FORENSIC PSYCHIATRY By Dr Faiz Ahmad Psychiatry it

FORENSIC PSYCHIATRY By Dr. Faiz Ahmad

Psychiatry– it deals with study, diagnosis, treatment and prevention of mental illness. Forensic psychiatry- application of knowledge of psychiatry in Administration of justice Insanity- Unsoundness of mind ds of mind & personality These are the person who are unable to cope with the ordinary social circumstance

Insanity or Unsoundness mind A disease of the mind or the personality, in which there is derangement of mental or emotional processes & impairment of behavioral control. Mentally Ill Person Any person who is in need of treatment by reason of any mental disorder other than mental retardation.

Forensic psychiatrist a) Provide services such as determination of competency to stand trial in a court of law to facilitate adjudicative process. b) Involved in care of prisoners , both in jails and mental health institutions. c) Often also do research work related to prison

Patients requiring expert mental health professionals opinion in judiciary ØThose harming themselves and others ØThose who are incapable of looking after themselves and unable to handle welfare of their family and properties ØPatients who are acting out to be dangerous due to psychiatric disorders ØSpouses of mentally ill patients in cases of divorce, etc ØPatients who are having criminal and civil litigation as a consequence of mental illness ØMental patients who are going for some contract or want to make a will ØMental fitness certificate of the person is needed for adoption of child and other issues

SOME COMMON PSYCHIATRY TERMS Abreaction This is a release phenomenon where old, forgotten things or events are brought into conscious state again. Circumstantiality When a person is not able to answer properly, in a straight manner, and keeps on giving irrelevant details or wanders off the subject many times in a conversation, the condition is called circumstantiality.

Consciousness It is the awareness of the self & environment Disturbance Ø Confusion Ø Clouding of consciousness Ø Delirium Ø Twilight state Ø Fugue Ø Disorientation Loss Ø Coma

Delirium It is a condition characterized by disturbance of consciousness where the critical faculty is blunted or lost, associated with impaired orientation and inconsistent or irrelevant thought contents. Etiology-: 1. Fever with high temperature 2. Drug intoxication 3. Alcoholic intoxication/Dhatura Clinically- Person is restless, excited, talkative (irrelevant) sometimes loss of self control become violent. MLI Person in state of delirium is not responsible of his criminal act.

Delirium tremens It is psychotic condition in alcoholics which occurs due to sudden increase of dose and sudden withdrawal. There are tremor, Insomnia, mental confusion, loss of memory, disorientation and hallucination of horror. Korsakoff’s psychosis It is a psychological and neurogenic deranged condition occurring in some chronic alcoholics where there is peripheral neuritis with polyneuritis, muscular degeneration with weakness, disorientation , some hallucination and retrograde amnesia.

Drunkenness It is the state of a person under the influence of alcohol such that he lost control to such an extent that he is unable to perform his duty in which he was engaged at the material time. Dementia It means degeneration of mental faculties after full development. It may occur due to old age, Alzheimer’s disease involving brain, etc. Loss of higher cognitive functions & social inhibition(sexual offences against children, shoplifting)

Memory Recent It is the ability to store and recall information Remote Disturbance in memory is called Amnesia Retrograde Anterograde Confabulation False interpretation of some recent events

ØUnconscious filling of gaps in memory by imagining experiences or events that have no basis in fact, commonly seen in amnestic syndrome. Ø Confabulation is considered “honest lying, ” but is distinct from lying because there is typically no intent to deceive and the individual is unaware that their information is false

Thinking ØThought blocking- sudden break of thought. ØCircumstantiality- slow talking with unnecessary details ØDerailment of thoughts- sliding of thoughts ØPerseveration- repetition of a word/phrase several times ØStereotype- constant repetition of a phrase & behavior in many different places irrespective of context

Delusion It is a false belief in something which is not a fact, and which persists even after it’s falsity has been clearly demonstrated Characteristics Ø A normal person can have a delusion, but is capable of correcting it by it’s reasoning power & by his past experience Ø Delusion in a insane person is a symptoms of brain ds Ø it is mainly found in epileptic, affective & schizophrenic patients but not seen in anxiety neurosis & other neurotic illness.

