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Eigen, who presented the 1997 Manfred S. Guttmacher Award Lecture last month at APA's annual meeting in San Diego, used the "Old Bailey Sessions Papers" to trace the conceptual development of the insanity plea in Victorian England. The papers were named for London's central criminal court, where the cases were held.
The Guttmacher Award is cosponsored by the American Academy of Psychiatry and the Law and APA and is funded by Professional Risk Management Services.
One statistic that clearly shows how the insanity plea gained credibility reveals that expert medical witnesses participated in only one in 10 trials in 1760 but in nine of 10 by 1840.
Eigen, a medical historian and professor at Franklin and Marshall College in Lancaster, Pa., excerpted testimony from three trials to illustrate the evolving concept of "lesion of the will."
In an 1850 murder trial of an asylum keeper, the only eyewitness, Richard Donnelly, was an inmate of the asylum. Standing in the dock at the Old Bailey, Donnelly recalled the brutal killing quite clearly, but said that the 20,000 spirits that lived inside his head were not sure on what day the killing occurred.
"We have to wonder how the mad doctor of London could both acknowledge the profoundly delusional world of Richard Donnelly, yet nonetheless argue the worth of his recollections, or put another way--how could he argue that the witness, though not in the medical sense competent, should be considered in the legal sense credible," Eigen remarked. "Surely this was a job description likely to challenge even the most self-assured of London's cadre of medical specialists on madness. But then, this first generation of forensic psychiatrists had faced more formidable hurdles than Richard Donnelly's spirits as they vaulted over lay and judicial suspicion to claim a privileged voice in the English courtroom."
When medical witnesses first entered the English courtroom, they generally served only as "legitimating witnesses" and played a relatively trivial role in the judicial process. "It's only when the medical witness decides to answer his own questions that the court begins to realize that something new, and potentially dangerous, is in the works," said Eigen.
"Dr. Leo" was the first medical witness who refused to answer the forced choice of a judge when asked whether a defendant was in a state of dementia or in a state of sanity when the crime was committed. Leo stated that the defendant "could have done it in a paroxysm of mania." This mania symbolized "purposeful but deranged behavior." Leo acknowledged that the prisoner was "following a plan, but it was a maniacal plan."
Despite the influence of Leo and other medical witnesses who followed, said Eigen, it is important to remember that the rise of medical testimony "was bound up with the arrival of an activist defense attorney," and it is not always clear whether the medical doctor or the defense attorney used medical insight better.
Another stage in the evolution of the insanity plea is revealed through the case of Edward Oxford, on trial for the attempted killing of Queen Victoria. Oxford suffered no delusions and had no resentment of the Queen, said Eigen. "No delusion, no motive, in fact, no reason at all to want to harm the Queen; this became the substance of the medical claim that Oxford was suffering from moral insanity--a derangement of moral sentiments, not the intellect," said Eigen.
This concept had its origins in the work of French psychiatrist-philosopher Phillipe Pinel and his disciples. According to Pinel, insanity was "no longer a matter of delusion or confusion or delirium" but rather a matter of a "diseased will," observed Eigen. In this view "madness was revealed in actions motivated by no logical reason at all. The impulsive nature of the will impelled the unfortunate victim into motiveless activity. Reason and sentiment were powerless." This "lesion of the will" went "far beyond a mere loss of control over conduct" and meant instead "a morbid propensity to crime, an impelling insistent compulsion to harm others," said Eigen. But "whatever else lesion of the will was supposed to signify, it reveals to the historian of forensic psychiatry a brilliant diagnosis. The medical theorists had managed to take British common law's fundamental criterion for assigning criminal responsibility--a wicked will, a will to harm--and rendered it all too physical, capable of infection."
The growing weight accorded this theory and the credibility of forensic psychiatrists is seen by the outcome of the trials noted above, namely, the conviction of the asylum keeper whose only eyewitness had confessed to speaking with 20,000 spirits and the exoneration of the would-be assassin of Queen Victoria.
In response to the legal challenge posed by the concept of lesion of the will or moral insanity, the M'Naghten rules evolved from a trial that followed the Oxford trial by only three years.
These rules "stressed cognition, not volition, knowing right from wrong, knowing the nature and quality of one's acts, not an inability to restrain one's will," said Eigen. "The disease of the defect of the mind responsible for not knowing right from wrong was left open, but the effects of the disease were not. Being out of control was given no home in the M'Naghten rules."
Despite this, subsequent trials found repeated violations of these principles as forensic psychiatry grew in stature and credibility, according to Eigen. If anything, said Eigen, the M'Naghten rules "appeared to have further legitimated the use of medical witnesses inside and outside the courtroom."
Although law and medicine represent two world views and dialects that are largely incompatible, they are inevitably thrown together in the courtroom, observed Eigen. Whatever the conceptual problems, "the medical witness in the insanity trial is here to stay, mostly because he's of tremendous use to the courtroom. . . . The notion that we can do without them is bizarre, and I think it would turn the clock back on 200 years of courtroom experience."
(Psychiatric News, June 20, 1997)