Forensic Psychiatry

Insanity
Mind in Psychology
DISORDERS OF COGNITION
DISORDERS OF AFFECT / EMOTIONS
DISORDERS OF CONATION / BODY FUNCTIONS
Classification of Psychiatric disorders ICD -10
LUCID INTERVAL- Psychiatry & Head Injury
Feigned Insanity
Test for determining criminal responsibilities
McNaughton Rules-The right or wrong test)
Durham’s Rule
Curren’s Rule
American law Institute Test
Civil and Criminal responsibility of an insane
Section 84 IPC
MENTAL HEALTHCARE ACT,2017
DISORDERS OF AFFECT / EMOTIONS
DISORDERS OF CONATION / BODY FUNCTIONS
Classification of Psychiatric disorders ICD -10
LUCID INTERVAL- Psychiatry & Head Injury
Feigned Insanity
Test for determining criminal responsibilities
McNaughton Rules-The right or wrong test)
Durham’s Rule
Curren’s Rule
American law Institute Test
Civil and Criminal responsibility of an insane
Section 84 IPC
MENTAL HEALTHCARE ACT,2017

1. Dr Arun PinchuXavier
Assistant Professor
Dept: of Forensic Medicine
SreeMookambikaInstitute Of Medical Sciences
FORENSIC PSYCHIATRY

2. I'mDepressedSadConfusedHurtLonely
UnlovedJudgedMisunderstoodInsignificant
BrokendislikedDyinglost…hmm,
Fine Dear.

3. Deals with the application of Psychiatry in the
administration of justice.
Insanity
(Lunacy, unsoundness of mind, mental derangement,
mental illness)
It is a disorder of mind or personality in which
there is derangement or impairment of mental or
emotional components.

4. Unsoundness of mind:
Here an individual loses the power of regulating his actions
andconduct according to the rules of the society to which he
belongs.
Forensic Importance:
In Criminal Cases:
•When defense is attempted on the grounds that a criminal
act has been committed by a person in a state of mental
unsoundness
•Inability to plead defense during trial on grounds of insanity
•To defer the executionof punishment till the convict is
mentally sound
•When a women of unsound mind is been raped

5. Unsoundness of mind…
In Civilcases:
•Testamentary capacity to make a valid will
•Nullity of marriage / divorce cases
•Validity to act as witness
•Appointment of a caretaker of a
mentally unsound person
who is unable to look
after his property.

6. Mind in Psychology
Feldman (1998) talked of the following 3 kinds of mental
processes
1.CognitiveMental process: -Knowledge.All mental
processes which provide us knowledge of stimuli, situation
and ideas come under this
2.Affectivemental processes:-Feeling and emotion. Wealso
the experience of pleasure and pain and of emotions like love
anger hatred jealousy hatred displeasure
3.ConativeMental processes: Action tendencies. Mental
forces which impel the individual to perform certain actions

7. 01.DISORDERS OF COGNITION
•DELUSIONS
•HALLUCINATION
•ILLUSION

8. Delusion

9. Delusion
It is a disturbance of thought.
It is a false belief in something which is not a fact and persists
even after its falsity has been clearlydemonstrated.
•
Types:
Delusion of GRANDEUR:-The patient imagine that he is
rich when he is actually poor.
•
Delusion ofPOVERTY :-Imagine he is poor, when he is
wealthy.

10. •Delusion of PERSECUTION:-
Imagine that other people are out to harm him.
•Delusion of REFERENCE:-
Imagines that people or events refer to him in special way.
•
Delusion of INFLUENCE (control) :-
Imagines that his thoughts and actions are controlled by some
external agency.
•Delusion of INFIDELITY:-
Imagines that spouse is unfaithful.
Delusion of SELF-ACCUSATION:-
• Keep blaming himself for trivial incidents that happened in the
past.

