Insanity

June 27, 2008

in Law,Mental Illness

Warning! This is a long one. I have been so busy putting this site together and getting ready for a trip, that I cheated. Wanting to put up something worth your time, I took an except from my book and adapted it. It is 6-7 pages long in that format.

Ask every physician you know to define this common word. Ask every attorney you know. Did you, perchance, find some disagreement? Did you encounter some confusion? I guarantee some of your sources will have experienced difficulty in providing you with an understandable, comprehensive definition.

The odds are that not one member of either group will know how to use this word correctly. Why? The members of these professions are trained in their respective disciplines.

Insanity is not a legal term. It is not a medical term. Their use, or rather, their misuse of this term follows from their assumption that the word falls within the jurisdiction of their specific academic discipline.

Insanity originated as a political term. The meaning is quite simple and straightforward. Insanity is the inability to function in an acceptable manner in a given society.

Before getting too deeply involved in this particular subject, it may be necessary to clarify a point. The following addresses the formal use of the term insanity. I am fully aware that it is used differently, much more broadly, informally. But, as Blacks would be offended by others using the word nigger while using it freely amongst themselves, those with mental illness use the term insane, and its variations and alternatives, among themselves but find it offensive when directed at them by others.

If our society considered it acceptable to kill and eat teenage boys, Jeffrey Dahmer would have been sane. Our society does not; he was not.

The system of jurisprudence would, or should, be bound to determine a person sane or insane, as regards a particular act, based upon the determination of society’s acceptance, not upon some static principle peculiar to the legal profession. The question of his ability to function in an acceptable manner is another matter.

Psychiatrists have no warrant to confine a person to an asylum if she or he is functioning in a manner within the acceptable norms of the community. The medical profession has no authority to stigmatize a particular behavior as insane unmindful of whether it is acceptable to the society. Despite their professional presumptions, society defines what is acceptable and unacceptable, what is sane and nsane.

Although behavior is a concern of the law and occasionally medicine, both professions are dependent upon the society in this matter. If such a decision is a matter for the society or community, it is a political question. The fact that the behaviors we are considering are those of individuals suggests the need to address the matter beyond the scope of the society. The above definition encompasses this need.

There is a criminal court judge with whom I have had a social relationship for more than two decades. A recent discussion with him could only be described as Kafkaesque. The subjects were insanity and mental illness.

Reasonably well-educated, at least in the forms and minutiae of his profession, he could not grasp the simplest concepts of the subjects at hand.

Having been a full-fledged member of that dubious fraternity, I have firsthand knowledge that hubris is endemic among our public servants. But it was with a weird combination of amusement and distress that I listened to the unappreciated confusion which was the basis for his judgments on these matters.

Even after another attempt to delineate the differences between insanity and mental illness in the most elemental fashion, I was faced with the statement that, “Anyone who commits a crime is mentally ill.” I regret not asking him why he didn’t find every criminal coming before his bench ‘not guilty by reason of insanity.’

If everyone shares the same classification, that classification essentially loses all meaning. It is difficult to fathom how someone can admit of ignorance on these topics while maintaining such strongly held convictions about them. Of even more concern is when that person is in a position to control others, using his ignorance as the basis for his decisions.

I watched an interview on television related to the Washington, D.C. snipers. The interviewee was either a psychiatrist or a psychologist, a profiler, purportedly an expert on serial killers. One statement from this supposed expert floored me. In discussing a particular case, he said that it was obvious that the person was not mentally ill. Why? Because there was evidence that the crimes were planned.

While it’s true that people with mental illness might commonly be in a state that is disassociated from reality, with their ability to plan being impaired or nonexistent, to say that the presence of planning is proof that the person is not suffering from mental illness is evidence of the ‘expert’s’ ignorance, not of his untutored conclusion.

Maybe I gave him too much credit. It might have been that he didn’t consider one with mental illness intelligent enough to formulate a plan. If the ‘experts’ are so in thrall to the stigma, how much can we expect of laymen? Perhaps he was unaware that Winston Churchill was afflicted with mental illness or that he played some small role in the planning of World War II.

Insanity is not merely functioning in an unacceptable manner. It is the inability to function in an acceptable manner.

