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Mental Disorder: Can Merleau-Ponty Take Us Beyond the “Mind–Brain” Problem?
Could Psychoanalysis be a Science?
Throughout its history, the insanity defense specifically and the more general concept of mental defect or incompetence have been grounded in the assumption that those people fit for the rule of law are able to give and to comprehend reasons for their actions. This chapter traces the evolution of perspectives on the nature of mental illness and the manner in which cultural and extra-scientific influences have shaped perspectives. These perspectives are most saliently expressed in statutory provisions and relevant case law summarized here and covering historical developments from ancient Greece and Rome to the present. Significant interactions between law and psychiatry are further highlighted and informed by core and controversial philosophical assumptions. Attention is given to differences between juridical and medical conceptions of responsibility.
The two most venerable domains of scholarship and inquiry addressed to the very nature of human nature are law and medicine. Both have passed through developmental stages as a result of advances in knowledge and alterations of perspective. Both seek practical solutions to problems arising in the actual context of lived life. At any given point in their respective developmental course, each has a more or less settled position on core precepts and accepted standards of evidence. Though different in so many respects, both—as systematic bodies of knowledge and principle—stand as sciences in the original understanding of the term. There is no corruption of language, therefore, in referring not only to medical science but also to jural science.
Of the several points of conflict and complementarity on which law and medicine converge, mental health has held a special place historically.1 The history of law in the West is never indifferent to this. Note, for example, that Rome’s Twelve Tables make provision for controlling the assets of one given to states of manic profligacy. Accordingly, through a study of legal history, one develops a more comprehensive understanding of how a given age addressed and, as it were, settled such philosophically vexing questions as those associated with notions of determinism and moral autonomy, contextual sources of mitigation, powers of agency, and degrees of responsibility. What history reveals is the interplay between law and science and between both of these and the philosophical foundations on which each depends for its credibility. The claims of science are said to be vindicated by evidence and proof, but both evidence and proof must satisfy criteria external to both; criteria developed through the resources of philosophical argument and analysis. The assumptions of law include centrally the proposition that persons are fit for the rule of law; that they can be held responsible and are expected to be able to give and to comprehend reasons for action. (p. 19) All this, too, is subject to what are finally philosophical modes of evaluation. What history makes clear is that the scientific and legal conceptions of the mind and mental life have been parasitic on more fundamental philosophical assumptions, often untested and occasionally at cross purposes with the aims of law. All this is especially evident in the history of the insanity defense, the focus of this chapter.
As noted, the rule of law presupposes creatures of a special kind; viz., those able to give and to comprehend reasons for their actions; persons able to defend their actions by supplying justifications which are, after all, reasons sanctioned by law. The concept of mens rea is but the technical term for what is otherwise one of the core and common sense assumptions of legal responsibility and liability. Even when a legal system is silent on the particular psychological or mental powers on which such responsibility depends, the very efficacy of law arises from the possession of such powers by the public at large. Otherwise, as H. L. A. Hart noted, “no legal system could come into existence or continue to exist” (Hart 1968, p. 230).
The ancient Greek world did not have written law until the archonship of Draco late in the seventh century bc. The laws were posted and, though most of them were later repealed by Solon, certain basic precepts were preserved. For example, Draco’s laws make a distinction between murder and involuntary homicide (see Gagarin and Cohen 2005). Centuries before written law there were customary understandings seemingly grounded in the very nature of those fit for the rule of law itself. Proto-legal systems depend on what is taken to be the counsel of the wise as the Eleatic Stranger makes this clear to Socrates in the Statesman. He argues that one who must legislate “will not be able, in enacting for the general good, to provide exactly what is suitable for each particular case” and “no art whatsoever can lay down a rule which will last for all time … (Thus) the best thing of all is not that the law should rule, but that a man should rule, supposing him to have wisdom” (Plato, Statesman, 294–295).
in a state of madness or when affected by disease, or under the influence of extreme old age, or in a fit of childish wantonness (hybris), himself no better than a child. And if this be made evident to the judges … he shall simply pay for the hurt which he may have done to another; but he shall be exempt from other penalties, unless he have slain some one and have on his (p. 20) hands the stain of blood. And in that case he shall go to another land and country, and there dwell for a year.
There is no evidence in the ancient sources, however, that such philosophical reflections, any more than prevailing medical theories of insanity, yielded exculpatory consequences in the arena of adjudication. Ancient courts regarded the criminal act itself as evidence of mental capacity and saw to it that damages were compensated, crimes punished, and society protected against the deeds of the mad.
