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Q. Explain and classify Insanity. Describe the medico legal aspects of Insanity. What are the main causes of Insanity. Differentiate between true and feigned insanity?

In English, the word "sane" derives from the Latin adjective sanus meaning healthy. Insanity, craziness or madness is a spectrum of behaviors characterized by certain abnormal mental or behavioral patterns. Insanity may manifest as violations of societal norms, including becoming a danger to themselves and others, though not all such acts are considered insanity. In modern usage insanity is most commonly encountered as an informal unscientific term denoting mental instability, or in the narrow legal context of the insanity defense. In the medical profession the term is now avoided in favor of diagnoses of specific mental illness such as schizophrenia and other psychotic disorders.When discussing mental illness in general terms, "psychopathology" is considered a preferred descriptor.

Indian Lunacy Act 1912 defined lunatic as an idiot or a person of unsound mind.

Mental Patients are governed by Mental Health Act, 1987.

Classification -
  1. Medical - Medical jurists such as Esquirol have classified insanity under four distinct forms:
    1. Mania - This is general derangement of the mental faculties, accompanied by greater or less excitement, sometimes amounting to violent fury. The individual is subject to hallucinations and illusions.
    2. Monomania - Here, the mental alienation is partial. The delusion is said to be confined either to one subject or to one class of subjects. It  monomania varies much in degree. Many persons affected with it are able to direct their minds with reason and propriety to the performance of their social duties, so long as these do not involve any of the subjects of their delusions.
    3. Dementia - In this state there is a total absence of all reasoning power. The mental faculties are not perverted, but destroyed. There is a lack of memory as well as of consciousness, on the part of the individual, of what he does or says. It is a frequent consequence of mania or monomania. It has been known to occur suddenly in individuals, as an effect of a strong moral shock.
    4. Idiocy (Amentia) - In this state, the lack of mental power is due to a congenital defect i.e. birth defect. Legally, mania, monomania, and dementia, are classified as "dementia accidentalis" and idiocy is classified as  "dementia naturalis". This intellectual deficiency is marked by a peculiar physiognomy, an absence of all expression, and a vague and unmeaning look, whereby an idiot may in general be clearly identified. In many cases of congenital deficiency, the mind is capable of receiving a few ideas, and of profiting to a certain extent by instruction.

      WHO has recommended in the "International Classification of Diseases", the following classification of psychiatric disorders - 
    1. Organic mental disorders - dementia, Alzheimer's disease, amnesic syndrome, behavioral disorders due to brain disease, damage, or dysfunction/
    2. Mental and behavioral disorders due to psychotropic substance use
    3. Schizophrenia
    4. Mood Disorders - depressive disorders
    5. Neurotic Stress related and somatoform disorders
    6. Behavioral syndromes associated with physiological disturbances and physical factors - eating disorders, non-organic sleep disorders, sexual dysfunction
    7. Personality disorders - specific personality disorders, gender identity disorder
    8. Mental Retardation
  2. Legal - Generally, two states of mental disorder or alienation are recognized legally -  1. Dementia naluralis, which corresponds to idiocy and 2. Dementia accidentalis, which means  general insanity in people who have once had reasoning power but are insane now due to some accidental cause.

    A third term lunacy is also used by lawyers generally for to all the disordered states of mind which have specific medical terms such as mania, monomania and dementia; and which may even be accompanied by lucid intervals.
    The main character of insanity, in a legal view, is said to be the existence of delusion; i. e., that a person should believe something to exist which does not exist, and that he should act upon this belief. Many persons may labor under harmless delusions, and still be fitted for their social duties; but should these delusions be such as to lead them to injure themselves or others in person or property, then the case is considered to require legal interference.

    Unsoundness of mind - Besides the terms Idiocy and Lunacy, another term is frequently employed in legal proceedings, namely, " unsound mind"  i.e. non compos mentis, for which there is no consistent legal definition. The test for unsoundness of mind in law does not just depend on the existence of delusion, but on proof of incapacity in the person, from some morbid condition of intellect, to manage his own affairs. Thus, there are two necessary conditions - morbid condition of intellect and incapacity to manage his own affairs. Neither condition will suffice to establish unsoundness without the other for the intellect may be in a morbid state, and yet there may be no legal incompetency, or the incompetency alone may exist because of bodily infirmity or want of education, which is obviously not insanity. It can be said that an insane person is lacks the controlling power of the will.

Causes of Mental Ill health
  1. Heredity
  2. Environmental Factors - parental attitudes
  3. Psychogenic causes - problems occurring due to reconciliation of natural desires with societal norms. When such reconciliation between conflicting desires becomes painful, patient may resort to various mental mechanisms to build defenses around it, which may then produce various types of mental symptoms
  4. Precipitating causes -  emotional or physical trauma
  5. Organic causes - diseases

Consequences of Insanity -
  1. Civil Responsibility
    1. Property - Chapter VI of Mental Health Act 1987 provides for the legal proceedings to be followed in cases concerning the protection and property of a mentally ill person. In general, a court may appoint a manager to manage the person's property.
    2. Contract -  Under S 11 of Indian Contract Act 1872, only persons of sound mind are eligible to enter into agreements or contract. As per S 12, a contract is invalid if one of the parties at the time of making the contract was by reason of insanity incapable of understanding it and forming a rations judgment as to its effect upon his interests.
      Court may order dissolution of the partnership of a firm if one of the partners is found to be mentally ill person.
      CPC Order 32 enacts special provisions regarding suits by and against a person of unsound mind. Ram Chandra vs Ram Singh AIR 1968 - SC held that a decree passed against a minor or a lunatic without appointment of a guardian is a nullity and is void and not merely voidable.
    3. Marriage - The HMA 1955 if a party is incapable of giving a valid consent to a marriage in consequence of unsoundness of mind, or if capable of consent but has been suffering from mental disorder of such a kind as to be unfit for marriage and procreation, or has been subject to recurrent attacks of insanity, then the marriage is voidable.
    4. Testamentary Capacity - Making a Will requires an understanding of the nature of the Will, a knowledge of the property to be disposed off, and an ability to recognize those who may have moral claims of the testator's bounty. A court may invalidate a Will if it is proved that the testator, at the time of making the Will, was of unsound mind.