If a man is caught robbing a bank, our inclination is to assume that he made the decision while aware of the option not to rob the bank and was capable of following that option. If our assumption is correct, he is not insane; he is considered just a bad person.

The act may have been acceptable to him. Perhaps, that it was unacceptable to society meant less to him than his own judgment. The possibility of capture and punishment were insufficient deterrents. His judgment may have been bad. He may have been stupid. He may not fear punishment. He may not have expected to be caught. He may have been coerced.

Since we have assumed the ability to act differently, he is not considered insane. Robbing a bank is a serious act, often with serious consequences to the felon and/or others. If the cause were insanity, although just as serious, it would be another matter. In any case, however, it would be a serious act.

While on the criminal aspect of this subject, there is a matter that strikes me as somewhat confusing. Admittedly, I have not delved into this to any great extent but press coverage sometimes brings it to mind.

With some regularity, I hear the phrase, “competent to stand trial.” In the situations to which it relates, there is the consideration of the defendant’s sanity. We have had the recent spectacle of the trial of a woman accused of killing her five children. As with most spectacles,we are treated to more scintillation than substance.

We had the perfect example of lawyers and legislators presuming to know what they were doing. The law they created is the result of their confusion and ignorance. They reached back to the Britain of 1843 to include, and then to misapply, a standard meant for entirely different circumstances.

They blithely stand on a formulation that predates modern psychiatry. This standard pertains to a defendant being able to ‘know’ right from wrong. It has a place but is inappropriate and irrelevant to the subject of insanity.

The standard may properly be used to decide whether a child has reached a level of maturity to be able to distinguish right from wrong or fantasy from reality. It may also be needed to assess whether a person with Down’s Syndrome or Alzheimer’s has the capability to appreciate the differences between right and wrong. The standard has its place. It’s merely that that place is not in a law delineating insanity.

Why is it digressive? I defined insanity above and, referencing that definition, I fail to find any mention of an awareness, understanding or appreciation of right or wrong. Such a standard is not included as part of the definition of insanity because it has no place there.

As to the question of right and wrong, there are complexities when dealing with mental illness. During a psychotic episode, there are possibly factors which skew any reckoning of right and wrong. There may be a voice that one identifies as authoritative telling one to behave in some particular manner or to commit some specific act.

In various individuals, that authority could seem to be a god, the president, an agent of some clandestine government agency or some similar figure. There might seem to be a rationale that trumps normal behavioral codes. The act may appear, or the authority may confide, that it is necessary to save the nation from its enemies or the person, or their loved ones, from eternal damnation.

Did Saint Francis of Assisi know right from wrong? We named a city, San Francisco, after a man who ran through the streets of his home town completely naked and screaming. He was trying to get away from the voice of God.

Another factor to be considered is paranoia. This is common among those with mental illness, to a less dramatic extent, even when not experiencing a full-blown psychotic episode. Would you ask someone suffering from extreme paranoia to refrain from self-protection? One should be able to see that a perceived but delusory need for self-defense can disorient a person sufficiently to make a judgment of right and wrong differ from one made under more normal conditions.

Every sane person makes allowances for their standards of right and wrong to change. Every sane person accepts the fact that right and wrong can be situational. Were it not for such situational ethics, it would be difficult for a nation to find people willing to defend it. Were it not for situational ethics, the sale of handguns would not be a thriving business.

Thou shalt not kill is hardly treated as universally applicable or as an eternal constant, even by the most devout defenders of the faith. We find in the Bible that God resorted to situational ethics on those occasions when he commanded that certain people or groups of people be killed. King Saul was denied the honor of having the Messiah come from his lineage because he failed to obey a divine order to kill. He was punished for not killing.

If sane people are permitted to indulge in situational ethics and God sets an example in that vein, why are those with mental illness to be held to a different, more stringent standard?

Sane people can justify and are permitted, sometimes commanded, to kill under certain circumstances. It should not be difficult, therefore, to comprehend that people who know right from wrong but are experiencing a psychotic episode might see themselves as being in a situation that commands behavior that they might otherwise see as wrong.

Recall that insanity is a political term. Its boundaries are set by the society. Society may presume to determine right from wrong but, in a judicial setting, this question is not suitable for such simplification.

Using the McNaughton Standard of 1843 to determine whether a person appreciates right from wrong, is to place the ball in the defendant’s court. It becomes, not society’s standards, but the defendant’s understanding of right and wrong.