Categories of mental competence were used to partition defendants in Roman law: non compos mentis, fanaticus, ideotus, furiosus. These indicate the refinement of ancient law. It was common for statutes pertaining to, e.g., conditions that invalidate a contract, to refer to infants (children) and the insane in the same context. A senile and childlike father, successfully charged with insanity (paranoia), could be legally stripped of control of his estate by his son. The Twelve Tables identify the madman (furiosus) specifically, and require the nearest relatives to take over the management of his affairs if no guardian (cura) has been appointed. Later, at the time of the codification and promulgation of Roman law, the Institutes of Justinian interdict the transactions of a prodigus (spendthrift), though similar transactions by the furiosus are not thus interdicted, for “what he did was valid if he was not mad at the particular time when he did it” (The Institutes of Justinian 1922/1970). Prodigality, regarded (p. 21) as something of an uncontrollable or obsessional disposition, is constrained by the laws of contract, whereas some forms of madness are taken to be episodic.
(F)rom the brain, and from the brain only, arise our pleasures, joys, laughter and jests, as well as our sorrows, pains, griefs and tears … It is the same things which makes us mad (paraphronimos) or delirious … and (causes) acts that are contrary to habit.
In his De Medicina, Celsus (b. ca. 25 bc) summarized Greek medical theories of insanity as well as therapies that had been employed for centuries. One form, called by the Greeks phrenesis, is the acute insanity caused by fever. In this state, “patients are delirious and talk nonsense.” In extreme cases, when the condition does not pass quickly or respond to treatments, the patient’s mind comes fully under the control of illusions and imaginings (“mens illis imaginibus addicta est”). Additionally there are those whose insanity is expressed in the form of sadness or hilarity, violence and rebelliousness. Of the violent ones, notes Celsus, some may be impulsively harmful, others may even be “artful” (etiam artes adhibent), seeming to be entirely sane only to reveal their madness in mischievous acts (Celsus 1935, pp. 289ff).
There has been a long and spirited controversy surrounding the question of the continuity of Roman law in early and late medieval jurisprudence (see Radding 1988, pp. 7ff). What is clear is that, for the Canonist and Christian moralist, the issue of insanity and diminished capacity was far more complex than it was in the ancient world, and this was for reasons both practical and theoretical. First, there was the question of the validity of sacramental rites when either conducted or received by those judged to be insane or incompetent. Then there was the need to distinguish between (merely) legal offenses and those that are genuinely sinful. Bound up with this was the biblical (textual) authority for the belief that certain debilitating conditions, including insanity, are visited upon certain persons as a punishment for their sins, such that these conditions—far from conferring immunity—add further evidence of guilt. In the matter of evidence, still greater burdens were created by the need to see into the heart and soul of the defendant; into that interior life in which guilt and innocence find their wellsprings.
At least from the time of Constantine, and even with the seat of empire moved to the East, there was no frontal attack on Roman law by the Christian world. Rather, in what now must seem like a remarkably brief time, its core principles were systematically absorbed into the larger political and social objectives of the Church; so much so that, beginning with the Corpus Juris Civilis, it becomes difficult to identify any fully independent lines of development of Canon law, common law or, for that matter, the laws of the contemporary western democracies. However, the early Church did not catch up with this bequest immediately. There were changes of a subtle nature imposed on the older tradition. Where classical juridical reasoning and procedure tended to ignore the private recesses of conscience and belief, these were just the domains of greatest concern and interest to the Church. Accordingly, (p. 22) much closer attention was paid in practice to the aspects of mental life and its special vulnerabilities to which classical jurisprudence had been nearly officially aloof.
Concerning the girl who becomes a leper after her betrothal. If it happens that after a girl or woman has been betrothed she becomes leprous or mad or blind in both eyes, then her betrothed husband shall receive back his property and he shall not be required to take her to wife against his will. And he shall not be guilty in this event because it did not occur on account of his neglect but on account of her weighty sins and resulting illness.