Types of Delusion 1. Delusion of grandeur Ø Also termed as delusion of exaltation Ø Pleasant delusion Ø Feeling of greatness, power & health. Ø ex- a man imagine himself to be very intelligent, or rich while in reality is different. 2. Delusion of persecution ØUnpleasant delusion

ØThe sufferer believe that something bad is going to happen to him Ø He fears that he may be killed by somebody. Ø The life of the person become full of distress & helpless. Ø Because of this apprehension he may commit suicide. 3. Delusion of influence Ø The sufferer strongly believe that his thought process, activities and behaviors all are controlled by some external supernatural power.

Ø Such person on the basis of some imaginary command from that supernatural power, he may commit some unlawful act. 4. Delusion of reference The person believes that people refer to him in a special way. This may create conflicts with strangers as he may think that strangers also looking at him & talking about him

5. Delusion of infidelity Ø Sufferer thinks that his/ her spouse is not loyal to him/ her Ø Usually males are sufferer. ØThe person thinks that his wife does not love him and she has some intimate relationship with some other person Ø For which the sufferer always torture his wife even he kill her wife & himself commit suicide.

6. Nihilistic delusion(Cotard syndrome) Ø It is an unpleasant delusion. Ø Mainly found in negative attitude persons. Ø The sufferer always think that world is not exist, as well as he also not exist. 7. Hypochondriacal delusion Modern people are very health conscious It’s over consciousness create a delusion that called hypochondriasis

Ø The person believe that there is some pathology or abnormality with some part or system or organ of his body, though in reality he is physically healthy Ø Some times he feels depressed by thinking of the different diseases in his body, he become helpless & in extreme depression he may commit suicide.

8. Delusion of self-reproach, or self criticism- Ø It is an unpleasant delusion ØThe sufferer realizes his fault in past Ø He blames himself for the failure Ø That creates depression and the person punish himself by terminating his own life. 9. Other type- 1. Delusion of jealousy 2. Delusion of religion 3. Delusion of poverty

Delusional Misidentification Syndromes include four types of syndromes ØCapgras syndrome (Delusion of doubles) -Person holds a delusion that a friend, spouse, parent, or other close family member has been replaced by an identical-looking impostor [stranger]. Familiar person is thus seen as a stranger. ØThe syndrome of subjective doubles - The patient’s own self is perceived as being replaced by a double.

ØThe syndrome of intermetamorphosis - Familiar persons are believed to have exchanged identities [no stranger is involved]. A person misidentifies his wife as his deceased mother and, later, as his living sister. ØFregoli syndrome -Delusional belief that one or more familiar persons, usually persecutors following the patient, repeatedly change their appearance.

Medico legal importance 1. It reflects mental abnormality 2. They will not responsible by their act 3. Suicide is a major risk 4. Partial delusion – doctrine of diminished responsibility

Perception We perceive various things around us through our sense organ Sense of perception Alteration Sensory distortion Sensory experience 1. Macropsia 1. Hallucination 2. Micropsia 2. Illusion

a. Auditory hallucination A person hears pleasant or unpleasant sounds or voices out of nothing. He may presume that someone is talking to him, when there is none. b. Visual hallucination A man thinks that he is seeing something where there is nothing. c. Olfactory hallucination. A person smells pleasant & non pleasant odour when none is present.

d. Gustatory A person feels sweat, sour, bitter, good or bad taste In his mouth, though no food is actually present. e. Tactile (formication or haptic hallucination) A man imagine rat, mice crawling into his bed. f. Psychomotor hallucination. A man will have feeling of movement of some part of the body in the absence of such movement.

Hallucination Disease Visual Auditory Organic brain diseases (focal CNS lesion) Schizophrenia Gustatory Temporal lobe epilepsy Olfactory Organic brain disease Tactile cocainism MLIThe persons suffering from hallucination may also commit suicide or homicide especially in some command hallucination.

