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Nineteenth-century treatments for mental illness reflected physicians' understanding of the moral and physical causes of insanity. Like other nineteenth-century physicians, CSH doctors tailored treatment to address both the moral depravity and the underlying physical pathology of their patients. In hopes of altering the patients' physiological and mental state, CSH physicians administered liberal doses of narcotics, stimulants, emetics, and purgatives. A few exceptional superintendents, such as William Fletcher, demanded that the medical staff limit severe drug treatment to the worst cases and reduce the dosage of milder drugs for the masses of patients. Unfortunately, Dr. Fletcher's reforms in the early 1880s were often ignored by his successors.



While Dr. Fletcher and his nineteenth-century collegues may have debated the merits of drug treatment, they did not debate the merits of moral therapy. CSH annual reports, prescription books, and patient histories illustrate the overwhelming support for moral therapy in both medical and political circles. Today, the notion of "moral therapy" conjures up images of wealthy philanthropists forcing their values and beliefs on the poor. In the context of Central State Hospital, this assertion rings true; moral treatment at CSH typically entailed impressing middle-class and protesant work ethics and mores on patients, most of whom were poor or struggling.



There were practical as well as ideological reasons for physicians' espousal of protesant and middle-class values. For most of the nineteenth century, physicians did not have the political or economic clout they have today. As a result, physicians attempted to curry the favor of politicians and their powerful constituents, in hopes of garnering financial support for their hospitals. To do this, physicians couched moral treatment in acceptable middle-class and upper-class terms. For CSH physicians, who were mostly middle-class and protesant, this did not require a large ideological leap.



In the early 1800s, middle-class values were synonmous with older, protesant beliefs that emphasized hard work and an orderly, religiously conservative lifestyle in an agricultural setting. Thus, in the nascent years of CSH, patients were encouraged to work on the hospital farm and were required to lead quiet, orderly lives separate from the chaotic world outside. This form of therapy also fit nicely into prevailing theories of insanity: if social, political, and economic freedoms were causing insanity, then it logically followed that severly limiting freedom in the context of the asylum would cure mentally-ill patients.



By the second half the nineteenth century, however, a new, burgeoning middle-class, the nouveau riche, redefined its values to include behaviors and beliefs that were beneficial to industrial capitalism.



And, now, the stakes were even higher: segments of the new middle-class were not only powerful and wealthy, but also embraced a reformist zeal and philanthropic spirit that far exceeded that of earlier generations. It became all that more important for CSH physicians to pander to middle-class reformers and philanthropists who were searching for a charitable outlet for their money and enthusiasm.



To prove their commitment to the new middle class values, CSH physicians attempted to engender in their patients a certain discipline and value system that fostered an industrial work ethic. Healthier patients were required, not encouraged, to follow strict work schedules, that included producing garment piece work and other products that could be sold to outside factories. In the early twentieth century, CSH instituted an "occupational therapy" program that entailed patients working with hand/foot operated machines to create products for no compensation. A few decades later, CSH built a cannery for patients, indicating that the hospital's full integration into the industrial world had been achieved. Importantly, the work therapy program served another equally imperative function: it provided additional moneys to supplement unreliable state funding that ebbed and flowed with the changing political tides.

Regulated work, however, was not enough. A "well-regulated" diet, a highly "regimented" morning and evening schedule, the reading of wholesome books from the hospital's "selected library", and the partaking in "mild and innocent amusements" were sure cures for mental illness and a sure way of inculcating white middle-class mores. In retrospect, the living conditions at CSH may seem overly oppressive and the motives of the physicians questionable, but this highly structured environment did offer solace to many patients, particularly in a period when few other cures existed.



f the moral universe of CSH was not sufficient to modify behavior, detention, physical restraints, and "baths" were used. Medical attendants employed cold and hot "baths" to calm patients, to force them into submission or to punish them. Attendants confined more violent patients to their beds or to holding chairs with mechanical restraints. Still others, the worst cases, were confined to the dark, dungeon-like basements of the hospital.

