Forensic Psychiatry Chapter Notes | Forensic Medicine and Toxicology (FMT) - NEET PG PDF Download

Introduction

Throughout history, the understanding and recognition of mental disorders have evolved significantly. Here are some key points to consider:

• Hippocrates, an ancient Greek physician, believed that the brain is the central organ of the mind and responsible for mental functions.
• In ancient Rome, the Justinian Code addressed insanity from a legal standpoint rather than a medical one, reflecting the societal views of the time.
• It is only in the past century that mental disorders have been acknowledged as a distinct and legitimate branch of medicine.
• The term "unsound mind" has historically been used to encompass all types of mental disorders.
• The Indian Penal Code refers to "unsoundness of mind" when discussing matters related to insanity, highlighting the legal recognition of mental conditions.
• Mental disorders are typically the focus of specialists who are trained to diagnose and treat such conditions.
• What differentiates Homo sapiens from other species is the advanced development of higher nervous system functions, which is referred to as the mind.

The human mind has always been a subject of fascination. However, it is important for all medical practitioners to understand how psychiatric knowledge is applied in legal contexts.

Mental Health Act, 1987

The Mental Health Act (MHA) 1987, which came into effect on 22nd May 1987, aims to modernize and unify the legal framework governing the care and treatment of individuals with mental health issues. It also addresses the management of their property and related concerns. This legislation has been implemented across all Indian states and union territories since 1st April 1993, replacing the outdated Indian Lunacy Act of 1912.

Purpose of the Act

• To regulate the admission of mentally ill individuals to psychiatric hospitals or nursing homes when they are unable to seek treatment voluntarily.
• To protect the rights of mentally ill individuals during their detention.
• To ensure the safety of society from individuals who may pose a danger or nuisance due to their mental health condition.
• To prevent unlawful confinement of citizens in psychiatric facilities.
• To clarify the responsibility for maintenance costs for individuals admitted to psychiatric care.
• To facilitate the establishment of guardianship for individuals who are unable to manage their affairs.
• To establish Central and State Authorities for Mental Health Services.
• To define the government's role in the establishment, licensing, and regulation of psychiatric hospitals and nursing homes.
• To provide legal aid to mentally ill individuals at the State's expense in certain circumstances.

The Mental Health Act comprises 10 chapters and 98 sections, all aimed at fulfilling the objectives outlined above.

Chapter I

This section provides definitions for various terms related to mental health and introduces some updated terminology as per the Mental Health Act, 1987.

Some Important Terms Defined in the Act

• Medical Officer:. government-appointed Gazetted Medical Officer by the State Government.
• Medical Officer in Charge: The Medical Officer overseeing a psychiatric hospital or nursing home.
• Medical Practitioner: An individual with a recognized medical qualification under this Act.
• Mentally Ill Person: Someone suffering from mental disorders, excluding mental retardation, who requires treatment.
• Mentally Ill Prisoner:. mentally ill individual ordered to be detained in a psychiatric hospital, jail, or other secure facility.
• Psychiatric Hospital or Nursing Home:. facility for mentally ill individuals, either government-run or private, with outpatient treatment options and registered with the appropriate authority. It is illegal to admit a mentally ill person to a general nursing home; they must be admitted to a psychiatric hospital.
• Psychiatrist:. medical practitioner with a postgraduate degree or diploma in psychiatry recognized by the Indian Medical Council (IMC) and declared by the State Government for this Act.
• Reception Order: An order for the admission and detention of a mentally ill person in a psychiatric hospital or nursing home.
• Relative: Anyone related to a mentally ill person by blood, marriage, or adoption.

Chapter II: Mental Health Authorities

• This chapter details the procedure for establishing mental health authorities at both the Central and State levels.

Chapter III: Psychiatric Hospitals and Nursing Homes

• Outlines the rules for the creation and maintenance of psychiatric hospitals and nursing homes.
• Introduces the Licensing Authority responsible for handling licence applications.
• Mandates regular inspections of psychiatric facilities to ensure compliance.
• Specifies that licences will be renewed every five years.

Chapter IV: Admission and Restraint Procedures

• Details the procedures for the admission and detention of individuals with mental illnesses in psychiatric settings.
• Discusses methods of restraint for individuals experiencing mental health crises.

Chapter V

• This chapter outlines the procedures for inspecting, discharging, granting leave of absence, and removing individuals with mental illness.

Chapter VI

• This chapter discusses the judicial inquiry process for mentally ill individuals who own property and the management of that property.
• If the court determines that the individual cannot care for themselves or their property, it has the authority to appoint a guardian.
• Conversely, if the court finds that the person can take care of themselves but has difficulty managing their property, it may appoint a manager instead.

Chapter VII

This chapter outlines procedures to protect the human rights of individuals with mental illness.

Chapter IX

This chapter specifies the penalties for violating the guidelines set forth in the Mental Health Act.

Chapter X

This chapter addresses various miscellaneous matters related to the Mental Health Act.

Current Concept

The current concept puts forward several recommendations regarding the treatment and perception of mentally ill individuals:

• Mentally ill individuals should be treated with the same respect and consideration as anyone else with a mental health condition, without any stigma attached to their illness.
• The law operates on the principle that mentally ill individuals are not responsible for their actions, implying that they cannot be punished for crimes committed during episodes of mental illness.
• There is a legal presumption that every person is mentally sound unless proven otherwise, meaning that individuals are considered mentally fit until evidence suggests a mental disorder.
• While the Mental Health Act of 1987 does not provide a specific definition for mental illness, it generally encompasses conditions such as psychoses, neurotic disorders, and various organic disorders.

Symptoms of Mental Illness

To gain a better understanding of psychiatry as a distinct field, it is essential to familiarize ourselves with common terms that describe the symptoms of mental illness. These terms are crucial for comprehending the legal implications associated with mental health conditions. The following list presents these terms in alphabetical order.

Affect

• Affect refers to the outward expression of a person's feelings, emotions, tone, or mood.

Abreaction

• Abreaction involves bringing to consciousness feelings and conflicts that were previously repressed. This process, known as catharsis, can be therapeutic and beneficial in a therapeutic context.

Aphasia

• Aphasia is a condition that affects communication abilities, and it can manifest in different ways:
• Motor Aphasia: This type involves the loss of the ability to express meaning through speech or writing. Individuals with motor aphasia may know what they want to say but struggle to find the words or produce them, leading to difficulties in verbal and written communication.
• Sensory Aphasia: Also known as auditory comprehension aphasia, this type refers to the inability to understand spoken or written language. Individuals with sensory aphasia may have trouble comprehending words and sentences, making it challenging for them to grasp the meaning of what is being said or written.

