Mental illness or insanity?



A schizophrenic is obsessed with his landlady who does not reciprocate the fond feelings. One day, he kills her dog. He then turns up the volume of the telly to drown her cries for help as he butchers her. He leaves a note that he is travelling somewhere in the north of England while he remains hidden in London. He’s eventually found out. Although medical experts testify that the bloke is a schizophrenic with auditory hallucinations, a case of insanity cannot be made in court. He is found guilty and gets a life sentence to be served at a maximum security forensic psychiatric hospital.

This is not fiction but the summary of a real case that I encountered during the couple of weeks that I spent in Forensic Psychiatry in 2005. I came across many similarly bizarre cases.

I asked the Consultant Forensic Psychiatrist why the guy remained guest-of-her-majesty after all the detailed history of schizophrenia and treatment. He said that a plea of insanity was not successful. It was difficult to demonstrate insanity in someone who was so rational in executing a murder and even tried to deceive people from finding him out. He definitely knew what he was doing and that it was wrong.

A madman is not necessarily insane in the eyes of the law. The law confuses rational thinking with sanity. But in medicine, we know that people with severe psychiatric illness are capable of lucid calculation. But it doesn’t make them less mad.

One of the enduring insights of my clinical attachment in Forensic Psychiatry is that laypeople frequently conflate two categories – one legal, the other medical – that do not exactly overlap. While schizophrenia, mania and depression are medical categories, insanity is not. Insanity is a legal category. To establish a defence on the ground of insanity, it must be clearly proved that, at the time of the committing of the act, the party accused was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing; or, if he did know it, that he did not know what he was doing was wrong (Herring, 2008).

The legal standard for insanity is not well aligned with the medical understanding of mental illness and needs to be revisited. The legal meaning of insanity needs to change. My perspective here is based on a UK experience. I don’t even know what it is like here in Nigeria. But I know that English Law has had a lasting impact on law in Nigeria.

I suspect that a number of people who should be in psychiatric care are being incarcerated without treatment in this country. Do we even have forensic psychiatric facilities for people with psychiatric illness who have committed criminal acts?

If a madwoman hearing voices inciting her to murder, kills her children, hides the bodies and runs away, she is likely to be found guilty and convicted. It doesn’t mean that she is a criminal. It only means that the law is an ass.

NB. I am still not convinced that ‘mad’ or ‘madness’ are necessarily derogatory. I use them in a rather literary sense. After all, the law has retained the use of ‘insane’, its historical synonym.


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