  2. Criminal Liability - Law presumes every individual of the age of discretion to be sane.
    McNaughten Rules - In this case, Danial M'Naghten was tried for the murder of a private secretary of the then prime minister of England. He was acquitted on the ground of insanity. This caused a lot of uproar and the case was sent to bench of fifteen judges who were called upon to lay down the law regarding criminal responsibility in case of lunacy. Some questions were posed to the judges which they had to answer. These questions and answers are knows as M'Naghten's Rules which form the basis of the modern law on insanity. The following principals were evolved in this case -
    1. Regardless of the fact that the accused was under insane delusion, he is punishable according to the nature of the crime if, at the time of the act, he knew that he was acting contrary to law.
    2. Every man must be presumed to be sane until contrary is proven. That is, to establish defence on the ground of insanity, it must be clearly proven that the person suffered from a condition due to which he was not able to understand the nature of the act or did not know what he was doing was wrong.
    3. If the accused was conscious that the act was one that he ought not to do and if that act was contrary to law, he was punishable.
    4. If the accused suffers with partial delusion, he must be considered in the same situation as to the responsibility, as if the facts with respect to which the delusion exists were real. For example, if the accused, under delusion that a person is about to kill him and attacks and kills the person in self defence, he will be exempted from punishment. But if the accused, under delusion that a person has attacked his reputation, and kills the person due to revenge, he will be punishable.
    5. A medical witness who has not seen the accused previous to the trial should not be asked his opinion whether on evidence he thinks that the accused was insane.

    The Indian Law recognizes the first two principals and incorporates them in section 84 of IPC, which says that nothing is an offence which is done by a person who, at the time of doing it is by reason of unsoundness of mind, incapable of the nature of the act or that he is doing what is either wrong or contrary to law.

    In criminal cases, the MO must consider 
    1. personal history of the the defendant
    2. the absence of motive
    3. the absence of secracy
    4. Multiple murders
    5. Want of preparedness or pre arrangement
    6. Absense of accomplices

  3. Tortious Liability - Even in England, there is little authority to show whether a person of unsound mind is liable for tort committed by him. The question here is whether the defendant knows the nature and quality of his act. If he is capable of knowing that his act was wrong, then he is liable in tort.
    The opinion of Salmon is as follows -
    Lunacy is not in itself any ground for exemption, but that, like infancy, it operates (if at all) only an evidence that the mental state requisite to create liability is no present. In applying this rule, the following species of wrong must be distinguished - 
    1. In wrongs based of malice or on some specific intent like malicious prosecution, malicious libel, or a privileged occasion, or deceit, lunacy may be a good defense because there is no ill intention.
    2. In wrongs of voluntary interference with the person, property, reputation or other rights of other persons, such as trespass, assault, conversion, or defamation, it is no defense that the defendant was under an insane delusion as to the existence of sufficient legal justification. For in such cases, mistake, however inevitable, is no defense and it can make no difference that mistake is due to unsoundness of mind.
    3. In wrongs of absolute liability, there is no reason why lunacy should be any defense at all.
    4. In wrongs dependent on negligence, the conduct of the defendant must be judged by reference to his knowledge or means of knowledge. Lunacy, therefore, may be relevant as evidence that the necessary knowledge or means of knowledge did not exist.

      In Williams vs Hays, the defendant, a co-owner of a ship was held liable to his co-owners for negligent wrecking of the ship owing to his insanity. It was held that an insane person is just as responsible in tort as a sane person except where malice and hence intention, actual or implied, is necessary.

      In the words of Justice Esher MR, "a lunatic is liable unless the disease of his mind is so great that he cannot understand the nature and the consequences of his act." But the onus lies on the defendant to prove that his disease is so great.

      Drunkenness is no defense in tort or in crime because it is presumed that a man knows that if he gets drunk he is likely to commit acts likely to result in injuries to others.

Feigned Insanity
Feigned insanity is the simulation of mental illness in order to avoid or lessen the consequences of a confrontation or conviction for an alleged crime. Malingering is the  medical term for feigned insanity that refers to fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives, which may include financial compensation (often tied to fraud); avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences; or simply to attract attention or sympathy.

Feigned Insanity True Insanity
Comes on suddenly Rarely develops all of a sudden
Usually has a motive Usually has no specific motive
Individual tries to pass of as mentally ill by putting forward incoherent maniacal symptoms, especially when he knows he is under observation. There is total remission of all symptoms when he thinks he is not being observed.
Symptoms are not uniform. Patient usually mixes up symptoms of two distinct types of mental illness.
Violent exertions occasioned by imitating maniacal frenzy will bring on exhaustion, perspiration, and sleep. Truelly ill person can exhibit all these symptoms for days without any exhaustion.
Usually not dirty or filthy in his habits.
Usually resents being examined repeatedly.
It is almost impossible to feign sleeplessness for long.