11. •Nihilistic delusion:-The patient is convinced that nothing
exists around him in the real sense of the term.
•
Erotomania :-
Usually in women. The patient is convinced that a
particular individual is in love with her.
•
Pseudologia Phantastica:-
In which the patient is convinced that he is seriously ill
and goes from doctor to doctor,hospital to hospital
in a vain attempt to diagnose his
non-existent
illness

12. Forensic Importance:
•Individuals with persecutory delusions may carry out
violent acts . Culpability may be determined to find out was
it because he was threatened and reacted in self defense or
he had equally deluded and carefully plotted revenge
•Erotomaniac delusion may lead to stalking

13. HALLUCINATION

14. It is a FALSE SENSORY PERCEPTION without any real,
external stimulus.
Types:
•
AUDITORY:-The patient hears imaginary voices.
•
VISUAL:-The patient sees non –existent shapes
or people or animals.
•
OLFACTORY:-Perceiving non-existing odours.
•
GUSTATORY :-Perceiving a bad taste in the mouth.
•

15. •TACTILE(Haptic):-This may take the from of imaginary
sensations over the skin.
•Commandhallucinations: Instructions spoken to patients,
some patients feel compelled to obey these commands
Forensic Importance:
•Command hallucination are dangerous as they may
command acts of violence to self or others

16. Illusion

17. •It is a misinterpretation of a real external stimuli and are
oftenvisual or auditory.
•They may be experienced by healthy persons in the dark or
during states of emotional stress
•An insane person is incapable of correcting the false
impression
E.g. :-
•Perceiving a rope as a snake
•Covering blanket misinterpreted to be a weight of a
collapsed building

18. 2.DISORDERS OF AFFECT / EMOTIONS
•PHOBIA
•OBSESSION

19. PHOBIA

20. A Phobia is an irrational intense persistent fear of certain
situationsactivitiesthingsor persons.
Types:
•Acrophobia-Fear of heights
•Agoraphobia-Fear of open spaces
•Claustrophobia –Fear of enclosed spaces
•Hydrophobia-Fear of water
•Nyctophobia-Fear of night

21. OBSESSION

22. OBSESSION
•
In this a single idea thought or emotion is constantly
entertained by the person which he recognizes as irrational,
but persists inspite of all efforts to drive if from his mind.
•Any attempt to resist makes them more strongly insistent,
usually associated with dread or fear.
•Such person lives in constant of having done or having
omitted to do something
Eg:-
•Washing hands again and again
•Checking the lock repeatedly
•Counting money again and again before going to shopping

23. 3.DISORDERS OF CONATION / BODY
FUNCTIONS
•SOMNABULISM
•IMPULSE

24. ImpulseControl Disturbance

25. There is a sudden and irresistible force compelling a person to
the conscious performance of an action without motive or fore
thought.
•Types:
Kleptomania :-Irresistible desire to steal articles of
little or no value.
•
Pyromania :-Irresistible desire to set fire to
objects.
•
Multilomania:-Irresistible desire to hurt or torture
animals.
•
Dipsomania :-In ability to stay off alcohol.

26. Somnambulism / Noctambulism
Walking during sleep.
They get up from bed, open the door, walk out and then
return to their bed to sleep, having no memory of these
activities when they wake up.
A somnambulist, when resisted may commit acts which he
is not aware
He is not in sleep but in a state of Dissociated
Consciousness in a hallucinatory state unrelated to his
immediate environment.

27. Somnambulism….
A crime committed in this state is never willful and
premeditated and lacks criminal intent, hence such persons
cannot be held responsible.
When a somnambulist knows that he has a tendency for
somnambulistic homicide but fails to take treatment and
subsequently commits somnambulistic homicide,he is likely
to pay damages for negligence

28. Classification of Psychiatric disorders
ICD -10 –It’s the 10
th
revision of the International statistical
classification of Diseases and related Health Problems.
Mental disorders are classified in Chapter F of ICD which is
categorized into 10Blocks.

