascertained, if
previous depression of mind had prevailed, resulting from grief,
anxiety or disappointment—and it should not be neglected to collect
any written documents; as insane persons will very often commit to
writing their feelings and opinions although they may suppress them in
discourse.
There appear however sufficient criteria to discriminate crime from
insanity, although it must be confessed, and such has been the
opinion of distinguished legal authority, that they have often seemed
to be intimately blended; yet there is a partition which divides
them, and it is by such well defined interposition that they are to
be separated:—for madness, clear and unequivocal insanity, must
be established by the medical evidence. It is not eccentricity,
habitual gusts of passion, ungovernable impetuosity of temper, nor the
phrensy of intoxication,[50:A] but a radical perversion of intellect,
sufficient to convince the jury that the party was bereft of the reason
of an ordinary man.
[50:A] A broad distinction should be made between the immediate
and remote effects of intoxication. A man is not held guiltless
who perpetrates a crime during the state of intoxication.
He voluntarily introduces into his system a stimulus which
augments his ferocity, diminishes his moral affections, and
overshadows his reason. But the usual effect of this stimulus
is temporary, he awakes from his debauch rational, and commonly
drags after him the heavy chain of reflection. It is however
equally true that this single excess may be continued into
permanent insanity: he may remain for many months in a state of
mental derangment, and during the prevalence of his disorder
may be compelled to forego all intoxicating beverage.—If such
person after the elapse of several weeks from the commencement
of his disorder, should, under its influence, commit a fatal
outrage, no system of jurisprudence would connect the violence
with the cause which originally produced the disease.
Notwithstanding the medical evidence may be incapable, totidem verbis,
to give a clear definition of madness, so as to be suited to the
conception of all persons, and to comprehend the various shapes of this
disease, on account of the various notions affixed by different persons
to the abstract terms he may employ; yet it is always in his power to
state such perversions of thought—such projects—and such conduct,
contradistinguished from that which all men hold to be rational, as
shall leave no doubt on the minds of those who are to appreciate his
evidence, that insanity exists: and if the person be really insane,
it must be from the ignorance or neglect of the medical practitioner,
if he do not satisfactorily establish his derangement, provided his
opportunities of visiting and conversing with the patient have been
sufficient.
In those cases where insane persons have deliberately destroyed others
there has been some existing and prominent delusion which has been
fully believed to be TRUE and GOOD and RIGHT, which has constituted
the motive, and urged on the miserable victim of this delusion to the
accomplishment of his purpose. Lord Erskine in the fewest words has
most impressively comprehended this subject, “_In cases of atrocity,
the relation between the disease and the act should be apparent_.”
And again, “_I think as a doctrine of law, the delusion and the act
should be connected_.” With the lunatic the object to be attained has
seldom been adequate to the hazard of the enterprize, nor has the
motive been proportionate to the violence committed: in the majority
of instances some previous intimation of the intended attack has been
communicated, if the object has been accessible; and the warning itself
has usually borne the stamp of a deranged intellect. These distempered
minds have never inflicted violence for private emolument, or personal
advancement, but have been persuaded, that they are selected from the
mass of mankind to confer exemplary justice, and to ameliorate the
condition of their species. The motive for the injury inflicted has
generally been virtuous and honorable in the deluded imagination of the
maniac. It is true that on most occasions there has been the utmost
subtilty of contrivance and deliberate execution of the projected
mischief, whether it has been directed against others, or exerted
for their own destruction. The execution of the project so far from
being unwise, has usually deceived and astonished the wisest; but the
principle, the firm belief, the motive to action, has been the “stuff
which dreams are made of.”
There is another form of this disorder under the influence of which
some insane persons become highly dangerous; but which has not been
hitherto sufficiently noticed, although it deserves the fullest
consideration. As several instances of this state have fallen under
my own observation I shall beg to relate two or three cases with as
much brevity as may adequately suffice to convey the facts. It has
been already remarked that some insane persons who have recovered
the proper direction of their intellects have thoroughly remembered
the particulars of their diseased state:—in the instances to be
related they have retained no trace of their disorder, nor any of the
circumstances which occurred during its continuance.
