Book Review

Witnessing Insanity: Madness and mad-doctors in the English court

N Engl J Med 1995; 333:465-466August 17, 1995

Article

Witnessing Insanity: Madness and mad-doctors in the English court
By Joel Peter Eigen. 240 pp. New Haven, Conn., Yale University Press, 1995. $32.50. ISBN: 0-300-06289-3

Many criminal cases in recent years have attracted the interest of the lay public and professionals interested in the sociology of the criminal trial. These are cases in which serious crimes have been committed and the responsibility of the perpetrator is under discussion. The name “Hinckley” has entered the vocabulary of the average citizen, and people from all walks of life have strong opinions about whether he knew what he was doing when he shot former President Reagan. Recent incursions onto the private grounds of the White House have once again raised the issue of how to think about the responsibility of the mentally ill for their actions that contravene criminal statutes.

Professor Joel Eigen, of Franklin and Marshall College, builds his book on the premise that most of us are intellectually curious enough to wonder how citizens thought about these questions in earlier days. He therefore looks at the English courtroom between 1760 and 1843 and provides a summary glimpse of more than 300 cases in which offenders represent “the display and negotiation of mental derangement.” Eigen, a sociologist by training, does a systematic analysis of the Old Bailey Sessions Papers, which are pamphlets that reported the outcome of trials at the Old Bailey, a well-known court in the City of London. Eigen focuses on the supposedly mad people who are at the center of these trials, as well as their witnesses and the judges and juries participating in the courtroom rituals.

The book reviews the origin of the notion of criminal responsibility and the influence of Canon Law on our understanding of “wicked will” and “evil intent.” It also points up how organized societies must inevitably struggle with the notion that some people simply do not deserve to be punished for their crimes. Behaving like a wild beast or being under seven years of age emerged as readily palpable criteria for deserving to be excused for one's actions. It is easy to see why such criteria led to the notion of total insanity as a requirement for establishing a lack of criminal responsibility.

What is striking, however, is Eigen's demonstration of the average person's eventual recognition that some people who deserved to be excused for their behavior were not totally mad 24 hours a day. Eigen presents wonderful snippets of court testimony to elucidate English society's struggle to resolve these problems. He shows, with subtlety and creativity, how witnesses to these crimes tried to describe in common parlance what the perpetrators had done and how they had behaved for months before the commission of the crimes. As time went on, the importance of these witnesses gave way to a focus on the testimony of general physicians who occasionally came in contact with madness and then eventually to that of doctors who were spending large amounts of time dealing with mad people.

Professor Eigen astutely emphasizes the need to understand the culture of the historical period in order to appreciate the evolutionary development of the insanity defense in the 18th and 19th centuries. He skillfully describes the confluence of a number of elements that contributed to the eventual drafting of the McNaughtan rules: the gradual development of the medical specialty of psychiatry, the role of attorneys in the criminal-trial process, the general society's struggle to come to terms with madness and its relation to evil acts, and even the perception of lawlessness as an increasing presence in London society.

This book is thoughtfully written and will certainly hold the interest of physicians, particularly psychiatrists. Professor Eigen's technique of trimming many of the descriptions of the cases will disappoint lay readers who view observation of the criminal-court process as a way of getting into other people's business.

Ezra E.H. Griffith, M.D.
Yale University School of Medicine, New Haven, CT 06519