29. F00-F09Organic, including symptomatic,
mental disorders
1) Delirium
2) Dementia
3) Organic amnestic Syndrome
4) Other Organic Mental Disorders

30. F10--F19 Mental and behaviourdisorders due
to psychoactive substance use
E.g. :-Alcohol, Cannabis, opioids, Amphetamines,
Cocaine, LSD, Phencyclidine etc.
F20-F29Schizophrenia, schizotypal and
delusional disorders
Disturbance of thoughts, perception, affect and
behavior.

31. •F30-F39Mood [affective] disorders
1) Bipolar affective disorder
2) Manic disorder
3) Depressive disorder
4) Persistent mood disorder

32. •F40-F48Neurotic, Stress –related and
Somatoform Disorders.
1) Anxiety
2) Phobic states
3) Obsessive –compulsive Disorder
4) Dissociative disorder
5) Somatoform disorder
6) Stress and adjustment disorder

33. •F50-F59–Behavioral syndromes associated with
Physiological & Physical Disturbances
1) Eating disorder
2) Sleep disorder
3) Sexual disorder
4) Puerperal psychiatric conditions

34. •F60-F69Disorders of adult personality and
behaviour
1) Personality disorders
2) Impulse control disorders
3) Gender identity disorders
4) Disorders of sexual preference

35. •F70-F79–Mental Retardation (MR)
Sub average general intellectual functioning that originates in
the developmental period and is associated with impaired
maturation and learning ,and social maladjustments.
Normal adult I.Q is 90-110%
1) Mild MR
2) Moderate MR
3) Severe MR
4) Profound MR

36. Degree of
MR
IQ Mental
age
Adult life and needs
Mild MR -
MORONS 50-70 6-11 years
Can achieve social and
vocational skill enough for
minimum self support
Moderate MR
IMBECILES
35-49 3-6 Years
May perform unskilled
semiskilled work, needs
supervision
Severe MR
IDIOCY
20-34 3 Years
Cannot speak intelligibly,
needs nursing care
Profound MR
IDIOTS
< 20 <3 years
No / Minimum capacity for
sensory motor functioning,
needs constant nursing care

37. •F80-F89–Disorders of Psychological
Development
Speech and language disorder
Development disorders

38. •
F90-F98Behavioral and emotional disorders
with onset usually occurring in childhood and
adolescence
1) Hyperkinetic disorder
2) Conduct disorders
3) Tic disorders
•F99 -Unspecified mental disorder

39. Causes of Mental illness
1) Predisposing factors :-
Heredity ,endocrine ,biochemical abnormalities, physical
illness, psychological factors
2) Precipitating factors :-
Physical stress, poverty, Sudden bereavement, financial loss,
Psychological stress, Marital disharmony
3) Environmental factors:

40. Civil Responsibility
Marriage
If it is proved that at the time of marriage one of the
spouses was insane, then such marriage is declared as null and
invalid.
Business Contract
As per the Indian Contract Act of 1872, if it is proved that
at the time of signing a contract one of the two parties was
insane, then the contract become legally invalid.

41. Management of Property
If a person who owns property becomes insane and is incapable
of managing his affairswith sound judgement any relative or
friend can approach the court for a judicial inquisition.
Capacity To Dispose As Witness
An insane person is not competent to give evidence if he is
incapable of understanding the questions put to him, or giving
rational answers to them

42. Testamentary capacity
Refers to the capacity of a person to make a valid will.
•Capacity of the testator to make a will is based on Medical
evidence
•The medical officer should verify whether the testator,
knows the nature and consequence of his act ,if he knows
the extend of the property ,the person to whom he is not
leaving it and his reason for doing so..
•Testator must sign the will in presence of 2 witness, one of
whom can be a RMP.
•A mentally ill person can make a valid will during Lucid
Interval

43. Requirement of a Valid will :
•A written properly signed witnessed document
•Testator must be a major and of sound mind at the time of
making will.
•Force ,undue influence or dishonest representation of facts
should not have been applied by other.
•Should have a sound disposing mind –capable of disposing
his property with understanding and reason..!