Cognition

• Cognition encompasses a range of higher mental functions that are crucial for daily life and functioning. These include:
• Memory: The ability to store, retain, and recall information. Memory is essential for learning and for carrying out everyday tasks.
• Intelligence: The capacity to learn, understand, and apply knowledge and skills. Intelligence involves problem-solving, reasoning, and the ability to adapt to new situations.
• Concentration: The ability to focus attention on a specific task or piece of information. Concentration is important for completing tasks and for effective learning.
• Orientation: Awareness of one’s environment, including time, place, and identity. Orientation helps individuals navigate their surroundings and understand their context.

Confabulation

• Confabulation refers to the phenomenon where individuals create imaginary events or fabrications to fill in gaps in their memory. This occurs due to memory loss, and the fabricated memories are believed by the individual to be real. Confabulation is not intentional lying; rather, it is an effort by the brain to make sense of missing information by constructing a narrative that seems plausible. These false memories can be detailed and vivid, leading the individual to confidently assert their accuracy, even though they are not based on actual events.

Delirium

Definition: Delirium refers to a sudden and severe state of confusion.

• Causes:Delirium can be triggered by various factors, including:
  • Intoxication from drugs or alcohol
  • Withdrawal from substances
  • Head injuries
  • High fevers
  • Stress
  • Other contributing factors
• Clinical Features:Individuals experiencing delirium may exhibit:
  • Clouded consciousness
  • Disorientation
  • Lack of coordination
  • Abnormal experiences such as hallucinations, delusions, and illusions
  • Impulsive behaviors, which can include suicidal or homicidal actions

Medicolegal Importance

• Delirium can persist for a period ranging from a few hours to several weeks, and the outcome is highly dependent on the underlying cause.
• As per Section 84 of the Indian Penal Code (IPC), an individual is not held criminally liable for offenses committed during a state of delirium.

Delusion (Disorder of Thought)

Delusion refers to a strong conviction in something that is factually incorrect.

Types of Delusions

• Hypochondriacal delusion. Believing there is a health issue when there is none.
• Delusion of poverty. Feeling poor despite having wealth.
• Nihilistic delusion. Asserting non-existence of oneself or the world.
• Delusion of grandeur. Imagining oneself as rich and famous without basis.
• Delusion of persecution. Feeling harmed by loved ones.
• Delusion of reference. Believing surrounding events are personally relevant.
• Delusion of influence. Feeling controlled by external forces like telepathy.
• Delusion of infidelity. Suspecting a partner's unfaithfulness.
• Delusion of self-accusation. Blaming oneself for minor past errors.
• Erotomania. Believing a specific person, often in authority, is in love with you.
• Pseudologia phantastica. Feigning severe illness and consulting multiple doctors for a non-existent condition.
• Bizarre delusion. An extreme and varied form of delusion.

 Delusions  are often indicative of underlying mental health disorders, such as schizophrenia. Consequently, individuals experiencing delusions may not be fully accountable for their antisocial behaviors, which could escalate to actions like suicide, homicide, or other criminal activities.

Déjà Vu

Déjà vu refers to the feeling of having experienced a situation before, even when it is happening for the first time.

Disorientation

• Disorientation occurs when an individual finds it difficult to comprehend aspects of time, space, or their personal relationships.
• For instance, patients experiencing disorientation might provide completely inaccurate information regarding time, place, or people.

Fugue

• Fugue is a condition in which a person behaves normally but has no recollection of their actions afterward.
• Causes of fugue can include disorders such as dissociative identity disorder and epilepsy.
• Medicolegal Importance: Fugue can lead to significant legal complications due to the nature of the condition.

Hallucination: A Disorder of Perception

• Definition: Hallucination refers to a false perception that occurs in the absence of any real sensory input. It involves perceiving something that is not actually there.
• Clinical Features: Individuals experiencing hallucinations may see, hear, smell, taste, or touch things that do not exist. These false perceptions can manifest in various ways, such as seeing imaginary figures, hearing non-existent sounds, or feeling sensations on the skin that are not present.
• Hallucinations can occur in altered states of consciousness and are associated with various conditions, including organic psychosis.
• Some of the conditions where hallucinations are commonly observed include:
  • Schizophrenia:. severe mental disorder characterized by distorted thinking, perceptions, and emotions.
  • Epilepsy:. neurological disorder that can lead to seizures and altered brain activity, sometimes resulting in hallucinations.
  • Drug Use: The use of certain substances can induce hallucinations as a side effect.
  • Depressive Disorders: Severe depression can lead to altered perceptions and hallucinations in some individuals.

Classification of Hallucinations

• Visual Hallucinations: In this type, a person may perceive non-existent visual stimuli, such as imagining being attacked by a lion or tiger that is not present in reality.
• Auditory Hallucinations: Individuals experiencing auditory hallucinations hear sounds or voices that are not actually present, such as hearing someone speaking to them when no one is around.
• Olfactory Hallucinations: This involves perceiving smells that are not present, whether they are pleasant or unpleasant. For example, a person may smell a flower that is not there or a foul odor that does not exist.
• Gustatory Hallucinations: Individuals may experience tastes in their mouth without any corresponding food, such as tasting something sweet or bitter that is not actually present.
• Tactile Hallucinations: This type involves feeling sensations on the skin that are not real, such as the sensation of insects crawling on the skin or bed when there are none.
• Trichotillomania: Trichotillomania is a specific condition where a person feels an uncontrollable urge to pull out their own hair, often leading to noticeable hair loss.
• Medicolegal Importance: Hallucinations can have significant legal implications, as individuals experiencing them may commit violent acts or engage in behaviors that pose a danger to themselves or others. This aspect highlights the importance of understanding and addressing hallucinations in clinical and legal contexts.

Illusion (Disturbance of Perception)

Definition: An illusion refers to a mistaken interpretation of something that is real. For instance, perceiving a stick as a snake.

• Causes: Factors such as aging, grief, and delirium can lead to illusions.
• Medicolegal Importance: Experiencing illusions does not indicate that a person is insane.

Insight

Insight refers to the awareness of one’s own mental state. This awareness can result in noticeable changes in behavior and personality.

Intelligence Quotient (IQ)

The intelligence quotient (IQ) assesses a person’s mental ability in comparison to others in the same age group. IQ is typically presented as a range.

• For adults aged 16 and older, the average IQ ranges from 90 to 110.

Lucid Interval

Meaning:. lucid interval refers to a period during mental illness when all symptoms of insanity temporarily subside, and the individual appears to be completely mentally normal.

Causes: Lucid intervals are commonly observed in conditions such as depressive mania and head injuries like epidural hemorrhage.

During a lucid interval, an individual experiencing mental illness can:

• Create a legally valid will.
• Provide valid evidence in court.

In criminal cases, determining the mental state of an individual at the time of committing a crime can be challenging and requires careful assessment.

Mood

• Mood refers to the long-lasting emotional state or feeling that a person experiences over a period of time.

