Forensic psychiatry

A POWER POINT PRESENTATION
BY
DR.SANGEETA CHOWDHRY
&
DR.SUNIL SHARMA
UNDER THE GUIDANCE
OF
DR. BHUPESH KHAJURIA
PROFESSOR AND HEAD
DEPARTMENT OF FORENSIC MEDICINE
&
TOXICOLOGY
GOVT. MEDICAL COLLEGE
JAMMU (JAMMU AND KASHMIR)
5/22/2013 1A SUZY PRESENTATION

FORENSIC PSYCHIATRY

When you live in the shadow of insanity, the appearance of
another mind that thinks and talks as yours does is sometimes
close to a blessed event.

When you speak to God it's called praying; but when
God speaks to you it's called schizophrenia.

A man might say that he picked a pocket from some
uncontrollable impulse, and in that case the law would
have an uncontrollable impulse to punish him for it

PSYCHIATRY

PSYCHIATRY:-It is the branch
of medical science which
deals with study, diagnosis,
treatment, prevention of
mental illness and behavioral
disorders.

FORENSIC PSYCHIATRY:-
deals with the application of
psychiatry in the
administration of justice.

INSANITY OR UNSOUNDNESS OF
MIND

INSANITY OR UNSOUNDNESS
OF MIND:- can be defined as a
disease of the mind which
effects the personality,
mental status, critical
faculties, emotional
processes and interaction
with social environment.

MENTALLY ILL PERSON

MENTALLY ILL PERSON:- any
person who is in need of
treatment by reason of any
mental disorder other than
mental retardation.

SOME COMMON PSYCHIATRY
TERMS
Abreaction:-This is a
release phenomenon
where old, forgotten
things or events are
brought into conscious
state again.

ABREACTION

AFFECT
It is commonly called
mood or feeling.

AFFECT

AMNESIA
Loss of memory about a
person or event is called
„amnesia‟.

AMNESIA

APHASIA
Loss of sensory or motor
ability to express by use
of speech or writing is
called „aphasia‟.

BINET-SIMON TEST
It is done to determine
the intelligent quotient
of an individual.

CONFABULATION
Unconscious filling of gaps in
memory by imagining experiences
or events that have no basis in
fact, commonly seen in amnestic
syndrome. 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.

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.

CIRCUMSTANTIALITY

COMPULSION
It is a repetitive behaviour
done by an individual in
spite of knowing that it is
not correct. Examples
being, repeatedly washing
hands, checking locked
premises again and again.

COMPULSION

DELIRIUM
It is an acute reversible mental disorder
characterised by confusion and impairment of
consciousness, disorientation(most
commonly time), emotional lability,
hallucination, or illusion and inappropriate,
impulsive, irrational or violent behavior.
The mental faculty of an individual does not
work properly. It may be seen in high grade
fevers or due to overwork, mental stress,
acute poisoning(dhatura), chronic alcoholics
or drug intoxication.

DELIRIUM

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.

FUGUE STATE

ECHOPRAXIA
Repeating the act of
another

ECHOPRAXIA

EMPATHY
The degree to which the
observer is able to enter
into the thoughts and
feelings of the patient
and establish good
contact.

EMPATHY

NEGATIVISM
Doing just the opposite of
what he is asked to do.

NEURASTHENIA
A condition arising out of
physical or mental
exhaustion.

NEURASTHENIA

PHOBIA
IS AN EXCESSIVE
IRRATIONAL FEAR OF A
PARTICULAR OBJECT
OR SITUATION.

PARANOIA
Rare psychiatric syndrome marked
by the gradual development of a
highly elaborate and complex
delusional system, generally
involving persecutory or
grandiose delusions, with few
other signs of personality
disorientation or thought disorder.

PARASUICIDE
It is a conscious often
impulsive, manipulative act,
undertaken to get rid of an
intolerable situation.
(attempted suicide or
pseudicide)

PARASUICIDE

STUPOR
Used synonymously with mutism
and does not necessarily imply a
disturbance of consciousness; in
catatonic stupor, patients are
ordinarily aware of their
surroundings.

STUPOR

TWILIGHT STATE
Disturbed consciousness of short
duration with hallucination during
which the patient may carry out
actions of which he has little or
no subsequent memory.

VEGETATIVE SIGNS
In depression, denoting
characteristic symptoms,
such as sleep
disturbance(especially early
morning awakening),
decreased appetite,
constipation, weight loss and
loss of sexual response.

VEGETATIVE SIGNS

PSYCHOPATH
psychopath is a person who is neither
insane nor mentally ill, but fails to
conform to the normal standards of
behavior. It refers to individuals who
have psychopathic personality. They
are usually antisocial and have long
criminal records. They have no
remorse feeling and are not amenable
to counseling. Some of them have
extra Y chromosome in their
chromatin.

PSYCHOPATH

ONEIROID STATES
It is a dream like state which
may last for days or weeks.
the patient suffers from
confusion, amnesia, illusions,
hallucination, disorientation
agitation and anxiety.

