Unsoundness of mind; madness; mental alienation or derangement; a morbid psychic condition resulting from disorder of the brain, whether arising from malformation or defective organization or morbid processes affecting the brain primarily or diseased states of the general system implicating it secondarily, which involves the intellect, the emotions, the will, and the moral sense, or some of these faculties, and which is characterized especially by their non-devel-opment, derangement or perversion, and is manifested, in most forms, by delusions, incapacity to reason or to judge, or by uncontrollable impulses. In law, such a want of reason, memory, and intelligence as prevents a man from comprehending the nature and consequences of his acts or from distinguishing between right and wrong conduct. From both the pathologic and the legal definitions are to be excluded temporary mental aberrations caused by or accompanying alcoholic or other intoxication and the delirium of fever. See Crosswell v. People, 13 Mich. 427, 87 Am. Dec. 774; Johnson v. Insurance Co., 83 Me. 182, 22 Atl. 107; McNeil v. Relief Ass'n, 40 App. Div. 581, 58 N. Y. Supp. 122; Haile v. Railroad Co., 60 Fed. 560, 9 C. C. A. 134, 23 L. R. A. 774; Meyers v. Com., 83 Pa. 136; Somers v. Pumphrey, 24 Ind. 245; Frazer v. Frazer, 2 Del. Ch. 263.
Other definitions. Insanity is a manifestation of disease of the brain, characterized by a general or partial derangement of one or more acuities of the mind, and in which, while consciousness is not abolished, mental freedom is subverted, weakened, or destroyed. Hammond, ervous System, 332. The prolonged departure, without any adequate cause, from tbe states of feeling and modes of thinking usual to the in¬dividual in health. Bouvier. By insanity is not meant (in law) a total deprivation of reason, but only an inability, from defect of perception, memory, and judgment, to do the act in ques¬tion, [with an intelligent apprehension ot its nature and consequences.] So, by a lucid in¬terval is not meant a perfect restoration to rea¬son, but a restoration so far as to be able, be¬yond doubt, to comprehend and to do the act with such reason, memory, and judgment as to make it a legal act Frazer v. Frazer, 2 Del. Ch. 263.
Synonyms.—Lunacy. Lunacy, at the common law, was a term used to describe the state of one who, by sickness, grief, or other accident, has wholly lost his memory and understanding. Co. Litt 2465, 247a; Com. v. Haskell, 2 Brewst (Pa.) 496. It is distinguished fr6m Idiocy, an idiot being one who from his birth has had no memory or understanding, while lunacy implies t£e pos-session and subsequent loss) »f mental powers. Bicknell v. Spear, 88 Misc. Rep. 389, 77 N.
Y. Supp. 020. On the other hand, lunacy is a total deprivation or suspension of the or-dinary powers of the mind, and is to be dis-tinguished from imbecility, where there is a more or less advanced decay and feebleness of the intellectual faculties. In re Vanauken, 10 N. J. Eq. 186, 195; Odell v. Buck, 21 Wend. (N. Y.) 142. As to all other forms of insanity, lunacy was originally distinguished by the occurrence of lucid intervals, and hence might be described as a periodical or recurrent insanity. In re Anderson, 132 N. C. 243, 43 S. E. 640; Hiett v. Shull, 36 W. Va. 563, 15 S. E. 146. But while these dis¬tinctions are still observed in some jurisdic¬tions, they are more generally disregarded; so that, at present, in inquisitions of lunacy and other such proceedings, the term "lun¬acy" has almost everywhere come to be syn¬onymous with "insanity," and is used as a general description of all forms of derange¬ment or mental unsoundness, this rule being established by statute in many states and by judicial decisions in others. In re Clark, 175 N. Y. 139, 67 N. E. 212; Smith v. Hickenbot-tom, 57 Iowa, 733, 11 N. W. 664; Cason v. Owens, 100 Ga. 142, 28 S. E. 75; In re Hill, 31 N. J. Eq. 203. Cases of arrested mental development would come within the definition of lunacy, that is, where the patient was born with a normal brain, but the cessation of mental growth occurred in infancy or so near it that he never acquired any greater intelligence or discretion than belongs to a normally healthy child. Such a subject might be
scientifically denominated an "idiot," but not legally, for in law the latter term is applicable only to congenital amen¬tia. The term "lucid interval" means not an apparent tranquility or seeming repose, or cessation of the violent symptoms of the disorder, or a simple (diminution or remission .of the disease, but a temporary cure—an intermission so clearly marked that it perfectly resembles a return of health; and it must be such a restoration of the faculties as enables the patleht beyond doubt to com-prehend the nature of his acts and transact his affairs as usual; and it must be continued for a length of time sufficient to give cer¬tainty to the temporary restoration of rea¬son. Godden v. Burke. 35 La. Ann. 160.173; Ricketts v. JolifT, 62 Miss. 440; Ekin v. Mc-Cracken, 11 Phila. (Pa.) 534; Frazer v. Fraz¬er, 2 Del. Ch. 260.