Many of the more harsh treatments fell out of vogue in the 1880s and '90s as compassionate superintendents and reformers, like William Fletcher and Nellie Bly, and physicians imbued with the scientific spirit, like CSH superintendent George Edenharter, pushed for change.

“My first treatment was medicine to try to strengthen my nerves. The personal influence of my doctor induced me to exert my will, but any good effect was but temporary. The next thing tried was cutting the clitoris but it grew again. The relief from this lasted only six weeks. I tormented the doctors to operate again, but they were afraid it would kill me.” (Morrison, 1885, p. 535)



This excerpt comes from an 1885 article in the Philadelphia Medical Times, which reprinted the letter of a woman describing her symptoms, diagnoses and treatments to her doctor. Printed alongside the letter, the doctor describes her as suffering from nymphomania and hysteria, among other difficulties.

What stands out strongly in her own narrative is the active role that she took in her own treatment: She researched her symptoms and sought physicians who would perform the treatments she desired. Even more surprising is that she requested various sexual surgeries.

The gynecological claim on female insanity

At the time, sexual surgeries were thought to relieve both the physical and mental symptoms associated with these organs. For instance, a procedure known as “Battey’s operation,” in which a woman’s healthy ovaries were removed, was performed to induce menopause, thus negating the ill effects of monthly menses. Clitorectomies — the act of removing a portion of or the entire clitoris — were also performed to give women relief from urges, temptations and “inappropriate” sexual desires.

Male sex organs were also subjected to sexual surgeries, including castration. These somatic treatments for psychological ailments brought the emerging professions of gynecology, neurology and alienism (the precursor to psychiatry) together in an uneasy relationship during the 19th century.

Regardless of the profession, the prevailing mode of treatment was to search for the site of a person’s “insanity” (the term for mental illness at the time): Alienists were known to perform autopsies on the bodies of their deceased patients to look for tumors, cysts or discolorations in the brain or body; gynecologists associated some mental symptoms with the sex organs; neurologists focused on regulating the nerves. Although each profession focused on different causal agents in the body, the rising trend in the second half of the 19th century was to think of insanity in an embodied manner.

Despite the focus on the body, insanity was not generally believed to affect one sex more than the other. However, because male and female sexual organs are different, a small subset of disorders were thought to be sex-specific, or to affect one sex more often than the other. For instance, men were considered to be more likely than women to fall victim to insanity as a result of masturbation. Conversely, women were believed to be at greater risk for hysteria than men. Moreover, only women could suffer from ailments such as “menstrual madness” or those associated with childbirth, such as “puerperal insanity.” Some symptoms, too, were specific to one sex or the other: a woman’s feeling that her womb was “wandering,” for example.

Sexual surgeries, while actively promoted and performed by some professionals, remained controversial even during the peak of their popularity in the second half of the 19th century. Some considered the practice to be a process of de-sexing that was no better than castration. Still, hundreds of operations were performed. Perhaps more so than other treatments for insanity, these procedures revealed the tensions among the developing professions of gynecology, alienism and neurology.

The role of patients

By the end of the 19th century, however, sexual surgeries had largely gone out of vogue. In 1888, the American Gynaecological Society officially condemned the use of Battey’s operation as a treatment for insanity. This shift in practice allowed the treatment of insanity to fall chiefly to alienists and neurologists. However, to view the rise and fall of sexual surgeries purely in professional terms misses the contributions of yet another group of actors: the patients.

In historical discussions of treatments, particularly sexual surgeries, it can sometimes seem as though patients were passive victims. However, as was depicted in the opening quotation, some actively researched available treatments and sought out the physicians most likely to give them their desired result. Sexual surgeries were no exception — some women suffering from a variety of symptoms sought out these invasive procedures, while others refused them. The important question then becomes: Why?