ONEIROID STATES

NEUROSIS AND PSYCHOSIS
Neurosis is when a patient suffers from
emotional or intellectual disorders
which causes subjective distress, but
does not lose touch with reality.
Psychosis is characterised by gross
impairment in reality-testing(with
drawl from reality), as if living in a
world of fantasy.

NEUROSIS PSYCHOSIS

PSYCHOSIS
Psychoses are usually of the following two
types:
1. Manic-depressive Psychosis: It is
expressed in following two phases:
(a) Mania phase: In this, the person is very
active, full of life, talking too much,
mostly irreverent, the mood is elated and
he does some action continuously. But he
does not have touch with reality. He can
commit any crime during this phase.
Sleep is very less. Appetite is also less.

PSYCHOSIS
(b) Depressive phase: It is just the reverse
of mania. The person is very sad, mood is
depressed. The person sits alone and may
speak very little. Touch with reality is not
there. He may commit suicide. The motor
functions are also quite depressed. A
person suffering from manic depressive
psychosis may fluctuate between the two
phases of mania and depression. It may
be possible that the person may be
normal between the two phases of mania.
This may be lucid interval and the person
is completely responsible for his actions.

NEUROSIS
Neurosis is a minor mental illness. It is of
following types:
1. Anxiety Neurosis: It is a very common
variety. The person remains anxious about
future events, relationships and
individuals. His pulse rate may be high,
blood pressure raised, respiratory rate
high and he may be sweating. He may be
restless, confused and apprehensive.
Treatment usually involves counseling and
use of anti-anxiety drugs
• like diazepam. Meditation also helps a lot.

NEUROSIS
Depression: It is the reverse of anxiety.
Here, a person would be aloof, sad and
withdrawn. His motor activities would
be quite less. He may have a low
appetite and may not eat well.
However, in chronic cases of
depression, the person may keep on
eating the whole day, while withdrawn
at home and hence may gain weight.
The following are the types of
depression commonly seen:

NEUROSIS
Reactive depression: It may be due to
some event or situation like the death
of spouse or a near one, failure in
exam, love, etc. It usually remains
there for sometime. Some form of
reactive depression is seen in all
individuals. Usually, with counseling
and use of anti-depressive drugs, most
come out of it.

NEUROSIS
Endogenous depression: It is more
serious as its etiology is not known
and develops slowly. Early morning
awakening, loss of appetite and mood
depression are quite common. This
depression may be associated with
psychosis too, where it carries a bad
prognosis. Usually with anti-depressive
drugs, most of the individuals recover.

NEUROSIS
Puerperal depression: A woman who has
recently delivered may have depression
commonly called „puerperal depression‟.
She may even kill her infant during this
time.
(d) Involution depression: During the age
group of 50–60 years, depression may set
in. Delusion of hopelessness and
unworthiness may be present. Due to
development of hypertension, diabetes or
somatic illness, person may get into
depression. Counseling, along with drugs
is very useful.

NEUROSIS
Hypochondriacal depression: In this type of
neurosis, the person usually complains of
vague aches and pains and may keep on
visiting many physicians but of no avail.
Usually no treatment is effective.
3. Obsessive-compulsive Neurosis: As described
earlier, obsession is a foolish thought which a
person knows but cannot avoid. But once this
thought turns into action, it is called
compulsion and may lead to obsessive-
compulsive neurosis. Common examples are
repeated washing of hands to remove dirt,
continuous checking of already locked
premises, etc.

NEUROSIS
Hysterical Neurosis: It is usually seen in
females where there may be convulsions
or stoppage of breath. Tonic and clonic
convulsions are reported. It should always
be differentiated from epilepsy, which it
can be confused with. In hysterical
neurosis, the person will never get hurt or
bite the tongue, as it is seen in epilepsy.
Some cause or intention can be found out
in hysterical neurosis while in epilepsy
usually no cause is found. Hysterical
neurosis can be treated with counseling
or correction of the underlying cause

DIFFERENCE BETWEEN NEUROSIS AND
PSYCHOSIS
S.NO FEATURE PSYCHOSIS NEUROSIS
1 Contact with
reality
lost Preserved
2 Interpersonal
behavior
Marked disturbance in reality
and behavior
Preserved
3 Empathy Absent Present
4 Insight Absence of understanding
current symptoms
Symptoms are
recognised as
undesirable
5 Organic causative
factor
Present absent
6 Symptoms Delusions. Illusions and
hallucinations
Usually physical or
psychic symptoms
7 Dealing with
reality
Capacity is grossly reduced Preserved
8 Examples Dementia, Schizophrenia Anxiety, phobia,
depression,
conversion
disorder

SOMNAMBULISM
• This is also called „sleep walking‟. A
person may move around while asleep
and may commit some crime or theft,
and then come back normally. He may
not be aware that he has committed a
crime.
• He will not be held responsible if it is
proved that he has done this act while
asleep.

