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Is insanity defined similarly in civil and criminal contexts? Is the type of insanity that leads to the exemption from criminal responsibility the same (in nature and severity) as the insanity that grants a wife the right to annul a marriage or that leads to the invalidation of transactions? In common literature of Imāmī jurisprudence and Iranian law, insanity has a single meaning in all rulings and regulations. In this approach, insanity is absolutely between being and not being; that is, a fason is either insane and therefore subject to all specific rulings; or not insane, in which case none of the specific rulings are applied to him/her. The present study primarily aims at highlighting the necessity for setting aside absolutism regarding the issue of insanity, and to consider the concept of insanity as a relative and comparative concept in all its dimensions. It is possible that the insane fason is only devoid of awareness in committing certain types of crimes, and yet faforms the rest of his actions willingly and fully consciously. Similarly, fasonal transactions made by someone suffering from the most severe types of mental illness can be entirely valid and effective. The authors primarily aim at clarifying a theory titled "Comparative Approach to the Concept of Insanity", and then providing possible foundations for it within Imāmī jurisprudence. Finally, the authors have explored the following four topics: "relative application of responsibility", "the multiplicity of defenses related to insanity", "the distinction between family law, criminal law, and contract law", and "distinction between the identification criteria for insanity". These are discussed as the four-fold implications of accepting the comparative approach. In the end, the study concludes with recommendations for further studies in research and judicial practices. [ABSTRACT FROM AUTHOR]

Background: England, Scotland and Norway have established Criminal Cases Review Commissions to review the convictions of persons who may have been wrongly found guilty of a criminal offence.Aims: The aim of this study was to explore the Norwegian Criminal Cases Review Commission (NCCRC) practice when legal insanity constitutes grounds for possible reopening of a criminal case.Methods: We identified all cases between 2004 and 2012 where an application to the NCCRC to reopen a case was on grounds of concerns about insanity. Data were extracted from records. Differences between reopened and disallowed insanity cases and variables that may explain the NCCRC's decision to reopen a case were analysed using multiple logistic regression.Results: Forty cases were allowed, and 34 disallowed. The NCCRC relied fully and unanimously on the conclusions of the expert reports in making these decisions. In 26 of the 40 cases that the Commission reopened, psychosis had gone undetected by the courts. Such undetected cases were most often discovered in the wake of a new criminal case in connection with the defendant. If the length of the sentence were short, it was less likely that insanity had been considered by the court in the index judgement.Conclusions: The NCCRC may rely excessively on the forensic psychiatric reports. The experts' conclusions may be uncertain, given that they often have to look back several years to establish mental state and its relevance at the time of the crime. As nearly two-thirds of the reopened insanity cases had been given penalties of under 6 months, it may be asked whether such further investigation of fairly low-level crimes is the best use of resources. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The timing of the English Law Commission''s consideration of reform to the law of insanity coincides with increasing scientific and in particular neuroscientific understanding of the brain. The work of researchers is leading to a greater comprehension of what had been termed irresistible impulses to commit crime and of the impact of brain damage, particularly evidence of brain lesions and frontal lobe damage on behaviour. There remain problems in establishing causal relationships which might diminish or eliminate criminal responsibility for crimes committed by those suffering from pre existing mental conditions at the time they commit a criminal offence. This is especially the case where those mental conditions are of short duration. However, the law should not ignore the best available scientific knowledge. Neuroscientific advances are already informing court deliberations in England and Wales: assisting in considerations of guilt, fitness to plead and in sentencing. In terms of the insanity defence the questions that the law seeks to address are not necessarily the most medically or scientifically pertinent questions. They remain grounded in 19th century scientific understanding. It is argued that the more nuanced Dutch approach to mental condition defences warrants very serious consideration by those charged with making proposals to reform the English law. [Copyright &y& Elsevier]