To gain insight into why patients selected one treatment over another, a number of factors need to be considered, including the relationship between patients and their physicians during the 19th century; the status of medicine and related professions; the role of politics, the law and shifting societal norms; the influence of friends or family; and the intersections of gender, race, class and other social categories on patient decision-making. This process was very individual and certainly varied depending on which combination of factors influenced the particular person most.

Patients sought out sexual surgeries because, from within their own personal context, they seemed to be the best treatment options available to them. Appreciating the complexities of situations such as these gives new insights not only into psychology’s past, but also into how modern-day psychology interacts with its consumers. Listening to these rare patient narratives, such as the one quoted at the beginning of this article, can thereby inform both historical research and current practice.

Throughout the course of history mankind's treatment of the insane has been, well, insane! While the day-to-day care of patients could be cruel, attempts at curing them could be even crueler. Everything from medieval chiseling of the skull to "let the devil escape" to the 1940's ice-pick lobotomies of Dr. Walter Freeman. In 1276, then Pope John XXI, who wrote several medical treatises, suggested that eating a roasted mouse "doth heal frantick persons." In the 16th Century it was believed that stones in the head caused madness. This belief is perpetuated in the oft-heard cliche "rocks in the head." Dr. Benjamin Rush (1745-1813), a pioneer of early American psychiatry, recommended relentlessly swinging the patient around to "shake out" the madness. And as the short era of moral treatment introduced by Dr. Philippe Pinel gradually faded from sight and the politics of forced treatment once again reared it's ugly head, novelist Charles Dickens wrote: "Chains, straw, filthy solitude, darkness and starvation; jalap, syrup of buckthorn, tartarised antimony and ipecacuanha administered every spring and fall in fabulous doses to every patient, whether well or ill; spinning in whirligigs, corporal punishment, gagging, continued intoxication; nothing was too wildly extravagant, nothing too monstrously cruel to be prescribed by mad-doctors." Perhaps no single group has undergone more widespread experimentation than the destitute "mentally-ill" in state-run institutions. A hit-movie recently filmed at an abandoned state hospital in the city of Danvers, Mass. (Session 9), reveals the severity exacted by it's patients. Surgical tables and eerie artifacts left over from more than a century of treating "the mentally-ill" have been left as they were at the hospital, which was abandoned in 1992. Cast and crew members were overwhelmed by the buildings disturbing aura. Said one crew member: "the walls there are very sad, full of hurt, it's not a place that you take lightly."



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"There Are Some Remedies Worse Than The Disease!" (Publius Syrus, First Century B.C.)



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The Spiritual Key to the Psyche: Nick Jouvanis, the author of this book delves into the often overlooked importance of the soul (or psyche) in the process of recovery and healing. It is often stated that a healthy mind leads to a healthy body (and vice-versa), but the soul has been discarded as a non-entity. While debate over the existence of the soul has gone on for centuries, it is this debate that gradually evolved into and gave birth to modern-day psychology. Have we come full-circle and has the time come for psychiatry to return to it's roots?



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Dr. Daniel Oxenbridge (1576-1642) a London physician, employed the latest methods in 1628 when trying to cure the young wife of a clothier. First he gave her an enema, then he bled her arms, her feet, and her forehead. After that, "once every three or four days, I either bled her or vomited her strongly." He then shaved off all the hair on her head to which he "applied the warm lungs of lambs, sheep and young whelps..."



Dr. Jan Baptista van Helmont (1577-1644) a Flemish physician, argued that water shock - to the brink of near death - could extinguish a mad person's "too violent and exorbitant form of fiery life." Dr. Jan Baptista discovered this cure by observing that "many fools who accidentally fall into water and are dragged out for dead are not only restored to life... but also to the full use of their understanding." Even American physicians experimented with the merits of this European cure. A Delaware physician, writing in an 1802 medical journal, told of the dousing therapy he'd utilized while treating an insane man confined at home. Another American physician who used this form of treatment was a Dr. Willard, who ran a private asylum in a small town near the border of Massachusetts and Rhode Island. Dr. Willard's technique was described by Isaac Ray, a prominent 19th century psychiatrist: "Dr. Willard had a tank prepared on the premises into which the patient, enclosed in a coffin-like box with holes, was lowered by means of a well-sweep. He was kept there until bubbles of air cease to rise, then was taken out, rubbed and revived." The idea was that if the patient was nearly drowned and then brought back to life "he would take a fresh start, leaving his disease behind." (Changing Faces of Madness: Early American Attitudes & Treatment of the Insane)