5/22/2013 A SUZY PRESENTATION 71
SOMNAMBULISM

COMMON SYMPTOMS OF
PSYCHIATRIC DISORDERS
Delusion
Hallucination
Illusion
Impulse
Obsession

DELUSION-
DELUSION IS A FALSE BELIEF IN
SOMETHING WHICH IS NOT A FACT,
AND THE BELIEF PERSISTS EVEN
AFTER ITS FALSITY HAS BEEN
CLEARLY DEMONSTRATED.

TYPES OF DELUSIONS
GRANDEUR OR EXALTATION
PERSECUTION(PARANOID)
REFERENCE
INFLUENCE
INFEDILITY
SELF-REPROACH
NIHILISTIC
HYPOCHONDRIAL
OTHER TYPES

DELUSION OF GRANDEUR OR
EXALTATION
The person imagines that he is very
rich, powerful, while in reality he
may be a pauper and may squander
away his money or property. It is
usually seen in mania, and may be
associated with delusion of
persecution.
This is a pleasant delusion.

DELUSION OF GRANDEUR OR EXALTATION

DELUSION OF
PERSECUTION/PARANOID
The person imagines that people are
after him and may kill him, poison
him(wife, sons or parents) or harm
him, or someone is going to rob his
property. The person remains
suspicious and depressed and may
commit some crime. ( He may commit
suicide or kill his family members or
innocent person thinking him/her to be
his enemy.)

DELUSION OF PERSECUTION/PARANOID

DELUSION OF REFERENCE
The person believes that everybody
is thinking about him only and is
being referred by all agencies,
media and persons around him in all
matters(usually of negative nature)
and this may put him in conflict with
the world.

DELUSION OF REFERENCE

DELUSION OF
INFLUENCE/CONTROL
The patient complains that his
thoughts processes, feelings and
actions are being influenced and
controlled by some external power,
like radio, hypnotism or telepathy.
On the basis of this imaginary
“command”, he may commit an
unlawful act.

DELUSION OF INFLUENCE/CONTROL

DELUSION OF INFEDILITY/JEALOUSY-
OTHELLO SYNDROME
In this, the person thinks that his/her
spouse is not loyal to him/ her.
Usually, males suffer more from this
delusion as compared to females.
The person may commit crime in
this state.

DELUSION OF
INFEDILITY/JEALOUSY-OTHELLO
SYNDROME

DELUSION OF SELF-REPROCH OR
SELF-CRITICISM
The person criticises himself for
some imaginary offence or misdeed
committed by him in the past. In
serious cases, the person may
punish himself by committing
suicide.

DELUSION OF SELF-REPROCH OR SELF-CRITICISM

NIHILISTIC DELUSION
In this, the person does not believe
in his existence or that the world
exists. They may commit suicide or
kill others.
It is commonly seen in depression.

HYPOCHONDRIAL DELUSION
The person in this delusion thinks
that he is ill always, while medically
he may be completely fit. He keeps
on visiting doctors. Usually the
person gives vague abdominal
complaints.

HYPOCHONDRIAL DELUSION

SOME OTHER - DELUSIONS
SOME OTHER - DELUSIONS

DELUSION OF POVERTY
The patient is convinced that he is,
or will be, bereft of all material
possessions.

DELUSION OF POVERTY

DELUSION OF DOUBLES
(DOPPELGANGER)
Patient believes that another person
has been physically transformed into
themselves.

DELUSION OF DOUBLES
(DOPPELGANGER)

EROTOMANIA
In this, a women thinks that a particular
person, especially superior, is in deeply love
with her. The erotomanic develops an
obsession for the person and starts believing
that the other person is reciprocating
The object is usually of a higher status, famous
superior at work but can also be a complete
stranger.
The erotomanic tries to get in close to the
person through telephone calls, e-mails,
letters, gifts and visits. More common in
women than in men.

DELUSION OF REPLACEMENT OF
SIGNIFICANT OTHERS(CAPRAS SYNDROME)
Patient believes that someone close
to him has been replaced by a exact
double.

DELUSION OF REPLACEMENT OF SIGNIFICANT
OTHERS(CAPRAS SYNDROME)

DELUSION OF DISGUISE(FREGOLI‟S
PHENOMENON)
Strangers are identified as familiar
people in the patient‟s life.

DELUSION OF DISGUISE(FREGOLI‟S PHENOMENON)

FOLIE A DEUX
Mental illness shared by two
persons, usually involving a common
delusional system.

FOLIE A DEUX

COTARD DELUSION/SYNDROME
Person holds a delusional belief that
he/she is dead, does not exist. Is
putrefying or has lost his blood or
internal organs.

COTARD DELUSION/SYNDROME

PSEUDOLOGIA FANTASTICA
This is a variation of Munchausen‟s
syndrome in which a person feels
convinced that he is seriously ill and
keeps on visiting many doctors in
vain.