Illusion ØThese are false interpretation of sensory stimuli often visual or auditory which has real existence. ØThey maybe seen in normal persons, in dark or during emotional stress and in organic brain disease and maybe associated with hallucination. E. g. A dog maybe interpreted as a tiger. A rope maybe mistaken for

ØCompletion Illusion: Where an unfinished pattern is completed by illusion. ØAffect Illusion: In this, mood of the person affects the nature of illusion. ØParabolic Illusion: When human faces or images are seen in illusion. In Illusion, The person may be corrected when confronted with Facts. He realizes that it was a misinterpretation of stimulus.

5. Emotion or mood or feelings (AFFECT) Symptoms related to Affect are ØAnxiety ØPhobia ØObsession Ø Panic Ø Mood Ø Irritability Anxiety It is the subjective distress may or may not accompanied by autonomic over activity. ØPalpitation ØSweating ØTremors ØDilated pupils It is the commonest symptoms of various neurotic disorders

Phobia It is the unreasonable and irrational fear of a particular object or situation. Type. Acrophobia- fear of high place. Agarophobia- fear of open space. Nyctophobia - fear of darkness Claustrophobia- fear of closed space Xenophobia- fear of stranger. Mysophobia- morbid fear of filth or contamination.

Obsession It is a condition characterised by appearance of a single idea, thought, or emotion which constantly disturbs the sufferer which he recognizes as irrational but persists in spite of all effort to drive it out from his mind. Usually found in neurotic people. The ideas are usually associated with some sort of fear Compulsion It is a repetitive behavior done by an individual in spite of knowing that it is not correct. Examples being, repeatedly washing hands, checking locked premises again and again.

Panic It is a state of attack of severe state of anxiety lasting for minute to hours. Irritability It is the unpleasant feeling in which the person feels an inner discomfort. Mood Feeling of well being Elevation of mood- the terms are ØEuphoria ØElation ØExaltation

ØEcstasy ØMania Abnormal elevation of mood Mainly found in bipolar disorder. 6. Body function Appetite- excessive eating- bulimia decrease appetite-anorexia Thirst- excessive thirst- polydispia- anxiety. Sex- loss of libido-seen in depression hyper sexuality- mania

Sleep- insomnia- anxiety hypersomnia – excessive sleep in night somnolence- excessive day sleeping somnambulism- sleep walking It is aimless wandering with incomplete arousal from sleep. Actually the person may get up from bed, open the door walk out a distance and return to bed to sleep again, No recollection of the event the next day. Somnolentia – sleep drunkenness Person aroused suddenly from deep sleep

Impulse Def- it is a sudden & irresistible force compelling a person to the conscious performance of some action without motive & forethought. Type- Kleptomania- steal article of small value Pyromania- to set fire Mutilomania – mutilate animals Dipsomania- desire for alcohol drink Sexual impulse Suicidal & homicidal impulse. MLIA person if commits some offence which is the result of impulse, can not be held responsible for his criminal act.

Lucid interval A period of normalcy with normal mental activities may found sometimes in an insane person -- The symptoms of insanity may cease altogether. -- Person behave absolutely normal -- He is able to judge and foresee the consequence of his act -- He may suddenly returns to his insanity state. insane Lucid interval This is the sane period of insane. He may held responsible for his criminal act & it mainly found in mania, melancholia, SDH

Difference between lucid interval in Insanity & head injury Trait Insanity Head injury History Of insanity Head injury Preceding symptoms Insanity Of concussion Following symptoms Insanity Of cerebral irritation & compression of brain Occurrence Frequent Only once

Fugue state The person becomes a wanderer who keeps on moving from place to place in an altered state of mind. He has episodes of amnesia. This stage is seen in depression, schizophrenia and other mental disorders. Twilight states It is state of diminished awareness of acts of relatively short duration of which he has no recollection. Oneirophrenia It is a dream like state which may last for days or weeks. The patient suffers from mental confusion , amnesia, illusions, hallucinations, disorientation and anxiety.