Fast-paced developments in psychiatry, neuroscience and emerging neuroimaging technologies place continual pressure on the legal recognition of mental illness and disease across jurisdictional boundaries. Nevertheless, the Canadian legal definition of exculpatory mental disease in the context of criminal liability has remained largely static, sheltered from the immediate influence of medical theory and advancements. In order to effectively reflect on the intersection of mental health and criminal justice systems in this area, it is important to understand its historical development and the English common law origins of the current approach. Specifically turning to the early 19th century, documented history and accounts of early medical witness testimony on the mental state of the accused provide a unique opportunity to understand the initial collision between fundamental concepts of moral and legal culpability and new scientific understandings of mental function and disease. In this article, I suggest that early psychiatric testimony to the accused''s mental state challenged the evolving criminal law of 19th century England to reconcile its restrictive definition of “insanity” with expanding scientific reasoning and accounts of mental disease. The trial of Edward Oxford, an attempted royal assassination case of 1840, is examined as a symbolic height in this conflict prior to the first common law pronouncement of the current approach in 1843. As debate continues on the role of medical advancement in the identification of exculpatory medical disorders in law, this historical perspective may serve as a touchstone in balancing the enforcement of legal culpability with our society''s greater appreciation for mental illness. [Copyright &y& Elsevier]

The McNaughton rules for determining whether a person can be successfully defended on the grounds of mental incompetence were determined by a committee of the House of Lords in 1843. They arose as a consequence of the trial of Daniel McNaughton for the killing of Prime Minister Sir Robert Peel's secretary. In retrospect it is clear that McNaughton suffered from schizophrenia. The successful defence of McNaughton on the grounds of mental incompetence by his advocate Sir Alexander Cockburn involved a profound shift in the criteria for such a defence, and was largely based on the then recently published 'scientific' thesis of the great US psychiatrist Isaac Ray, entitled A Treatise on the Medical Jurisprudence of Insanity. Subsequent discussion of this defence in the House of Lords led to the McNaughton rules, still the basis of the defence of mental incompetence in the courts of much of the English-speaking world. This essay considers one of these rules in the light of the discoveries of cognitive neuroscience made during the 160 years since Ray's treatise. A major consideration is the relationship between 'the power of self-control' and 'irresistible impulse' as conceived by Cockburn on the one hand, and by cognitive neuroscience on the other. The essay concludes with an analysis of the notion of 'free will' and of the extent to which a subject can exert restraint in the absence of particular synaptic connections in the brain. [ABSTRACT FROM AUTHOR]

The author offers an argument on the moral significance of the insanity defence from an Anglo-American point of view. He discusses the rationale for abolishing insanity defence. He presents a definition of criminal insanity. He cites the differing approaches towards the defence in the U.S. and English settings.

The Home Office files of all 295 cases of defendants being found unfit to plead between 1976 and 1988 were evaluated. The majority were male and either schizophrenic or mentally impaired. Median age was 32 years. Two-thirds had past criminal convictions, and nearly 90% had past contact with psychiatric or social services, but only 28% were receiving psychiatric care at the time of their alleged offence; 14% were hospital in-patients. Offences of theft and violence predominated, but in most cases they were not of a serious nature: 34% were rated as mild or nuisance, 40% moderate, and 26% severe. In more than 80% of cases, evidence linking the accused with the offence seemed good. Less than one-third were admitted to special hospitals. Forty-six per cent of the population (135 patients) eventually regained their capacity to plead (within a median of four months), with 76 (26%) returning for trial. Of the remainder, 68 (23%) are still in hospital, 39 of whom have been there for more than five years. Time to discharge without trial reflected the severity of the alleged offence. [ABSTRACT FROM AUTHOR]

In a minority of persons interviewed for the purposes of a court report it will be found impossible to determine retrospectively their intention at the material time with any exactness. This in itself is an indication of an abnormal mental state when the alleged crime was committed, irrespective of how the accused may appear when interviewed later. As well as issues arising under the McNaughton Rules or Diminished Responsibility to which intention is relevant, many offences require a specific intention to be proved so that the reporting psychiatrist should enquire into the accused's intention when preparing a court report. [ABSTRACT FROM AUTHOR]