PSEUDOLOGIA FANTASTICA

MEDICO-LEGAL IMPORTANCE
The doctrine of diminished
responsibility is applicable to an
insane person who does an unlawful
act due to delusion, which reduces his
power of reasoning and understanding
capacity, e.g. If he commits some act
which is not directly related with the
effect of delusion, but has indirect
bearing, such a person cannot be
regarded as fully responsible for his
illegal acts. ( Section 84 IPC)

HALLUCINATION
It is a false sensory
perception which manifests without any external
object or stimulus.
They may occur in :-
Schizophrenia
Affective disorders
Organic mental disorders
They are also seen in insanity and conditions,
like
High fever
Drug intoxication
Withdrawal from drug addiction

HALLUCINATION

TYPES OF HALLUCINATION
VISUAL
AUDITARY
OLFACTORY
GUSTATORY
TACTILE
PSYCHOMOTOR
LILLIPUTIAN
SYNESTHESIA

VISUAL
HALLUCINATION
The person may see lights or images or scenes. The
patient experiences non –existent sights. He
observes something without any being present. A
person sees a plane in the sky when there is none.
Such hallucinations are quite common in
schizophrenia, epilepsy and drug withdrawal
syndromes.
Visual hallucination may be of following types:-
Elementary type:-person sees only flashes of light.
Partly organised:- person sees as patterns or
unformed images.
Completely organised:- person sees as images,
figures or image of people, animal or object.

VISUAL
HALLUCINATION

AUDITORY
HALLUCINATIONS
False perception of sound, usually noises, but
also music. Here, the person hears voices of
known or unknown persons without any source.
They are quite common in schizophrenia. In some
cases a person hears a command from God or
Satan to do certain acts which may land up the
person in conflict with law. They are also referred
as COMMAND HALLUCINATIONS.
Elementary type:-person hears only noises.
Partly organised:- person hears only music.
Completely organised:- person hears
hallucinatory voices.

AUDITORY HALLUCINATIONS

OLFACTORY
HALLUCINATIONS
Hallucination primarily involving
smell or odors. There is false
sense of smelling (pleasant/
unpleasant/sweet/sour/bitter)
without any source. They are felt
in schizophrenia and temporal
lobe epilepsy.

OLFACTORY HALLUCINATIONS

GUSTATORY
HALLUCINATIONS
Hallucinations involving taste.
Without any food or drink, the
patient experiences different
taste.

GUSTATORY HALLUCINATIONS

TACTILE/HAPTIC
HALLUCINATIONS
They are hallucinations of abnormal
touch. They are commonly seen in
cocaine addiction where bugs or rats
seems to be creeping in layers of
skin.(Formication)
Some patients experiences feeling of
cold winds blowing on them or
sensation of heat present over skin;
actually things are not present.

TACTILE/HAPTIC HALLUCINATIONS

LILLIPUTIAN (MICROPSIA)
HALLUCINATIONS
In this a person perceives objects
to be of a much smaller size than
they actually are.

LILLIPUTIAN (MICROPSIA) HALLUCINATIONS

PSYCHOMOTOR/KINESTHETIC
HALLUCINATION
There is feeling of movement of a
part of the body, say a limb, though
in reality, there is no such
movement.

PSYCHOMOTOR HALLUCINATION

SYNESTHESIA HALLUCINATION
A stimulus perceived by a sensory
organ other than the one that
should actually perceive it. e.g.
visualising music, hearing
different colours, etc.

SYNESTHESIA HALLUCINATION

SOME COMMON FACTS ABOUT
HALLUCINATIONS
Visual hallucinations are the commonest in organic
mental disorders (delirium tremens)
Auditory hallucinations in functional (non-organic)
disorders (schizophrenia)
Gustatory hallucinations in temporal lobe epilepsy
Olfactory hallucinations in medical disorders (especially
in the temporal lobe)
Tactile hallucinations in cocainism
Auditory hallucinations are the commonest followed by
visual
Hallucinations are not under voluntary control and a
person suffering from unpleasant hallucinations may be
incited to commit suicide or homicide

ILLUSION
It is false interpretation by the
senses of an external object or
stimulus which has real existence.
Optical illusions are quite common
in deserts where water may be
seen at places. A rope may be seen
as a snake at night.

ILLUSION

TYPES OF ILLUSIONS
(a) Completion illusion: Where an
unfinished pattern is completed by
illusion.
(b) Affect illusion: In this, mood of the
person affects the nature of illusion.
(c) Parabolic 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.

Completion illusion

Affect illusion

Parabolic illusion

IMPULSE
This is defined as a sudden and
irresistible force which compels a
person to do some action without
motive or forethought, a normal
person always tries to analyse his
actions whether they are consistent
with law or not. Once he realises
that his action may be contrary to
law he stops it. But in impulse, a
person is not able to control himself.