Neurosis

• Neurosis is a type of emotional disorder where the individual remains connected to reality, despite experiencing emotional distress.

Obsession (Obsessive-Compulsive Disorder)

• Obsession, often seen in Obsessive-Compulsive Disorder (OCD), involves a persistent thought or idea that continues to intrude the mind, even when the person knows it is irrational.
• This intrusive thought persists despite efforts to eliminate it.

Panic

• Panic refers to a sudden and intense episode of anxiety that can feel overwhelming to the individual.
• During a panic attack, there is often a feeling of impending doom or disaster.

Phobia

A phobia is an overwhelming or irrational fear directed towards a specific object, situation, or activity.

Psychopath (Sociopath)

A psychopath is someone with a personality disorder who, while not being mentally ill, does not adhere to the usual ethical standards of behaviour in society. This can lead to criminal behaviour without feelings of guilt or remorse.

• Individuals with this disorder may display a range of behaviours, including:
• Abnormal aggression, asocial behaviour, or antisocial tendencies.
• Submissiveness, demanding behaviour, or mistrustfulness.
• Involvement in criminal activities.
• A childhood history of similar problematic behaviour.
• A normal or high IQ, with some individuals potentially being geniuses.
• A charming demeanor that can impress others, coupled with the ability to deceive for long periods. This can include engaging in fraud, theft, deception, assault, and other criminal actions.
• Sudden temperamental outbursts and verbal or physical attacks that occur without provocation, which the individual finds relieving. These reactions are often referred to as "short circuit reactions."

Understanding Psychosis

Psychosis is a severe mental condition where an individual loses touch with reality, immersing themselves in a world of delusions (false beliefs) and hallucinations (seeing or hearing things that aren't there). This disorder leads to a decline in one's personality and a gradual disconnection from the real world.

Clinical Features. People experiencing psychosis are convinced that their perceptions and beliefs are accurate. They often create their own version of reality, which can include hearing strange voices or experiencing other unusual sensations. This altered perception can be so convincing that they attract followers or individuals who believe in their distorted reality.

Types of Psychosis. 1. Organic Psychosis. This type has identifiable physical causes and can be further classified into: a. Acute Organic Psychosis. Conditions like high fever or delirium can trigger sudden episodes of psychosis. b. Chronic Organic Psychosis. Long-term conditions such as dementia can lead to persistent psychotic symptoms. 2. Functional Psychosis. This includes mental health disorders such as schizophrenia, characterized by distorted thinking, emotions, and behaviors, and bipolar disorder, which involves extreme mood swings.

Individuals with psychosis often experience significant emotional distress and require empathetic support to help them navigate their challenges.

Instances of Murderers and Their Psychological Profiles

• The Psychotic Killer. These individuals are unable to grasp the reality of their actions, or their judgement is compromised due to delusions and hallucinations.
  • While those with depression might exhibit a higher propensity for violent behaviour, it is inaccurate to claim that they frequently commit murders.
  • Individuals suffering from schizophrenia might engage in murder driven by feelings of persecution.
  • Intense jealousy linked to alcoholism could lead a person to murder a spouse based on a false belief of infidelity.
  • It is rare for individuals experiencing mania or hypomania to commit murder as a result of delusions.
• The Psychopathic Killer. In this case, the act of killing may be unintentional and occur due to a loss of control.
  • An over-controlled murderer is someone who typically exercises significant control over their aggressive impulses but may resort to killing following a severe emotional breakdown.
  • After committing the violent act, they often return to their usual, highly controlled behaviour.
  • In certain instances, there may be an absence of typical emotional responses.

Stupor

• Stupor is a condition characterized by a lack of movement and speech, while the person remains aware of their surroundings.
• This state is commonly observed in various mental and neurological disorders, including:
  • Depression
  • Dissociative disorders
  • Epilepsy

Trance

• Trance refers to a state of altered awareness where there is a lack of voluntary movement.
• This condition can resemble behaviours seen in:
  • Hypnotism
  • Epilepsy

Twilight State (Psychomotor Automatism)

• The twilight state is characterized by low awareness during brief actions that often lead to little or no memory of the events afterwards.
• This state is frequently observed in conditions such as:
  • Dissociative disorders
  • Epilepsy

Undue Influence

Undue influence occurs when someone exerts strong physical or mental pressure on another person, making it difficult for them to act according to their free will. For example, a son might withhold pain medication from his father after surgery unless the father agrees to sign a will that leaves all his property to the son.

Disorders of the Mind and Behaviour

Various types of disorders affect the mind and behaviour, and these can be classified based on their causes.

Causative Factors

• Heredity: Some disorders are inherited, such as Huntington's chorea and amaurotic family idiocy.
• Environmental Factors: Poor parental attitudes and inadequate mental hygiene can contribute to the development of these disorders.
• Psychogenic: Disorders can arise from unresolved mental conflicts.
• Precipitations: Factors like financial problems, sexual disappointments, or the death of a close relative can trigger these disorders.
• Organic: Conditions such as head injuries, atherosclerosis, senile degeneration, myxedema, and pernicious anaemia can lead to mental disorders.
• Unknown: Some mental disorders occur without any identifiable causes or specific factors.

Classification of Psychotic Disorders

• The International Classification of Diseases, 10th Edition (ICD-10), Chapter F, provides a detailed classification of psychotic disorders.
• ICD-10 codes from F00 to F99 reflect recent advancements in the field of psychiatry.