French and British doctors experimented with the transfusion of sheep's blood into their patients... hoping that the life force of a docile creature "might tame their mad passions." In France, Dr. Jean Denis tried it on a patient, with, at first, good results. In England, on November 23rd, 1667, an "insane" man named Arthur Coga was paid twenty shillings to undergo the transfusion, receiving up to twelve ounces of blood from the four-footed beast. "Some think it may have a good effect upon him as a frantic man by cooling his blood," wrote famed diarist Samuel Pepys. Following the transfusion Pepys noted that, "he is a little cracked in his head, though he speaks very reasonably." In January of the following year, back in France, Dr. Denis performed another transfusion on his patient because he'd had a "mental relapse". The patient died and Dr. Jean Denis was accused of murder. Sheep transfusion fell out of vogue shortly thereafter.



Dr. Benjamin Rush (1745-1813) is sometimes called the father of American psychiatry, however, what's conveniently overlooked in tributes to him is that he also drained buckets of blood from those he treated and was sometimes accused of killing more patients than the illness itself. Dr. Rush believed that a physician should try to bring his patients under control by the sheer power of his will, and if that didn't work, to use such devices as a strait-jacket, the tranquilizer chair, cold water, cold air, forcing a patient to stand erect for an extended period of time and blood-letting from 20 to 40 ounces of blood at one time which he believed was wonderful for calming mad people. (Please note that blood makes up 7% of the human body. A person who weighs 100 pounds has seven pounds of blood, which is 2.2 quarts or 69 ounces. If you remove just one quart of blood or 32 ounces, you effectively remove 46% of the person's total blood volume.) He put his best hope for a cure in "swinging." Dr. Rush argued that mental patients should be strapped into gyration devices suspended from the ceiling by chains, and that attendants should swing and spin them for hours. He believed that the spinning would reduce the force of the blood flowing into the brain, thereby relaxing the muscles and lowering the pulse.



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"I HAVE SWORN UPON THE ALTAR OF GOD ETERNAL HOSTILITY AGAINST EVERY FORM OF TYRANNY OVER THE MIND OF MAN!" Thomas Jefferson



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1. DR. BENJAMIN RUSH'S "TRANQUILIZER CHAIR" (1811)





The most complete restraint of a patient's every move ever devised. 2. A board attached to the back of the chair which is made to rise and fall according to the height of the patient. To the end of the board is attached: 3. A wooden box lined with stuffed linen in which the patient's head is held immobile so it cannot move backward or forward, nor incline to either side. 4 and 5. Chest and belly bands, made of flat pieces of strong leather, which confine and limit the body's movement in the chair. 6. Strong leather bands which confine the arms and hands of the patient to the arms of the chair, thereby limiting their movement. 7. Pieces of wood which protrude slightly from the chair to which the patient's feet are confined, so as to prevent their moving in any direction. 8. A stool-pan (half-filled with water) attached so as to be drawn out from behind the chair and emptied and replaced, without removing or disturbing the patient. The chair is fastened to the floor so as to remain stationary. (Three Hundred Years of Psychiatry 1535-1860)