SOME COMMON TYPES OF
IMPULSES
• (a) Kleptomania: An irresistible desire to steal things usually
of low value.
• (b) Pyromania: An irresistible desire to set things on fire.
• (c) Mutilomania: An irresistible impulse to maim animals.
• (d) Dipsomania: An irresistible impulse to drink at periodic
intervals.
• (e) Sexual impulses: All sexual perversions.
• (f) Homicidal impulses: To kill some persons.
• (g) Suicidal impulses: To commit suicide. Impulses are quite
commonly seen in various mental disorders like depression,
• schizophrenia, mania, etc.
• (h) Trichotillomania: It is an irresistible desire to pull out
one‟s own hair
• (i) Oniomania: compulsive desire to shop (shopping
addiction)

KLEPTOMANIA

PYROMANIA

MUTILOMANIA

DIPSOMANIA

SEXUAL IMPULSES/SEXUAL PERVERSIONS

SUICIDAL IMPULSES

TRICHOTILLOMANIA

ONIOMANIA

OBSESSION
An obsession is defined as a persistent and
irresistible thought, image, affect or
impulse that cannot be removed by the
sufferer although he knows that this is
foolish. He continues to suffer. When this
converts into action, it is called
„compulsions‟. The person keeps on
repeating foolish behaviour though realising
that it is untrue. Normal persons also
sometimes have obsessions but they
overcome them over a period of time. But
once it becomes pathological, it may turn
into obsessive compulsive neurosis

COMMON EXAMPLES OF
OBSESSION
1. The person may keep on
checking the locks even though
he knows that he has bolted
them well.
2. The person may keep on
washing hands for hours.

SCHIZOPHRENIA
Eugen Bleuler introduced this term.
Literally it means disintegration of
mind. Commonly also called „split
personality‟. There is a complete loss
of reality.
The exact reason of schizophrenia is not
known but it runs in families.
Schizophrenia is a major illness. It is
quite common in the lower strata of
society.

SCHIZOPHRENIA

SYMPTOMS
Diagnostic symptoms as proposed by
Bleuler are summorised as :-
(They are also called as 4 „A‟ of Bleuler
1. Ambivalence-inability to decide for or
against
2. Autism-withdrawal into self
3. Affect disturbances-disturbance of
feeling
4. Association disturbance-loosening of
association, thought disorder

AMBIVALENCE

AUTISM

AFFECT DISTURBANCES

ASSOCIATION DISTURBANCE

TYPES OF SCHIZOPRENIA
Simple schizophrenia: It is the
commonest type. It mainly affects
the mood of the person. He
remains depressed, talks very
little and is withdrawn. The motor
activities are quite less.

SIMPLE

Hebephrenia: In this type, the
thought process is primarily
deranged. Incoherence of
thoughts, delusions and
hallucinations are reported. The
motor activities are also quite
less.

HEBEPHRENIA SCHIZOPRENIA

Catatonic: In this type, the behaviour
of the person is primarily abnormal.
There is a wild excitement and
violent and abusive behaviour.
Homicidal and suicidal tendencies
are very high. The person may
assault someone on minor
provocations. Sometimes, the
person may be so violent that he
needs to be restrained by force.

CATATONIC SCHIZOPRENIA

Paranoid schizophrenia: Suspicion is the
primary thought process in this type. The
person may be thinking that some persons
are behind him and can kill him. He may
have suspicion about his wife, parents,
kids, friends and colleagues. It occurs more
in males than in females. Delusions are very
common. Usually, personality is well
preserved and these people are detected as
suffering from mental illness after a long
time. Auditory hallucinations are quite
common. He may commit crime as he
thinks people are after him.

PARANOID SCHIZOPHRENIA

INSANITY
The word “insane” has no technical meaning and is
commonly used to refer to individuals who cannot take
care of themselves or adhere to the social fabric, due
to some mental disorder. It refers to individuals who by
virtue of being mentally ill, are not competent to
discharge their legal duties and are not aware of the
legal implications of their behaviour. In the Indian
Penal Code, the phrase „unsoundness of mind‟ is used
as synonymous to terms such as insanity, lunacy,
madness or any mental disorder where a person is not
capable of regulating his behaviour according to the
socio-legal system.
A medical officer is often called upon to opine whether a
person is insane or not. He should not opine in a
hurried manner, instead he should examine the person
in detail and then express his opinion.

CAUSES OF INSANITY
Heredity: Insanity often runs in
families. The exact reason is not
known. Usually, most of the
mental diseases are not
transmitted genetically but it has
been observed that mental illness
runs in families.

CAUSES OF INSANITY
Environmental Factors: If during the early years of
childhood, the upbringing of a child is not taken well
care of, there are chances of developing mental
illness. Attitude of both parents is very important in
shaping good personality. Over protection, rejection,
unnecessary peer comparison, or sibling rivalry can
cause maladjustment in a child. Emotional
maladjustment is quite common in adolescent
period. A good sex education is very essential for
adolescents to fashion their personality according
to the social fabric. In adults, domestic quarrels,
financial and business losses, failure in love, death
of near ones, unemployment and job pressures can
precipitate mental illness.

CAUSES OF INSANITY
Organic Causes: Head injuries like cerebral
haemorrhages, high fever and epilepsy may
induce mental disorder. Addiction to
alcohol, opium and dhatura may induce
violent behaviour. Addiction to severe
narcotics like heroin, cocaine and LSD may
cause anti-social behaviour, and the person
may commit crime. In severe, systemic
diseases like uncontrolled hypertension,
diabetes or other debilitating diseases, the
person may land up in depression.

