The intersection of mental illness, crime, and law has fascinated observers of the courts, among them legal and medical historians and sociologists. Heinous crimes, often involving brutal murders of family members by those closest to them, left in their wakes communities asking why and looking for a motive or a reason. For legal historians, these extreme cases allow for an examination of the question of criminal intent, or mens rea, and the ways in which judges and jurors have defined responsibility and exceptions from it. Joel Peter Eigen’s study of the medical testimony involving “mad-doctors” has resulted in his publication of three monographs on the subject. The third in this trilogy, Mad-Doctors in the Dock, seeks to answer a seemingly simple question about the diagnosis of homicidal mania, tracing its medical and legal origins, and demonstrating how it became an accepted explanation for crime. As Eigen points out, the law approached issues of guilt or innocence as a binary, while “psychiatric testimony, on the other hand, was all about degrees; shadings of impairment” (172). Conflicts between these two systems of understanding and their vocabularies unfolded in the courtroom. While at the beginning of the period under examination judges and legal authorities resisted using the crime as evidence of insanity and therefore as a pathway to excuse, Eigen’s book demonstrates that there was consensus about the diagnosis of homicidal mania by the beginning of the twentieth century. To source his analysis, Eigen returns to the Old Bailey Sessions Papers, a tantalizing and rich set of trial transcripts from London’s central criminal court. The book covers the period from the first appearance of a mad-doctor at a trial, in 1760, until the Papers ceased publication, in 1913. Medical men, who included physicians, apothecaries, and surgeons, did not face an easy task as they brought their evidence to court. In the first place, they faced the challenge of claiming an authority, expertise, and observational acuity that was by no means considered unique to them. In fact, until the doctors appeared in court in the mid-eighteenth century, evidence about insanity had been delivered by neighbors, family, and friends—those most familiar with the defendant. Those witnesses sought to prove that the defendant’s crime was the result of an ongoing (though perhaps episodic or interrupted) condition. They testified about their observations and experiences, often arguing that the defendant had suffered some sort of diminished mental capacity or episodes of insanity prior to the crime. In physicians’ quest to professionalize themselves, they claimed to find underlying psychological pathologies, hidden and masked from the view of laypersons, made visible to doctors because of their medical training. An appeal to science and objectivity was central to their presentations in court despite their appearance on behalf of one of two sides in the adversarial process. The other constraint on mad-doctors was the law that exculpated insanity if the condition rendered its victim unable to distinguish right from wrong. But it was the jury’s task to assign responsibility for a crime, and the legal authorities, most often embodied by the presiding judges, guarded this as a role that belonged only to the jury. Eigen shows the co-constituted nature of law and medical testimony. The development of the adversarial trial in the eighteenth century allowed for defense attorneys in the courtroom, and the expansion of policing led to the state’s appointment of surgeons in police divisions as well as of prison and jail doctors who saw the defendants at the time of the crime or as they awaited trial. The growth of the apparatus of the state meant more medical witnesses. The rules of the courtroom shaped the innovative diagnoses made by physicians and the evidence brought to support their findings—ultimately serving the purposes of the law (168). The book begins with an overview of the criminal trial, explaining that with the introduction of defense attorneys in the mid-eighteenth century, the trial expanded, as did the sort of witnesses brought, the kinds of questions pursued, and the kinds of evidence found admissible. Chapter 2 provides a summary of the vocabulary of mental states and the psychological diagnoses most commonly made in the late eighteenth and early nineteenth centuries, including melancholia, mania, and delusion; chapter 3 lays out the different medical practitioners, their training, and the ways in which they might interact with a defendant accused of a crime. While chapters 4 and 5 examine new diagnoses that took shape over the course of the nineteenth century, chapter 6 focuses on homicidal mania. This diagnosis is important because it called on the crime as evidence of insanity, thereby excusing the crime with the crime. Chapter 7 pans back to the judge and his role as arbiter between the traditional definition of insanity, which stressed cognitive impairment, and the new medical diagnoses, which fixed on impaired volition and unrestrained impulses as the explanations for crime. The book is well written, and the evidence from the Old Bailey trials will be compelling to a wide audience. But Mad-Doctors raises as many questions as it answers. The sources include thousands of cases from the Old Bailey, as well as legal commentary and medical literature. What of the other influences and forces at play? Beyond a gesture to Charles Darwin’s On the Origin of Species (1859) and very general references to cultural anxieties and preoccupations with degeneration and social deviance, there is no sustained examination of the larger cultural and historical contexts that shaped the world views of the physicians, their patients, friends, and neighbors, or the judges and jurors, and of how these influences found their way into the courtroom. Nonetheless, by bringing together legal and medical history, the book makes an important methodological contribution to historiographies that do not always engage each other directly. The analysis of interlocking medical and legal discourses and of the effects that they had on each other reveals that neither is an isolated system of thought. The book will be a valuable resource for scholars interested in the history of legal insanity as well as for those interested in broader questions related to responsibility. © The Author 2018. Published by Oxford University Press.
The American Historical Review – Oxford University Press
Published: Feb 1, 2018
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