A very powerful man, above the ordinary stature, who in his youth
had been subject to epileptic attacks, and frequently to intervals
of sullen abstraction, which increased after the epileptic fits
had subsided, became suddenly furious, and during the transports
of his disorder destroyed two children and a woman. For this act
there appeared to be no motive. He was ordered to be confined, where
he continued until his death. For many years during his seclusion
I had constant opportunities of seeing and conversing with him.
He was ordinarily in a very tranquil state, and did not discourse
irrationally;—indeed there was no particular subject on which his mind
appeared to be disarranged, nor were there any persons against whom he
entertained an aversion. Much of his time was passed in reading, which
he said afforded him great consolation. On many occasions I endeavoured
to draw from him some account of the motives which induced him to
destroy the persons above-mentioned; but he uniformly and steadily
persisted that he had no recollection whatever of such occurrence. He
said, he understood he had done something which was very wicked, and
for which he was confined; and which he had no doubt was true, from
the respectability of the persons who informed him of his crime; but
he thanked God he had no more memory of what had passed than if it
had been committed in his sleep.—During the years of his confinement
he had many furious paroxysms, and in order to be fully satisfied of
the truth of his asseverations as to his want of recollection during
these attacks, he was once blooded at the commencement of the paroxysm,
although with considerable difficulty, and on another occasion cupped
when its violence was subsiding,—yet when he was restored to his
ordinary state of tranquility he neither recollected the persons
who were present nor the operations which had been performed.—Of
the same class of mental affection was the case of a young lady,
who became insane in consequence of having experienced some severe
disappointments. She attempted to destroy herself in various ways,
and was therefore obliged to be strictly restrained; but to others she
manifested no evil intentions. When spoken to, she returned correct
answers, although she never began a conversation. During the day she
sat apparently sullen and abstracted, and seemed to take no notice
of what was passing. After the elapse of three weeks, as she was
sitting in her usual manner, she uttered a shriek, appeared for a few
moments in a state of alarm and confusion, and suddenly recovered.—Of
her repeated attempts at suicide she had not the slightest
recollection.—When I visited her the following day she received me as
a perfect stranger; and was not conscious she had ever seen me before;
and during several subsequent interviews, in order to be certain of her
recovery, I was persuaded she did not retain the slightest remembrance
of any of the circumstances of her malady. A third case of this
nature lately occurred. A young man with hereditary predisposition to
insanity, his mother and grandmother having been so disordered; in
consequence of severe losses, was seized with a paroxysm of furious
madness, which continued without abatement for four months. At the
expiration of three months he had a considerable mortification on the
lower part of the back, which required surgical attention during three
weeks. When the sore was healed he was removed to another situation for
the treatment of his insanity, where he perfectly recovered. After his
complete restoration he neither recollected the asylum where he was
first placed, the disease of his back, nor his removal to the situation
where he ultimately regained his reason.
To the states of mind above described, the question of good and
evil can in no way apply; because these persons have wanted all
recollection of their state, and of any act perpetrated; which
implies that they were unconscious of any motive urging them to its
commission; and which being unremembered, renders them incapable, as
moral agents, of contemplating the RIGHT or WRONG of the act previous
to its execution. It is likewise well known, that even ideots, who are
ordinarily tranquil, and apparently harmless, will occasionally burst
into paroxysms of fury, and deal indiscriminate destruction to those
around them, frequently without the slightest cause, and certainly
without pre-meditation:—and whose inferior scale of intellect does not
enable them to give a reason for their actions. These states have been
mentioned that they may be recognized by the medical practitioner, and
become known to the advocate, in order that he may apply them to the
existing law.
Finally, it is necessary to observe that insanity may be counterfeited
by the criminal, in order to defeat the progress of justice;—and with
this view, may attempt to impose on the medical practitioner. During
the course of my experience I have witnessed only two attempts of
such imposture, and in both instances the deception was so clumsily
executed, that it required but little knowledge of the disorder to
detect it. To sustain the character of a paroxysm of active insanity
would require a continuity of exertion beyond the power of a sane
person;—they do not keep up the deception when they suppose themselves
alone and unwatched;—the assumed malady then disappears, and the
imposture is re-commenced when they are in the society of others. They
are likewise unable to prevent sleep. If they endeavour to imitate
the passive form of this malady, which is an attempt of considerably
greater difficulty, they are deficient in the presiding principles,
the ruling delusion, the unfounded aversions, and causeless attachments
which characterize insanity—they are unable to mimic the solemn
dignity of systematic madness, nor recur to those associations which
mark this disorder; and they will want the peculiarity of look, which
so strongly impresses an experienced observer.
