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Handbook of Forensic Psychiatric Practice in Capital Cases


If the act was carried out impulsively, or through ‘loss of control’, then that is unlikely to come within the terms of insanity.


In regard to knowledge, or its lack, of the legality of the defendant’s actions, consider whether any of the following apply:


• Evading police during the latter process of committing the actus, or soon thereafter • Comments made by the defendant close to the material time, or subsequently in retrospect


Te clinical syndromes most likely to be relevant to a defence of insanity are psychoses and acute or chronic brain syndromes.


Automatism


Automatism is a complete defence to any criminal charge. It is not identical to medical concepts of automatism. In law it is defined as the commission of an action that the mind of the defendant did not will. Te defendant effectively pleads that their actions were completely involuntary. An impulsive or irresistible response is not an involuntary one. If automatism is argued successfully, then it results in total acquittal. Finally, an automatism can be defined as a sane, or insane automatism, dependent upon whether the cause of the automatism was a legal ‘disease of the mind’, as defined within the law relating to ‘insanity’ (see above). Hence, a finding of ‘insane automatism’ will amount to a finding of ‘not guilty by reason of insanity’ (see above).


Insane or non-insane automatism


Te distinction between insane and non-insane automatism is not based on the presence at the time of a medical condition or diagnosis. If the cause is intrinsic to the defendant without any ‘external blow’ (for example, in a post concussion confusional state) then the cause of the automatism will be determined to have been a legal ‘disease of the mind’, and the automatism to have been an insane automatism. However, since any intrinsic factor can determine the presence of a legal disease of the mind, this can lead to incongruence with medical notions of ‘disease’, in that an epileptic seizure, parasomnia, hyperglycaemia arising from diabetes or cerebral ischaemia can lead to a finding of insane automatism, these not being conditions that psychiatrists would consider ‘diseases of the mind’. However, less incongruity is inferred in relation to a state of ‘dissociation’, if the defendant has an inherent tendency mentally to dissociate.


By contrast, if the cause of the automatism was external to the defendant, such as in concussion after head injury, or hypoglycaemia occurring after insulin administration, then the automatism amounts to be ‘non-insane’, with resultant total acquittal. Te distinction is therefore related to the interpretation of whether the cause was external, determined in R v Quick, and not based upon any category of mental disorder defined medically.


Where the cause of the automatism was ‘mental dissociation’ (see below), and such dissociation resulted from an ‘external blow’, be it a physical or a psychological ‘blow’, the legal determination will be in terms of non-insane automatism. Hence, for example, mental dissociation triggered by


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