Automatism (automatic behaviour) ØActing without volition ØIt is a conduct that is performed by a person whose consciousness is impaired to such an extent, that he is not fully aware of his actions. ØThere may be no consciousness at all of the actions in question, or there may be awareness that fall below the level of N consciousness. ØFollowed by amnesia Causes - Concussion or cerebral disease, Epilepsy, Alcohol/Drug usage, Hypoglycaemia, During sleep (Somnambulism) MLI - Defence in a criminal charge.

Psychopath It is a personality disorder, where the person has recurrent episode of impulsive behavior, which is not acceptable to social structure. Ø They are neither Insane nor mentally defective Characteristics ØThey always offend against society. Ø Lack of sympathy Ø Behavior not modified by experience & punishment

ØEmotionally cool Ø Incapable to understand the feelings & motivation of other ØThey may have temper outburst, may make verbal or physical attack without sufficient provocation. MLI-: They are criminally responsible for their act.

Mental age Ø Mental development with age Ø I. Q – Intelligent Quotient. Mental age 100 Chronological age Level of intelligence a) Idiot b) Imbecile c) Moron d) Normal e) Genius I. Q range 0— 24 25— 49 50— 69 90— 109 > 140

Psychosis It is a state of mental illness which is characterized by Disorder of behavior being withdrawal from reality Ø Insight – absent Ø Empathy- lacking Ø Contact with reality- lost Neurosis It is a state of mental illness where the patient suffers from emotional or intellectual disorders, but his insights remain intact and the sense of reality also present. Ø No change in personality Ø No disorder of thinking Ø It is the reaction against conflicts & stress in mind.

Difference between psychosis & neurosis Trait Psychosis Neurosis Severity Major Minor Genetic predisposition Present Absent Insight absent Present Contact with reality Lost Present Empathy Lack of empathy Present

Psychosis associated with organic ds Dementia - degeneration of memory, loss of power of judgment Ø senile ->65 yrs Ø pre senile - <65 yrs Ø pseudo dementia- Alzheimer ds Drugs induced psychosis- Ø Barbiturate Ø Amphetamine Ø Cannabis Ø Cocaine Ø L. S. D

Deficiency of vitamins- Ø Cyanocobalamin Ø Niacin GPI- General paralysis of insane Found in meningo vascular syphilis. Epilepsy- It is due to head trauma, tumor or parasitic infestation. Alcoholics- Ø Alcoholic blackout Ø Delirium tremens Ø Alcoholic hallucination Ø Korasakoff’s psychosis Ø Delusion of jealousy.

Classification of mental diseases(WHO 1965) Neurosis Personality disorder a) Anxiety neurosis b) Obsessive compulsive neurosis Psychosis organic Drugs dependence Sexual perversion functional a) Dementia schizophrenia b) Intra cranial inf. c) Metabolic/endocrinal ds. Affective disorder a) Manic depressive psychosis b) Involutional melancholia

ICD-10 BY WHO(1992) CLASSIFICATION OF MENTAL AND BEHAVIOURAL DISORDERS 1. ORGANIC MENTAL DISORDERS DELERIUM, DEMENTIA 2. MENTAL DISORDERS DUE TO SUBSTANCE ABUSE ALCOHOL, COCAINE, CANNABIS 3. SCHIZOPHRENIA, SHYZOTYPAL AND DELUSIONALDISORDERS SCHIZOPHRENIA 4. MOOD DISORDERS(AFFECTIVE) MDP, MANIC DISORDER, DEPRESSION.