* * * * *
It now remains to treat of that morbid condition of intellect which
requires the interposition of the law to protect the person and
property of the party so affected.[61:A] The general reasoning
which has been adopted concerning insanity, in criminal cases, will
equally apply to the present subject; but there are some particular
considerations deserving attention in this part of the enquiry. The
members of the medical profession have long and anxiously endeavoured
to frame a definition of insanity, which is an attempt in a few words
to exhibit the essential character of this disorder; so that it may be
recognized when it exists;—these efforts have been hitherto fruitless,
nor is there any rational expectation that this desideratum will be
speedily accomplished. The Lawyer has taken a different view of the
subject: he has been little solicitous to become acquainted with the
physiological distinctions of disordered intellect, or the causes
producing such state:—these he has confided to the medical evidence
to explain. His enquiry has been directed to ascertain if such state
of mind prevails, as actually disqualifies the particular person
from conducting himself, or managing his affairs, and he expects
from the medical evidence sufficient proofs of such incompetence. To
this condition of intellect, when satisfactorily demonstrated, the
law applies its remedy and protection. This incapacity of conducting
himself, or of managing his affairs, arising from a morbid state of
intellect;—whether it be from perversion of mind or imbecility, is in
the estimation of the lawyer equivalent to a definition of insanity,
and perhaps it is the best that can be furnished.
[61:A] It has been observed that the finding a commission is
like signing the death-warrant of an individual: it certainly
consigns his person and property to the management of others
appointed by the chancellor. But it should be fully understood
that this process is exclusively a process of law, and resorted
to by the relations, or trustees for the insane person. The
medical practitioner has no interest whatever in this legal
instrument—on the contrary, he is generally a loser by the
finding of the commission, which ordinarily implies (though
improperly) a confirmed state of disease, rendering less
necessary medical advice and attendance.
In many instances, the insanity of the person is so clear, so
evident and demonstrable, that it is immediately acknowledged by the
commissioners and jury;—in such cases the medical practitioner has
an easy duty to perform. There are however occasions where the state
of the person’s mind involves considerable doubt, and creates much
difficulty in determining: and in these equivocal and embarrassing
circumstances, the skill and experience of the physician must furnish
the documents and reasons for the decision of the jury. He is presumed,
in consequence of his previous attendance on the patient, from the
repeated conversations he has held with him, and from an attentive
observation of his conduct, to be fully informed of the state of
his mind: and as the commission is commonly granted by the medical
affidavit of the party’s lunacy, it is a natural expectation that
such medical evidence should be competent to prove to the extent he
has deposed on oath. The gentlemen who compose the jury and whose
province it is to determine on the lunacy of the party, may not be
acquainted with the different species of insanity, nor possess any
considerable knowledge of the physiology of the intellect; yet they are
entitled, and fully able to exercise their judgment, their honest and
plain sense, on those opinions and that conduct which characterize an
insane mind, and which disqualify the person so affected from having
the management of himself or of his affairs. It is the duty of the
medical evidence to become acquainted with his prevailing opinions, and
also with his propensity to act on them, to ascertain his capricious
partialities and unfounded resentments:—and whether he meditates his
own destruction, or seeks to take away the life of another. Either
of these propensities originating purely from insanity, both for the
safety of the patient and of the community claim the protection of the
law. Although the commissioners and jury have a right to expect from
the medical evidence a full developement of the patient’s condition
of intellect, yet it has not unfrequently occurred that even medical
persons have so widely differed concerning the mental state of an
individual, that one party has deposed to his sanity, and the other
has testified to his madness; if therefore such contrariety of opinion
should exist between those persons who are supposed most competent to
detect insanity, it cannot diminish our confidence in the decision of
an intelligent and impartial jury.
