Part 3

It has been stated in a former part of this tract, that the medical 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.

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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.