5. NEUROTIC, STRESS RELATED AND SOMATOFORM DISORDERS ANXIETY, PHOBIC STATES , OBCESSIVE COMPULSIVE DISORDERS 6. BEHAVIOURAL SYNDROMES ASSOCIATED WITH PHYSIOLOGICAL DISTURBANCES EATING DISORDERS SLEEP DISORDERS SEXUAL DYSFUNCTIONS 7. DISORDERS OF ADULT PERSONALITY AND BEHAVIOUR PERSONALITY DISORDERS

8. MENTAL RETARDATION 9. DISORDERS OF PSYCHOLOGICAL DEVOLOPMENT SPEECH AND LANGUAGE DISORDERS 10. BEHAVIORAL DISORDERS OF CHILDHOOD AND ADOLESENCE HYPERKINETIC DISORDERS TIC DISORDER 11. UNSPECIFIED MENTAL DISORDERS

Functional psychosis. Schizophrenia - Ø Split personality Ø Disorder of thought Affective - MDP Diagnosis of mental diseases 1. Proper history. 2. Signs & symptoms 3. Other lab investigation 4. Observation Mental condition 1. General appearance 2. Talk 3. Speech 4. Writing 5. Behavior 6. Mood 7. Memory 8. Sleep 9. Gait 10. Thought content.

THE MENTAL HEALTH ACT, 1987 Act was passed by the Indian Parliament in 1987. The aims and objectives ØTo consolidate and amend the law relating to mentally ill persons ØTheir better treatment and care, better management of their property, and their overall better protection It changed certain objectionable and stigmatic terms into more acceptable terms

Ø Mentally ill person is defined as a person who is in need of treatment by reason of any mental disorder other than mental retardation [S. 2(l)]

ØEstablishment and maintenance of psychiatric hospitals or psychiatric nursing homes can only be with license [S. 6] which has to be renewed every 5 years [S. 94] ØThe license will be revoked if the hospital is not maintained according to provisions of the Act [S. 11] ØIf hospital is run without license, the penalty is imprisonment of 3 months and/or fine of `200 for first offence, 6 m and/or 1000 for second offence and if hospital is continued to run without license even after that, a penalty of `100 per day [S. 82]

ØRegular inspection of psychiatric hospitals by Inspecting Officers In order to know that psychiatric hospitals are working well and in accordance with the Act, the State Government or licensing authority will appoint an ‘Inspecting Officer’ who at any time can enter and inspect any psychiatric hospital, inspect its records and talk to patients in private. If working of hospital not found satisfactory, he will report to the licensing authority who will take appropriate action [S. 13]

Appointment of visitors and monthly inspection by them ØFor every psychiatric hospital, the Govt shall appoint 5 or more visitors (of these at least one should be a medical officer, preferably a psychiatrist, two should be social workers and two others) [S. 37] ØEvery month three or more visitors will make a joint inspection of every part of the psychiatric hospital and examine every minor admitted as a voluntary patient, and preferably every other mentally ill person admitted [S. 38] ØRegular visits by inspecting officers and visitors ensure that psychiatric hospitals are run smoothly

RESTRAINT OF THE MENTALLY ILL Restraint of the mentally ill refers to lawful restraint of a mentally ill person, who is a danger to himself or others. (A) Immediate restraint (B) Admission in a psychiatric hospital.

[A] Immediate restraint means taking a mentally unsound person into immediate control whose illness has exacerbated acutely, or who has suddenly become violent. There is no specific provision in MHA 1987 for immediate restraint. It is done U/s 81, IPC [act done to prevent other harm] Prerequisites – informed consent of guardian must be obtained. If consent not obtainable for any reason, person can be restrained without consent, but only as long as danger exists. Method – by safely locking up in a room under immediate personal care of attendants.

[B] Admission in a Psychiatric Hospital ØProcedures for admission in a psychiatric hospital have been made so no person may exploit the law. ØIf a person is aggrieved over an unfavorable will made by a relative, he may try to prove him mentally ill by getting him admitted to a psychiatric hospital. ØA criminal may himself get admitted in order to claim benefit of S. 84, IPC

[1] Admission on a voluntary basis ØAny person >18 y who considers himself a mentally ill person and desires to be admitted to any psychiatric nursing home for treatment, may request the doctor in charge for being admitted as a voluntary patient [S. 15]. ØIn case of persons <18 y, request is made by guardian [S. 16].