45. LUCID INTERVAL
in Psychiatry

46. Lucid interval in Psychiatry...
Period occurring in insanity, during which all symptoms of
insanity disappears completely
•Here, the persons mind remains clear, and capable of
judging things properly and hence legally liable for his
actions
•It varies from person to person and as such one cannot be
certain about the time when a person passes again in the
state of insanity
•Common in mania , melancholia
MLI-
An insane person may take a plea

47. • UnConsiouness
Cerebral concussion
• CONSIOUNESS
• Unconsiouness
Raised intracranial tension
Lucid interval in
Head Injury

49. Feigned Insanity

50. A person may pretendto be insane
or presentedto be insane with
some motive.
REASONS..?
To avoid punishment \trial
To leave defense \Police services
To avoid civil responsibilities

51. Feature True insanity Feigned insanity
Onset Gradual Abrupt & dramatic
Motive Absent Present
Precipitating
factors Maybe present Absent
Symptomatology
Conforms to a
particular type
psychiatric
disorder.
Usually doesn’t
confirm to any of known
type of psychiatric
disorder and
is often exaggerated

52. Feature True insanity Feigned insanity
Facial,
expression
Usually listless, vacant
& fixed
Frequent changes
exaggerated
Insomnia
Often present Can’t withstand
lack of sleep for
more than a night
or two.
Exertion Can withstand
fatigue & hunger
for prolonged
periods.
Cant withstand for more
than a day or two

53. Feature True insanity Feigned insanity
Personal
hygiene
Doesn’t pay attention to
his personal hygiene
May only pretend to be
disinterested in his
personal appearance or
hygiene
Frequent
psychiatric
examinations
Does not
mind
Resists , since
he fears detention.
examinations

54. Rules regarding insanity in other
countries
Test for determining criminal responsibilities
•McNaughton Rules
(the right or wrong test)
•Durham’s Rule
•Curren’s Rule
•American law Institute Test

55. Historical aspects –McNaughton Rules
•Guideline followed by British courts for consideration of
liability of a mentally ill person who commits a crime
‘McNaughtonRules’-these are based on the answers
given by the judges who acquitted a paranoid schizophrenic
patientDaniel McNaughtenon charges of killing the British
PM,to the questions raised by the House of the Lords .
He was suffering from :
➢Paranoid schizophrernia
➢Auditory hallucinations
➢Persecutory delusions

56. Daniel McNaughton
29 Years
Robert Peel, PM of England
Edward Drummond,Private Secretary
Shot dead on 20
Th
Jan 1843

57. 10 Physicians found him not guilty of Mental
Illness
Verdict created -Public outcry ..!
Summoned to House of lords
Lord Chancellor ,Panel of 14judges
5questions to clarify the legal position
Answers given on 19
th
June 1843 –Mc Naughten
Rules

58. Mc Naughten
•Mc Naughtenrules –According to these rules, to establish
defense on the ground of insanity it must be clearly proved
that at the time of committing the act, the accused was
laboring under such defect of reason from disease of mind,
as not to know the nature and quality of the act he was
doing, or if he did know it, that he did not know what he
was doing was wrong.

59. Mc Naughten …in brief
•An accused is not criminally responsible if it is proved that
at the time of commiting the crime he was suffering from
such defect of reason from disease of mind, that he did not
know the nature and quality of the act he was doing or that
what he was doing was wrong .
•This legal test has been accepted in INDIA as the law of
criminal responsibility ..under S.84 IPC

60. American law Institute Test
•A person is not responsible for his criminal
conduct if, at the time of such criminal conduct as
a result of mental disease or mental defect,he
lacked substantial capacity to appreciate the
criminality of his conduct or to conform his
conduct to the requirements of law

61. Criminal responsibility
A person may plead mental illness to avoid :
•Conviction
•Trial
•Capital punishment
•The law presumes that every person is sane and responsible
for his actions. The defense has to prove the accused is
mentally ill.
•Every criminal act should have MensRea & ActusReus

62. •Resp: Liability of a person for his acts or omissions
•Section 84 (Indian Penal Code)
“ Nothing is an offence which is done by a person, who,
at the time of doing it, by reason of unsoundness of mind, is
incapable of knowing the nature of the act, or that he is
doing what is either wrong orcontrary to law ”
•According to this law, the act done by a insane person is not
a crime even if it is punishable by law !