List of Psychotic Disorders and Their ICD-10 Codes

• F00: Alzheimer’s disease (G30)
• F01: Vascular dementia
• F02: Dementia in other diseases classified elsewhere (G31.8)
• F03: Unspecified dementia
• F04: Organic amnesic syndrome, not caused by alcohol and other psychoactive substances
• F05: Delirium, not caused by alcohol and other psychoactive substances
• F06: Other mental disorders due to brain damage and dysfunction and to physical disease
• F07: Personality and behavioural disorders due to brain disease, damage, and dysfunction
• F09: Unspecified organic or symptomatic mental disorder
• F10: Mental and behavioural disorders due to use of alcohol
• F11: Mental and behavioural disorders due to use of opioids
• F12: Mental and behavioural disorders due to use of cannabinoids
• F13: Mental and behavioural disorders due to use of sedatives or hypnotics
• F14: Mental and behavioural disorders due to use of cocaine
• F15: Mental and behavioural disorders due to use of other stimulants, including caffeine
• F16: Mental and behavioural disorders due to use of hallucinogens
• F17: Mental and behavioural disorders due to use of tobacco
• F18: Mental and behavioural disorders due to use of volatile solvents
• F19: Mental and behavioural disorders due to multiple-drug use and use of other psychoactive substances
• F20: Schizophrenia
• F20.0: Paranoid schizophrenia
• F20.1: Hebephrenic schizophrenia
• F20.2: Catatonic schizophrenia
• F20.3: Undifferentiated schizophrenia
• F20.4: Post-schizophrenic depression
• F20.5: Residual schizophrenia
• F20.6: Simple schizophrenia
• F20.8: Other schizophrenia
• F20.9: Schizophrenia, unspecified
• F21: Schizotypal disorder
• F24: Induced delusional disorder
• F25: Schizoaffective disorders
• F28: Other non-organic psychotic disorders
• F30: Manic episode
• F31: Bipolar affective disorder
• F32: Depressive episode
• F33: Recurrent depressive disorder
• F34: Persistent mood (affective) disorders
• F38: Other mood (affective) disorders
• F40: Phobic anxiety disorders
• F41: Other anxiety disorders
• F42: Obsessive-compulsive disorder
• F43: Reaction to severe stress and adjustment disorders
• F44: Dissociative (conversion) disorders
• F45: Somatoform disorders
• F48: Other neurotic disorders
• F50: Eating disorders
• F51: Non-organic sleep disorders
• F52: Sexual dysfunction, not caused by organic disorder or disease
• F53: Mental and behavioural disorders associated with the puerperium, not elsewhere classified
• F54: Psychological and behavioural factors associated with disorders or diseases classified elsewhere
• F55: Abuse of non-dependence-producing substances
• F59: Unspecified behavioural syndromes associated with physiological disturbances and physical factors
• F60: Specific personality disorders
• F61: Mixed and other personality disorders
• F62: Enduring personality changes, not attributable to brain damage and disease
• F63: Habit and impulse disorders
• F64: Gender identity disorders
• F65: Disorders of sexual preference
• F66: Psychological and behavioural disorders associated with sexual development and orientation
• F68: Other disorders of adult personality and behaviour
• F69: Unspecified disorder of adult personality and behaviour
• F70: Mild mental retardation
• F71: Moderate mental retardation

Intellectual Disabilities

• F72 Severe intellectual disability
• F73 Profound intellectual disability
• F78 Other intellectual disabilities
• F79 Unspecified intellectual disability

Developmental Disorders

• F80 Specific developmental disorders of speech and language
• F81 Specific developmental disorders of scholastic skills
• F82 Specific developmental disorders of motor function
• F83 Mixed specific developmental disorders

Pervasive and Psychological Disorders

• F84 Pervasive developmental disorders
• F88 Other disorders of psychological development
• F89 Unspecified disorders of psychological development

Disorders of Attention and Behaviour

• F90 Hyperkinetic disorders
• F91 Conduct disorders
• F92 Mixed disorders of conduct and emotions
• F93 Emotional disorders with onset specific to childhood
• F94 Disorders of social functioning with onset specific to childhood and adolescence
• F95 Tic disorders
• F98 Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence

Other Mental Disorders

• F99 Mental disorder, not otherwise specified

Widely Accepted Classification of Psychiatric Disorders

The classification of psychiatric disorders that is most commonly accepted worldwide is as follows:

• I. Organic Psychoses
• 
  
  • Dementia. Includes both senile (age-related) and presenile (occurring before old age) types.
  • Drug-Induced Psychosis
  • Confusional State Psychosis
  • Psychosis Following conditions such as epilepsy, pregnancy, childbirth, trauma, and general disease.
• A. Functional Psychoses
• 
  
  • Schizophrenia. Various forms including simple, hebephrenic, catatonic, paranoid, and other atypical forms.
  • Paranoid Status
  • Affective Disorders. Includes involuntary affective disorders, melancholia, mania, depression, paranoid status, and other atypical forms.
• II. Neurotic Disorders
• III. Personality Disorders
• IV. Sexual Deviations
• Intellectual Disability

The subcategories under the second classification will be discussed in detail below.

Understanding Dementia

Dementia is a type of brain disorder where the brain's functions start to decline after reaching a certain level of maturity. It typically begins gradually, worsens over time, and affects multiple areas of functioning simultaneously. Individuals with dementia experience a decline in their intellectual abilities, including memory, understanding, and reasoning.

Types of Dementia

Dementia can be classified into various types, including:

• Organic Dementia
• Senile Dementia
• Pseudodementia

Organic Dementia

Causes: Organic dementia is caused by either a specific or widespread injury to the brain.

Clinical Features: Patients with organic dementia may exhibit the following characteristics:

• Restlessness
• Irritability
• Experiencing episodes of delirium, excitement, or depression

Symptoms: Common symptoms of organic dementia include:

• Memory loss
• Confusion regarding time and place
• Difficulty recognizing familiar people
• Childish or inappropriate behavior

Senile Dementia

• Causes: Old age and cerebral arteriosclerosis.
• Types:
  • Alzheimer's dementia
  • Vascular dementia (multi-infarct dementia)
  • Dementia due to Parkinsonism
  • Huntington's disease
• Clinical Picture: Progressive mental deteriorationcharacterized by:
  • Loss of memory
  • Childishness
  • Perverted behavior
  • Delusions of family neglect

Other Types of Dementia

• Creutzfeldt-Jakob disease
• Pick's disease
• Dementia due to head injury
• Anemia
• Hyperthyroidism
• Infections such as syphilis and HIV

Drug-Induced Psychoses

• Alcohol
• Heroin
• Morphine
• Cannabis indica
• Cocaine
• D-lysergic acid diethyl amide (LSD)

Alcoholic Psychoses

• Mental disorders resulting from alcohol consumption include:
• Delirium tremens and acute confusion
• Korsakoff’s psychoses (characterized by confabulation)
• Alcohol-related dementia
• Alcohol use can also lead to behaviors driven by sexual jealousy and related criminal activities.
• These conditions can have a profound impact on an individual's life and relationships.

Heroin/Morphine Psychoses

• Both heroin and morphine can cause gradual mental deterioration leading to:
• A diminished interest in the surroundings
• Decreased intellectual capacity
• A loss of self-respect and trust
• Individuals may resort to criminal activities to obtain these drugs.

Cannabis Psychosis

• Cannabis psychosis is a severe mental condition that can occur due to cannabis use, known as cannabis-induced psychotic disorder. It is characterized by:
• Addiction to cannabis
• Sensory hallucinations, where individuals experience things that are not present, such as seeing or hearing things that do not exist
• Delusions, which can include feelings of grandeur (believing one is exceptionally important or powerful) or persecution (feeling that one is being targeted or harmed by others)
• During episodes of agitation, individuals may exhibit violent behavior toward perceived threats and could even contemplate suicide.

Cocaine Psychoses

• Cocaine-induced psychoses are characterized by:
• Tactile hallucinations, often referred to as cocaine bugs, where individuals feel insects crawling on or under their skin, along with visual hallucinations
• Prolonged use of cocaine can lead to both mental and physical deterioration.

