Homicidal Insanity, 1800-1985

10. The Phenomenology of Homicidal Insanity

The Phenomenology of Homicidal Insanity 10 From the beginning of the nineteenth century to the 1980s, physicians believed that mental disorder could make people dangerous . At first, insane homicide was associated with insanity as a unitary disease; then, as a more critical clinical empiricism evolved, the profession associated homicide with only certain types of disorders. Although notions about the essential nature of mental illness changed amid the scientific and cultural changes over the past two centuries, doctors have maintained a remarkable intersubjective agreement about homicidal insanity. Throughout almost two hundred years, psychiatrists conceived of mental disorder as having predominantly intellectual, emotional , or volitional features. The early classifications of the French and British clinicians were squarely founded upon a faculty psychology. After this idea waned, psychiatric thinkers continued to organize the critical features ofdisorders in this way. Therefore, it is possible to trace certain concepts from 1800 to the present using this framework. Intellectual Insanity By 1800 physicians had noted that people who committed insane homicide sometimes did so under the influence of delusions and 131 132 Homicidal Insanity, 1800-1985 command hallucinations. They referred to this phenomenon as delusional insanity, but tended to identify puerperal mania as a separate entity, though in many instances the disorder was characterized by delusions and hallucinations. Esquirol, in 1828, called delusional insanity "intellectual monomania"; and, though this remained the most commonly used term over the next sixty years, others employed "homicidal mania" and "delusional insanity." By I 860 physicians had identified the "homicidal crank" as predictably dangerous. These patients were usually troublesome individuals whose delusions were reinforced by the cirsumstances they created in their daily lives. During the 1880s the concept of monomania as homicidal insanity underwent theoretical change, but the belief that delusions and command hallucinations were predictors ofdangerousness did not. The German neurophysiologists introduced the term Primiire Verucktheit to designate a condition in which the sole mental symptom was delusions ofpersecution; Richard von Krafft-Ebing used the term "paranoia" to designate the phenomenon. Englishspeaking physicians rapidly adopted the latter. Many psychiatrists continued to believe that delusions were the principal, if not the sole, cause of insane homicide. Most patients who committed homicide under the influence of delusions and command hallucinations were not brought to trial. However, throughout the nineteenth century, cases were reported in the literature ofinsane patients who were executed for homicide despite the predominance of delusions and hallucinations and despite the influence of expert medical testimony. By the end of the nineteenth century, Kraepelin's clinical description and classification of mental disorders began to be used in the United States. Alienists considered delusions and hallucinations to be part of the complicated symptomatology of dementia praecox. Although Adolf Meyer had suggested a dynamic interpretation of this disease in 1909, Eugen Bleuler's similarly dynamic interpretation modified the concept into schizophrenia. By 1930 psychiatrists wrote more about the dynamics of schizophrenia in their textbooks and papers than the prediction of dangerousness . Nevertheless, it was believed that the delusions, Phenomenology 133 hallucinations, and senseless impulsivity of schizophrenia made these patients dangerous. After the 19SOS less was written about their dangerousness, but the predictors have remained the same to the present time. Psychiatrists came to recognize that paranoia as a pure disorder of the intellect was rare. After 1910 they tended to think in terms of a continuum of paranoid "states," in which a subclinical form was at one extreme and the frank psychosis of paranoid schizophrenia at the other. Still, belief in the potential dangerousness of the paranoid patient did not change. Emotional Insanity Pinel, in 1801, and Rush, in 1812, both described insane behavior they believed was caused by derangement ofthe emotional faculty. They contended that the intellect could remain unaffected in certain forms of insanity, an idea debated throughout the nineteenth century. Esquirol differentiated between emotional insanity (manie sans delire) and volitional insanity (variously called irresistible impulse, homicidal impulse, and homicidal monomania throughout the nineteenth century). By 1835 Prichard had described moral insanity, which at first included both the emotional and volitional insanities. In 1842 he modified the concept and defined moral insanity as a disorder of the emotions. Like Esquirol, he conceived of the insane impulse as a disorder of volition. From 1840 until the start of the twentieth century, some physicians rejected the existence of moral insanity as a psychiatric disorder because they believed that the intellect could not remain unaffected in any insanity. Yet, reported cases...