Dr. Franz Josef Gall (1758-1828): This is a chapter in the history of psychiatry that is often overlooked and rarely acknowledged, but deserves mention because Dr. Gall's classification of mental faculties is a precursor to the present-day Diagnostic and Statistical Manual of Mental Disorders (the DSM). Dr. Gall was the founder of a branch of psychiatry known as Phrenology, a term which was derived from the two Greek words for mind and discourse. After an extensive study of the brain Dr. Gall came to the conclusion that its various regions were correlated to specific mental functions. He reported that the concentration of fiber clusters indicated the degree of development pertaining to a particular mental faculty and that the outer conformation of the skull could be measured to make specific diagnoses. A phrenological chart sectioning off areas of the brain was drawn by Dr. Gall identifying the various talents, propensities and character traits. According to Dr. Gall, he was just a schoolboy when he first noticed that the most outstanding scholars were those with "prominent eyes and, even more significantly, certain peculiarities in the shapes of their heads, the shapes caused by variations in the development of certain areas on the surface of the brain." After graduating from the university, Dr. Gall spent several years visiting schools, prisons, and lunatic asylums, where he studied, felt, and measured hundreds of skulls. Calling his system a "scientific form of divination" (comparable to the present-day scientific prediction of human behavior), he used calipers to discover whether or not a patient had an "underdeveloped organ of benevolence" or an "overgrown organ of theft." Early phrenologists classified the bumps on the head into twenty-six divisions, and read character according to how well or how poorly the bumps were developed (O.S. Fowler listed 42 divisions). For example, a large bulge in a particular area of the skull would signify a sensual nature, an underdeveloped one would signify coldness.



According to Professor O.S. Fowler, leading American phrenologist: "Phrenology was discovered and established by induction. This is proven by the entire history of this science as a whole and of each particular organ and faculty. No part of it rests on theory. In all its parts and details it is wholly a matter-of-fact science." Today the science of phrenology is cleverly categorized as a psychic art - rather than what it was actually designed to be - a psychological art. Professor Fowler's The Practical Phrenologist notes the following testimonials in favor of phrenology: "As far as twelve years' observation and study entitle me to form any judgement, I not only consider Phrenology the true science of the mind, but as the only one that, with a sure success, may be applied to the education of children and to the treatment of the insane and criminals." C. Otto, M.D., Professor of Medicine at the University of Copenhagen. "I candidly confess that until I became acquainted with Phrenology, I had no solid foundation upon which I could base my treatment for the cure of insanity." Sir William Elles, M.D., Physician to the Lunatic Asylum, Middlesex, England. (The Practical Phrenologist: A Compendium of Phreno-Organic Science, by O.S. Fowler, 1869)



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Between 1906 and 1917, psychiatrist Giuseppe Paravicini dissected patients at the Mombello Provincial Mental Health Center in Italy and sawed off their body parts, including heads, arms and ears. In 1980, the extremely well-preserved bodies of people who had been mummified, apparently some while still alive were discovered, along with the head of a woman, an aborted fetus, brains, kidneys, lungs, legs, arms and ears. ("Il Secolo", Milano, Italy, Feb. 12th, 1980)



Dr. Henry Cotten (1886-1933), acting on his theory that infections caused mental illness, surgically removed "potentially infected" body parts. "The insane are physically ill," he stated, arguing that if a doctor could locate and remove the infection, he could abruptly stop the lunacy. From this initial site of infection, he reasoned, bacteria could spread through the lymph or circulatory systems to the brain, where it "finally causes the death of the patient or, if not that, a condition worse than death - a life of mental darkness." (Journal of Dental Research 1, 1919, The Relation of Oral Infection to Mental Diseases) Between 1919 and 1921 - Dr. Cotton ordered 11,000 teeth removed from his patients at Trenton State Hospital in New Jersey and if the patient wasn't cured by his dental work, the doctor surgically removed parts of the stomach, bowels and/or genitalia. "It was awful to work there", recalled one hospital employee. "There was a young girl who worked in the office right by the door where they had to roll the baskets past that carried the bodies and organs and stuff. One day she ran out screaming that she couldn't take it any longer." Dr. Cotten had killed more than 100 patients with his intestinal surgeries alone. The mortality rate among those treated by Dr. Cotten hit 43%!