LSD Psychoses

• LSD can lead to a harmful reaction in some cases.
• This reaction can cause symptoms like:
  • Intense fear or anxiety
  • Feeling disconnected from oneself (depersonalization)
• The psychotic episode triggered by LSD can persist for several months.
• Prolonged use of LSD may have negative impacts on how the brain functions.

Confusional State Psychoses

• In this condition, the patient experiences confusion, which can be brought on by various factors, such as:
  • Severe physical or mental exhaustion
  • Acute infections
  • Epileptic seizures
  • The process of childbirth
  • Significant life stressors
  • Physical trauma, including head injuries

Clinical Manifestations

• Restlessness and insomnia
• Confused ideas and mistaken identity
• Apprehensive and uncertain state
• Auditory and visual hallucinations

However, recovery is common, and these symptoms may also occur with acute delirium and stupor.

Psychosis Following Epilepsy

Epileptic automatism is often used as a defence in serious crimes when no other defence is available. An EEG must be provided as evidence of epilepsy, making it a significant medico-legal issue. To understand this better, let's look at epilepsy in more detail.

Characteristics of epileptic convulsions include several stages:

• Pre-epileptic confusional state. This may start a few days before convulsions occur.
• Mood irritability
• Clouding of consciousness
• Delusions and hallucinations which may lead to committing a crime. A normal state returns after the convulsion stops.

Masked or psychomotor epilepsy. In this type, the patient does not show any convulsions but experiences a mental disturbance that replaces the convulsion entirely. These disturbances can lead to serious actions, such as committing murder, usually against a stranger. Characteristics include:

• No motive
• No preparation
• No accomplices
• No attempt to hide or conceal after the crime
• No attempt to escape after the crime

Post-epileptic automatism. This occurs after convulsions, while absence seizures involve brief lapses in consciousness without convulsions. For example, in petit mal epilepsy, the patient may have a lapse in consciousness and perform actions without realising it, such as taking items in shops and being arrested for theft.

Schizophrenia

Schizophrenia is a kind of functional psychosis that impacts thought processes and emotional stability, causing a rift between a person's thoughts and feelings. For instance, someone with schizophrenia might discuss a violent act with interest, regardless of its seriousness.

The clinical characteristics of schizophrenia can be divided into two primary stages: the early stage and the late stage.

Early Stage

• Thought Disorder: This involves misinterpretations of reality due to hallucinations, illusions, and delusions, leading the individual to retreat into their own mind.
• Emotional Instability: Changes in behaviour, such as withdrawal or exhibiting depressive or aggressive tendencies.

Late Stage

• Lack of motivation and goals.
• The individual may give up all hobbies.
• Loss of interest in friendships.
• Indifference to their surroundings.

Schizophrenia typically manifests in four subtypes:

Schizophrenia Simplex

In this subtype, the patient exhibits all the clinical signs mentioned earlier, but the primary symptoms are their reactions to significant events, which seem to lack personal concern.

Hebephrenic Schizophrenia

Patients experience severe disorganization of thought due to hallucinations, illusions, and delusions, which may result in impulsive behaviour and potential criminal acts. These impulses might not be recognized during the act.

• Case example:. patient heard voices instructing him to harm his mother but hesitated. The following day, without hearing any voices, he silently attacked her.

Paranoid Schizophrenia

Patients maintain much of their original personality but suffer from distorted thoughts, often involving persecutory or grandiose delusions, leading to a distorted view of the world.

• Othello Syndrome:. dangerous form of jealousy where the patient believes their partner is unfaithful, potentially prompting violent actions against them.

Catatonic Schizophrenia

Patients display mood disorders and symptoms such as rigidity, stupor, agitation, and unusual posturing. There is a risk of malnutrition, exhaustion, and self-harm.

Undifferentiated Schizophrenia

This subtype includes a combination of positive and negative symptoms characteristic of schizophrenia but does not fit neatly into other categories.

Patients may present with: Paranoid delusions. These delusions can lead to criminal behaviour. Since much of the original personality remains, such actions may not be impulsive but are often preceded by planning, suggesting that legal definitions of insanity may not apply.

Understanding Paranoid State

A paranoid state is a type of functional psychosis where the main feature is the presence of delusions. These delusions may be accompanied by hallucinations, but there is no significant change in mood, thinking, or personality. The individual’s personality remains intact.

Paranoid states typically occur in middle age or later and can be categorized into two types:

• Paranoia
  • Age of onset: Between 25 to 40 years.
  • Gender prevalence: More common in males.
  • Description: In this type, individuals develop gradual and systematized delusions of persecution, which may involve serious criminal connections. It is a less common mental health issue.
• Paraphrenia
  • Age of onset: Around 45 years.
  • Description: This is a rare form of mental illness where individuals experience systematized delusions, ideas of reference, and often auditory hallucinations.

Individuals with paranoid states may experience difficulties with neighbours due to persecution delusions, which can lead to police involvement. They may also suspect unfair decisions by the court or police in a case and express these thoughts publicly.

Diagnosing Mental Illness and Issuing Certificates

Diagnosing a clear case of mental illness is relatively straightforward. However, challenges arise primarily in the early stages of mental health issues. This emphasizes the importance of a thorough assessment when any mental health concern is suspected. The assessment should include the following examination scheme:

Preliminary Details

• Record the individual's name, age, sex, marital status, education, occupation, income, address, religion, and socio-economic background.
• Document information about the accompanying person, including their name, age, sex, and address, regardless of whether they live with the individual.
• Record and evaluate statements from both the individual and the accompanying person.
• Note two identification marks, such as moles, birthmarks, etc.

Presenting Complaints

• While noting down the presenting complaints, pay close attention to the following aspects:
  • When did the current illness begin?
  • How long have the symptoms been present, and how have they changed over time?
  • Are there any factors that trigger, worsen, maintain, or relieve the condition?

History of Present Illness

• Record when the patient was last in good health and how the symptoms have evolved since then.
• Include details about:
  • Any thoughts of self-harm or past suicide attempts
  • Sleep issues such as insomnia, hypersomnia, or sleep apnea
  • Changes in appetite
  • Sexual function and any related concerns

Past History

• Document any significant or minor illnesses and treatments from the past.
• Ask about any history of alcoholism or drug abuse.

Family History

• There might be a background of chorea, epilepsy, or severe mental illness in the patient's parents or siblings.
• Various mental illnesses can be familial, shaped by both genetic factors and environmental influences, as evidenced by family members.

Personal History

• Gather detailed information about the patient's childhood, including their play history, friendships, puberty, and for females, their menstrual and obstetric history.
• Inquire about any head injuries, drug addiction, and significant issues such as domestic problems and emotional distress.
• Record details about the premorbid personality, including interpersonal relationships, attitudes towards self and others, work and religious beliefs, moral values, mood, habits, fantasy life, and leisure activities.