Idlooy is congenital amentia, that Is, a want of reason and intelligence existing from birth and due to structural defect or mal¬formation of the brain. It is a congenital obliteration of the chief mental powers, and is defined in law as that condition in which the patient has never had, from his birth, even the least glimmering of reason; for a man is not legally an "idiot" if he can tell his parents, his age, or other like common matters. This is not the condition of a deranged mind, but that of a total absence of mind, so that, while idiocy is generally classed under tbe general designation of "in¬sanity," it is rather to he regarded as a nat¬ural defect than as a disease or as the re* suit of a disease. It differs from "lunacy," because there are no lucid intervals or periods of ordinary intelligence. See In re Beaumont, 1 Whart (Pa.) 53, 29 Am. Dec. 33; Clark v. Robinson, 88 111. 502; Crosswell v. People, 13 Mich. 427, 87 Am. Dec 774; Hiett v. Shull, 36 W. Va. 563, 15 S. E. 146; Thompson v. Thompson, 21 Barb. (N. Y.) 128; In re Owings, 1 Bland (Md.) 386, 17 Am. Dec. 311; Francke v. His Wife, 29.La. Ann. 304; Hall v. Unger, 11 Fed. Cas. 261; Bick-nell v. Spear, 38 Misc. Rep. 389, 77 N. Y. Supp. 920.
Imbecility. A more or less advanced decay and feebleness of the intellectual facul¬ties; that weakness of mind which, without depriving the person entirely of the use of his reason, leaves only the faculty of con¬ceiving the most common and ordinary ideas and such as relate almost always to physical wants and habits. It varies in shades and degrees from merely excessive folly and ec-centricity to an almost total vacuity of mind or amentia, and the test of legal capacity, In this condition, is the stage to which the weakness of mind has advanced, as measur¬ed by the degree of reason, judgment, and memory remaining. It may proceed from paresis or general paralysis, from senile de¬cay, or from the advanced stages of any of the ordinary forms of insanity; and the term is rather descriptive of the consequen¬ces of insanity than of any particular type of the disease. See Calderon v. Martin, 50 La. Ann. 1153, 23 South. 909; Delafield v. Par¬ish, 1 Redf. (N. Y.) 115; Campbell v. Camp¬bell, 130 111. 466, 22 N. E. 620, 6 L. R. A. 167; Messenger v. Bliss, 35 Ohio St 592.
Non oompos mentis. Lat. Not of sound mind. A generic term applicable to all in¬sane persons, of whatsoever specific type the insanity may be and from whatever cause arising, provided there be an entire loss of reason, as distinguished from mere weakness of mind. Somers v. Pumphrey, 24 Ind. 244; In re Beaumont, 1 Whart. (Pa.) 53; Burn-ham v. Mitchell, 34 Wis. 136; Dennett v. Dennett, 44 N. H. 537, 84 Am. Dec. 97; Potts v. House, 6 Ga. 350, 50. Am. Dec. 329; Jack¬son v. King, 4 Cow. (N. Y.) 207, 15 Am. Dec. 354; Stanton v. Wetherwax, 16 Barb. (N. Y.) 262.
Derangement. This term includes all forms of mental unsoundness, except of the natural born idiot. Hiett v. Shull, 36 W. Va. 563, 15 S. E. 147.
