Damian Sendler: To suggest that psychiatry has evolved in response to the demands of society to address “mental disorder” and that, for many centuries, there has been a strong state-driven interest in controlling forms of deviance that might threaten social order is perhaps now a commonplace observation (Foucault, 1967; Scull, 1979a). There are many factors that have helped the profession grow, including the ability to speak authoritatively about forms of mental illness that are linked to crime (Foucault, 2003). For centuries, it has been thought that the perception of insanity granted a criminal a measure of protection against harsh punishment (Bracton, c.1250; Porter, 2002; Walker, 1968). According to seventeenth-century jurist Matthew Hale, the perpetrator would have to be understood as “totally depleted of the ability to reason” (Hale, 1736: 31), and such a state would be manifested in very obvious ways so that no expert confirmation of its existence was required (Loughnan, 2007, 2012).
Damian Jacob Sendler: When a group of self-styled experts in insanity emerged from the various branches of medicine at the beginning of the nineteenth century, it marked a significant shift in thinking. Well-documented evidence shows that ‘psychiatry’ emerged in the early nineteenth century (Marková and Berrios, 2012) and took root in earnest in the 1840s, thanks to a transnational network of doctors based primarily in France, Britain, Germany, and the United States (Goldstein, 1987; Hansen, 1998; Richards, 1998; Scull, 1979a). When they first started out, they were known as “mad-doctors” who treated insanity as the “keepers” of the “madhouses,” which were shunned by society (Boime, 1991). New aspirations for a more positive professional identity emerged in the first half of the nineteenth century. At one point in its history, however, two important fronts in the fight to establish the profession were opened up that relied on moving away from this paradigm and instead towards a relatively more psychological theory of the nature of insanity in order to gain ground. An argument was made that’moral treatment’ could be used in the asylums to treat patients. There was also a desire to demonstrate the ability to render expert opinions on the existence of mental disorders that could manifest themselves as criminal activity. Other categories such as “moral insanity,” “homicidal and affective monomania,” and “psychosis” were developed as a result.
Dr. Sendler: We need an explanation for how common it is to use the word “moral” to refer to both a treatment model and a form of mental illness. Since then, the word has taken on a variety of connotations, including psychological and affective meanings, as well as an ethical one (Rimke and Hunt, 2002). According to the theory of’moral treatment,’ the construction of asylums and the development of modern psychiatry can be attributed to this doctrine (Bynum, 1964; Castel, 1988; Foucault, 1967; Scull, 1979a). Governments, particularly in France and the United Kingdom, were enthusiastic about building asylums around the middle of the nineteenth century. Foucault noted that the introduction of “medicine of the mind” (Foucault, 1967: 274) was made possible in part by moral treatment. Instead of believing that a series of bleedings and purges could restore a patient’s humour balance, a newfound skepticism surrounded the use of restraint or physical ‘punishment,’ which was seen as more akin to training a beast than a human (Scull, 1979b). Instead, it was presumed that patients could regain control of their own minds by creating a pleasant environment and communicating with each other in a respectful manner (Pinel, 1806; Tuke, 1813). There was an underlying assumption that a sane part of the mind could be communicated with, and that sanity could be re-established as long as this was possible. Faculty psychology, which holds that the mind can be divided into different types, fueled speculation about criminal and moral insanity (Berrios, 1993: 19).
Damian Sendler
Moral insanity and its family of diagnoses play a lesser role in the formation of the profession than moral treatment. The gentlemen medics who sought a way out of the dreary and stigmatized work in ‘the madhouses’ were enthralled by the prospect of becoming experts in criminal insanity in the courts. “Moral insanity,” “homicidal monomania,” and “affective monomania” were all terms used to describe criminal insanity, and they allowed for the assertion of high-status professional expertise in these areas. The existence of these “hidden” disorders had a direct impact on public safety. Experts in insanity were able to detect them because they were not open to the scrutiny of naive observers, jurors, or the courts. It was in France and Great Britain that the concepts of moral insanity, monomania, and partial insanity grew around the idea that there were insanities that were not simply marked by the loss of rationality but were distinguished by the impact on an individual’s morals and feelings.