ONSET OF INSANITY
The onset of insanity is gradual.
The person may be brought to the
medical officer for treatment. In
some cases the person may
malinger to avoid punishment. So,
the medical officer has to decide
whether insanity is true or false

Differentiate between and a true insane person
and a person who is pretending to be an insane
S.NO. FEATURES TRUE INSANE FEIGNED INSANE
1. Onset & Motive Usually gradual or rarely sudden but
almost always without any motive.
Always sudden and there is
some motive.
2. Predisposing/exciting
cause
May be present, like h/o insanity in
parents
Not present.
3. Facial expression There are usually a peculiar
characteristic facial expressions like
worried look, agitated
Normal or easily
distinguishable.
4. Signs & Symptoms The true insane individual shows signs
and symptoms of insanity irrespective
of his conduct being observed or not.
A false insane will show signs
of insanity only when he is
observed and there is total
absence of symptoms when he
thinks that he is alone or not
being watched.
5. Characteristic
feature
Sign and symptoms usually point to a
particular type of insanity. ( e.g.
schizophrenia, mania, Bipolar disorder
etc)
A non insane person will do
whatever comes in to his mind
and his signs and symptoms
don't indicate a particular type
of insanity.
6. Effect of violent
exertion
Can stand violent exertion for
several hours or days without
exhaustion, perspiration or sleep.
Violent exertion leads him
to relaxation, exhaustion
and sleep.

Differentiate between and a true insane person
and a person who is pretending to be an insane
S.NO. FEATURES TRUE INSANE FEIGNED INSANE
7. Mood Excited, depressed or fluctuating May over react to
show abnormality
in mood
8. Habits Habits are invariably dirty or filthy.
He may smear his body with stool or
urine.
Habits are not
usually dirty or
filthy.
9. Physical
manifestation
Dry harsh skin, furred tongue,
constipation, anorexia (loss of
appetite)
Not present
10. Repeated
examination
Not worried about being repeatedly
examined
Shows dislike for
repeated
examinations.
11. Insomnia Present Cannot persist,
patient usually
sleeps after a day
or two
12. Dressing up Carelessly dressed Dressed
reasonably
properly5/22/2013 171A SUZY PRESENTATION

CLASSIFICATION OF MENTAL
DISEASES
The classification of mental diseases is done according
to two well-accepted methods which are as follows:
1. DSM IV: This is an American system. It stands for
Diagnostic and Statistical Manual of Mental Disorders,
IVth edition 1994.
2. ICD-10: It means international classification of
diseases, injuries and cause of death, 10th edition,
1992. ICD-10 classification is more popular and is
followed worldwide.
The following is the classification of mental diseases
according to the World Health Organisation:

DISEASES
1.Psychosis (Major Illness): It may be of following
types:
(a) Organic psychosis: When there is an organic cause
associated with psychosis, it is called „organic
psychosis‟. Common examples are alcoholic psychosis,
psychosis following head injury, endocrine
disturbances, old age, epilepsy, drug dependence, etc.
(b) Functional psychosis: In this, there is no apparent
cause of psychosis. It is of following types:
(i) Schizophrenia.
(ii) Manic-depressive illness.
(iii) Paranoid state.

DISEASES
2. Neurosis (Minor Illness): The following are the
common types of neurosis:
(i) Anxiety neurosis.
(ii) Depression.
(iii) Hypochondriacal.
(iv) Obsessive compulsive neurosis.
(v) Hysterical neurosis.
3. Personality Disorders as in Psychopaths.
4. Sexual Perversions.
5. Drug Dependence.

MENTAL RETARDATION
"Mental retardation refers to
significantly sub average general
intellectual functioning existing
concurrently with deficits in
adaptive behavior, and manifested
during the developmental period".

MENTAL HANDICAP
It refers to mental sub normality in
an individual, acquired at the time
of birth or early childhood.
Intelligent quotient is low.
It is usually of the following types:

IDIOCY
Here, I.Q. level is around 20. The person
is mentally retarded severely. He may
be associated with some other genetic
problems too. He may need physical
and mental rehabilitation to lead a
normal life. Usually, idiots remain
cheerful as their achievement goals
are almost absent and they can lead
their life easily on a survival basis.

IMBECILE
Their I.Q. level is between 20 and 50.
They are incapable of managing their
affairs themselves. They also require
physical and mental rehabilitation by a
therapist to lead a normal life.

FEEBLE MINDEDNESS
Their I.Q. level is between 50 and 75. They
appear normal but their mental faculties,
especially intelligence, is less as compared
to a normal person. They are usually school
dropouts. They do not fare well in academic
and financial career. They may get easily
involved in criminal activities

CLASSIFICATION OF MR
Level of Retardation IQ
Mild retardation
50-69
Moderate retardation
35-59
Severe retardation 20-34
Profound retardation
< 20

PSYCHOSIS

THE MENTAL HEALTH ACT, 1987
An Act to consolidate and amend
the law relating to the treatment
and care of mentally ill persons,
to make better provision with
respect to their property and
affairs and for matters connected
therewith or incidental thereto.