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Damaging the Brain to Cure the Patient



According to Galen the ancient Greeks sometimes applied an electric eel to the body to numb pain, or to the head to alleviate headaches. The Greek word for electric eel was "narka", hence the word "narcotics", meaning drugs that numb the pain. In the 18th century Benjamin Franklin, who sustained two electric shocks himself, inflicting minor retrograde amnesia, suggested "trying the practice on mad people." So in 1787, Dr. John Birch, a British doctor, did just that, trying to cure a popular but suicidal singer suffering from depression. The more modern pioneer in this field was the Italian doctor Ugo Cerletti who in 1938 noticed that workers in a slaughterhouse used electric shock to send pigs into convulsions in order to make killing them easier. This is what electroshock "therapy" does to humans. It generates a severe grand mal convulsion of long duration through the application of 180 to 460 volts of electricity across the brain (hence Electro-Convulsive Therapy or ECT), frequently inducing amnesia. During the first World War an electric shock box was designed for use on German soldiers who were afraid to fight on the battlefield. Since it's inception, it's very design was a means of discipline used to enforce the honor demanded of German soldiers. With this instrument it was not uncommon for German soldiers to be killed, not by the war, but by electro-convulsive electrocutions.



Between 1939 and 1941, Nazi doctors produced a film called "The Mentally-Ill" which presented the pros and cons of electroshock and gassing procedures. Incredibly, this film details the false notion of curing "the mentally-ill" with electroshock and proposes gassing them to death as the only other alternative. Following a series of shock treatments at the Mayo Clinic in 1960 and 1961, Ernest Hemingway lamented: "It was a brilliant cure - but we've lost the patient!!!" One month after his final shock treatment and a few days after being released from the clinic, Hemingway committed suicide. In the introduction to "The History of Shock Treatment", psychiatrist Dr. Lee Coleman said of ECT: "The changes one sees when electroshock is administered are completely consistent with any acute brain injury such as a blow to the head from a hammer. In essence, what happens is that the individual is dazed, confused and disoriented, and therefore cannot appreciate current problems." In 1970, as he recalled the first time he had performed ECT on a human being, Cerletti remarked to a colleague: "When I saw the patient's reaction, I thought to myself, this ought to be abolished!" While some psychiatrists still deny that electroshock causes irreversible brain damage and memory loss, neurologists and anesthesiologists empathically disagree. Studies between 1979 and 1991 revealed abnormal neurological signs following electroshock, as well as brain atrophy and enlarged ventricles. This procedure is still practiced today as a form of involuntary treatment.



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"A hundred and fifty years ago a well-recognized shock treatment method was to flog or frighten the patient, and in some instances the results were excellent. Now we do it electrically and we get about the same percentage of good results, but with some breaking of bones and memory losses which frightening and flogging never produced. Memory losses in modern shock therapy may be passed off as infrequent, limited and temporary - but they are really frequent, they cannot be limited, and they are usually permanent. I have heard doctors laugh about them as they laugh about other things in mental patients, but the losses are serious to the patients themselves. And along with such losses go changes in general intelligence and personality, but when these changes are too obvious to be overlooked they are ascribed to the mental illness with no mention at all of the treatment." (John Maurice Grimes, M.D., "When Minds Go Wrong", 1954)



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The history of the treatment (or lack there of) of the mentally ill in the United States is a checkered one. The first colonists blamed mental illness on witchcraft and demonic possession, and the mentally ill were often imprisoned, sent to alms houses, or remained untreated at home. Conditions in these prisons were appalling. In 1841, Dorothea Dix volunteered to teach a Sunday-school class for women prisoners; she was outraged by the conditions she witnessed. Dix went on to become a renowned advocate for the mentally ill, urging more humane treatment-based care than that given to the mentally ill in prisons. In 1847 she urged the Illinois legislature to provide “appropriate care and support for the curable and incurable indigent insane.” In 1851, Jacksonville Insane Asylum, where Elizabeth Packard was later confined, was opened.



