Madness and Crime

Philip Bean

• Publisher: Willan
• Year: 2013
• ISBN:
  9781134036264
• Edition: 1
• Topic: Sciences sociales
• Subtopic: Criminologie

This book provides an authoritative and highly readable review of the relationship between madness and crime by one of the leading authorities in the field. The book is divided into four parts, each essay focusing on selected features of madness which have relevance to contemporary society.

Part 1 is about madness itself, exploring three main models ? cognitive, statistical, and emotional. Part 2 is a short discussion on madness, genius and creativity. Part 3 is about the much neglected area of compulsion, an issue that has largely disappeared from public debate. The mad may have moved from victim to violator, yet fundamental questions remain ? in particular how to justify compulsory detention, and who should undertake the process? The answers to these questions have sociological, ethical and jurisprudential elements, and cannot just re resolved by reference to medical authorities. Part 4 is about the links between madness and crime ? focusing less on the question and nature of criminal responsibility and the various defences that go with this, more on the links between madness and crime and which particular crimes are linked with which types of disorder.

Part 1

Some thoughts on the nature of madness

Introduction and overview

I read somewhere, I’ve long since forgotten where, that most of us can expect to have at least one period of madness in our lifetime. It may not be severe, it may not last long, but it will certainly be unpleasant. It might act as a beacon from which to judge or measure our subsequent sanity, or it might be forgotten, buried and never reconsidered. Whatever its legacy, madness is not a benign condition; it is not one of those slight quirks which the labelling theorists were wont to dismiss as a minor deviance (see Roth and Kroll 1986: 88). Nor is it simply the product of those who enforce the label, as if the rule enforcers decide on the basis of some manufactured evidence, or conspiracy, that some were mad and others not – surely one of the greatest pieces of inhuman theorising of our age, and a disservice to the mad. It ignores their suffering. Madness is painful; if acute, it can be debilitating, and if chronic it can ruin one’s life.

I want to look a little more closely at what constitutes madness, and to do so by concentrating on the empirical model, sometimes called the cognitive. I have selected this because I think it offers a promising solution to some of the more intractable problems associated with insanity. If madness is ‘something’, painful though that may be, how best can it be described?

There is no shortage of material from which to draw. We know a great deal about how the mad were dealt with, whether by alienists or in the early asylums (see Scull 1979; Porter 1991; Foucault 1977). Historians, and in particular some psychiatric historians, have put their own slant on the subject, as we all do, some interpreting the history of psychiatry and treatment as progressive, adding their hopes for the future. Others offer a different interpretation. Nonetheless, all these historical accounts remind us of the complexities of the subject matter and the dangers of making simple generalisations. Alongside these are the interpretations of the treatment by professionals, lawyers and others who have managed, treated and written about them. Together these add to a burgeoning and impressive literature, although this has produced rather less emphasis on the nature of madness itself. It means, in Roy Porter’s terms, that we know about them, but almost nothing of them (Porter 1985: 64; Scull 1979).

This failing, if it is a failing, is often offset through the writings of the mad, but these too can be slanted, aimed at providing an excuse or apology for their shortcomings, or blaming those who detained them. Countless autobiographies and biographies have described what it is like to be mad, sometimes the authors insisting that they, or others, were wrongly accused, or if not then madness was the tunnel through which they gained enlightenment. In their writings madness appears to shade into sanity, or vice versa. There seems to be no clear dividing line. It is part of the great mystery that this is so. Their writings also show the pain and the extravagance of maniacal fury or the sinking into despondence and melancholy (Porter 1991: 4–8, 12–13). If anyone doubts this the accounts by Kay Jamison of her life with a bipolar condition (Jamison 1996) or by Peter Chadwick, suffering from schizophrenia, should dispel any illusions (Chadwick 1997).

