The Encyclopedia Americana (1920)/Insanity (medicine)

INSANITY. This is a purely legal term. Its use as a medical term should cease as it leads to interminable confusion and defeats the ends of justice. The confusion is very old however and will take time to eradicate. Insanity then simply represents certain legal situations which by reason of one or another disease, chiefly involving the brain, render the individual responsible or not responsible for a criminal act, an act of contract making or of making a will. If, according to the evidence adduced before a properly constituted legal tribunal, it is decided that the individual's acts in question were not responsible, or he did not have contract capacity, or he did not possess testamentary capacity, because of some disease, injury or defect of the brain, then the individual in question has thrust upon him a legal status — insane. It is necessary to insist upon the purely legal character of the situation — because the tests for responsibility for contract capacity, for testamentary capacity vary with every jurisdiction. Thus a man may be insane in New York and sane in New Jersey, or vice-versa. He only has to step over the line. Certainly this is not a medical concept of a disease. No disease can change by crossing a territorial line. Thus it must come about that the word insane — insanity, etc., must be confined purely to its legal usage — or better abolished entirely.

The confusion arose in the days of the Roman law, and law is such a conservative instrument it is hard to eradicate old conceptions. In Roman days all brain diseases were lumped into one. The Romans despised Greek subtleties, they said, just as most stupid people despise their superiors in intelligence. The Greeks had separated various brain diseases and gave them different names. They were really a scientific people. But the Romans had a passion for organization. They lumped all of these very diverse diseases and called them “Insania.” To them insania was a brain disease. What are really different brain diseases, they called “forms of insanity.” This is a false and nonsensical concept and leads to much mischief in our present law court practice. Thus in New York State the legal test for responsibility is whether the individual knows the nature and quality of an act and knows whether it is wrong. There are a number of very severe and chronic mental illnesses which totally destroy an individual's responsibility, but such individuals may still retain this purely intellectual test. New York State would electrocute such seriously sick individuals and commit an act of gross injustice. In New Jersey — another feature is added to this test — namely, the capacity to resist an impulse, and in other States other tests. The whole test business is largely a farce, and is founded on the totally erroneous idea in the minds of law givers that there is such a disease as “insanity” and that it has different “forms.” There is no such thing as a disease “insanity” — and there are no forms of it, just as there is no disease called “cough.” One may cough from dust, from gas, from tuberculosis, from bronchitis, from cancer of the larynx, to warn a friend or to hide a confusion. Certainly dust, gas, tuberculosis, bronchitis, cancer, warning and hiding are not a disease. So an individual may have a brain tumor, he may have a meningitis, a syphilis of the brain, tuberculosis of the brain, thyroid poisoning, a paranoia, a dementia precox or any of a hundred different and dissimilar diseases, and as a result of such a disease he may commit an antisocial act, which if resulting from the disease caused him not to know the nature and the quality of the act, not know it was wrong, or knowing these things even, may have believed himself commanded by God to do the deed, then, varying with the State's legal definition, he becomes legally insane. He acquires a purely legal status. He has not got any insanity. There is no such disease. He may have one of the diseases just enumerated, which causes him to acquire a legal status. See Psychiatry; Mental Diseases.