Delusion is sometimes loosely used as syn-onymous with insanity. But this is incor¬rect. Delusion is not the substance but the evidence of insanity. The presence of an in-sane delusion is a recognized test of insanity in all cases except amentia and Imbecility, and where there is no frenzy or raving mad¬
ne*s; and In this sense an Insane delusion Is a fixed belief in the mind of the patient of the existence of a fact which has no objec¬tive existence but is purely the figment of his imagination, and which is so extravagant that no sane person would believe it under the circumstances of the case, the belief, nevertheless, being so unchangeable that the patient is incapable of being permanently dis¬abused by argument or proof. The charac-teristic which distinguishes an "insane" de-lusion from other mistaken beliefs is that it is not a product of the reason but of the imagination, that is,* not a mistake of fact In-duced by deception, fraud, insufficient evi-dence, or erroneous reasoning, but the spon-taneous conception of a perverted imagina-tion, having no basis whatever in reason or evidence. Riggs v. Missionary Soc, 35 Hun (N. Y.) 658; Buchanan v. Plerie, 205 Pa. 123, 54 Atl. 583, 97 Am. St Rep. 725; Gass v. Gass, 3 Humph. (Tenn.) 283; Dew v. Clarke, 8 Add. 79; In re Bennett's Estate, 201 Pa. 485, 51 Atl. 336; In re Scott's Estate, 128 Cal. 57, 60 Pac 527; Smith v. Smith, 48 N. J. Eq. 566, 25 Atl. 11; Guiteau's Case (D. C) 10 Fed. 170; State v. Lewis, 20 Nev. 333, 22 Pac 241; In re White, 121 N. Y. 406, 24 N. E. 935; Potter v. Jones, 20 Or. 239, 25 Pac 769, 12 U R. A. 161. As to the distinctions between "Delusion" and "Illusion" and "Hal¬lucination," see those titles.
Forms and varieties of insanity. With¬out attempting a scientific classification of the numerous types and forms of insanity, (as to which it may be said that there is as yet no final agreement among psychologists and alienists either as to analysis or nomenclature,) defini¬tions and explanations will here be appended of the compound and descriptive terms most com¬monly met with in medical jurisprudence. And, first as to the origins or causes of the disease: Traumatic insanity is such as results from a wound or injury, particularly to the head or brain, such as fracture of the skull or concus¬sion of the brain.—Idiopathic insanity is such as results from a disease of the brain it¬self, lesions of the cortex, cerebral anemia, etc. —-Congenital Insanity is that which exists from the birth of the patient, and is (in law) properly called "idiocy. See supra.—Cretin¬ism is a form of imperfect or arrested mental development, which may amount to idiocy, with physical degeneracy or deformity or lack of evelopment; endemic in Switzerland and some other parts of Europe, but the term is applied to similar states occurring elsewhere.—Pella¬grous insanity. Insanity caused by or de¬prived from pellagra, which is an endemic dis¬ease of southern Europe, (though not confined to that region,) characterized by erythema, di¬gestive derangement, and nervous affections. (Cent Diet.)—Polyneuritic insanity is in¬sanity arising from an inflammation of the nerves, of tbe kind called "polyneuritis" or "mul¬tiple neuritis" because it involves several nerves at the same time. This is often preceded by tuberculosis and almost always by alcoholism, and is characterized specially by delusions and falsification of the memory. It is otherwise called. "Korssakoffs disease." (Kraepelin.)— Choreic insanity is insanity arising from chorea, the latter being a nervous disease, more commonly attacking children than adults, char¬acterized by irregular and involuntary twitch-ings of the muscles of the limbs and face, popu¬larly called "St. Vitus' dance.'—Puerperal in¬sanity is mental derangement occurring in women at the time of child-birth or immediately after: it is also called "eclampsia parturienr ttam."—Folie brightique. A French term sometimes- used to designate an access of in¬sanity resulting from nephritis or "Bright's dis¬ease/' See In re McKean's Will, 31 Misc. Rep. 703, 66 N. Y. Supp. 44.—Delirium tremens. A disease of the nervous system, induced by the excessive and protracted use of intoxicating liquors, and affecting the brain so as to produce incoherence and lack of continuity in the intel¬lectual processes, a suspension or perversion of the power of volition, and delusions, particular¬ly of a terrifying nature, but not generally prompting to violence except in the effort to es¬cape from imaginary dangers. It is recognized in law as a form of insanity, and may be of such a nature or intensity as to render the pa¬tient legally incapable of. committing a crime. United States v. McGlue, 1 Curt. 1, 26 Fed. Cas.. 1093; Insurance Co. v. Deming, 123 Ind. 384, 24 N. E. 86; Maconnehey v. State. 