Physical Examination

• The patient may exhibit abnormalities in the shape of the head or body.
• Their clothing may be inappropriate for the situation.
• An irregular walking pattern (gait) could be observed.
• A tongue that appears thickened (furred) and skin that is dry might be present.
• On the other hand, moist palms and soles could also be noticeable.
• Signs such as a rapid pulse and elevated body temperature may be evident.

Examination of Mental Status/Conditions

Various tests can assist in diagnosing the condition. Recommended assessments include:

• Memory Test: Inquiring about the day, date, time, name, and names of relatives, with the expectation of unclear responses.
• Reasoning and Judgment: Simple mathematical questions that the patient may find difficult to answer.
• Handwriting: Typically observed as messy rather than tidy.
• Speech: Monitoring aspects such as rate, volume, tone, flow, and rhythm of speech.
• Conduct: Noting any lack of response to stimuli or behaviors that seem disconnected from events.

General Appearance and Behaviour Assessment

General appearance and behaviour are evaluated by considering:

• Physical attributes such as physique, build, height, weight, and hygiene.
• Gait and posture.
• Behavioural aspects including cooperation, hostility, evasiveness, combativeness, excitement, involuntary movements, and restlessness.
• Presence of catatonic signs and the nature of eye contact.
• Ability to establish rapport and indications of hallucinations, like talking to oneself or making unusual gestures.

Cognition Assessment

• Cognition assessment involves evaluating consciousness, orientation, attention, concentration, and abstract thinking abilities.
• Insight assessment measures the patient’s awareness and understanding of their condition.
• Judgment assessment examines the capacity to comprehend situations and respond appropriately.

Investigations

• Complete medical toxicological screening tests.
• Drug levels.
• Electrophysiological tests.
• Brain imaging tests.
• Neuroendocrine tests.
• Genetic tests.
• Sexual disorder investigations, and other relevant investigations.

Diagnostic Formulation

• After a thorough psychiatric evaluation, diagnosis and differential diagnostic assessments are conducted along with a comprehensive treatment plan.

Certification

• A certification of mental illness by a doctor based on a single examination is insufficient.
• Recommendations for issuing a certificate for mental illnesses are as follows:
• Conduct three consecutive examinations on three occasions.
• Describe the actual clinical picture in the certificate.
• Provide clear reasons for the diagnosis made.
• Rule out the possibilities of feigned insanity.

Feigned Insanity

Feigned insanity involves an individual pretending to be mentally ill.

Purpose

• To evade capital punishment in criminal cases.
• To escape from business transactions or legal agreements.
• To withdraw from military service.

It is up to doctors to detect and report cases of feigned insanity. Observation should continue for at least 10 days, although this period can be extended with a magistrate's approval.

Key Characteristics

• The onset of feigned insanity is often sudden and may be driven by an underlying motive.
• The individual exhibits signs of insanity only when under observation.
• The symptoms do not align with a specific type of insanity.
• Deceiving others can lead to exhaustion.
• Individuals pretending to be ill typically maintain their personal hygiene and eat well.
• A malingerer often feels frustrated by frequent examinations.
• Examples of feigned conditions include deafness and mutism.

Restraint of Mentally Ill Individuals

Restraint of mentally ill or insane individuals refers to the practice of keeping dangerous individuals with severe mental health issues securely under control in a mental hospital. The Mental Health Act, 1987 updated the laws concerning the treatment and care of mentally ill individuals, enhancing provisions related to their property and affairs. There are primarily two types of restraint: immediate restraint and admission to a psychiatric hospital.

Immediate Restraint

Immediate restraint involves confining the patient without delay. The following situations may indicate the need for immediate restraint:

• When a person exhibits severe mental incapacity, posing a serious risk to themselves or others.
• Delirium caused by underlying medical issues such as infections or metabolic problems.
• Delirium tremens.

True vs. False Insanity

• True Insanity: Develops gradually and subtly, without a clear motive. Symptoms align with a specific psychiatric disorder and may include insomnia, neglect of personal hygiene, and the ability to endure extended fatigue and hunger. Individuals do not mind being detected, and symptoms may disappear when not under observation.
• False Insanity: Appears suddenly and dramatically, often with a motive related to committing an offense. Symptoms are exaggerated, not fitting any known disorder, and include frequent changes in behavior. Insomnia is not maintained for more than a night, personal hygiene is typically intact, and individuals cannot tolerate extended fatigue and hunger for more than 1-2 days. They resent being detected due to fear of exposure.

Methods: The methods for restraint involve safely confining the individual in a room, ideally with consent from guardians or authorized individuals. Consent is not required if there is no time to obtain it. However, the individual should be released once they are no longer a danger.

Ways to Get Admitted to a Psychiatric Hospital

There are several legally approved methods for admitting individuals to a psychiatric hospital. These methods include:

• Voluntary or Direct Restraint
• Reception Order on Petition
• Reception Order Other than on Petition
• Reception after Judicial Inquisition
• Reception of Mentally Ill Criminals
• Reception of Escaped Mentally Ill Individuals

Voluntary or Direct Restraint

This method involves an individual with mental health issues voluntarily requesting admission and treatment at a psychiatric hospital. The process includes the following steps:

1. Written Request: The individual submits a written request for admission directly to the officer in charge of the hospital.
2. Assessment: The request is assessed to determine the necessity of inpatient care.
3. Consent from Visitors: The individual must obtain consent from two appointed visitors of the hospital. These visitors are responsible for confirming that the individual requires inpatient care and treatment.

Petition for Admission: Steps Involved

A person struggling with mental illness can be admitted to a mental health facility through a legal process that involves several important steps:

• Petition Submission:. relative or friend who has been caring for the individual for at least 14 days must submit a formal petition to the magistrate. This petition requests the admission of the person to a mental hospital.
• Required Documents: Along with the petition, several crucial documents need to be submitted to support the request:
• Medical Certificate:. certificate from a registered medical practitioner is necessary, stating that the patient requires mental treatment in a hospital.
• Examination Certificate:. certificate from a medical officer who has examined the patient within the last 7 days is required, confirming the need for hospitalization.
• Fitness for Travel:. doctor’s certificate indicating the patient’s physical fitness for travel is also necessary.

Magistrate's Role: Once the petition and documents are submitted, the magistrate will review them and may issue an order for reception. In some cases, the magistrate may personally examine the patient before making a decision.

Validity of Order: The order issued by the magistrate for reception is typically valid for 30 days, allowing for the necessary arrangements to be made for the patient’s admission to the mental health facility.

Reception Order Other Than on Petition

Following are the indications and procedures.