63. MENTAL HEALTHCARE
ACT,2017

64. MENTAL HEALTHCARE ACT,2017
•The Mental Healthcare Act came into force from 7
th
July
2018
•It superseded the Mental Health Act of 1987.
Aims:
•To provide mental healthcare services ,protect ,promote and
fulfill their rights
•Mental illness should be determined in accordance with
nationally and internationally accepted standards
•It ensures that these persons have a right to live life with
dignity by not being discriminated against or harassed

65. Admission of person with Mental illness as
independent Patient (Sec 85)
1.“independent patient or an independent admission” refers to
the admission of person with mental illness, who has the
capacity to make mental healthcare and treatment decisions or
requires minimal support in making decisions.
2.All admissions in the mental health establishment shall, as
far as possible, be independent admissions except when such
conditions exist as make supported admission

66. Independent admission and
treatment(Sec 86)

67. Sec 86
1.A person who is not a minor has capacity to make decision
regarding his mental healthcaretreatment and requires no /
minimal support in making such decisions ,when he considers
himself to have mental illness.
2.On receipt of such request, the medical officer in charge
shall admit the person, if he is satisfied with the following :
✓Person has a mental illness of a severityrequiring
admission
✓Person is likely to benefit from admission and treatment
✓He gives a valid consent after understanding the nature and
purpose of admission

68. 3.If a person is unable to understand the purpose, nature,
likely effects of proposed treatment and of the probable
result of not accepting the treatment or requires a very high
level of support in making decisions, he or she shall be
deemed unable to understand the purpose of the admission
and therefore shall not be admitted as independent patient
under this section.
4.A person admitted as an independent patient shall be
bound to abide by order and instructions.
5.An independent patient shall not be given treatment
without his informed consent.

69. 6.The mental health establishment shall admit an
independent patient on his own request, and shall not
require the consent or presence of a nominated
representative or a relative or care-giver for admitting the
person to the mental health establishment
7.Under the provision of Section 88,an independent patient
may get himself discharged from the mental health
establishment without the consent of the medical officer

70. Discharge of independent patients -(Sec 88)

71. Discharge -Sec 88
The medical officer in charge of a mental health establishment
shall discharge such patient immediately
But a medical officer may prevent the discharge and hold him
back for 24 hoursfor assessment if he is of the opinion:
(a)Person is unable to understand the nature of his decisions
(b)has recently threatened or attempted to cause bodily harm
to himself
(c)has recently behaved or is behaving violently towards
another person
(d)Shows inability to take care for himself

72. Admission of a Supported Patient upon
Application by caregivers (Sec 89)

73. Sec 89
Shall admit every such person to the establishment, upon
application by the nominated representative of the person,
if:
1.On the day of the persons admission or during the preceding
7days,he has been independently examined by a psychiatrist
and a mental health professional or a medical practitioner, who
has independently concluded, on the basis of examination
and information provided by others, that the person has a
mental illness of such severitythat:
•Person is threatening or attempting to cause bodily harm
•Behaving violently to others
•Shows inability to take care of himself

74. 2.On the advance directive, the persons admission to
mental health establishment is the least restrictive care
option possible in the circumstances
3.The person is ineligible to receive care and treatment
as an independent patient because he is not able to take
decisions independentlyand needs greater amount of
support from his nominated representative in making
decisions