Beginning in the late eighteenth century “moral treatment” had become the prevalent school of treatment in the United States. Replacing the model of demonic possession, “moral treatment” hypothesized that insanity was caused by brain damage from outward influences on the soft and fragile brain. Removing patients to an appropriate environment where they could indulge in clean, healthy living, and would be offered exercise, work, education and religious instruction, was thought to facilitate their cure.



But the “moral treatment” method was riddled with problems. As doctors and other hospital personnel grew frustrated by their lack of progress and a shortage of willing qualified staff, conditions often deteriorated. Faced with overcrowded hospitals, and concerned about the rise of the spiritualist movement (which some attributed to the “moral treatment” method), many superintendents resorted to physical restraints. By the middle part of the century, heredity also was considered a root cause of mental illness. Many in the field believed that weak family and vices, like alcoholism and masturbation, could lead to madness. The mentally ill were considered “genetically inferior” and eugenics and warped interpretations of Darwin’s theories suggested that mental illness could be eliminated through social engineering.



By the 1880s the tide was turning against asylums, thanks to stories of their poor conditions, some true, some sensational, appearing in the press. Greater oversight and medical standards for asylums were implemented. New theories promoted by neurologists included “rest cures” and treatment using static electricity. By the close of the century, Freud’s theories began to arrive in America, precipitating a revolution in psychiatry.

Insanity, craziness or madness is a spectrum of behaviors characterized by certain abnormal mental or behavioral patterns. Insanity may manifest as violations of societal norms, including becoming a danger to themselves and others, though not all such acts are considered insanity. In modern usage insanity is most commonly encountered as an informal unscientific term denoting mental instability, or in the narrow legal context of the insanity defense. In the medical profession the term is now avoided in favor of diagnoses of specific mental illness such as schizophrenia and other psychotic disorders. When discussing mental illness in general terms, "psychopathology" is considered a preferred descriptor.



In English, the word "sane" derives from the Latin adjective sanus meaning "healthy". The phrase "mens sana in corpore sano" is often translated to mean a "healthy mind in a healthy body". From this perspective, insanity can be considered as poor health of the mind, not necessarily of the brain as an organ (although that can affect mental health), but rather refers to defective function of mental processes such as reasoning. A Latin phrase for "sane" is "compos mentis" (lit. "of composed mind"), and a euphemistic term for insanity is "non compos mentis". In law, mens rea means having had criminal intent, or a guilty mind, when the act (actus reus) was committed.



Madness, the non-legal word for insanity, has been recognized throughout history in every known society. Primitive cultures turned to witch doctors or shamans to apply magic, herbal mixtures, or folk medicine to rid deranged persons of evil spirits or bizarre behavior, for example. Archaeologists have unearthed skulls (at least 7000 years old) that have small round holes bored in them using flint tools. It has been conjectured that the subject may have been thought to have been possessed by devils which the holes would allow to escape.

However, more recent research on the historical practice of trepanation supports the hypothesis that this procedure was medical in nature and intended as means of treating cranial trauma.

In ancient Israel it was held that disturbances of the mind or emotions were caused by "supernatural forces" or an angry God, as a punishment for sin or failure to follow the commandments. The Old Testament is replete with references to kings and commoners that go insane, and the Jewish prophets were thought to be psychologically abnormal because they acted in strange ways, departed markedly from the norm in appearance, and foretold of future events that few understood.

The Greeks replaced concepts of the supernatural with a secular view, believing that afflictions of the mind did not differ from diseases of the body. They saw mental and physical illness as a result of natural causes and an imbalance in bodily humors. Hippocrates frequently wrote that an excess of black bile resulted in irrational thinking and behavior.



Romans made further contributions to psychiatry, in particular the precursor to contemporary practice. They put forth the idea that strong emotions could lead to bodily ailments, the basis of today’s theory of psychosomatic illness. The Romans also supported humane treatment of the mentally ill, and to support such codified into law the principle of insanity as a mitigation of responsibility for criminal acts, although the criterion for insanity was sharply set as the defendant had to be found "non compos mentis", a term meaning with "no power of mind".