Procedure The doctor in-charge shall make such inquiry [examination etc]as he may deem fit within 24 h and if satisfied that the applicant or minor requires treatment he may admit him [S. 17] Comments A straightforward procedure. The possibility of patient malingering illness is prevented by doctor himself examining such person. Very few patients are admitted under this law.

[2] Admission under special circumstances [application by relative or friend] If mentally ill person is unable to express his willingness for admission (i) Patient may be admitted for up to 90 days on an application by relative or friend [S. 19(1)] (ii) Application should be on prescribed form (iii) It should be accompanied by certificates from 2 medical practitioners [allopath, homeopath, or ayurveda (S. 2 k)], one of whom should be a Govt doctor (iv) Each doctor should have examined the MIP separately within 10 days prior to application[S. 30] (v) If above certificates are not attached, the doctor in charge may appoint 2 doctors working in the hospital to examine him [S. 19(2)].

[3] Reception order on application Reception order [RO]– means a magisterial order for MIP to be “received”, admitted and kept in hospital. Application by doctor in charge If doctor thinks that treatment is needed for >6 m or detention is needed for patient’s own safety and that of others, he would make an application to magistrate for a reception order [S. 20(2)].

Application by husband, wife or relative ØHusband or wife of patient can make an application to magistrate. ØIf there is no husband or wife or if they are ill or absent or can not make an application for whatever reason, any relative of patient can make an application [S. 20(3)]. ØHe must state why the husband or wife is not making the application. He should also indicate his relationship with the patient, and the circumstances under which the application is being made [S. 20(4)].

ØAll persons making application under this provision [husband, wife, relative] must be >18 y and must have seen the patient within 14 days of making application [S. 20(5)]. ØThe application must be in prescribed form and must be accompanied by certificates from 2 medical practitioners, one of whom must be a Govt doctor [S. 20(6)].

ØEach medical practitioner should examine the patient independently [S. 21(a)] ØThe certificate should state that the MIP is suffering from mental disorder of such a nature and degree that his treatment in the psychiatric hospital is required and that such detention is necessary in the interests of the health and personal safety of patient or for the protection of others [S. 21(b) ].

[4] Reception order on production of mentally ill person before Magistrate [a] Wandering or dangerous mentally ill person ØA police officer in charge of a police station may detain any wandering mentally ill person (WMIP) [who is wandering aimlessly] or dangerous mentally ill person (DMIP) [who is dangerous to himself or others due to his violent behavior][S. 23(1)].

ØThe Police officer would immediately inform him why he is being detained. If WMIP or DMIP is incapable of understanding, their relatives or friends must be informed [S. 23(2)]. ØSuch WMIP or DMIP must be produced before a magistrate within 24 h of detention. The period of journey is not included [S. 23(3)].

ØIn respect of examination - Magistrate shall (a) examine the personally (b) cause him to be examined by a doctor (c) make any other relevant enquiries [S. 24(1)]. ØIn respect of admission – Doctor must certify the person to be mentally ill. ØIf he feels that patient may be malingering and needs sustained observation or there is some other difficulty in on-the-spot diagnosis, he may ask the magistrate to pass a temporary order for detention for observation of a period of up to 10 days [S. 28(1)]

ØIf diagnosis cannot be made during that period, two more such orders can be passed ØThe doctor must make a diagnosis within 30 days [S. 28(2)] ØIf after medical certificate from doctor the magistrate is satisfied of the need of his treatment or for protection of himself or others (a) he may make a RO.

ØIf any relative or friend wants him to be admitted to a particular licensed psychiatric hospital and agrees to bear cost, and doctor in-charge of that hospital consents, an RO for that particular hospital is made. ØIf relative or friends furnishes a bond ensuring that WMIP or DMIP would neither injure himself nor others, and agrees to keep him, the magistrate, instead of making an RO, would hand over such person to the relative or friend [S. 24(2)].

