Medical Jurisprudence - Insanity

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M edical Jur i spr udence - Insani ty

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Q. Explain and classify Insanity. Describe the medico legal aspects of Insanity. What are the main causes of Insanity. Differentiate between true and feigned insanity? In English, the word "sane" derives derives from the Latin adjective adjective sa nus m eaning healthy. healthy. Insan Insan ity ity,, craz craziness iness or mad ness is a spectrum of behaviors behaviors charact characteriz erized ed by certain certain abno rmal mental or behavioral patterns. patterns. Insanity may manifest as violations of societal norms , including becoming a danger to thems elv elves es and o thers, though though not all such acts are consid ered insani ty ty.. In modern us age ins anity is m ost comm only encountered as an informal uns cientif cientific ic term denoting mental ins tability tability,, or in the narrow legal context context of the the ins anity defense. In the medical professi on the term is now avoided in favor favor of diagnos es of  specific mental illness such as schizophrenia and other psychotic disorders.When discussing mental illness in general terms, "ps ychopathology chopathology"" is considered a preferred descriptor. Indian Lunacy Act 1912 defined lunatic as an idiot or a pers on of unsound mi nd. Mental Patients a re governed by Mental Mental Health H ealth Act, 1987 1987.. Classification Classification  1. Medical Medical - Medical Medical jurists such as Esquirol have clas clas sified ins anity under four distinct forms: 1. Mania Mania  - This is general derangem ent of the the m ental faculties faculties , accomp accomp anied by greater greater or less ex excitement, citement, som etimes amo unting to violent violent fury. fury. The The individual is s ubject to to hallucinations and i llus ions. 2. Monomania Monomania  - Here, the the men tal alienation is partial. The The delus ion is said to be confined either to to one su bject or to one class of subjects. It mono mani a varies varies m uch in degree. Many Many persons aff affected ected with it are are able to direct their their m inds with reason and propriety to the performance performance of their social duties , so long as these do not involv inv olve e any of the subjects of their delusi ons. 3. Dementia Dementia  - In this state there is a total absence of all reas oning power. The mental faculties are not perverted, perv erted, but destroy destroyed. ed. There is a lack of mem ory as well as of conscious ness , on the part of the the individual, of what he does or s ay ays. s. It is a frequent consequence of mania or monom ania. It has been known to occur  suddenl y in individuals, as an effect effect of a strong moral s hock. 4. Idiocy Idiocy (Amentia)  (Amentia) - In this state, the lack of mental power is due to a congenital defect i.e. birth defect. Legally, mania, monomania, and dementia, are classified as "dementia accidentalis" and idiocy is classified as "dementia naturalis". This in tellect tellectual ual deficiency is marked by a peculiar physiognom y, an abs ence of all express ex press ion, and a vague and unm eaning loo k, whereby an idiot m ay in general be clearly identified. identified. In In m any cases of congenital deficiency, deficiency, the mind is capable of receiving receiving a few ideas , and of profiting to a certain extent extent by instruction. WHO has recomm ended in the "Int WHO has "International ernational Class ificat ification ion of Diseas es", the following class ificat ification ion of  psychiatric psychiat ric disorders 1. Organic men tal disorders - dementia, Alz Alzheim heim er's diseas e, amnesi c syndrome, syndrome, behavioral behavioral disorders due to brain dis ease, dam age, or dysfunction/ dysfunction/ 2. Mental and behavioral behavioral disorders due to psychotr psychotropic opic subs tance use 3. Schizophrenia 4. Mood Disorders - depress iv ive e disorders 5. Neurotic Str Stress ess related and somatoform disorders 6. Behav Behavioral ioral syndromes as sociated with physiol physiol ogical disturbances and physical physical factors factors - eating disorders , non-organic sleep disorders , sexual dysfunction dysfunction 7. Personality dis orders - specific personality disorders , gender identity identity disorder  8. Mental Retardation 2. Legal - Generally Generally,, two states of mental dis order or alienation are recognized recognized legally - 1. Dementia naluralis, naluralis , which www.hanumant.com/MJ- Insanity.html