To use it as a criterion for sanity, means that the jury has to determine and use the defendant’s mind-set at the time of the commission of the crime. That would seem an exercise fraught with insurmountable difficulties, absent a Ouija board.

Insanity is insanity. It need not be elaborated upon, particularly by those ignorant of what it is. There is no need to strictly hold those who are insane to a standard which the sane are allowed to alter as they see fit.

It is only proper that the defendant should be competent to assist his attorney in his defense. I have no problem with delaying the trial in such instances until sanity can be assured. It seems, though, that sanity at the time of the criminal act usually is what evokes the question of competency at trial. Those are entirely different matters.

Insanity is commonly episodic. The phrase ‘temporary insanity’ is not, therefore, especially helpful and certainly is not descriptive of a rare state, as the media and the legal system routinely seem to suggest.

One could be insane at the time of the criminal act but not at trial. The reverse could also obtain. Obviously, either sanity or insanity could be in play at both times. As one’s state need not be the same at both times, sanity at trial should not determine the validity of a claim of insanity at the time of the act.

There does, however, seem to be a prejudice among jurors, encouraged by prosecutors, to deny the claim of insanity at the time of the act, if the defendant appears competent at trial. The term ‘temporary insanity’ has become a pejorative, comparable to ‘taking the Fifth.’

Let us now consider an act that is, to our society, of somewhat less moment. We would be hard-pressed to find someone who has never wanted to just roll over in the morning instead of getting up. We do not normally think of staying in bed as proof of being either bad or insane.

We do not expect the courts or physicians to become involved. If we do not go to work, we may lose some income or even our job but society at-large does not find it to be too serious an act; it certainly is not considered a crime. Is it insane, however?

There have been several periods in my past when the depressive phase of my manic-depression was so overwhelming as to make it impossible to leave my bed. Other than for quick trips to the bathroom and the refrigerator, I would remain in bed for two or three weeks.

Was I lazy? To those without an understanding of the nature and power of mental illness, and initially including myself, the answer was obviously yes. Just get up. Snap out of it.

As disruptive as it was to my life and that of my children, it was not a crime. It was not of major consequence to society, or even my physician. Was I lazy? No. Was I insane? Yes.

Even if I had not had the responsibility as a widower of raising two young children alone, society would not have considered my behavior acceptable. My employer didn’t. My parents didn’t. My friends didn’t.

Children and Family Services would not have approved, had they known, but, as the children were unharmed, it did not constitute a crime. Was I insane? My behavior was unacceptable. I had no ability to force myself to behave acceptably. Just get up? Would that be a reasonable demand of someone just out of heart surgery?

The disease eventually progressed, or abated, to the point where I was capable of behaving acceptably, i.e., getting out of bed. Was I insane? Yes. Was I dangerous? No. Am I usually insane? No. Is mental illness insanity? It may play a role in bringing about some episodes of insanity but, no, it is itself not insanity.

A person may have mental illness and be sane or insane. A person may be ‛normal’ as opposed to having a mental illness, and be sane or insane. Insanity, whether in one diagnosed with a mental illness or one otherwise without psychiatric problems, is usually episodic. It may be a single episode or it may recur
with varying degrees of frequency and severity. Mental illness and insanity are not interchangeable terms. Mental illness and dangerous are not synonymous. Even insane and dangerous have different meanings.

If you were not aware of the definitions and of their differences, don’t fret. At the time of the hearings on the sanity of Jeffrey Dahmer there was a national television interview show discussing this matter. The participants included two nationally-known psychologists and a professor of psychiatry from Columbia Medical School. During the entire hour all three used the term “seriously mentally ill” interchangeably
with the word insane.

Their misuse of the terms did not lead to any confusion on the part of the audience; it merely reinforced the audience’s misunderstanding. If those claiming expertise and holding positions of dominance in the system are so lacking in the most basic understanding of the words upon which their profession is based, we suffer as much from the system and its high priests as from the disease.

Misuse of the word insanity should stigmatize the user as confused or ignorant of the subject. It is probably advisable merely to ignore anyone using the words insanity and mental illness interchangeably, particularly those presenting themselves as ordained and pedigreed experts on the subjects.

Crawford Harris - Polymath




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