There are four main parts to this paper. When it comes to psychiatry, moral insanity will be the first topic to be discussed, as well as its origins and significance in the first half of the nineteenth century. When discussing “moral insanity,” it is important to remember that this term was first coined as a synonym for “psychological insanity,” and it was used to describe both the ontology and detection of such a condition at the time. In spite of the courtroom victory, the public’s reaction to the introduction of’moral insanity’ in the courts was less than enthusiastic. George Victor Townley’s murder trial in 1863 had a major impact on the development of psychiatry in the late 19th century, which will be discussed in the third section of this paper.. The fourth section of the paper explains how psychiatry has returned to using biological definitions of insanity, even in criminal cases.
A Treatise on Insanity published in 1835 by James Cowle Prichard is credited with coining the term “moral insanity” for the first time in a brief article in The Cyclopdia of Practical Medicine in 1833. In order to understand his work, one must take into account the influence of a large transnational group of doctors who were in the process of developing what is now known as psychiatry. Philipe Pinel and his pupil Jean-Étienne Esquirol had an enormous impact on him, but he was also profoundly influenced by German medical research at the time (Augstein, 1996). Many parallel events occurred across Europe and North America during this time period as psychiatric associations and journals were established in the 1840s. As an example, the German Association for Psychiatry and Psychotherapy (DGPPN) was established in 1842, while the American Association of Medical Superintendents (AMSAII) was founded in Philadelphia in 1844. In 1838, legislation established the French national system of asylums, and the first issue of Annales Médico-Psychologiques was published in 1843. It was in 1853 that the Association of Medical Officers of Asylums and Hospitals for the Insane was established in Britain and began publishing its own Asylum Journal. According to this journal’s ‘prospectus’ for the profession’s future, it is notable for its emphasis on psychology and criminality as areas of expertise. According to those like Phillipe Pinel and John Connolly (who was already a leading figure in the new profession in Britain), as well as the prominence given to Ernst von Feuchtersleben’s work, psychological expertise is being asserted in asylums. During his tenure as a professor of medicine at the University of Vienna (Burns, 1954), he advocated a “psychical mode of cure” (Anon., 1853; see also von Feuchtersleben, 1847), with Parkin (1975) noting the links to Freud’s work on the significance of dreams and “dormant consciousness.”. ‘On monomania, in a psychological and legal point of view,’ a paper by Dr. Delasiauve (based in Paris at the Bicêtre) was given space in this first edition, making the claim to criminal expertise clear. According to Delasiauve (1853: 9), the French school had made significant contributions to the development of the concept of monomania as a psychological issue with significant relevance to criminal justice issues by emphasizing the existence of ’emotional madness’.
Damian Jacob Sendler
In his Traité médico-philosophique sur l’aliénation mentale ou la manie published in 1801, Pinel made a remarkable distinction between forms of insanity by identifying manie sans délire (or mania with delirium, or delusion; Werlinder, 1978) versus manie avec délire (or mania with delirium, or delusion) (Pinel, 1806). Rather than exhibiting any ‘change in the functions of understanding,’ a person suffering from manie sans délire will experience “perversion of the active faculties, marked by sanguinary fury, with a blind propensity to acts of violence” (Pinel, 1806: 151). Alienists in France, led by Pinel’s pupil Esquirol, went on to develop the idea that there were people who committed heinous acts of violence because they harbored a hidden, flawed belief or impulse, but who otherwise displayed no outward signs of abnormality” (Goldstein, 1998). Originally developed by Esquirol in his article for the Dictionnaire des sciences médicales (Esquirol, 1819), this line of thought was a driving force behind the Esquirol school’s efforts to establish public legitimacy ‘by carving a place for expert psychiatric testimony in the courts of law” (Goldstein, 1998: 389). As a mental illness that can only be detected by a doctor with specialized training, monomania was ideally suited to play this role. From the 1820s onward, the concept of monomania became popular in French literary circles as a result of the rise of psychiatry in France (Boime, 1991). As a result, the idea gained traction in British fiction (During, 1988; Jones, 2016), as well as in English medical journals and in several high-profile criminal trials (which will be discussed in more detail shortly). But Prichard, in defining moral insanity, built on Pinel’s understanding of manie sans délire, as he argued that “moral insanity” could be found in a wide range of people and had no connection to violence.