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Medical Jurisprudence - Insanity

corresponds to idiocy and 2. Dementia accidentalis , which means general insa nity in people who have once had reasoning powe r but are insane now due to som e accidental cause.  A third term lunacy is also used by lawyers gene rally for to all the dis ordered states of m ind which have specific medical terms s uch as mania, monomania and dementia; and whi ch m ay even be accompanied by lucid intervals . The main character of insan ity, in a legal view, is sai d to be the existence of delusion; i. e., that a person shoul d believe s omething to exist which does not exist, and that he sho uld act upon this belief. Many persons may labor  under harmles s delus ions, and still be fitted for their social duties; but shoul d these delus ions be s uch as to lead them to injure thems elves o r others in pers on or property, then the case is considered to require legal i nterference. Unsoundness of mind - Besi des the terms Idiocy and Lunacy, another term is frequently employed in l egal proceedings, namel y, " unsou nd mind" i.e. non compos men tis, for which there is no consis tent legal definition. The test for unsoundnes s of m ind in law does not just depend on the existence of delusion, but on proof of incapacity in the person, from som e m orbid condition of intellect, to m anage his own affairs. Thus, there are two necess ary conditions - m orbid condition of intellect and incapacity to manage his own affairs. Neither condition will s uffice to establis h uns oundnes s w ithout the other for the intellect may be in a morbid state, and yet there ma y be no legal incompetency, or the incompetency alone may exist because of bodily infirmity or want of education, which is obviousl y not insani ty. It can be s aid that an ins ane pers on is lacks the controlling power of the will.

Causes of Mental Ill health 1. Heredity 2. Environm ental Factors - parental attitudes 3. Psychogenic causes - problems occurring due to reconciliation of natural desires wi th societal norms. When such reconciliation between conflicting des ires becom es pai nful, patient may resort to various m ental mechanis ms to build defenses around it, which may then produce various types of mental s ymptom s 4. Precipitating causes - em otional or physical trauma 5. Organic causes - dise ases

Consequences of Insanity 1. Civil Responsibility 1. Property - Chapter VI of Mental Health Act 1987 provides for the legal proceedings to be followed in cases concerning the protection and property of a m entally ill pers on. In general, a court ma y appoint a manag er to manag e the person's property. 2. Contract - Under S 11 of Indian Contract Act 1872, only persons of sound m ind are eligibl e to enter into agreements or contract. As per S 12, a contract is invalid if one of the parties at the tim e of m aking the contract was by reason of ins anity incapable of understanding it and forming a rations judgm ent as to its effect upon his interests. Court may order dissolu tion of the partnership of a firm if one of the partners i s found to be m entally ill pers on. CPC Order 32 enacts spe cial provisi ons regarding s uits by and agains t a person of unsound m ind. Ram Chandra vs Ram Singh AIR 1968  - SC held that a decree pass ed agains t a minor or a lunatic without appointment of a guardian is a nullity and is void and not m erely voidable. 3. Marriage - The HMA 1955 if a party is incapable of giving a valid cons ent to a marriage i n cons equence of  unsound ness of mind, or if capable of consent but has been s uffering from me ntal disorder of such a kind as to be unfit for marriage a nd procreation, or has been s ubject to recurrent attacks of ins anity, then the marriage is voidable. 4. Testamentary Capacity - Making a Will requi res an understanding of the nature of the Will, a knowledge of  the property to be dis pose d off, and an abili ty to recognize those who m ay have m oral claim s of the testator's bounty. A court may invalidate a Will if it is p roved that the testator, at the time o f making the Will, was of  unsound mind. 2. Criminal Liability - Law presum es every individual of the age of dis cretion to be s ane. McNaughten Rules - In this case, Danial M'Naghten was tried for the murder of a private secretary of the then prime mini ster of England. He was acquitted on the ground of insanity. This caused a lot of uproar and the case w as sent to bench of fifteen judges who were called up on to lay down the law regarding crim inal res ponsi bility in case of lunacy. Some ques tions were pose d to the judges which they had to answer. These ques tions and answ ers are knows as M'Naghten's R ules which form the bas is of the m odern law on i nsani ty. The following principals were evolved in this case www.hanumant.com/MJ-Insanity.html

