T HE controversy that has arisen over the True case has
been marked by a misunderstanding of the attitude of medical opinion to the question of criminal responsibility, and also by a complete failure to grasp the nature and scope of the assistance which medical evidence gives to the court in deciding criminal charges in which the defence of insanity is submitted. Let us say then, first, that the determination of criminal responsibility is a purely legal affair, to be decided by considerations, some medical, some social, and some inherent in the generally accepted system of the administration of justice. It is a far cry to 1843, when the McNaughton case gave occasion for the framing of certain Rules of Law by the Bench of Judges at the request of the House of Lords, whose outraged feelings at the acquittal of McNaughton, on the ground of insanity, from the charge of shooting Mr. Drummond, the Prime Minister's private secretary, were thus appeased. Although it has been the habit of lawyers to say that the Rules have afforded a satisfactory legal test of criminal responsibility, yet it must be said that they have been freely criticized by medical men engaged in lunacy practice. The British Medical Association and the Medico-Psycho- logical Association set up committees of experts to consider the position, but both committees reported in terms that provided no practicable suggestions for a change in the law. It must be admitted that in undertaking this self- imposed task both Associations went beyond their province, but it cannot be maintained that their failure proves the soundness of the 1843 Rules. The fact remains that the Rules lack two essential features, viz., ease of appli- cation and general acceptance of the resulting decision. A Rule is intended in practice to reduce the number of contested cases, but here every case is con- tested and the result is a toss-up----some insane persons finding their way to Broadmoor and some to the con- demned cell. This is the basis on which public security rests and the moral sanction for the "iron firmness of the criminal law."
The harrowing thought is that before 1843 the courts considered the relevant facts in each case on their merits, whereas now the facts must be considered in the light of a formula based upon a strictly metaphysical view of mind, which obscures if it does not exclude altogether the pathological view of insanity—Did the accused "know the nature and quality of the act " ? All this is profoundly unsatisfactory to medical men whose daily duty is the care of the insane and the study of mental diseases.
The action of the Home Secretary in the proceedings under the Criminal Lunatics Act, 1884, whereby True was respited and removed to Broadmoor has called forth angry comments. But it Was left to the Times to declare that the Criminal Lunatics Act, 1884, was "a yielding to pathologists, and no contribution to the welfare and economy of our social system." An utterance like that makes it less difficult to understand the widespread failure to grasp the nature and scope of medical evidence in cases of insane persons accused of crime.
In 1843 little was known of the pathology of mind, but Prichard had shortly before described the clinical features of moral insanity ; his description brought disorder of conduct, as distinguished from intellectual disorder, into the picture of mental diseases. This observation led to the recognition of the pathological origin of defects of conduct in other forms of insanity, notably by Clouston in his studies upon adolescent insanity and the Neuroses of Development. That these defects had a pathological basis became apparent by the work of Hughlings Jackson and Maudsley, scientists and philosophers, and, shall we not also say, in the best sense philanthropists of the first rank, to whose record we may add the work of Ferrier and Mott among many others. These men have placed our knowledge of mental diseases upon a sure basis of ascertained fact and sound general- ization. Have these achievements imperilled the security of society ? Are the Lunacy Acts which have been enacted because we have become more familiar with the true nature of insanity to be scrapped, in so far as they run counter to the application of a legal formula which nobody supports as it stands? The pathological view of mental disorders excludes the false assumption of two kinds of insanity— medical and legal. To the medical mind there is no such thing as insanity, it is not an entity, it is an abstract term used to denote the quality that attaches to insane persons. To the legal mind insanity is a thing embodied in law. Since 1843 many Acts relating to lunatics and mental defectives have been placed upon the Statute-book. These provide the body and substance of the thing called legal insanity. When, therefore, a medical witness is asked whether an accused person is certifiably insane he replies " Yes " or " No " according to whether he regards the person as insane or not in the legal sense—i.e., according to statute. It is when we come to apply the vague tests of the 1843 Rules that are held to embody the criminal law that difficulties arise and will continue to arise until a better test is provided. It is for lawyers, not doctors, to provide the remedy, but perhaps the suggestion may be allowed that pathology may be found to be a more trust- worthy guide than metaphysics. JOHN CARSWELL.
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