THE MENTAL HEALTH ACT, 1987
It replaces the Indian Lunacy Act of 1912
resulting in change of certain terminologies
as shown below
 Asylum to psychiatric hospital
 Lunatic to mentally ill person
 Criminal lunatuc to mentally ill prisoner
The mental health act came into affect only in
April 1993 in all the states and union
territories of India.

OBJECTIVES OF THE ACT
 Regulate admission of the mentally ill patient
to a psychiatric hospital or psychiatric
nursing home and to protect his rights while
under detection
 Prevent harm to himself and the society by
the mentally ill person
 Protect citizens being detained in psychiatric
hospitals without sufficient cause.
…………….cont…………..

OBJECTIVES OF THE ACT
 Fix liability for maintenance charges of mentally ill
patient admitted to the hospital or nursing home.
 Provide facilities to establish guardianship or
custody of the mentally ill patient and management of
his property.
 Establish central and state authority for mental health
services
 Provide licensing and control of psychiatric hospitals
by the state government
 Ensure legal aid to the mentally ill person at state
expense in certain cases

MENTAL DISORDER AND
RESPONSIBILITY
Responsibility, in the legal sense,
means the liability of a person for
his acts or omissions, and if these
are against the law, the liability to
be punished for them.
The law presumes that every
person is mentally sound, until
the opposite is proved.

CIVIL RESPONSIBILITY
The question of civil responsibility arises in
following conditions:-
 Management of property and affairs
 Insanity and contracts
 Insanity and marriage contract
 Competence of insane to be a witness
 Consent and insanity
 Insanity and testamentary capacity

MANAGEMENT OF PROPERTY
AND AFFAIRS
 If a person who owns property becomes insane and is
incapable of managing his affairs with sound judgment, a
relative or friend can approach the court for judicial
inquisition. The medical evidence is given in the form of a
certificate which should state “that insanity is of such a
degree as to make him incapable of managing his property.”
 On enquire if it‟s found that the person is incapable of
managing his property the court can appoint a guardian or
manager depending on the circumstances.
 The court may order the sale or disposal of the person‟s
property, for the payment of his debts and expenses.
 The court may order a second inquisition, if it‟s reported that
unsoundness of mind had ceased.

BUSINESS CONTRACT
 If it is proved that at the time of signing a contract one
of the two parties was insane, then the contract
becomes legally invalid.
 Insanity developing subsequently to a legal agreement
will not necessarily invalidate the contract.
 If at the time of signing, the fact that one of the
signatories to the contract was insane was not known
to the other party, the contract may not be declared
invalid.
 For the purpose of a contract, a person is said to be of
sound mind if at the time of making the contract, he is
capable of understanding it and forming a rational
judgment.

MARRIAGE
A marriage is considered invalid if at the time
of marriage, either party is
1) Incapable of giving valid consent due to
insanity.
2) Though capable of giving valid consent,
has been suffering from such kind or degree
of mental disorder as to be unfit for marriage
or procreation.
3) Has been suffering from recurrent
attacks of insanity.

THE COMPETENCE OF INSANE
TO BE A WITNESS
 An insane person is not competent to give
evidence, if he cannot understand the
necessity of telling the truth due to insanity.
 A person of unsound mind who suffers from
delusions, but is capable of telling what he
has seen and who understands the
importance of an oath, is competent to give
evidence
 An insane person is competent to give
evidence during the lucid interval.

CONSENT AND INSANITY
Consent to certain acts like, sexual
intercourse or hurt is not valid, if
such consent is given by a person
who due to unsoundness of mind
is unable to understand the nature
and consequences of the act.

TESTAMENTARY CAPACITY
 Testamentary capacity refers to the capacity of a
person to make a valid will. The law defines it as
possession of a sound disposing mind (corpus mentis)
which must be certified by a doctor.
 A will is a document detailing the disposition of
property owned by a person, which is prepared by him
during his lifetime but takes effect only after his
demise.
 The person who makes the will is referred to as the
testator.
 Will written by the testator in his own handwriting is
called “Holograph will”.
 It can be revoked or changed any number of times

ELIGIBILITY FOR MAKING A
WILL
As per Indian succession act 59, the following persons
are eligible to make a valid will
 Every person of sound mind who is over age of 18
years
 An insane person cannot write a valid will unless he is
in a lucid interval.
 An intoxicated person cannot make a will, unless it is
certified by a doctor that he was under his senses
 A deaf dumb or blind person can make a will if he can
communicate effectively
 Convicts are not debarred from making a will.

PROCEDURE
 The will must always be in writing, the only exception
provided under law is for members of the armed forces who
are out on expedition or engaged in warfare. They can make
an oral will (privileged will). Muslims are permitted to make
an oral will by their personal law.
 There is no particular format for a will. It need not be even
on a stamp paper. The testator can write a will himself using
a fountain or ball pen (holographic will). The will must be
attested by at least 2 witnesses, neither of them can be
beneficiaries.
 It is preferable that one of them should be a doctor.
 The signature or thumb impression of the testator is
mandatory
 The will comes into effect only on the death of the testator.