There is also a rich classical literature on which to draw. Various types and aetiologies of madness are displayed in fiction, ranging from bereavement, a lost love, intense personal pressure, or simply being in love. King Lear talks of the pain of madness (Act IV scene 7: 45) and compares the sane to being ‘a soul in bliss’ for his world was ‘bound Upon a wheel of fire, that mine own tears Do scald like molten lead.’ Lear’s madness was speeded up by self-pity. He pleads with his daughters to remember, ‘Your kind old father whose frank heart gave all’, then rebukes himself for ‘O that way madness lies! Let me shun that; No more of that’ (Act 3 scene 4: 20).¹ Self-pity distorts the truth of relationships. Lear’s associate the Duke of Gloucester blamed his condition on the failings of his son: ‘The grief hath crazed my wits’ (Act 3 scene 4: 164). Grief unhinges the mind. Gloucester’s madness occurred when ‘thoughts are sever’d from griefs’, that is, split from each other, or separated (broken) from the conscious world.

Lear’s madness moved him to another level of consciousness, but when sanity returned he was restored to an earlier mental state. His madness provided insights that are often the prerogative of those who have gone beyond us to reach new points of reflection. ‘When we are born we cry that we are come To this great stage of fools’ (Act 4 scene 6: 180). That is more than recognition of old age, but a sad, realistic recognition of existence. For this is a stage of fools, with some actors more foolish than others. Dr Johnson saw it less in theatrical terms and more as capable of producing suffering: ‘Every man will readily confess that his own condition discontents him’, and ‘The general lot of mankind is misery’ (quoted in Porter 1985: 69). Madness is stark, there is no way of hiding it; the mad give themselves away by their appearance, by the way they look, walk, and talk. Everyone knows who they are, what Porter calls ‘behaving crazy, looking crazy and talking crazy’ (Porter 1987a: 35). There are no special skills needed to identify them.

This slight digression into classical literature reveals more than the quality of its poetry; it suggests there remain numerous aetiologies embedded deep within our consciousness. We assume, and often know, that some angry people will become mad, as will some who are grief-stricken. But then others may not, for not all fit the scheme of things.² Sometimes madness or the cause of it is easily explained, common knowledge perhaps, yet sometimes we are puzzled why it should occur.

Nor is normality any easier to understand. While normality may be the converse of madness, as reason is to unreason, with the latter a parody on the former, normality does not mean a perfect state; it can in certain circumstances include a measure or degree of disorder or instability. Indeed the idea that everyone is a little mad, and craziness a way of the world is not uncommon. The young Charles Darwin said that his father thought there was a perfect gradation between the sane and insane, but that everybody was insane at some stage of their lives (quoted in Porter 1987a: 1). Others, however, were convinced that there was a clearer divide. John Haslam (1764–1844), a British psychiatrist, argued early in his career that reason and madness, or sanity and insanity, were as distinct as black and white; as clear as straight and crooked. However, in old age he confessed that he knew no one who was in their right mind except perhaps the Almighty, and of this, incidentally, he had been reassured on the authority of eminent Church of England divines (quoted in Porter 1991: 2).

Finally, there is an equally extensive and rich literature on the aetiology of madness going back at least to Plato and Aristotle. In the late seventeenth century John Locke distinguished between those who were born witless and those who fell out of their wits, the mad being the latter. Locke saw a difference between madmen and idiots, the former having too many ideas, the latter too few; while Voltaire, anticipating modern psychiatric thinking, saw it as a disease of the brain: ‘A lunatic is a sick man whose brain is in bad health.’ He then adds somewhat pessimistically, and rather worryingly for modern psychiatrists, ‘Doctors will never understand why a brain has regulated and consistent ideas. They will believe themselves to be wise and they will be as mad as the lunatic’. (quoted in Porter 1987a: 17). In 1810 the London physician William Black tabulated the causes of insanity among admissions to Bedlam. Of the 800 or so patients over 200 were there due to ‘Disappointments, Grief, and Troubles’. The next largest group, over 100, were due to ‘Family and Hereditary Matters’, closely followed by ‘Fevers’, then ‘Religion and Methodism’. ‘Love’, ‘Drink, Intoxication’, and ‘Fright’ all figured prominently (Porter 1987a: 33). So too did ‘Study’; the idea that too much learning turns one’s head was a providential threat found in the New Testament. And just as there was no shortage of aetiologies in the early nineteenth century, nor would there be today. It would not be difficult to compile a similarly lengthy list, which might not tally with that of William Black but would have many ‘causes’ in common.