The Middle Ages, however, witnessed the end of the progressive ideas of the Greeks and Romans.

During the 18th century, the French and the British introduced humane treatment of the clinically insane, though the criteria for diagnosis and placement in an asylum were considerably looser than today, often including such conditions as Speech disorder, speech impediments, epilepsy and depression.

Europe's oldest asylum is the Bethlem Royal Hospital of London, also known as Bedlam, which began admitting the mentally ill in 1403. The first American asylum was built in Williamsburg, Virginia, circa 1773. Before the 19th century these hospitals were used to isolate the mentally ill or the socially ostracized from society rather than cure them or maintain their health. Pictures from this era portrayed patients bound with rope or chains, often to beds or walls, or restrained in straitjackets.



In medicine



Wikinews has related news: Dr. Joseph Merlino on sexuality, insanity, Freud, fetishes and apathy

Insanity is no longer considered a medical diagnosis but is a legal term in the United States, stemming from its original use in common law. The disorders formerly encompassed by the term covered a wide range of mental disorders now diagnosed as organic brain syndromes, schizophrenia, bipolar disorder and other psychotic disorders.



Legal use of the term



Main article: Insanity defense

In United States criminal law, insanity may serve as an affirmative defense to criminal acts and thus does not need to negate an element of the prosecution's case such as general or specific intent. The States differ somewhat in their definition of insanity but most follow the guidelines of the Model Penal Code. All jurisdictions require a sanity evaluation to address the question first of whether or not the defendant has a mental illness.

Most courts accept a major mental illness such as psychosis but will not accept the diagnosis of a personality disorder for the purposes of an insanity defense. The second question is whether the mental illness interfered with the defendant's ability to distinguish right from wrong. That is, did the defendant know that the alleged behavior was against the law at the time the offense was committed.

Additionally, some jurisdictions add the question of whether or not the defendant was in control of their behavior at the time of the offense. For example, if the defendant was compelled by some aspect of their mental illness to commit the illegal act, the defendant could be evaluated as not in control of their behavior at the time of the offense.

The forensic mental health specialists submit their evaluations to the court. Since the question of sanity or insanity is a legal question and not a medical one, the judge and or jury will make the final decision regarding the defendant's status regarding an insanity defense.

In most jurisdictions within the United States, if the insanity plea is accepted, the defendant is committed to a psychiatric institution for at least 60 days for further evaluation, and then reevaluated at least yearly after that.

Insanity is generally no defense in a civil lawsuit. However, in civil cases, the insanity of the plaintiff can toll the statute of limitations for filing a suit until the plaintiff has recovered from this condition, or until a statute of repose has run.



Feigned insanity



Feigned insanity is the simulation of mental illness in order to avoid or lessen the consequences of a confrontation or conviction for an alleged crime. A number of treatises on medical jurisprudence were written during the nineteenth century, the most famous of which was Isaac Ray in 1838 (fifth edition 1871); others include Ryan (1832), Taylor (1845), Wharton and Stille (1855), Ordronaux (1869), Meymott (1882). The typical techniques as outlined in these works are the background for Dr. Neil S. Kaye's widely recognized guidelines that indicate an attempt to feign insanity.

One particularly famous example of someone feigning insanity was the case of Mafia boss Vincent Gigante, who pretended for years to be suffering from dementia, and was often seen wandering aimlessly around his neighborhood in his pajamas muttering to himself. However, testimony from informants and surveillance showed that Gigante was in full control of his faculties the whole time, and ruled over his Mafia family with an iron fist.

Today feigned insanity is considered malingering. In a 2005 court case, United States v. Binion, the defendant was prosecuted and convicted for obstruction of justice (adding to his original sentence) because he feigned insanity in a Competency to Stand Trial evaluation.