CONDITIONS
 The person making a will should
 Have a sound disposing mind
 Have thorough knowledge about his
wealth and property
 Be free from undue influence, or fraud
 Do it voluntarily

CRIMINAL RESPONSIBILITY OF
THE INSANE
MCNAUGHTON'S RULE
In 1843, one person named McNaughton, under delusion of
persecution shot dead Mr. Drummond, the private secretary
of Sir Robert Peel, Prime Minister of England. In fact, he
wanted to kill Sir Robert Peel but since he could not identify
him properly, he shot dead Mr. Drummond by mistake. He
was later arrested and sent to prison. Since he was insane
and there was no English law at that time to fix criminal
responsibility of an insane, a committee of 14 judges were
constituted to frame law which resulted in “McNaughton's
Rule” or “Legal Test” according to English law which states
as follows:
……cont…

THE INSANE
That to establish a defense on the ground of
insanity, it must be clearly proved that “at the
time of committing the act, the accused was
laboring 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 he was
doing what was wrong.”
…..cont…………..

THE INSANE
In India, Section 84 of the I.P.C. defines the legal test or
criminal responsibility of the insane, as:
“Nothing is an offence which is done by a person who, at
the time of doing it, by 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.”
Section 85 of the I.P.C. defines legal responsibility of a
person under intoxication. If it is proved that a person
was given intoxication without his knowledge or
against his will, and due to intoxication he lost mental
reasoning and then committed the crime, he will not
be held responsible for it. Drunkenness caused by
voluntary use of alcohol or drugs offers no excuse for
committing the crime.

Loss of Self-control or Sudden and Grave
Provocation
Sometimes, a person may lose self-control, or
there is sudden and grave provocation, and as
a result, he may commit crime. Common
situation is that, if a person sees his wife
teased by goons, he may lose self-control and
may kill any goon. In such cases doctrine of
partial responsibility is used and the murder
may be charged the under Section 304 of the
I.P.C. rather than Section 302 of the I.P.C.
Section 304 the of I.P.C. prescribes less
sentence as compared to Section 302 of the
I.P.C.

LOSS OF SELF-CONTROL OR SUDDEN AND GRAVE
PROVOCATION

HYPNOSIS
It is also a sleep-like stage, indeed
by suggestion. But it is very
difficult to convince a person in
hypnosis to commit some act
which he would not do in normal
circumstances. It is a wrong
impression that a person may
commit murder under
• hypnosis.

SOME RECENT GUIDELINES
One of the major defects in the McNaughton's Rule, is
that, from deciding that a person is insane, only
cognitive (intellectual) faculties are taken into
consideration, where as emotional factors,
hallucination and the ability of the individual to control
the impulse (resistible impulse) are not considered. So,
these neurotic disorders are not given any importance.
Some western countries have taken this into
consideration and have formulated some guidelines.
Some of them are known as:
 Durham Rule (1954)
 Curren‟s Rule (1961)
 American Law Institute Test. (1970)
 The Brawner rule (1972)
 The Irresistible impulse

DURHAM RULE (1954)
The Durham rule states that an accused is not criminally
responsible if his unlawful act was the product of
mental disease or mental defect. The Durham rule was
eventually rejected by the federal courts, because it
cast too broad a net. Alcoholics, compulsive gamblers,
and drug addicts had successfully used the defense to
defeat a wide variety of crimes.
The federal insanity defense, established by the
Comprehensive Crime Control Act, now requires the
defendant to prove, by "clear and convincing
evidence," that "at the time of the commission of the
acts constituting the offense, the defendant, as a
result of a severe mental disease or defect, was
unable to appreciate the nature and quality or the
wrongfulness of his acts".

CURREN‟S RULE (1961)
An accused person will not be held criminally
responsible, if at the time of committing act,
he did not have the capacity to regulate his
conduct to the requirement of law, as a result
of mental disease or defect.
As per Curren‟s rule, it was contested that, at
the time of committing the criminal act, a
person may have the knowledge that what he
was doing was wrong but he neither had the
capacity nor the will to control (adjust) his
act. Therefore such person should not be held
responsible.

AMERICAN LAW INSTITUTE
TEST. (1970)
A person is not responsible for his
criminal conduct if at the time of
such conduct as a result of
mental disease or defect, he lacks
substantial capacity either to
appreciate the wrongfulness of
his conduct or to adjust his
conduct to the requirement of
law.

THE BRAWNER RULE (1972)
According to this rule,
insanity should be decided
by a jury. Under this
proposal, juries are
allowed to decide the “
insanity question” as they
see fit.

IRRESSISTABLE IMPULSE
An accused person is not criminally
responsible, if he knows the nature and
quality of his act and knows that it is wrong,
if he is incapable of restraining/control
himself from committing the act because the
free agency of his will has been destroyed by
mental disease.
In 1994. Lorena Bobbitt was found not guilty of
a crime, when her defense argued that an
irresistible impulse led her to cut off her
husband‟s penis.

213
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