Records from Carolingian Europe, covering the period 830–832, provide a similar picture. Lothar, judging Gerberga to be a witch, “tortured her for a long time and then executed her by the judgement of the wives of his wicked counsellors.” Lothar’s own passion for Waldrada was also taken to be caused by witchery. And, in order to preserve “the peace of the Church,” Charles will promulgate laws in 873 that will put to the ordeal all suspected of witchcraft.8 When Roman jurists concerned themselves with mens rea, the matter was more or less disposed of by the very nature of the offense. Matters are different on the assumption that one has sinned in his heart and that, “there cannot be a sin which is not voluntary” (Augustine, Concerning the Truth of Religion, Book XIV, ch. 27).
We have known certain individuals suddenly unbalanced who, with club and cudgel, stones and bites … were not found guilty because of the fact that they had done these things unknowingly and not freely, but by the impulse of some force, I know not what. For how can a man be called guilty who does not know what he has done?
Working against this leniency, however, was the very strong voluntarist theory of criminal liability embraced by Christianity, thereby narrowing to some extent the range of legal defenses available to the mentally afflicted, even as the range of moral offenses constitutive of sin was enlarged. Some of these offenses were clearly tied to mental disturbances but assumed to be of the sinner’s own making. Mental illness bore the heavy burdens of shame and concealment which, in the ancient world, were either muted or remarkably lacking. Theory was replacing matter-of-factness, and with mixed results.
Pope Gregory I (590–604) ruled that no cleric could be ordained if at any time he had been beset by insanity (see Pickett 1952, p. 39). But Cassian, the Egyptian monk of the fifth century, had rejected such exclusions, proposing further that the sacraments be administered every day. He and his fellow monastics were satisfied that the very existence of insanity established the reality of demons and possessions, but whose ability to possess persons could be resisted by the angelic part of human nature (Pickett 1952, p. 42). Gradually, the judgment of the instructed class began to change, aided by the introduction of long-lost texts from the classical period. Late medieval scholarship in the matter of insanity was thus classically informed and guided far less by superstition than by the now rigorous canonical principles of the Roman Catholic Church. By the conclusion of the thirteenth century, and largely as a result of the writings of St. Thomas Aquinas and the more general revival of aristotelianism, medieval theories of mental illness were increasingly naturalistic.
On such matters as the validity of sacramental rites, Thomas Aquinas carefully distinguished between insanity from birth and that occurring later in life; and between insanity without remission and that in which lucid intervals are common. It should be noted that “temporary insanity” is not a legal concept indebted to modern psychiatry, nor were medieval jurists at all reluctant to consider it. For example, in a trespass case of 1378, counsel for the defendant, Ralph Paranter, contends that, “every month between lucid intervals he was stricken with a serious sickness and thus became virtually insane during those times” (Arnold 1987, 34.23, p. 390). The point of such distinctions, so important in the context in which Thomas Aquinas wrote, is to establish the conceptual and moral dependence of sin and guilt on rationality and consent. The fineness of the requisite analysis is conveyed by his discussion of marriage covenants and insanity. He argues that, although the present mental state of a person is sufficient for the commission of mortal sin, the marriage contract calls for consent that bears on the future. Therefore, greater discretion is required. Accordingly, “man can sin mortally before he can impose upon himself some future obligation.”10 What is clearly recognized here is that there are gradations of mental status, and that incapacity as (p. 24) regards one class of thought or action may not extend to another class. It is in passages such as this that evidence is clearest of the Church’s thorough absorption of classical (Roman) juridical reasoning into its own canonical context. It is worth mentioning that, to the extent the Natural Law tradition is properly identified as integral to Roman Catholicism, it is so because of this very absorption. How unsurprising, then, that Bracton borrows freely from Romanists and Canonists (e.g., Bernard of Paivia) in compiling his De legibus Angliae (Bracton 1915). Canon law, under the inspiration of scripture but everywhere beholden to Roman law, dealt with specific cases involving questions of mental competence. The growing canonical authority of the Pope resulted in any number of such issues being brought to Rome for settlement. The mode of settlement was adjudicative in that cases were disposed of according to carefully gathered evidence (e.g., depositions), settled law, well-established precedents, and (papal) interpretations in hard cases. R. Colin Pickett summarized a number of cases occasioned by allegations of insanity, of which the following is illustrative. A monastic priest, just before he died, declared to witnesses his intention that his earthly belongings be conveyed to the monastery, thus excluding the local church as a beneficiary. Here, then, was a conflict of interests between a bishop and an abbot. In this dispute, the Bishop of Nevers insisted that the deceased had been insane at the time he expressed his intentions and, therefore, should be regarded as having died intestate (Pickett 1949). In deciding the matter, Innocent III (1198) ruled that in such cases there is both the presumption of sanity and the resulting burden of proof imposed on those who would challenge the validity of testaments. But what of cases in which one declares himself to have been insane at some earlier time; for example, a priest seeking relief for some offense on the grounds that he had been entirely beside himself (extra se positus)? Again, Canon XV had long established the nullity of vows taken by the insane, but with Innocent III there is this modification: the burden of proof now shifts to the defendant, again because of the presumption of sanity. By the middle of the thirteenth century Bracton had summarized English law in this area in a phrase that could have been found in Justinian and defended by Aristotle: “For no crime is accomplished except that the desire to harm intercede” (Bracton 1915). The centuries of witch hunts and persecutions in Europe and America mark off a significant period in the evolution of legal concepts of insanity. The special nature of witchery called for alterations and even the suspension of trial procedures that had become settled features of law. In the ancient worlds of Greece and Rome, ordinary citizens readily accepted that some persons possessed exotic powers or might be chosen by the gods to be the medium for divine stratagems. It was understood that practitioners were able to perpetrate evil through a “black magic” harmful to others (maleficium); or that they might employ a benign “white magic” to cure illnesses and bring about good weather or a decent run of luck. Rome’s Twelve Tables threatened only witches guilty of maleficia. As the power of ecclesiastical courts increased, along with the pronounced urbanization of European communities late in the Middle Ages, the adaptation of Roman law to Church interests was ever more vigorously pursued. Ancient distinctions between “black” and “white” magic were dissolved, all witchcraft now taken as proof of a covenant with Satan. These effects would come to be catastrophic in many European communities, but only after the merging of secular and religious thought. Given the very nature of the emerging but still undeveloped scientific outlook of the Renaissance, (p. 25) it becomes less paradoxical that the greatest excesses of witch hunting would take place well into the modern era. The accusatorial procedures of early medieval law required that complaints and charges originate with the aggrieved or injured party. It was not the judge or the jurisdictional authority who prosecuted. Rather, the authorities heard the charges, weighed the evidence, and then ruled. Where the weight of evidence was insufficient to support a ruling, the contestants in a criminal action were called upon to face one or another ordeal. With the evolution of more refined (classical) procedures and the greater centralization of power, the accusatorial method was replaced by the inquisitorial, the judge now centrally involved in trying the case. With these developments the burdens imposed on accusers were now all but eliminated. A court finding the charges at all credible would take up the case, the officers of the court having the power to obtain and weigh the evidence, determine guilt or innocence, and set the penalties. The major gain in these procedural developments was the elimination of savage and juridically meaningless practices and their replacement by rules of evidence applied by competent jurists acting in behalf of Church or Crown. But the major liability, during the long season of the witch hunt, was that a successful prosecution for a crime such as heresy or the “white magic” of witchcraft—which often had neither victim nor eyewitness—would require the defendant’s confession; a defendant no longer having the option of counter-suit. The melding of the civil offense of maleficium with that of heresy greatly enlarged the pool of potential suspects. Predictably the hardships wrought by these developments would be greatest for those whose medical, social, or psychological conditions resulted in signs or symptoms not readily explicable in the primitive medical idiom of the day. Epileptic seizures, various movement disorders, hysterical and neurological conditions that mar the body or modify memory, thought, and consciousness are illustrative of diseases that would prove to be especially congenial to demon-based or possession-based explanations. As for the recovered classical approach to law, the declared witch again lost out. The crime of witchcraft was the crimen exceptum for which standard procedures were ill-suited. Where physicians were consulted, the rationale was quite different in cases of possession and those of alleged witchcraft. D. P. Walker has noted in this connection that medical experts in witch trials were called upon to examine the accused for the devil’s mark or to determine if there were supernumerary mammaries with which to nourish the demons. But doctors were not asked whether the witch was insane (see Walker 1968, p. 32). Nonetheless, in that widely adopted handbook for identifying and interrogating witches, the Malleus Maleficarum, necessary distinctions must be made between scientific and satanic practices and it therefore becomes important to know about each genre. The authors, Kramer and Sprenger (1486/1970), refer to information that has been gleaned by direct experience; to findings that have been reported in medical (Galenic) or naturalistic settings; to Aristotle’s scientific analysis of the prophetic power of dreams—a power based on the ability of the imaginative faculty to record states of the body that might, indeed, portend disease. Further distinctions are made between healing based on mere superstition (as in believing in the power of Saturn over lead) and that based on witchcraft.