Mental illness may be manifested in the impairment of understanding or of volitional control. Impairment of understanding may be manifested in delusions. Impairment of volitional control is shown when a person is unable to act in accordance with good reasons that he himself accepts. In order for an impairment of understanding or of self-control to exculpate, the offence must be causally connected with the impairment in question. The rationale of exculpation in general, which applies also to the case of mental illness, is that the offence does not indicate a morally bad attitude in the offender. A consequence of this rationale is that Kenny is wrong to hold that no injustice would result from the elimination of the legal defence of diminished responsibility. [ABSTRACT FROM PUBLISHER]

The article looks at court trials of assassins in 1843 in England and 1981 in the U.S. that forced changes in the insanity defense. Topics mentioned include murder trial of Daniel McNaughten on March 2, 1843, the 1838 book "A Treatise on the Medical Jurisprudence of Insanity," by physician Isaac Ray, and the trial and acquittal of John Hinckley, Jr. on March 30, 1981 by reason of insanity under the federal standard after shooting U.S. President Ronald Reagan.

Holmes is concerned with a conflict between law and medicine about the problem of psychopathy, in particular as it relates to homicide. He looks for a consistent set of legal principles based on a variety of medical concepts and in doing so criticises the court for its commonsense approach, its disregard for medical evidence and for employing lay notions of responsibility and illness. This commentary explores how Holmes's notions fit into existing legal rules and explains how the court seeks the assistance of medical evidence when looking at the evidence as a whole to enable it to decide upon issues of defence, which involve legal and not medical concepts. [ABSTRACT FROM PUBLISHER]

A letter to the editor is presented to point out that the law on fitness to plead in Great Britain is generally held to be highly unsatisfactory.

Background: It has been stated that rates of homicide due to mental disorder are constant over time., Aims: To examine whether there were changes in the rates of homicide due to mental disorder over time, and whether changes in these rates were associated with changes in the rates of other homicides in England and Wales., Method: Examination of four sets of official homicide statistics from England and Wales from 1946 to 2004., Results: The rate of total homicide and the rate of homicide due to mental disorder rose steadily until the mid-1970s. From then there was a reversal in the rate of homicides attributed to mental disorder, which declined to historically low levels, while other homicides continued to rise., Conclusions: The reasons for the rise and fall in homicides attributed to mental disorder are not clear. The earlier increase in such homicides may have been due to the same sociological factors that caused the increase in other homicides over that time. The subsequent decline may have been due to improvements in psychiatric treatments and service organisation. Another possibility is that there has been an informal change to the legal tests for the finding of homicide due to mental disorder.

Court diversion schemes have been running for a decade in New Zealand and are increasing in number in Australia. This paper aims to give an international and historical context to these developments, by reference to psychiatric initiatives at courts in the US and in England and Wales. From a review of the specialist literature, an account is given of three forms of psychiatric intervention in courts over the last 90 years: court psychiatric clinics and mental health courts in the US, and court diversion schemes in England and Wales. High levels of psychiatric morbidity among prisoners, coupled with a continuing increase in prisoner numbers, demonstrate the need for systems for dealing with mentally ill people who come before the courts. Court diversion in England and Wales developed as part of a system where the mentally ill who are found guilty are sent to hospital in lieu of any other sentence. Its focus is on a form of psychiatric triage, and its ethos is the health of the patient. Court psychiatric clinics in the US grew up as an alternative to assessment in prison. Their focus has been on full psychiatric evaluation in an insanity and incompetence jurisdiction. The ethos has been that of serving the court. Mental health courts are heavily influenced by ideas of therapeutic jurisprudence, and their emphasis has been on a judge holding minor offenders in community care through the threat of judicial sanction. Experience in England and Wales has shown that court diversion can be a powerful and effective intervention. In order for it to function properly, those running court schemes need direct admission rights to psychiatric beds, both open and locked. Court diversion schemes are best as part of a spectrum of services to police stations, courts and prisons, which involved both general and forensic psychiatrists.