5 Ohio St 77; Erwin v. State, 10 Tex. App. 700: Carter v. State, 12 Tex. 500. 62 Am. Dec. 539. In some states the insanity of alcoholic intoxica¬tion is classed as "temporary," where induced by the voluntary recent use of ardent spirits and carried to such a degree that the person becomes incapable of judging the consequences or the moral aspect of his acts, and "settled," where the condition is that of delirium tremens. Settled insanity, in this sense, excuses from civil or criminal responsibility; temporary in¬sanity docs not. The ground of the distinction Is that tbe former is a remote effect of imbibing alcoholic liquors and is not voluntarily incurred, while the latter is a direct result voluntarily sought for. Evers v. State, 31 Tex. Cr. R. 318, 20 S. W. 744, 18 L. R. A. 421. 37 Am. St. Rep. 811; Maconnehey v. State, 5 Ohio St 77. —Syphilitic insanity is paresis or progres¬sive imbecility resulting from the infection of syphilis. It is sometimes called (as being a se¬quence or result of that disease) "metasyphitis'9 or "parosyphilis"—Tabetic dementia. A form of mental derangement or insanity com¬plicated with "tabes dorsalis" or locomotor ataxia, which generally precedes, or sometimes follows, the mental attack. As to insanity re¬sulting from cerebral embolism, see EMBOLISM; from epilepsy, see ETILEPSY. As to chronic alcoholism as a form of insanity, see ALCOHOL¬ISM.
General descriptive and clinical terms. -Affective insanity. A modern comprehen¬sive term descriptive of ail those forms of in¬sanity which affect or relate to the feelings and emotions and hence to the ethical and social relations of the individual.—Involutional in-sanity. That which sometimes accompanies the "involution" of the physical structure and physiology of the individual, the reverse of their ^evolution," hence practically equivalent to the imbecility of old age or senile dementia.—Ma-niaeal-depressivo Insanity. A form of in¬sanity characterized by alternating periods of high maniacal excitement and of depressed and stuprous conditions in the nature of or resem¬bling melancholia, often occurring as a series or cycle of isolated attacks, with more or less com¬plete restoration to health in the intervals. (Kraepelin.) This is otherwise called "circular insanity" or "circular stupor."—Circular in¬sanity. Another name for maniacal-depressive insanity, which see.—Partial insanity, as a legal term, may mean either monomania (see infra) or an intermediate stage in the develop¬ment of mental derangement. In the former sense, it does not relieve the patient from re-sponsibility for his acts, except where instigat¬ed directly by his particular delusion or obses¬sion. Com. v. Mosler, 4 Pa. 264: Com. v. Bar-ner, 199 Pa. 335. 49 Atl. 60; Trich v, Trich. 165 Pa. 586, 30 Atl. 1053. In the latter sense,
it denotes a clouding or weakening of the mind, not inconsistent with some measure of memory, reason, and judgment. But the term, in this sense, does not convey any very definite mean¬ing, since it may range from mere feeble-mind-edness to almost the last stages of imbecility. State v. Jones, 50 N. H. 383, 9 Am. Rep. 242; Appeal of Dunham, 27 Conn. 205.—Recurrent insanity* Insanity which returns from time to time, hence equivalent to "lunacy" (see supra) In its common-law sense, as a mental disorder broken by lucid intervals. There is no presump¬tion that fitful and exceptional attacks of in¬sanity are continuous. Leache v. State, 22 Tex. App. 279, 3 S. W. 538, 58 Am. Rep. 638.— Moral insanity. A morbid perversion of the feelings, affections, or propensities, but without any illusions or derangement of the Intellectual faculties; irresistible impulse or an incapacity to resist the prompting of the passions, though accompanied by the power of discerning the .moral or immoral character of the act. Moral insanity is not admitted as a bar to civil or criminal responsibility, for the patient's acts, un¬less there is also shown to be intellectual dis¬turbance, as manifested by insane delusions or the other recognized criteria of legal insanity. Leache v. State, 22 Tex. App. 279, 3 S. W. 539, 58 Am. Rep. 638; In re Forman's Will, 54 Barb. (N. Y.) 291; State v. Leehman, 2 S. D. 171, 49 N. W. 3. The term 'emotional in¬sanity" or mania transitoria applies to the case of one in the possession of his ordinary reasoning faculties