To ignore these sources is to miss out on numerous insights that direct attention towards a more eclectic view of madness, or rather towards one that emphasises multiple causes and myriad responses. I am not suggesting that all these views be considered, but I want to show that the current fashionable modern view, which concentrates on psychosis as a disease, is not the only one, nor is it necessarily the sole path to the truth. In fact I suggest such a view has serious shortcomings.

Madness and the disease model

Madness can be seen as arising from different origins; a socio-psychological model, to be called multi dimensional, and a disease model, to be called quasi dimensional, the latter an extension of the clinical. These different models have produced schisms in the research programmes and given rise to different conclusions. (Claridge 2001: 95). The aim here is to emphasise the multi dimensional, that is to see madness as arising from a set of socio-psychological dimensions. In essence this means madness lies at one extreme of a continuum, with sanity at the other, and with personality traits of a more or less severe kind in between. Claridge (2001: 96) calls these ‘personality variations,’ i.e. they represent individual differences.

A multi-dimensional view opens up numerous opportunities, one of which is to break from traditional medical terminology – more specifically, to use the term ‘madness’ in preference to ‘psychosis’ or other such medical terms. It would, of course, be possible to stick to established terminology found in standard psychiatric textbooks, but to do so would be to accept the psychiatric paradigms and become more attuned to matters of diagnosis and treatments than I would wish. It would tie the debate into the world of medicine, and the disease model of psychiatry, and that would not do.

There is another reason: using the term madness does more than create distance from the clinicians; madness is an evocative word, poetic and able to encapsulate the depth of the subject matter. When King Lear recognised the turmoil devouring him and said to his Fool: ‘O Fool! I shall go mad’, he feared the onset of an overpowering presence. Would he have said the same had he thought he was becoming psychotic or mentally ill? I think not. King Lear was ‘mad’. That says more than he was ‘mentally ill’, ‘psychotic’, or ‘mentally disordered’. Madness also conveys the richest resonances in everyday parlance. It can be widely applied to all manner of abnormalities and extremes, such as being madly in love, or being mad at someone who has upset us (Porter 1991: xi). It encapsulates terms like ‘crazy’, ‘loopy’, and numerous others, all of which suggest variations in mad behaviour.³ Yet it is not just the language and the poetry that makes things different, ‘madness’ reflects a different way of looking at the world.

Of course, it is not without its problems. Like all such concepts definitional problems abound. What, for example, are its borders and boundaries? Where does the Visionary, the Religious Prophet or the Eccentric fit in? (Porter 1991: xiv). Or, how does it differ from other terms, such as insanity? But, following Polonius, no definition seems able to answer the question, for what is it ‘To define true madness’ except to say, ‘is’t to be nothing else but mad’.

The impression might be conveyed that there is something afoot here that is anti-psychiatry, or a relic of the anti-psychiatry movement of the 1960s. Quite the reverse. The stance is not confrontational, extensive use will be made of the psychiatric literature, and of the insights gained. Yet there are differences; the aim is not to classify patients, or diagnose their condition, or suggest treatments. Psychiatry takes that stance; it is also interested in the neuroses, the personality and psychopathic disorders. I do not regard the latter as falling within the compass of the debate, the former are but milder forms of disorder, although sometimes as painful, and for the latter, I am persuaded these conditions have little or nothing to do with madness. Leaving aside the psychopath means ignoring many of the real difficulties faced by the criminal justice system, and the countless issues that have held up the new Mental Health Act, but to include that condition opens up too many avenues to be handled in a work of this length. (Personality disorders and psychopathic disorders are, however, dealt with more fully in Part 4). It has not been possible to eschew all psychiatric terms; modern research uses these terminologies, and clinicians likewise.

