Insanity - a Medical-legal Enigma?

There is no mental disease called insanity. Insanity is a legal term used to designate the condition of certain people who exhibit particular symptoms of mental diseases. A patient may be psychotic, but the law acts upon the assumption that he is not insane until there is a judical determination that he is. Where insanity as a defense in criminal cases is concerned, many medical men believe that the question before the court is whether or not the accused is insane, ie., psychotic, either at the present moment or at the time of the crime. If he is insane at the time of the trial, many doctors say that he is not fit to stand trial, and if he were insane at the time of committing the crime, they would say that he is not guilty because of insanity. Such is not the case. The law is not concerned primarily with the question of existing psychosis. The law's concern is with responsibility 3 does the accused suffer from mental disease which is so severe that he ought not to be held responsible for his act? It has been the aim of the law to determine not if the patient was mentally ill at the time of the offense, but rather if his mental illness was of such severity that he was not responsible for his act. What rules does the law apply to the determination of this responsibility and hence sanity or insanity? In 1843 England adopted the M'Naghten Rules. In order to establish defense on the grounds of insanity, it must be clearly proved "that at the time of committing the act the accused was labouring under such a defect of reason from diseases of the mind as not to know the nature and quality of the act he was doing; or if he knew what he was doing, that he did not know that it was wrong". The Criminal Code which became Canada's law on the first day of July, 1893, con-