Throughout the macabre spectacle, physicians of the mind began to appear, some in the fearsome garb of inquisitor and witch-pricker, others in the long gowns of cabalistic shaman and Magus, still others in the stained and singed tunics of the herbalist, alchemist, the hermeticist; a few in the modest role of the diligent doctor. Johann Weyer’s De praestigiis daemonum et incantationibus ac veneficiis saw six editions between 1563 and 1583 (Weyer 1991). Weyer did not deny the reality of Satan. He did not rule out the participation of (p. 26) demons in mental illness. Rather, he considered the weakened mind of the aged and the psychologically distressed to be something of a devil’s workshop wherein all varieties of illusion may be crafted. Women tend to float, given their lighter constitution, a fact known since the time of Hippocrates. To Weyer, this was simply a fact of nature, lacking in any and all spiritual implications. He observed that drugs such as belladonna, opium, henbane, and tobacco enhanced such hallucinatory effects and could produce them in their own right. Again, forms of mental disorder did not require the participation of occult forces or beings. Those who regard themselves as possessed and admit to being witches are, he reasoned, generally suffering from melancholia. They need the attention of a physician, not an inquisitor. Inevitably Weyer’s name was placed on the Index in Roman Catholic Europe as his book was set on fire by the Protestant faculty of Marburg.
At the time of its publication in 1563, Weyer’s De Prestigiis Daemonum was exceptional but not entirely unique. Earlier in the sixteenth century, Paracelsus (1493–1541) wrote his brief treatise On diseases that deprive man of health and reason, noting in the Preface that the European clergy attribute these diseases to “ghostly beings,” whereas “nature is the sole origin” of them. In this work Parcelsus argues that the loss of reason reveals itself in four principal forms: the Lunatici get the disease from the moon and react to its phases. The Insani are born with the malady, insanity being part of the family heritage. The Vesani suffer from toxic reactions to food, drink, or poison. The Melancholici become insane, losing reason in the course of a lifetime. Thus, even as approaches such as Weyer’s faced hardship, the medical perspectives on insanity were growing in prominence during these very centuries.
The important trial of Hacket, Coppinger, and Arthington is illustrative. The three were charged with conspiracy, Hacket having declared himself King of Europe. In reporting the details of the case, Richard Cosin (1592/1963) set down the grounds of an insanity defense as English courts would understand this at the end of the sixteenth century. The principal categories affirmed by “the best writers” on the subject are Furor sive Rabies; Dementia sive Amentia; Insania sive Phrenesis; Fatuitas, Stultia, Lethargia, & Delerium. Furor, as Cosin discussed it, is the condition of the venerable furiosus, whose mind suffers “full blindnes or darkening of the understanding,” the actor knowing not at all what he is doing or saying. Dementia (Mente captus) is an unremitting insanity, distinguished from insania in its severity. With insania the sufferer, though “braine-sicke, cracked-witted … or hare-brained” is still fit for social life and is not entirely void of understanding. Fatuitas is the condition of the “natural fooles,” though with stultia the victim is not included among the Idiotes. However, although Cosin’s taxonomy is clearly informed by medical knowledge and the opinions of “the best writers,” the courts at the time still hold all perpetrators responsible who are not totally mad.
By the turn of the century the naturalistic perspective had made even greater progress. As a result, courts began to consult physicians directly in ambiguous cases. Thus, when Elizabeth Jackson was tried in 1602 for bewitching Mary Glover, doctors testified in her behalf that the victim’s fits were caused naturally.11 However, even as the scientific mode of thought inaugurated by Bacon, Newton, and Galileo swept across Europe, the phenomena of the human mind remained refractory to the new methods and perspective.
(p. 27) Developments in law reflected the broader influence of that classical perspective that had been embraced by the leaders of Renaissance thought. Sir Edward Coke’s Institutes of the Laws of England appeared in 1628 and would be authoritative for the better part of two centuries. Written by one who would come to be regarded as England’s greatest common lawyer, the work presents a naturalistic perspective on insanity wherever Coke addresses the matter. The perspective is an older Roman one, not at all remote from Coke’s own. Coke moved the law toward secular understandings of all such matters, but more by the weight of past traditions than the light of the new science. According to the laws of England, he writes, persons of “non-sane memory” may purchase but not sell lands. But if the person then recovers, agreements entered into are “unavoydable.” Coke specifies the legal sense of a diseased mind and considers the various forms of mental deficiency recognized by law: “amens, demens, furiosus, lunaticus, fatuus, stultus.” However, the true mark of insanity from the law’s perspective is given by the phrase pos mentis.