Objective: Although maternal infanticide is a rare event, a high proportion of cases occurs in the context of postpartum mental illness. The author reviews historical, legislative, and contemporary psychiatric perspectives on infanticide and discusses ways in which the psychiatric community can improve prevention of infanticide and promote appropriate treatment of mentally ill women who commit infanticide., Method: The case of Texas v. Andrea Yates, involving a mother with mental illness who drowned her five children, is used to illustrate society's complicated reactions to infanticide in the context of postpartum mental illness., Results: In the United States, the complexity of the response to infanticide is demonstrated by the judicial system's reaction to such cases. Whereas England's Infanticide Law provides probation and mandates psychiatric treatment for mothers with mental illness who commit infanticide, "killer mothers" may face the death penalty in the United States. Contemporary neuroscientific findings support the position that a woman with postpartum psychosis who commits infanticide needs treatment rather than punishment and that appropriate treatment will deter her from killing again. Psychiatrists have a vital role in recognizing the signs and symptoms of peripartum psychiatric disorders, particularly postpartum psychosis, and in early identification of and intervention with at-risk mothers., Conclusions: The absence of formal DSM-IV diagnostic criteria for postpartum psychiatric disorders promotes disparate treatment under the law. The psychiatric community should develop guidelines for the treatment of postpartum disorders, foster sharing of knowledge between psychiatry and the law, and do more to enlighten society about the effects of mental illness on thought and behavior so that decisions about the treatment and punishment of mentally ill persons will not be left exclusively in the hands of the judicial system.

This study concerns the preliminary evaluation of an instrument, the MacArthur Competence Assessment Tool-Fitness to Plead (MacCAT-FP), for assessing competence to stand trial, according to the legal requirements in England and Wales. The purposes of the study were to ascertain whether the instrument can be administered practically to groups of prisoners, both those with mental illness and those without; to examine its internal consistency and interrater reliability; to determine whether it can distinguish between fit and unfit individuals, as judged by expert forensic psychiatrists; and to discover whether it is sensitive to changes over time. The instrument was administered to two groups of remanded prisoners: those transferred to psychiatric units for treatment and those without mental illness. In addition to the MacCAT-FP, scales measuring symptom severity and IQ were administered to all participants. Results suggest that the instrument is practical, with good internal consistency and interrater reliability. The correlation of scores with psychiatrists' opinions as to fitness was 0.77. Scores of unfit patients were significantly different from those of fit individuals. The instrument was able to detect significant differences in scores over time. It is suggested that once the instrument has been further validated for research purposes, it may be developed for clinical application.

Background: Various studies suggest that 20-30% of patients in England and Wales in high security could be safely managed in medium security but there are no objective criteria and little attention has been paid to differences of opinion., Method: The authors compare the views of the referring and receiving team on the security needs of all special hospital patients from two London health authorities., Results: Disagreements were found in only 8% of cases, and they were more likely to occur in patients detained under the legal category of psychopathic disorder. Between 21% and 33% of patients were rated as misplaced by one or other team but these figures include patients who were either already on trial leave in another hospital or on the waiting list for an identified placement. Patients for whom there was agreement on misplacement, with no identified route out of high security, account for 9% of the total. Most patients with treatment-resistant schizophrenia were not receiving atypical anti-psychotic medication., Discussion: It may be more realistic to plan future services on the basis that only 9% of patients are misplaced, rather than the previous estimates that appear to have guided current policy. Patients detained under the legal category of psychopathic disorder present particular problems and there is a need to develop appropriate facilities at medium secure level. In the meantime, no patients should be admitted to high security without consultation with the catchment area service and a jointly agreed plan for future rehabilitation.