who allows his passions to convert him into a temporary maniac. Mutual L Ins. Co. v. Terry, 15 Wall. 580, 583, 21
L. Ed. 236.—Psychoneurotic Mental disease without recognizable anatomical lesion, and without evidence and history of preceding chron¬ic mental degeneration. Under this head come melancholia, mania, primary acute dementia, and mania hallucinatoria. Cent. Diet. "Neuro¬sis," in its broadest sense, may include any dis¬ease or disorder of the mind, and hence all the forms of insanity proper. But the term "psy¬ehoneurosis" is now employed by Freud and oth¬er European specin lists to describe that class of exaggerated individual peculiarities or idiosyn¬crasies of thought towards special objects or topics which are absent from the perfectly nor¬mal mind, and which yet have so little influence upon the patient's conduct or his general modes of thought that they cannot properly be describ-ed as "insanity" or as any form of "mania," especially because ordinarily unaccompanied by any kind of delusions. At most, they lie on the debatable border-land between sanity and in¬sanity. These idiosyncrasies or obsessions may arise from superstition, from a real incident in the patient's past history upon which be has brooded until it has assumed an unreal impor¬tance or significance, or from general neuras¬thenic conditions. Such, for example, are a ter¬rified shrinking from certain kinds of animals, unreasonable dread of being shut up in some enclosed place or of being alone in a crowd, excessive fear of being poisoned, groundless con¬viction of irredeemable sinfulness, and countless other prepossessions, which may range from mere
weak-minded superstition to actual mono¬mania.—Katatonia. A form of insanity dis¬tinguished by periods of acute mania and melan¬cholia and especially by cataleptic states or con¬ditions; the "insanity of rigidity." (Kahl-baum.) A type
of insanity characterized par-; ticularly by "stereotypism, an instinctive in¬clination to purposeless repetition of the same expressions of the will, and "negativism," a senseless resistance against every outward in¬fluence. (Kraepelin.)—Folie eireulaire. The French name for circular insanity or maniacal-depressive insanity.—General paralysis. De-mentia paralytica or paresis.
Amentia, dementia, and mania. The
classification of insanity into these three types or forms, though once common, has of late given way to a more scientific nomenclature, based chiefly on the origin or cause of the disease in the particular patient and its clinical history. These terms, however, are still occasionally en¬countered in medical jurisprudence, and the names of some of their subdivisions are in con¬stant use.
Amentia. A total lack of intelligence, rea-son, or mental capacity. Sometimes so used as to cover imbecility or dotage, or even as ap-plicable to all forms of insanity; but properly restricted to a lack of mental capacity due to original defective organization of the brain (idiocy) or arrested cerebral development, as distinguished from the degeneration of intellec¬tual faculties which once were normal.
Dementia.. . A form of insanity resulting from degeneration or disorder of the brain (ideo-pathic. or traumatic, but not congenital) and characterized by general mental weakness and decrepitude, forgetfulness, loss of coherence, and total inability to reason, but not accompanied by delusions or uncontrollable impulses. Pyott v. Pyott, 90 111. App. 221; Hall v. Urger, 2 Abb. U. S. 510, Fed. Cas. No. 5,949; Dennett v. Dennett, 44 N. EL 531, 84 Am. Dec 97; People v. Lake, 2 Parker, Cr. R. (N. Y.) 218. By some writers dementia is classed as a ter¬minal stage of various forms of insanity, and hence may follow mania, for example, as its final condition. Among the sub-divisions of de-mentia should be noticed the following: Acute primary dementia is a form of temporary de¬mentia, though often extreme in its intensity, and occurring in young people or adolescents, accompanied by general physical debility or ex* baustion and induced by conditions likely to produce that state, as malnutrition, overwork, dissipation, or too rapid growth. Dementia par* ralytica is a progressive form of insanity, be* ginning with slight degeneration of the physical, intellectual, and moral powers, and leading to complete loss of mentality, or imbecility, with
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