Coke uses memory and understanding interchangeably in identifying the degree of psychological deficit worthy of the law’s attention. Although acknowledging the exculpatory nature of a temporary insanity that is interrupted by lucid intervals, he requires of insanity itself what is essentially the total loss of cognitive prowess. The causes alluded to are all natural. The phrase he takes to be “the most sure and legall” is the one that describes one who has no power of mind whatever.
Hale’s chapter concerned with insanity begins with a classification of the defects and incapacities of mind other than infancy. In considering dementia, Hale delineates the usual causes (“distemper of the humours,” adult cholera, melancholy, violent fevers and palsies, “a concussion or hurt of the brain, or its membranes or organs”) noting that these may result in either partial or total insanity. The former is not exculpatory of capital offenses for the defendants, “are not wholly destitute of the use of reason” (Hale 1778, p. 30).
Note that the criterion remains a total want of reason. Because of this, and because total insanity is exculpatory, Hale alerts readers to the importance and the difficulty (p. 28) of assessing the degree of damage and injury caused. The criterion of 14 years is “the best measure” Hale can think of to guide jurors in difficult cases. Total insanity does not present a difficult case, for the defendant suffers from a complete alienation of mind that will be obvious to all. Partial insanity is difficult, for the defendant clearly is able to comprehend some things but not others. What one must ask in the latter case is whether there is sufficient rationality for the defendant to have more than a child’s comprehension. It is as if Hale would take partial insanity to be more akin to ideocy than to perfect madness.
Taking out the pardonably dated references to lunar influences, Hale’s brief summary of the chief causes of dementia is not only informed by the science of his day but compatible with what might even be called the modern view. He understands the several forms of dementia to be the result of a diseased brain, or biochemical (humoral) disturbances, or heredity. However, the issue at law is not one of etiology but of responsibility. The question to be settled is whether, at the time the offense was committed, the defendant was in sufficient possession of understanding to be held accountable. This question, on Hale’s understanding, can be answered independently of any consideration of the defendant’s brain, bile, or pedigree.
Two years after Hale had sentenced the widows to death for witchcraft, Thomas Willis’s pioneering studies of the comparative anatomy of the brain were published. All of his major publications found large audiences, his Opera Omnia alone going through 11 editions by 1720 (see Frank 1990). The conclusions he reached after painstaking research and clinical observations establish the brain as the central organ of experience, action and emotion. Cerebral pathologies result in identifiable psychological disturbances. By the early eighteenth century, the major medical centers of Europe were given over either to essentially mechanistic or essentially chemical theories of health and disease, with all notions of “spirit” now cast chiefly in psychological and mental terms. The courts both followed and to some extent led developments along these lines.
(p. 29) Arnold was convicted, was sentenced to be executed, and was spared through the intercession of his victim.
Sir Thomas Erskine (1750–1823; Fig. 3.1) was the product of a distinguished but not prosperous family of lawyers. With the family’s limited means, Erskine was unable to pursue university studies and chose to enter into military service with the Royal Navy. He rose to officer rank quickly. Indeed, in Boswell’s Life of Johnson, we learn that Johnson met the young Erskine and was judged as conversing, “with a vivacity, fluency and precision so uncommon, that he attracted particular attention.” With the encouragement of persons of influence, he retired from the army to undertake studies at Lincoln’s Inn, simultaneously completing requirements for a degree from Trinity College, Cambridge.
Erskine would come to record a number of celebrated pleadings in his career as a barrister. Over a course of years he defended Lord George Gordon, Thomas Paine, and, in a case that materially altered the law’s understanding of insanity, James Hadfield. His achievements gained him significant wealth and high repute. He was elected to Parliament for Portsmouth and rose to the office of Lord Chancellor in 1806. His pleadings before juries are emblems of refined and effective rhetoric, combined with a total mastery of legal procedure and precedent.
Erskine’s defense of James Hadfield, who had made an attempt on the life of George III, did much to introduce what at the time was advanced thinking in medicine on the marks and measure of psychopathology. He stands as a significant figure in the rise of medical jurisprudence.