All referrals to medical officers in Brixton Prison over a five-month period in 1989 were examined. This paper reports the progress through this remand prison of those men who were considered to be suffering from a major psychiatric disorder. Many men had been charged with relatively minor offences. The net effect of medical intervention was to delay release from custody. Because of the administrative delays inherent in the system of medical referral and hospital admission under section 37 of the Mental Health Act 1983, it was those prisoners who were most ill who tended to remain in prison for the longest periods. Judged in terms of its efficiency to ensure speedy treatment for mentally ill remanded offenders, the present system is regarded as cumbersome and extremely inefficient. It is suggested that greater use should be made of section 48 of the 1993 Act to divert mentally ill, remanded offenders from prison.

This article examines a recent decision of the English Court of Appeal. It concerned a psychiatrist who examined and reported on a convicted murderer in a secure hospital. The report was commissioned by the patient's solicitors as evidence in support of his release. The report was emphatically unfavourable and the doctor insisted that it be revealed to the hospital authorities. The solicitors refused and litigation ensued. The courts were forced to rule on the conflict between the patient's right to privacy and the public interest in revealing the report.

The case records of 55 people from the West Midlands (UK) fulfilling the Mental Health Act 1983 criteria for mental impairment or severe mental impairment, were studied. Most were young men with mild mental retardation. 73 per cent were resident in (or on leave from) mental handicap hospitals, and 27 per cent resident in special hospitals. 29 per cent were subject to a Restriction Order. Most had lived in hospital for more than six years. The commonest problem behaviours were aggression, property offences and inappropriate or offending sexual behaviour. 31 per cent were mentally ill or had a past history of mental illness. A diverse range of services appears necessary to meet the needs of this group of people.

Automatic episodes of aggressive or violent behaviour may occur during or after an epileptic fit. Epileptic automatisms are regarded by the law as 'insane automatisms'. A person who commits a crime during the course of a seizure is therefore legally insane and must be committed to a psychiatric hospital. The law of insanity is inappropriate when applied to epileptic automatisms. A change in the law is therefore necessary to remove epileptic offenders from the legal ambit of insanity, and to save them the threat of detention in a mental hospital as a consequence of their crime.

This article sets out the provisions of S.2 (1)-(3) of the Homicide Act 1957 and the judicial interpretations placed thereon and relates the importance of this section to the offence of murder and considers the province of the expert in regard to the Act and the difficulties encountered when experts interpret the words 'disease' and 'injury'. This is illustrated in relation to a recent Murder case where the Defendant had taken LSD and cannabis voluntarily, and deals with the question as to whether construction of the Act involves any assumption that permanent injury and non-self-induced injury are necessary ingredients to bring the defendant within provisions of S.2 (1), i.e. abnormality of mind induced by injury substantially impairing mental responsibility. Similarities are suggested between persons suffering from hallucinations, due to delirium tremens, severe concussion cases and LSD trip cases, and the question is posed as to whether it would be logical to say that temporary injury to the brain by poisoning has occurred in situations where there is a motiveless and bizarre killing following ingestion of large quantities of alcohol or drugs.

The insanity defence is considered in terms of the operation of incommensurable scientific and legal discourses, a dualism which in turn is held to reflect individualist values. This analysis is used to explain both the recurring nature of medico-legal controversy and the historical results of the defence in Victorian England.

The development in the United States of psychiatric services for delinquents and criminals, which had a considerable influence on mental health services in South Africa, is described. It was followed by the appointment of court psychiatrists in thsi country, mainly to assist the Children's Courts. The findings of the Rumpff Commission on the responsibility of the mentally deranged persons are described, and psychiatric services for children are discussed.

A summary of the symptoms, prevalence and history of premenstrual syndrome (PMS) is presented. The legal implications of PMS, particularly its use as a defence in criminal prosecutions and as an implicit factor in specific offences, are discussed by means of an analysis of Canadian legal cases, with reference to those in England and the United States. The authors offer suggestions on how physicians can make use of PMS in a courtroom more reliable. They conclude that PMS is unlikely to become a substantive criminal defence until the medical community more fully recognizes its significance. Although the role of PMS as a mitigating factor in sentencing may be illogical, the courts now recognize the syndrome in a legally and practically important manner.