• Individualswho may pose a risk to themselves or others:
  • Police officers are authorised to arrest such patients and bring them before a magistrate.
  • The magistrate can issue a reception order directly.
  • If there is any doubt, the magistrate may send the patient for a medical examination.
  • The order is issued only if the patient is certified as mentally ill and dangerous.
• Individualswho are not receiving adequate care:
  • Police officers can present individuals with mental illness who are not properly cared for or are cruelly treated by their relatives to the magistrate.
  • A reception order can be sanctioned in such cases.

Reception after Judicial Evaluation

• When a person with substantial assets is found to be mentally ill, the high court or district court has the authority to order a judicial evaluation. Based on the findings, the court can facilitate:
• Admission to a Mental Hospital: The individual may be admitted to a mental health facility for proper care and treatment.
• Property Management: The court can ensure that the individual's property is managed appropriately to protect their interests.
• Fee Recovery Arrangements: Arrangements can be made to recover necessary fees from the income generated by the individual's property. This process will be under the supervision of the court to ensure transparency and legality.

Reception of Mentally Ill Criminal

• This process involves individuals who are mentally ill and have either committed a crime or have developed mental illness after being incarcerated. In such cases, the presiding officer of the court will issue an order for the reception of these individuals to ensure they receive appropriate care and treatment.

Reception of the Escaped Mentally Ill

A police officer or any staff member of the hospital can readmit such a patient to a mental hospital.

Discharge of Mentally Ill from Psychiatric Hospital

Discharging a patient from a mental hospital depends on several factors, including:

• Recovery or cure of the patient
• Request from the individual who initiated the discharge petition
• Order from an authority, ensuring proper care by relatives
• Judicial requisition confirming the patient 's sanity
• Intent to discharge by the voluntary or direct boarder

Responsibilities of an Insane Individual

The legal obligations of a sane person for their actions or lack thereof, and the associated punishments under the law. The responsibilities of an insane person are considered under two categories:

• Civil responsibilities
• Criminal responsibilities

Civil Responsibilities

Civil responsibilities relate to the following:

• Management of property —According to Sections 50, 51, 53, and 54 of the Mental Health Act, 1987, the court can oversee the property of an insane individual by appointing a manager. This occurs only when a friend or relative requests this, a judicial inquiry is conducted, and it is proven beyond a reasonable doubt that the person is mentally unsound.
• Contracts —Under Section 12 of the Indian Contract Act (IX) of 1872, any contract with a mentally ill person is considered invalid. However, it is valid if made during a lucid interval. If insanity develops later, it does not automatically invalidate the contract. Furthermore, if one party was unaware of the other party's mental illness at the time of signing, the court may declare the contract invalid.
• Marriage and divorce —As per the Divorce Act of 1869, a marriage is null and void if one partner is mentally ill at the time of the marriage. This means the marriage is legally regarded as never having occurred, even if it was consummated afterwards. However, if one spouse becomes mentally ill after the marriage, it does not lead to nullity but may be grounds for divorce.
• Competency as a witness —According to Section 118 of the Indian Evidence Act, a mentally ill person cannot serve as a witness unless they are in a lucid interval. It is up to the judge to decide if the person is in such an interval.
• Validity of consent —Under Section 90 of the IPC, consent given by a mentally ill person is invalid in all circumstances.
• Testamentary capacity —Under the Indian Evidence Act, a will can be contested and is not valid unless it can be shown that the testator is mentally sound ( compos mentis ).

Criminal Responsibilities

Criminal responsibility in law refers to the duty to face punishment for one's actions. The legal system presumes that individuals are sane and accountable for their actions unless proven otherwise. Conversely, those deemed insane are not held accountable for their actions.

Section 84 of the Indian Penal Code (IPC) states that a person is not committing an offence if, at the time of the act, they are suffering from a mental disorder that prevents them from understanding:

• The nature of their act
• That what they are doing is wrong or against the law

This provision is similar to McNaghten’s Rule in English law.

Legal Test for Insanity

• The legal test for insanity aims to determine if an individual is responsible for a crime based on the presence of a mental illness or defect at the time of the offence.
• To establish this defence, three key factors must be demonstrated in court:
• Existence of Mental Illness or Defect: There must be evidence of a mental illness or defect affecting the individual's mental capacity.
• Timeliness: The mental illness or defect must have been present at the time the crime was committed.
• Lack of Awareness: The condition should prevent the individual from recognising that their actions were wrong or illegal.

Insanity and Murder

• When a person with a mental disorder, such as schizophrenia, commits murder, legal outcomes can vary under Section 84 of the IPC.
• Examples of different types of killers include:
• Psychotic killers: Individuals with severe mental disorders who commit murder.
• Sexual killers: Murderers motivated by sexual factors.
• Psychopathic killers: Individuals, such as hired assassins, who commit murder for personal gain.
• Jealous killers: Individuals driven by intense jealousy, such as those experiencing Othello syndrome.
• Alcoholic killers: Individuals whose criminal behaviour is linked to alcohol abuse and issues like infidelity.

Insanity and Other Legal Defences

• Somnambulism: Crimes committed while sleepwalking are generally considered unintentional and not subject to punishment.
• Hypnosis:. person under hypnosis cannot be compelled to engage in immoral or dishonest acts.
• Delirium: Individuals in a state of delirium, experiencing hallucinations and delusions, are not held criminally responsible for their actions.
• Drunkenness: According to IPC Section 85, individuals are not criminally liable for acts committed under the influence of alcohol or drugs if they were unaware of their consumption.
• Impulse: Acts driven by uncontrollable impulses, such as kleptomania or pyromania, are not punishable if the impulse originates from a mental illness.

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Thomas Aquinas and Criminal Responsibility

Thomas Aquinas believed that it's impossible to truly know what is going on in a person's mind. Lady Wootton built on this idea when talking about whether someone is criminally responsible based on their mental state. She argued that figuring out if someone can resist temptation and how responsible they are is something deep within their consciousness, which no one can access. Other philosophers like Descartes (through John Locke) and Jeremy Bentham also argued against our ability to judge someone's responsibility, saying that our actions are linked to our thoughts but are still separate. However, these ideas can be challenged by theories that see things as one whole.

Logical Flaws in Responsibility

• Lady Wootton points out a logical problem in the concept of responsibility.
• She argues that there are no clear guidelines to distinguish between those who are responsible and those who are not.
• Wootton, along with others, believes that even science cannot provide answers to questions about responsibility.
• This critique emphasizes how juries rely on common sense to evaluate a person's intentions and criminal responsibility.
• Juries consistently use this reasoning without significant issues.

The Role of Philosophers and Juries

Philosophers may criticize the law for its complexities, but those who enforce it, represented by juries, do not rely on intricate moral arguments. Instead, juries base their judgments on a straightforward understanding of human behavior, reflecting everyday perceptions rather than philosophical debates.

