Legal Definitions of Insanity

• M’Naghten Rule (1843)—defendant was responsible if he knew the nature and consequences of his act, and that it was forbidden by law (cognitive test).

• Irresistible Impulse (1887)—emotional inability to resist act (supplement to M’Naghten)

• Durham rule (1954)—not criminally responsible if behavior is product of mental disease (product test).

• ALI Standard (1962) American Law Institute—”lacks substantial capacity” to appreciate criminality, or conform behavior to law.

• Insanity Defense Reform Act (1984)—not guilty, if due to mental disease and was unable to appreciate the wrongfulness of act. Shift of burden to defendant to prove insanity. Back to M’Naghten Rule

Visualizing HysteriaMultiple Personality &

Suggestion

Jean-Martin Charcot (1825-1893)

Inscribed to Freud, on the day Freud left the Salpêtrière

Clinico-Anatomic Method

Charcot (profile, far left) at theatrical reading,

with writers Emile Zola and Edmond de Goncourt

Photographic Iconography of theSalpêtrière (1876-77)

Hugh Welch Diamond,Uses of Photography in Psychiatry

1856 Paper to the Royal Society, London

1. Provides physiognomical data to physicians regarding nature of disorder.

2. Allows for identification of escaped or returning patients.

3. Aids patients in contemplating and improving their own mental states.

4. Documents cured patients.

PUERPERAL MANIA (Post-Childbirth)IN FOUR STAGES--Cured

Melancholy Passing into Mania

(Etching)

(Photograph)

SENILE DEMENTIA

(Photograph) (Etching)

“What words can adequately describe either the peculiar character of the palsy which accompanies sudden terror when without hope, or the face glowing with heat under the excitement of burning anger, or the features shrunk and the skin constricted und ghastly under the influence of pale rage? –Yet the photographer secures with unerring accuracy the external phenomena of each passion, as the really certain indication of internal derangement, and exhibits to the eye the well known sympathy which exists between the diseased brain and the organs and features of the body.” Diamond, On the Application of Photography to the Physiognomic and Mental Phenomena of Insanity, 1856

Suicidal Melancholy (Diamond 1856)

INSANITY RESULTING FROM INTEMPERANCE(Diamond 1856)

Guillaume B. Duchenne (de Boulogne)(1806-1875)

The Mechanism of Human Facial

Expression (1862)

Duchenne’s double current volta-faradic

apparatus

Facial Musculature

Duchenne, 1862

Muscle of Reflection

Muscle of Aggression

Muscle of Sadness Muscle of Terror

Muscle of Joy and Benevolence

Genuine Laughter False Laughter

Charcot’s Four Stages of Grand Hysteria

1. Tonic rigidity: limb contractures that mimicked a typical epileptic fit.

2. Dramatic body movements: contortions, illogical movements; clownism.

3. Passionate Attitudes: expressions of vivid emotional states.

4. State of delirium

Stages of the Hysterical Attack

“AUGUSTINE”

Beginning of the Attack

Tonic Rigidity—Stage 1

Contracture of the FaceStage 1

Stage 2—Clownisms, Illogical Movements “Circular Arch”

Passionate AttitudesStage 3

“Menace”

Passionate AttitudesStage 3

“Menace”

Passionate AttitudesStage 3

“Aural Hallucinations”

Passionate Attitudes: “Loving Supplication”

Passionate Attitudes“Ecstasy”

Passionate Attitudes:Crucifixion

Zones of Hysterical Anesthesia

Metalloscopy:Use of Magnets to

shift areas of anaesthesia

Artificial Contracture

Catalepsy produced by sound

Charcot and Blanche Wittman

A Case of Traumatic Male Hysteria

Hippolyte Bernheim (1840-1919)

SuggestiveTherapeutics (1886)

head of the Nancy School

Pierre Janet (1859-1947)

Dissociation—Traumatic event and

accompanying memories split off from consciousness

Imperative Suggestion—suggestion that thesememories didn’t exist

Janet’s Somnabulisms• Monoideic—dominated by one idea,

usually a transient episode.

• Polyideic--complex states or ideas; called fugue states, could involve a loss of identity for extended period.

• Recriprocal or Dominating Somnabulism (double personalities)—relatively permanent transition into another state;

memory impaired across these states

Reciprocal SomnambulismLady MacNish/Mary Reynolds

Alfred Binet (1857-1911)

On Double Consciousness (1890)

Alterations of the Personality (1896)

Examples of Automatic Writing with an anesthetic hand

Binet (1890 and 1896)

Insensible Arm—hearing aMetronome

Sensible arm

Insensible arm while subjectcounted to five

Sensible Arm

Subject held dynamometer,connected to a

recording cylinder.Binet (1896, p. 201)