75. Duties of Police officers with respect to
person with mental illness (Sec 100)

76. Sec 100
1.Every officer in-charge of a police station is duty bound to
take under protection any person found wandering at large
within the limits of the police station whom the officer has
reason to believe has mental illness and is incapableof taking
care of himself or others
2.The police officer should inform the person who is taken
into protection of the reasons for such measures
3.Such persons should be taken to the nearest public health
establishment with 24 hours of being taken into protection

77. Sec 100…
4.If the medical officer finds, the person does not have any
mental illness requiring admission, the same has to be
informed and the person,and should be taken to his
residence or to a government establishment for homeless
person
5.The station house officer shall have a duty to trace the
family of such a person and inform the family about the
whereabouts of the person

78. Duties of Police officers In-Charge of a Police
Station with respect to Persons with Mental
illness (Sec 101)

79. Sec 101
1.Any police officer in charge of a Police station , who has
reason to believe that any person residing within the limits of
the police station has a mental illness and is being illtreated or
neglected, shall report the fact to the respective Magistrate
2.Any person who has reason to believe that a person has
mental illness and is being ill-treated or neglected by his care
givers, shall report the fact to the police officer in-charge of
the police station within whose jurisdiction the person with
mental illness resides.

80. Sec 101…
3.If the Magistrate on the basis of the report of a police
officer or otherwise, that any person with mental illness
within the local limits of his jurisdiction is being ill-treated
or neglected, the Magistrate may cause the person with
mental illness to be produced before him

81. Admitting person with mental illness to
mental health establishment by
magistrate (Sec 102)

82. Sec 102
When any person with mental illness appears or is brought
before a Magistrate, the Magistrate may, order a referral and
authorize the patients admission to a public mental health
establishment for assessment and treatment for a period not
extending 10 days
That medical officer should submit the report of the
assessment of such person to the magistrate

83. Prisoners with mental
illness (Sec 103)

84. Sec 103
The Prisoners Act, the Air Force Act, the Army Act, the Navy
Act and section 330 and section 335 of the Code of Criminal
Procedure, direct the admission of a prisoner with mental
illness for the care and treatment to the psychiatric ward of
medical wing of the prison. If in cases there is no psychiatric
ward in medical wing, he can then be transferred to mental
health establishment with prior permission from the Board

85. Restraints and seclusion (Sec 97)

86. Sec 97
1.A person with mental illness shall not be subjected to
seclusionor solitary confinement, and, where necessary,
physical restraint may only be used prevent imminent and
immediate harm to person concerned or when it is authorized
by the psychiatrist in charge of the person’s treatment at the
mental health establishment.
2.Physical restraint shall not be used for a period longer than it
is absolutely necessary to prevent the immediate risk .

87. 3.The medical officer or mental health professional in
charge of the mental health establishment should ensure
that the method, nature of restraint, justificationfor its
imposition and the durationof the restraint are
immediately recordedin the person’s medical notes
4.The nominated representative of the person with mental
illness should be informed about the use of restraint within
a period of 24 hours.
5.A person who is placed under restraint shall be kept in a
place where he can cause no harmto himself or others
6.All instances of use of restraint should be reported to
concerned Board on a monthly basis.

88. Prohibited procedures (Sec 95)

89. Sec 95
The following procedures are prohibited on any person
with mental illness:
1.Electroconvulsive therapy (ECT)without the use of
muscle relaxants and anesthesia.
2.ECT on minors
3.Sterilisation of men and women affected by mental
illness, that is intended as treatment for mental illness
4.chainedin any manner or form

90. Presumption of severe stress in case
of Suicide attempt case (Sec 115)

91. Sec 115
A person who attempts to commit suicide shall be presumed
to be under severe stress and shall not be tried and punished
under Section 309 IPC
It is the duty of the government to provide care, treatment and
rehabilitation to such a person

92. MAY THE GRACIOUS GOD
BLESS US ALL ALWAYS
WISHING YOU ALL SUCCESS
FOR YOUR UPCOMING
EXAMS
Your valuable suggestions are
entertained -
[email protected]