Difference between real & feigned insanity Features True /real Feigned insanity Onset Gradual Sudden Motive Nil Presence of crime Predisposing factors Present Absent Signs & symptoms Uniform Present only when being observed Facial expression Vacant look Frequently changing Insomnia present Absent Exertion Absent Present Habits Dirty Not so Skin & lips Dry Normal Frequent examination Does not mind Resists for fear of detection

[b] Cruelly treated mentally ill person ØPolice officer – may inform magistrate if a MIP is in the custody of relative or guardian, and is being cruelly treated by him [cruelly treated mentally ill person, CTMIP] [S. 25(1)]. ØAny private person – can similarly inform magistrate [S. 25(2)].

ØThe magistrate would call CTMIP, relative who is cruelly treating him and person who is legally bound to maintain such CTMIP [S. 25(3)]. ØMagistrate would order the person who is legally bound to maintain such CTMIP to take his proper care. If he willfully neglects to comply with the order, he can be fined up to `2, 000 [S. 25(4)]. ØIf it appears to magistrate that despite fine etc, the CTMIP would not be properly looked after, he would make an RO, under same procedural guidelines as with WMIP and DMIP above [S. 25(5)].

[5] Discharge of a mental ill person in asylum 1. A voluntary patient must be discharged within 24 hrs of receipt of request for discharge made by the patient himself or by the guardian 2. Admission by application can be discharged by request but it must first be made certain that the patient is fit to be discharged. 3. The O. I. C of psychiatric hospital can order the discharge of any patient, on the recommendation of two medical practitioner one of whom should be a psychiatrist.

4. A relative of a mentally ill person can make an application for his discharge even if he is not fully cured, provided that he is not dangerous to society. 5. A person detained on a reception order can be discharged if a judicial inquisitions finds him of sound mind.

Civil & criminal responsibility of an insane person Responsibility of mentally ill Civil ØManagement of property ØContract ØMarriage & divorce ØAdoption ØCompetency of witness ØValidity of consent ØTestamentary capacity Criminal ØMc Naughten rule ØSection 84 I. P. C ØDurham's rule ØCurren; s rule ØThe Irresistible impulse act ØThe American Law Institute act ØDoctrine of diminished responsibility

Civil responsibility 1. Management of property & affairs of the insane Judicial inquisition regarding alleged mentally ill person possessing property, custody of his person Apply in and management of his property. Court for inquiry To prove the person Is mentally ill or not Court will send the case for medical examination to a psychiatrist & wait for his report regarding the insanity

That the extent of mental illness Whether the person is capable of looking after his property or not Court will decide as follows 1. The court may order for the appointment of guardian to take care him & his property. 2. When the court find that person is mentally ill but he can take care of himself but can not manage his property then it may issue an order for management of his property

3. The court may order to sell the property for the purpose to meet up the expenses. (debt, maintenance, payment of the cost for any judicial inquisition) 4. The manager has no power to mortgage or sell such properties without permission of court. 5. If it is reported that the person has improved or cured then another inquiry by court If court satisfy All the proceeding will be stopped

2. Contracts Only a person of sound mind is competent to contract When is a person said to have sound mind ØIf at the time when he makes the contract, he is capable of understanding it and of forming a rational judgment as to its effect upon his interests ØIf other party can show it did not know the mental condition of the other party, and the contract was fair " Contract may be held valid

If mental illness develops after contract is signed ØContract is valid, until and unless mental illness makes the other party unable to perform service relevant to contract. ØContract can be made during lucid interval ØA sane man, who is delirious from fever or who is so drunk that he cannot understand the terms of a contract or form a rational judgment as to its effect on his interests, cannot contract whilst such delirium or drunkenness lasts

3. Marriage and divorce Ø Either party is incapable of giving valid consent due to unsound of mind. Ø Recurrent attack of insanity or epilepsy. Ø Divorce can be granted if either party prove unsoundness of mind. 4. Adoption Ø Any Hindu male who is of sound mind and is not a minor can adopt a child with the consent of his wife.

5. Government service ØA mentally ill person cannot enter a govt service. 6. Inheritance ØMentally ill person cannot be disqualified from inheritance to any property ØThe situation is less clear if a mentally ill person commits murder.

