Sanity and insanity

Legal definition of sanity

Law in criminal and mental health law, sanity is a legal term donating that an individual is
of sound mind and therefore can bear legal responsibility for their actions. The official legal term
as compos mentis, it is generally defined in terms of the absence of sanity (non-compos mentis).

Sanity mean

Sanity is a word for having a healthy state of mind – people with sanity don’t have any
loose marbles. Outside of mental hospitals, people often use this word in an exaggerated way when
they have had a stressful, difficult day, shouting “ I am losing my sanity”

Insanity mean

The state of being seriously mentally ill, madness.

Extreme foolishness or irrationality.

Definition of insanity

Here’s the first came lengthy definition insanity n mental illness of such a severe nature
that a person cannot distinguish fantasy from reality; cannot conduct his , her affairs due to
psychosis, or is subject to un controllable impulsive behavior.
 The Insanity Defense

What is the Insanity Defense?

For a person to be convicted of a crime, the prosecution must prove not only that the person
engaged in a guilty act (actus reus), but also that he or she had guilty intent (mens rea). If a person
does not have criminal intent during an act, no crime occurs: a person, who takes someone else’s
property, honestly believing it is his own, is not guilty of larceny.

But what about situations in which the person commits the act, and intended to do so, but
was suffering from a mental or physical condition that impairs their ability to appreciate that they
are doing something wrong or to control their behavior? That’s where the insanity defense comes
in.

While the insanity defense is a legal doctrine, at its heart it is the expression of a moral
principle found in societies across time and multiple cultures: individuals should not be punished
for their otherwise criminal acts if they lack certain characteristics that relate to the ability to
engage in rational thinking, including an appreciation of the wrongfulness and consequences of
their actions, or control their behavior. Take, for example, children. A five year old who sets fire
to the drapes because the flames are pretty, will not be charged with arson when the house burns
down.

The same is true for people with severe developmental disabilities. What about people who
cause harm to others or commit crimes while sleepwalking? Yes, those cases exist, and the
defendants are generally not held criminally responsible.

What Qualifies as a “Mental Disease or Defect” for the Insanity Defense?

While any mental or medical condition could theoretically serve as a basis for an insanity
defense, the law limits the conditions that can be considered for that purpose. These restrictions
are aimed at insuring that only those who truly deserve to be relieved of responsibility are eligible
for it. To that end, voluntary intoxication is excluded, as are conditions that have antisocial
behaviors as their primary characteristic, e.g. kleptomania, pyromania, and pedophilia and appear
to have no physiological basis. Some legal standards require that the mental illness serving as the
basis for the defense be “severe.”

Not every condition that qualifies to be the basis for an insanity defense has an equal chance
of succeeding in achieving an acquittal. Those that succeed tend to be marked by either severity
or evidence that they arise from a physiological, as opposed to a purely psychological, disorder.
These are, for example, mental illnesses that severely affect a person’s perception of reality or, in
some jurisdictions, ability to control their behavior. They include psychoses, severe depression,
mania, or anxiety disorders like posttraumatic stress disorder (PTSD). An argument that an act of
violence was the result of a traumatic brain injury causing irritability and poor impulse control is
more likely to be convincing than the assertion that the violence arose
from personality disturbance.

How Will Advances in Neuroscience and Genetics Affect the Insanity Defense?

The presence of abnormal brain function due to injury, tumor, and epilepsy has been
successfully offered as the basis for an insanity defense in number criminal cases hundreds of
years. When it has been successful, the apparent key to the success of these defenses lies in the
concrete and observable nature of the abnormality: juries can see the tumor on a brain scan, and
may be presented with evidence that the criminal behavior did not occur before the injury or that
it stops after treatment.