Looking back over the history of the subject in 1876, Henry Maudsley would state matter of factly that, “It was at the trial of Hadfield, in 1800, for shooting at the King in Drury Lane Theatre, that Lord Hale’s doctrine was first discredited, and a step forward made for the time” (Maudsley 1876, p. 91).
(p. 31) Difficulties arising from Hadfield soon made their way into both criminal and civil cases. In 1812, John Bellingham was tried and convicted of the murder of the Prime Minister, Spencer Perceval, previously Chancellor of the Exchequer. The motive was Bellingham’s groundless claim that the Crown owed him money for time he had served in a Russian prison while Perceval had been Chancellor of the Exchequer. Failing to secure compensation from the Treasury, he hunted down Perceval and fired a fatal bullet at him in the lobby of the Commons House of Parliament. A plea of insanity was filed, though contested by Bellingham himself. There was no express attempt to link Bellingham’s defense with that of Hadfield. Nonetheless, the odd rationale developed in Hadfield fostered the conclusion that actions arising from morbid delusion should be judged according to what the law would require or permit were the contents of the delusion true. If, indeed, James Hadfield had been commanded by God to rid the world of himself but not by taking his own life, and if he sought to obey this by having the King’s defenders kill him, no English court would have found him guilty of a crime. But supposing John Bellingham’s grievance to be valid, his lethal assault on Spencer Perceval would still have resulted in the law’s maximum penalty.
at the time of the committing of the act, the party accused was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing, or, if he did know it, that he did not know he was doing what was wrong.
What the judge seeks to make clear is that a court, in propounding a legal principle, cannot thereby establish a scientific or medical fact. He takes the question of responsibility in such cases to be a medical question and thus beyond the resources of the general principles on which the rule of law depends.
Nonetheless, in most jurisdictions the controlling criminal statutes well into the twentieth century in the United States and elsewhere commonly held to “right-wrong” as well as notions of the “irresistible impulses” on which Erskine had focused in Hadfield.
A person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of law.
Still other standards have come to modify or replace Brawner. The 1984 Comprehensive Crime Control Act recovered the very “right–wrong” test so roundly condemned by the experts of a century ago. Utah, Idaho, and Montana eliminated the insanity defense altogether, the balance of the states being roughly divided in adopting either Brawner or McNaughtan.
There have been other proposals to suspend the search for precision in specific cases and to adopt a form of categorical exemption from punishment. H. L. A. Hart concluded from the well-known failures to identify mental disorders with precision that it might be best to adopt a “coarser-grained technique” such as that which creates the class of legal infants.
The question of mens rea continues to occupy practitioners and theorists both in law and psychiatry. Some, such as Barbara Wootton, would have the concept simply “wither away.” (p. 35) Or, following H. L. A. Hart, others would reserve the question to a time after conviction, and then to determine whether punishment or treatment is the proper course of action (Hart 1968; Wootton 1964). Others have argued for the defense of “Guilty but insane,” now applicable in a number of jurisdictions. These questions are likely to remain unsettled at the level of psychology and psychiatry for at base they are at once juridical questions beyond the range of scientific or technical solutions and metaphysical questions perhaps beyond the range of settled knowledge itself. The history of the insanity defense displays the same oscillations found in philosophy’s ageless engagement with the free will–determinism conundrum and it would be unrealistic to assume that psychiatry might offer a conclusive argument capable of settling a metaphysical dispute. It would appear that such matters, for better and for worse, are provisionally settled in the court of common sense which is guided but seldom ruled by an expertise both real and imagined.
(1) A fuller discussion of this history is the author’s Wild Beasts and Idle Humours: The Insanity Defense from Antiquity to the Present (Robinson 1996).
(2) This limitation is offset to some extent by the tendency in Islamic countries and in China to follow the rationale and often the very letter of Western law in addressing such cases. For an examination of Islamic law in this connection, see Chaleby (2001). Chapter 20 considers the insanity defense as understood in Islamic law. China’s legal system is relatively young. Cases involving mental disorders have been recently discussed by Guo (2010).
(3) See also Trevor Saunders’ study of Plato’s analysis of insanity and its medical and conceptual dimensions (Saunders 1991).
(4) For further discussion see Harrison (1968, pp. 138ff). See also the discussion of Greek law as it applied to the elderly in Garland (1990, pp. 261ff).
(5) The Twelve Tables are available online at: <http://www.fordham.edu/halsall/ancient/12tables.html>.