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1. Regardles s of the fact that the accused was un der insane delus ion, he is punis hable according to the nature of the crime if, at the tim e of the act, he knew that he was acting contrary to law. 2. Every ma n m ust be pres umed to be sane un til contrary is proven. That is, to establis h defence on the ground of insanity, it mus t be clearly proven that the person s uffered from a condition due to which he was not able to understand the nature of the act or did not know what he was do ing was wrong. 3. If the accused was conscious that the act was one that he ought not to do and if that act was contrary to law, he was punishable. 4. If the accused s uffers with partial delusion, he mus t be conside red in the sam e situation as to the respons ibility, as i f the facts with resp ect to which the delu sion exists were real. For exampl e, if the accused, under delusi on that a person is about to kill him and attacks and kills the person in s elf defence, he will be exem pted from punis hme nt. But if the accused, under delusio n that a person has attacked his reputation, and kills the person du e to revenge, he will be punis hable. 5. A medi cal witness w ho has not seen the accused previous to the trial should not be asked his opinion whether on evidence he thinks that the accused was ins ane. The Indian Law recognizes the first two principals and incorporates them in s ection 84 of IPC, which s ays that nothing is an offence which is done by a person w ho, at the tim e of doing it is by reason of unso undnes s of mi nd, incapable of the nature of the act or that he is d oing what is either wrong or contrary to law. In crim inal cases , the MO mus t consider 1. personal his tory of the the defendant 2. the absence of mo tive 3. the absence of secracy 4. Multiple murders 5. Want of preparedness o r pre arrangem ent 6. Absens e of accomplices 3. Tortious Liability -  Even in England, there is little authority to show whe ther a person of unsou nd m ind is liable for tort comm itted by him. The question he re is whether the defendant knows the nature and quality of his act. If he is capable of knowing that his act was wrong, then he is liable in tort. The opinion of Salmon is as follows Lunacy is no t in itself any ground for exem ption, but that, like infancy, it operates (if at all) onl y an evidence that the mental s tate requisi te to create liability is n o present. In applying this rule, the following s pecies o f wrong mus t be distinguished 1. In wrongs bas ed of mal ice or on som e specific intent like mal icious pros ecution, ma licious libel, or a privileged occas ion, or deceit, lunacy may be a good defense becaus e there is no ill intention. 2. In wrongs of voluntary interference with the perso n, property, reputation or other rights of other persons , such as trespas s, ass ault, conversion, or defamation, it is no defense that the defendant was under an ins ane delus ion as to the existence of su fficient legal jus tification. For in s uch cases , mis take, however inevitable, is no defense and it can make no difference that mi stake is due to unsoundnes s of mind. 3. In wrongs of absolute liability, there is no reas on why lunacy shou ld be any defense at all. 4. In wrongs dependen t on negligence, the conduct of the defendant mus t be judged by reference to his knowledge or mea ns of knowledge. Lunacy, therefore, may be relevant as evidence that the neces sary knowledge or mea ns of knowledge did not exist. In Williams vs Hays, the defendant, a co-owner of a ship w as held liable to his co-owners for negligent wrecking of the ship owing to his insa nity. It was held that an insane pers on is ju st as res ponsi ble in tort as a sane person except where m alice and hence intention, actual or im plied, is n ecess ary. In the words of Justice Esher MR, "a lunatic is liable unles s the diseas e of his mind is so great that he cannot understand the nature and the consequences of his act." But the onus lies on the defendant to prove that his diseas e is s o great. Drunkenness is no de fense in tort or in crime becaus e it is pres umed that a man knows that if he gets drunk he is likely to comm it acts li kely to result in injuries to others.

Feigned Insanity Feigned insanity is the s im ulation of mental illnes s in order to avoid or less en the consequences o f a confrontation or  conviction for an alleged crim e. Malingering is the medi cal term for feigned ins anity that refers to fabricating or exaggerating the symptoms of mental or physical dis orders for a variety of "secondary gain" m otives, which may include financial www.hanumant.com/MJ-Insanity.html

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compens ation (often tied to fraud); avoiding s chool, work or m ilitary service; obtaining drugs; getting lighter crimina l sentences; or simply to attract attention or sympathy. Feigned Insanity

True Insanity

Comes on suddenly

Rarely develops all of a sudden

Usually has a motive

Usually has no specific motive

Individual tries to pass of as m entally ill by putting forward incoherent maniacal symptoms , especially when he knows he is under observation. There is total rem iss ion of all symptoms when he thinks he is not being observed. Symptom s are not uniform. Patient usually mixes up s ymptom s of two distinct types of  mental illness . Violent exertions occasioned by imitating m aniacal frenzy will bring on exhaustion, perspiration, and sleep.

Truelly ill pers on can e xhibit all these s ymptom s for days without any exhaustion.

Usually not dirty or filthy in his habits. Usu ally resents being examined repeatedly. It is alm ost imposs ible to feign sleepless ness for long.

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