7. Competency as a witness ØAn insane person is not competent to give evidence. ØBut if he understand the obligation of an oath is competent to give evidence. ØAt lucid interval he can competent to give evidence. 8. Consent is not valid in case of rape, causing death or grievous hurt/MTP 9. Testamentary capacity It is the capacity to make a valid will or it is the mental ability of a person to make a valid will.

Will denotes as a testamentary document. Components 1. An understanding of the nature of will 2. A knowledge of the property to be disposed 3. An ability to recognize those who may be have justifiable claims on the property. Silent points regarding testamentary deposition ØMust in writing ØSigned by the testator in presence of two witness ØAn executor is appointed under the will by the testator to carryout it’s term after his death ØWill can be modified by the testator any time before his death ØThe testator must be of a sound mind, not being minor,

Will is invalid when 1. If it is taken under influence of other person 2. Loss of judgment due to extreme age 3. In excessive drinking state 4. Insanity Will is valid when 1. In lucid interval 2. If testator commit suicide immediately after making the will in the absence of evidence of mental ds. 3. Delusion not affecting any way for disposal of property.

Criminal responsibility of the insane A mentally ill person is not punished for his crime as he devoid of free will, intelligence, and knowledge of the act The murderer Take the plea of mental illness For escape from capital punishment Mc Naughten rule A 29 yrs Scottish had been suffering a delusion of persecution That the party in power were constantly following him, harassing him, planning conspiracy against him

So he decide to kill the Prime minister in power that Sir Robert peel so he made a plan for the crime. He wait from distance of the prime minister residence Suddenly he found that the Prime minister came out with some other officers then he started firing to the P. M but mistakenly he shot his private secretary Henry Drummond In court found him as insane as not guilty by reason of insanity he was sent to Psychiatric hospital for treatment for life.

An accused person is not legally responsible, if it is clearly proved that at the time of committing the crime he was suffering from such a defect of reason from abnormality in mind, that he did not know the nature & quality of the act he was doing or that what he was doing was wrong. Section 84 IPC Nothing is an offence which is done by a person who at the time of doing it, by the reason of unsoundness of mind is incapable of knowing the nature of the act or that he is doing what is either wrong or contrary to law.

2. Durham Rule (1954) “an accused person is not criminally responsible, if his unlawful act is the product of mental disease or mental defect. ” 3. Curren’s Rule (1961) “an accused person is not criminally responsible, if at the time of committing the act, he did not have the capacity to regulate his conduct to the requirements of the law, as a result of the mental disease or defect. ”

4. The Irresistible Impulse Test (New Hampshire Doctrine) “an accused person is not criminally responsible, even if he knows the nature and quality of his act and knows that he is wrong, if he is incapable of restraining himself from committing the act, because of free agency of his will has been destroyed by mental disease. ” 5. The American Law Institute Test (1972) “a person is not responsible for criminal conduct if at the time of such conduct, as a result of mental disease or defect he lacks adequate capacity either to appreciate the criminality of his conduct, or to adjust his conduct to the requirement of the law. ”

Insanity and Murder ØIf the mental disorder impairs the cognitive faculties of the accused, he is not held responsible for his acts. ØIf insanity affects only emotions and the will, but not the cognitive faculties, the person is held responsible for his acts.

Doctrine of Diminished Responsibility ØIf an unlawful act is committed by a person who is suffering from some degree of mental illness, should not be treated like a sane person who committed an unlawful act. ØAccording to this theory, such mentally ill persons have diminished responsibility. ØPunishment for them for commission of an unlawful act should be less.

Responsibility of Intoxicated Persons In Civil cases Ø If any intoxicated person involves in any civil responsibility, then the case will be considered according to the nature of the work and merit of the consequences. In Criminal cases ØAn intoxicated person may not be held responsible for his act, if at the time of commission, due to the effect of intoxication, he did not understand the nature and quality of the act and its consequences and legal position ØIf the person has taken the intoxicating agent on his own and with a mind to perform the criminal act easily, he will be held responsible for its commission.

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