(6) The treatise itself was probably composed between the fourth and third centuries bc and is fully consistent with the teachings of the Hippocratic school.
(7) Quoted material is from Drew (1973). This discussion is also indebted to Dr. Drew’s Introduction to the volume and to the Foreword by Edward Peters.
(8) The relevant records were kept at St.Bertin and were composed apparently by a number of chroniclers. See Nelson (1991).
(9) For detailed studies of these influences see Horden (2008).
(10) Thomas Aquinas, Summa Theologiae, Q. 43, Art. 2. It should be noted that a jurisprudential context for Thomas’s own efforts was already in place at least as early as the middle of the twelfth century. In his chapter on “The age of mixed jurisprudence,” Charles Radding discusses the remarkable Expositio of this period as evidence of the revival of jurisprudence. The work “situates the study of law into the tradition of the liberal arts” (1988, p. 129), as the expositor proceeds to list and interpret Lombard law.
(11) A thorough and informing study of the trial of Elizabeth Jackson, together with Edward Jorden’s Discourse in which a decidedly psychiatric interpretation of the victim’s vexations is offered, is Witchcraft and Hysteria in Elizabethan London: Edward Jorden and the Mary Glover Case (MacDonald 1991).
(12) Matthew Hale, The History of the Pleas of the Crown, edition of 1778. Published from the original manuscripts by Sollom Emlyn. The first publication of Hale’s papers was ordered by the House of Commons on November 29, 1680. It went through many editions.
(13) 6 State Trials. 687 (1665).
(14) Rex v. Arnold, 16 Howell’s State Trials 695 (10 George I. ad 1724).
(15) Rex v. Arnold, 16 Howell’s State Trials 695 (10 George I. ad 1724): 754–765.
(16) Cartwright v. Cartwright, 1 Phillimore Ecc. 90.
(17) Cartwright v. Cartwright, 1 Phillimore Ecc. 90, at 121.
(18) Rex v. Hadfield. 40 George III. ad 1800. In Howell’s State Trials, Vol. XXVII, 1820; 1281–1356.
(19) Rex v. Hadfield. 40 George III. ad 1800. In Howell’s State Trials, Vol. XXVII, 1820; 1310.
(20) Rex v. Hadfield. 40 George III. ad 1800. In Howell’s State Trials, Vol. XXVII, 1820; 1310.
(21) DANIEL M’NAGHTEN’S CASE, House of Lords Mews’ Dig. i. 349; iv. 1112. S.C. 8 Scott N.R. 595; 1 C. and K. 130; 4 St. Tr. N.S. 847; May 26, June 19, 1843. Richard Moran was able to establish this as the correct spelling (Moran 1981).
(22) The first edition of this work (1845) was immediately accepted as authoritative.
(23) State v. Jones. 50 New Hampshire 369.
(24) The complete account of this trial is found in Bigelow and Bemis (1844). Isaac Ray would discuss this trial in an article in the Law Reporter in 1845, reprinted in his anthology, Contributions to Mental Pathology. Boston, MA: Little, Brown, 1873. Ray said of this case that, “No criminal trial in this country, in which insanity was pleaded in defence, has become more widely known and been oftener cited than that of Abner Rogers” (p. 210).
(25) Henry Maudsley would remark that, although initially docilely following the lead of British jurists, recent decisions in the United States constituted a marked advance on anything that been settled to date in England (Maudsley 1876, pp. 100ff).
(26) Boardman v. Woodman. 47 New Hampshire 120 (1869); State v. Jones. 50 New Hampshire 369 (1872); p. 139.
(27) State v. Pike. 49 New Hampshire 399 (1872); State v. Bartlett. 43 New Hampshire 224.
(28) Holloway v. United States. 326 U.S. 687 (1945).
(29) Davis v. United States. 160 U.S. 469; 40 L. Ed. 499; 16 S. Ct. 353.
(30) Durham v. United States. 214 F. 2d 862 (1954).
(31) Royal Commission on Capital Punishment Report (Cmd. 8932), 1953; p. 113.
(32) Blocker v. United States. 274 F. 2d 572 (1959); Blocker v. United States. 288 F. 2d 853 (1961).
(33) United States v. Brawner. 471 F. 2d 969 (1972), establishing the “Brawner” standard.
(34) 113 S. Ct. 2786, 1993.
(35) 54 App. D.C. 46, 47, 293 F. 1013, 1014.
(36) 113 S. Ct. 2786, 1993.

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