In this series, I dig a little deeper into the meaning of psychological terms.
This week’s term: Insanity
Wikipedia is always the first place I look when writing a post for this series, but I think the Wikipedia page for insanity could use some work. It opens with: “Insanity, madness, and craziness are terms that describe a spectrum of individual and group behaviors that are characterized by certain abnormal mental or behavioral patterns.” That particular spectrum sounds like a load of crap to me.
In most contexts insanity is a very old school term. In 1840, the term “idiocy/insanity” was used as a category in the United States census. Over time that classification grew to include what were then known as melancholia, paresis (physical weakness), mania, monomania (obsession with a particular thing), dipsomania (excessive water consumption to the point of intoxication), dementia, and epilepsy. In 1917, a predecessor to the DSM was published, titled Statistical Manual for the Use of Institutions for the Insane. As far as I can tell insanity was never included as a diagnosis in the DSM.
Although insanity is no longer a medical term, it’s used in a legal context to describe whether an individual was of sufficiently sound mind to be able to differentiate right from wrong at the time of committing a criminal act. That timing piece is very important, because simply having a mental illness is not sufficient to be considered insane in a court of law. Even if someone was ill at the time of the crime, if they were still able to distinguish right from wrong then they wouldn’t be considered insane. There is no particular diagnosis that insanity is linked to, although it often arises from psychotic symptoms.
How the courts deal with this depends on the jurisdiction. In the United States, an insanity defense is presented by the defendant’s counsel. Forensic psychiatric evaluations are done to support this defense. In the end, the jury decides whether or not to accept the insanity defense. According to Wikipedia, in the U.S. it’s more common for the defense counsel to argue diminished responsibility or diminished capacity, which involves a lessening of responsibility due to a temporary mental state. There are variations from state to state in terms of availability of this defense, type of evidence required, burden of proof, and standard of proof.
In certain U.S. states a particular type of insanity defense can be used called “settled insanity”. This refers to a permanent mental impairment brought about by long-term substance abuse. While voluntary intoxication is not permitted as a defense, settled insanity is considered different because it takes away the capacity for criminal elements like malice aforethought (premeditation).
In Canada, a finding of “not criminally responsible” by reason of mental disorder is used when a mental disorder resulted in the individual being unable to appreciate the nature of the act and understand that it was wrong at the time of committing the offense. If there is information to suggest the accused is not criminally responsible, the judge can order a forensic psychiatric evaluation, which is done over a period of time at a forensic psychiatric hospital. A judge then makes the final determination, and the standard of proof is based on a balance of probabilities.
In Nordic countries, it is the responsibility of the court to evaluate the accused’s mental state, even if the defense does not make an insanity argument.
What I find so interesting about insanity is that I suspect the average person knows little about how it’s used and what it actually means. It makes me wonder if lack of awareness around this serves to perpetuate stigma. There are already far too many ignorant assumptions connecting mental illness and violence. Does it help anything for people to be throwing around terms like “criminally insane”, a term which gets 3.8 million hits on Google? Even if it weren’t horrendously stigmatizing, “criminally” is redundant given that insanity only has meaning in the justice system.
I think insanity is an old-fashioned term that’s better off left in the past, along with lunatic, and various others. “Not criminally responsible” as used in Canada seems much more appropriate. And criminally insane certain belongs in the rubbish bin of history.
You can find the rest of my What Is series here.
My book Making Sense of Psychiatric Diagnosis breaks down the different categories of DSM-5 diagnoses, explaining the diagnostic criteria and providing first-hand stories of the various illnesses. It’s available on the MH@H Store, as well as Amazonand other online retailers.