The disease model offers one approach but not an entirely satisfactory one, and its weaknesses are becoming increasingly apparent. I admit to being unconvinced by it, although in saying this I am not giving support to the Szaszian view that madness is nothing more than ‘a problem of living’. Eschewing the former does not mean support for the latter. Madness is more than a problem of living, it is a special condition, unique in its way. It requires special attention, but that does not make it an illness. Nor am I impressed by the constant search for a physiological basis for those mental disorders such as schizophrenia or depression, a view incidentally increasingly shared by others (Clarke 2001; Read 2004). And even if an underlying physiological condition were to be identified there remains a basic logical problem that attempts to deduce a causal relationship from a correlation. Is the mental state a product of or cause of the physiological change? And how to tell? Assume a correlation, then what? Is it anything more than a connection to the ‘person’s way of life’, with all its physical and psychological dimensions? (Ingleby 1981: 37). And how is a correlation to be interpreted? High levels of adrenalin clearly accompany anger or excitement; but no one seriously suggests that adrenalin causes the anger – nor incidentally, as a treatment for anger that patients should have their adrenalin levels adjusted or reduced by neuro-physiology.

For convenience we can call the quasi-dimensional the disease model – not the medical model, for as Tyrer and Steinberg (1998) say, the medical model is a generic term; the disease model is more specific. The disease model regards mental malfunction as a consequence of physical and chemical changes, primarily in the brain but sometimes in other parts of the body (Tyrer and Steinberg 1998: 9). This model asserts that psychoses are clearly identifiable disease syndromes with a distinct biological and genetic substrate, a view that was given a boost by the development from the 1950s of neuroleptic medication, which provided marked symptom relief (Clarke 2001). Typical of many modern psychiatrists, Tyrer and Steinberg recognise that knowledge of mental illnesses is incomplete, but do not want to abandon the disease model; i.e. they make the assumption that there exists an underlying recognised disease condition and operate as if this were so. The hope is that the elusive physical pathology will one day be found, confirming all suspicions that at last psychiatric illnesses are explicable in terms of physical illness. That would allow psychiatry to take its place at the medico-scientific table.

The disease model offers a materialist conception of madness and encapsulates the mind-brain theory. It leaves no problem about explaining how the mind and brain interact, or about whether mental states are able to provide a causal explanation of behaviour (Glover 1980: 8). So for each piece of behaviour there is some reaction in the brain, and all behaviour is reducible in that form. Psychosis (madness) is explained by defects or changes in the brain.

But things are never that simple. Attractive though it may be there remains the same age-old problems of Cartesian dualism; that is, what is the relationship that is supposed to exist between the brain and the mental states it produces? And if they are identical, as some have suggested, do they have the same or different properties, such as those observed by neurosurgeons and those accessible by introspection, i.e. through consciousness. This intriguing question was asked by Jonathan Glover: what would happen if future work provided all the answers the materialist ever wanted, where every mental state would be claimed to be identified as a so-called brain state (1980: 9)? And the answer, he says, is that we are no further forward, for the Cartesian dualist would simply claim that all the neuro-physiologists have done is to show correlations between two different kinds of states (1980: 9). It is the old mind-body problem all over again; Descartes would recognise it immediately. (Descartes implied that consciousness was rational, and if so insanity must be a consequence of some precarious connection to the brain (Carter 1983).) So, the mind-brain materialist offers a variation on an old Cartesian theme.

There has been, at least since the 1960s, an incessant demand to have the disease model accepted by patients and public alike. Whatever its strengths, and there are many, in my view the model has been overplayed. It has been promoted and accepted by clever marketing, that is by linking it to the idea of a progressive enlightened psychiatry where rejection is to return to dark, unsympathetic days. Its acceptance has also been assisted by the law of repetition: if assertions are made with sufficient regularity, and by people of high status, eventually they will become accepted. And so it has proved. This is in spite of some weak and curious arguments by those making the assertions; for example, as Tyrer and Steinberg say, ‘the fact that we cannot identify a part of the brain that is pathological at the present state of our knowledge does not mean that no such change exists’ (1998: 29).⁴ Well yes, but that argument could apply to any social problem, or any other piece of behaviour that one cared to name. Second, it is often asserted that there must be a disease condition, as treatment, through the medium of chemical therapy, cures or alleviates it. The trouble with this is that one cannot assume that the condition is that which the chemicals change, or which tranquillisers tranquillise. Tranquillisers may block or simply change matters that have little or nothing to do with the so-ca...