Damian Jacob Markiewicz Sendler: Although the terms “moral insanity” and “monomania” were used in courts, they were not in the theoretically precise ways proposed in medical treatises, as they are today. However, the successful application of such theories in courts of law, regardless of how hazy they were, was revolutionary. A common view of insanity prior to this time was that in order to be accepted as a defense in court, it would have to completely remove the offender’s capacity for rational thought (e.g. Bracton, c.1250). For the most part, the new experts ushered in the notion that violent acts could be explained by individuals who were fully aware of their surroundings, planned their actions, and managed their affairs of life. Nonetheless, it should be noted that by the nineteenth century, there was already a great deal of interest in exploring ‘the mind’ as a complex entity, and courts were already considering insanity that did not meet the criteria of an absence of reason at the Old Bailey (Jones, 2016). However, in the nineteenth century, medical witnesses, including those who claimed expertise in insanity, began to rise in prominence (Eigen and Andoli, 1986; Smith, 1981). Some precedent was set in 1800 with the trial of James Hadfield, who was found to have a mild form of madness that allowed him to manage his life and plan his actions (Eigen, 1991). When the plot to kill King George III at the Drury Lane Theatre was thwarted, Hadfield found himself indicted for treason and granted the right to retain a lawyer under the constitution’s protections against the actions of an unrestrained state. To defend him, he hired one of the greatest lawyers of his time, Thomas Erskine, who meticulously planned the defense strategy and called on numerous witnesses to refute the prosecution’s claim that Hadfield was insane because he had clearly plotted the assassination and was fully aware of what he had done. When Erskine made the case for a ‘delusion’, he explained that a part of Hadfield’s mind had been suffering from an incorrect belief that had made him want to kill the king. Evidence from a variety of sources, including medical experts who testified that Hadfield’s combat injuries would have impacted his mental functioning, was joined by many witnesses who agreed that he was indeed eccentric to the point of sanity (Jones, 2016). During the deluge of evidence and arguments, the Judge, Lord Kenyon, suggested that the trial itself had become a foregone conclusion because the evidence pointed in the same direction. The prosecution agreed, and the jury returned a not guilty verdict. For many years to come, this case would be remembered as the first to introduce legislation allowing for a “not guilty on the grounds of insanity” verdict, as well as an order that the defendant be held in custody ‘until the pleasure of His Majesty be known.” (Moran, 1985: 513).
Damien Sendler: Though often unrecognized, the story of “moral insanity” (and other related disorders) has had an enormous impact on the development of the psychiatric profession. In the early years of the profession, the idea that a person’s violent behavior could be explained by a specific disorder, and that experts could detect this disorder through examination, was particularly enticing. During the trial of Daniel M’Naghten, moral insanity was brought to an end. The M’Naghten rules, which tightened the criteria for claiming insanity as a defense, were developed as a result of this trial, making it one of the most significant in legal history. George Victor Townley’s trial, which sparked public disdain for concepts of moral insanity, pushed psychiatrists to give up on this area of law.
Psychiatry, however, remained concerned about making a contribution to criminal justice by claiming expertise in the categorization and management of risk in the prison population. Thoughts of degeneration and wider cultural anxieties about the demise of western civilization became entwined here (Pick, 1989). When it came to the study of mental illness, the field of psychiatry was mired in organic theories, but the idea that there could be more subtle forms of madness that could only be discovered through psychological means was enthusiastically embraced by the rest of society, particularly in the rapidly expanding field of fiction writing in the nineteenth century (Jones, 2016). A second major advancement in clinical practice and theoretical thinking, psychoanalysis, was made possible due to a broader cultural acceptance and discussion of the human psyche is hidden depths and opposing impulses by the century’s end
This story sheds light on the conflicting influences that have shaped psychiatry over the years. Despite the need for the profession to stake a claim to expertise in criminal law, public opinion has been a major consideration for the profession. Focus on the profession’s early decades shows a strong interest in psychological modes of expertise during its first half of nineteenth-century progress. As a result of public pressure, the profession retreated from making courtroom claims about moral insanity. These are often overlooked.