It may here be proper to notice that in the criminal court the
testimony of others is sufficient to establish the insanity of the
prisoner. Under a writ de Lunatico Inquirendo, superadded to the
testimony of others, the person supposed to be insane, is usually
produced before the commissioners and jury, and by them examined, in
order to confirm or invalidate the evidence which has been adduced,
and to satisfy their minds that he _is_ a lunatic at the time of
their enquiry. Although there is much fairness and impartiality in the
examination of the patient by the commissioners and jury to ascertain
by actual enquiry that his state of mind tallies with the evidence
deposed: yet it sometimes occurs, that the patient, fully aware of
the proceedings, will by subtilty endeavour to defeat them. He will
artfully conceal his real opinions and even affect to renounce such
as have been deemed proofs of his insanity, and on many occasions he
has been so skilfully tutored as to foil the united penetration of
lawyer and physician. It is on such occasions that the sagacity and
experience of the medical practitioner are demanded, and it will in
some instances occupy a considerable time to institute such examination
as shall suffice to unravel the real state of his opinions. It is
nearly impossible to give any specific directions for conducting such
examination as shall inevitably disclose the delusions existing in the
mind of a crafty lunatic; but in my own opinion it is always to be
accomplished, provided sufficient time be allowed, and the examiner
be not interrupted. It is not to be effected by directly selecting
the subjects of his delusion, for he will immediately perceive the
drift of such enquiries, and endeavour to evade, or pretend to disown
them:—the purpose is more effectually answered by leading him to the
origin of his distemper and tracing down the consecutive series of
his actions and association of ideas:—in going over the road where
he has stumbled he will infallibly trip again. If in a case of actual
insanity the medical practitioner, from inattentiveness, mistake, or
want of experience should fail to expose the real condition of the
patient’s intellect, and he should be found not lunatic, he would be
set afloat, to pursue the dictates of his perilous volition; he might
uncontrolled dissipate his property, and reduce himself and family to
beggary:—if his life were insured, if he subsisted on an annuity, or
held a commission in the naval or military service he might wander and
destroy himself, and thereby deprive his successors of their immediate
support or expected benefit:—or he might commit some outrage for which
he would be arraigned in a criminal court. The record of having been
found not lunatic by a jury legally constituted to enquire into the
state of his mind, would be the strongest bar to a plea of insanity in
a criminal court, who after such proceedings would be little disposed
to credit the theories of medical metaphysicians.
It is not necessary to enter on an investigation, or to enumerate all
the particular states of mind which may be comprehended under the
terms Insanity, Madness or Lunacy, but it is a subject of grave and
important enquiry to ascertain what degree of mental derangement, or
imbecility ought to disqualify an individual from being the master
of his person and property. It has sometimes occurred that persons
evidently under mental derangement have for months continued to
transact their affairs with prudence, and have conducted themselves
quietly in society. Notwithstanding the disordered state of their
ideas, they have not obeyed the impulse, nor followed the direction
of their insane opinions, and have forborn to act to their own
detriment or to the annoyance of others. Several of such instances
have fallen under my own observation: but the greater part have
eventually destroyed themselves, or become so furious that seclusion
was absolutely necessary. It is therefore impossible, under a state of
existing insanity to predict the future conduct of an individual thus
affected, or to become responsible for the continuance of his harmless
disposition.
In the discussion of this question it should be kept in view that the
medical evidence is called upon to state, in the first place, that
the person is of insane mind: and secondly, that in consequence of
such state, he is incapable of conducting himself or of managing his
affairs. If it be a matter of general and legitimate inference, that
a person of insane mind is consequently unable to the management of
himself and affairs; the proof of his insanity necessarily involves
his incompetency: if it be supposed that, although of insane mind, a
man may be capable of conducting himself and his affairs, it is then
incumbent on the medical practitioner to shew from the nature and
tendency of his particular insanity that he is unfit to be trusted with
either. Such prediction must necessarily be the result of copious
experience, and formed in the way of a general conclusion, and it
should be understood that this opinion of his incompetency regards
his existing condition of mind at the time of the legal enquiry.
Although a person might labour under a variety of mental infirmities,
which by medical practitioners might be technically denominated false
perception, delusion, hallucination, &c. still if these symptoms did
not go to the extent of disqualifying him from conducting himself and
managing his affairs, such symptoms in a legal point of view would,
probably, not amount to insanity, nor justify the restraint of a
commission of lunacy. It is true such symptoms seldom occur without
producing the incompetency which the law regards as the warrant for its
restraint, and fulfils the legal interpretation of insanity.