The Historical Treatment of the Mentally Abnormal Offender

• In early Indian criminal history, there is limited information available regarding the treatment of the insane.
• Under Roman law, insane offenders were treated with leniency, as madness was considered a form of punishment in itself.
• This perspective was morally acceptable and was influenced by Greek moral philosophy, particularly the ideas of Aristotle, as well as by Hebrew law.
• One of the earliest mentions of the ‘right-wrong test’ can be found in legal texts from this period.
• In the 13th century, Bracton asserted that for a crime to occur, there must be a ‘will to harm,’ implying that individuals with mental health conditions were not criminally responsible.
• Sir Edward Coke (1552-1634) supported this idea in a case called Beverley (1603), arguing that a madman did not understand his actions and therefore lacked criminal intent.
• This laid the groundwork for assessing ‘insanity’ based on whether the individual knew their actions were wrong, known as the ‘right-wrong’ test.
• Sir Matthew Hale, in his History of the Pleas of the Crown (1736), noted that only those who were ‘totally insane’ could use this excuse for criminal responsibility.
• He likened the understanding of a madman to that of a child, suggesting that both lack reason and behave like brute animals.
• Hale’s writings had a significant impact on lawyers in the 18th and 19th centuries.
• Various notable cases during this time helped to clarify the common law stance on the responsibility of individuals deemed ‘mad.’

Case of R v. Arnold (1724)

• In the case of R v. Arnold in 1724, Arnold claimed that Lord Onslow had put a spell on him, leading him to a place filled with devils and imps that disturbed his mind and caused him sleeplessness.
• Arnold believed that Onslow was the source of all the nation's troubles.
• Despite his delusions, Arnold's defense was not successful, possibly because he still exhibited some level of reasoning, and he was eventually hanged.
• During the judge's summary, Arnold was compared to both an infant and a wild beast, which was part of the 'wild-beast test' for assessing criminal responsibility.
• This case established a new standard for criminal responsibility that focused on the ability to distinguish between good and evil.
• This standard later developed into an independent criterion for insanity.
• Following this, juries were allowed to give a special verdict of not guilty by reason of insanity, even if the offender acknowledged their actions but did not comprehend that they were wrong.

R v Earl Ferrers (1760)

• In this case, Earl Ferrers shot Johnson, the receiver of his estate, because he believed Johnson was conspiring against him.
• The shot was not immediately fatal, and Ferrers called for medical assistance.
• During his murder trial, Ferrers claimed he acted on an "irresistible impulse," but this defence was unsuccessful.
• For a prisoner to be acquitted on grounds of lack of reason, there must be a total, permanent, or temporary absence of reason.

R v Hadfield (1800)

• James Hadfield believed he needed to sacrifice his life for the world's salvation.
• He did not intend to commit suicide but thought that by attempting to kill the king, he would be executed.
• On 15th May 1800, Hadfield fired at King George III at the Theatre Royal, Drury Lane, London.
• Hadfield was tried for treason, a charge that allowed him legal counsel, which was not permitted in other trials until the Prisoner's Counsel Act 1836.
• His lawyer, Erskine, challenged the traditional tests of insanity, arguing that a person could "know what he was about" but still be unable to resist a delusion.
• Hadfield was acquitted largely due to Erskine's strong arguments, and historians believe the jury may have sympathised with Hadfield because of medical evidence of his severe war injuries.

R - v - Bellingham (1812)

• Bellingham, who was paranoid, blamed the Government, particularly Prime Minister Sir Spencer Perceval, for his business problems.
• He assassinated the popular Perceval.
• Despite his mental state, Bellingham was convicted and hanged after the court applied a strict interpretation of the insanity law.

R - v - M’Naghten (1843)

• Daniel M’Naghten, a man with schizophrenia, believed he was being targeted by various authorities, including Prime Minister Sir Robert Peel.
• On January 20, 1843, M’Naghten shot the wrong person, thinking he was targeting Peel.
• The case raised complex questions about the motives behind crimes and the nature of insanity.
• M’Naghten was found not guilty due to his delusion, which impaired his ability to control his actions.
• This decision caused public outrage and led to the establishment of the M’Naghten Rules, defining the legal criteria for insanity.
• The rules state that individuals are presumed sane unless proven otherwise and that the insanity defense requires a significant mental defect affecting the understanding of the act's nature or wrongfulness.
• The test is cognitive and does not account for partial insanity or delusions.
• Critics argue for improvements, such as the 'irresistible impulse' concept, seen in other jurisdictions.
• Various committees have recommended changes to the test in England, but these suggestions were often rejected due to judicial skepticism about partial insanity.
• Baroness Wootton warned that broadening the rules could lead to unclear responsibility.
• After meeting the criteria for insanity, the accused would not be released immediately but kept in custody until further decisions were made.
• This was due to the Criminal Lunatics Act 1800, which ended simple acquittals based on insanity.
• While it seemed to absolve mentally ill offenders of criminal responsibility, it recognised the risks of treating them as innocent.
• Queen Victoria attempted to change the verdict of 'insane' to 'guilty but insane' due to multiple assassination attempts against her.
• Legal cases affirmed that this verdict was indeed an acquittal, but a qualified one.
• The Criminal Procedure (Insanity) Act 1964 reaffirmed the traditional stance on 'special verdicts'.

Diminished Responsibility

• Diminished responsibility is a legal concept that originated in Scottish law before being introduced to England and Wales through the Homicide Act 1957.
• In Scottish law, the idea of partial insanity has been reducing punishments since the 17th Century. However, it was not a separate legal defence but rather a factor that helped lessen the severity of punishment.
• The introduction of diminished responsibility changed the classification of certain crimes from murder to manslaughter.
• According to the Homicide Act 1957:
  • If a person kills or is involved in the killing of another and was suffering from an abnormality of mind that significantly impaired their mental responsibility at the time of the act, they should be convicted of manslaughter instead of murder.
• The language used in this legal defence was influenced by the Mental Deficiency Acts of 1913 and 1927. This led to a broad interpretation of what constitutes an abnormality of mind and mental responsibility in legal cases.
• If a defendant successfully proves diminished responsibility, the court can impose a range of penalties, including:
  • Life imprisonment
  • Commitment to a mental hospital
  • Absolute discharge
• The understanding of criminal responsibility has evolved to include not only cognitive factors from common law insanity but also the defendant's ability to control their impulses and demonstrate self-control.
• Despite the intention behind introducing this defence, there was no significant increase in manslaughter convictions compared to murder. Researchers observed that:
  • The rates of offenders being found insane at different stages of the legal process remained relatively stable.
  • After the introduction of diminished responsibility and the abolition of capital punishment in 1965, offenders were less likely to plead insanity to avoid life imprisonment. Instead, they could plead guilty to manslaughter.
• The introduction of diminished responsibility modernised the legal perspective on insanity and mental illness, aligning it more closely with contemporary understanding and views on these issues.