Advances in neuroscience and genetics provide a means for less obvious brain
abnormalities to be offered as the basis for a defense. And this presents a challenge to traditional
notions of the causes of mental illness, as well as some types of criminal behavior. There is
growing evidence for genetic transmission of numerous psychiatric conditions, including
personality disorders, as well as their underlying anatomic and physiological abnormalities.
Psychopathy, for example, is an extreme form of personality disturbance, with no established
effective treatment, marked by indifference to right and wrong, lack of empathy, conning and
manipulation, and aggressive pursuit of self-interest. It is associated with criminal behavior of all
sorts, including crimes of extreme violence in some cases. As such, it has been excluded from
consideration as the basis for an insanity defense. But discoveries of fundamental anatomical and
physiological differences between the brains of psychopaths and non-psychopaths--including non-
psychopathic criminals—as well as evidence those psychopathic traits may be inherited, has set
the stage for arguments that even those who commit the worst of crimes should not be held
responsible for them. After all, they didn’t choose their genetic makeup or to be born without the
capacity for empathy. The current issue of Science contains a report that while a diagnosis of
psychopathy may result in a longer criminal sentences, judges seem inclined to impose more
lenient sentences where evidence of a biological basis for the defendant’s psychopathy was
introduced.
 So far, these new arguments have failed in preventing guilty verdicts. But as the evidence
mounts, we can expect to see more such arguments, and perhaps more leniency in sentencing.
When, and if, the insanity verdict is extended to individuals with psychopathy, society must be
prepared for the next question: What do we do with those who are not criminally responsible, but
who are too dangerous to live in society and for whom there is little, if any, effective treatment? It
will be a fascinating debate that challenges our notions of justice, morality, and science.

Historical Perspective

Insanity, madness, and craziness are terms that describe a spectrum of individual and group
behaviors that are characterized by certain abnormal mental or behavioral patterns. Insanity can
be manifest as violations of societal norms, including a person or persons becoming a danger to
themselves or to other people. Conceptually, mental insanity also is associated with the biological
phenomenon of contagion (that mental illness is infectious) as in the case of copycat suicides. In
contemporary usage, the term insanity is an informal, un-scientific term denoting "mental
instability"; thus, the term insanity defense is the legal definition of mental instability. In medicine,
the general term psychosis is used to include the presence either of delusions or of hallucinations
or both in a patient;[1] and psychiatric illness is "psychopathology", not mental insanity.

In English, the word "sane" derives from the Latin adjective sanus meaning "healthy".
Juvenal's phrase mens sana in corpore sano is often translated to mean a "healthy mind in a healthy
body". From this perspective, insanity can be considered as poor health of the mind, not necessarily
of the brain as an organ (although that can affect mental health), but rather refers to defective
function of mental processes such as reasoning. Another Latin phrase related to our current concept
of sanity is "compos mentis" (lit. "sound of mind"), and a euphemistic term for insanity is "non
compos mentis". In law, mens rea means having had criminal intent, or a guilty mind, when the
act (actus reus) was committed.

A more informal use of the term insanity is to denote something or someone considered
highly unique, passionate or extreme, including in a positive sense. The term may also be used as
an attempt to discredit or criticise particular ideas, beliefs, principles, desires, personal feelings,
attitudes, or their proponents, such as in politics and religion.
Historical views and treatment

Madness, the non-legal word for insanity, has been recognized throughout history in every
known society. Some traditional cultures have turned to witch doctors or shamans to apply magic,
herbal mixtures, or folk medicine to rid deranged persons of evil spirits or bizarre behavior, for
example. Archaeologists have unearthed skulls (at least 7000 years old) that have small, round
holes bored in them using flint tools. It has been conjectured that the subjects may have been
thought to have been possessed by spirits which the holes would allow to escape. However, more
recent research on the historical practice of trepanning supports the hypothesis that this procedure
was medical in nature and intended as means of treating cranial trauma.

Ancient Greece

The Greeks appeared to share something of today's[when?][where?] secular and holistic

view, believing that afflictions of the mind did not differ from diseases of the body. Moreover,
they saw mental and physical illness as a result of natural causes and an imbalance in bodily
humors. Hippocrates frequently wrote that an excess of black bile resulted in irrational thinking
and behavior.

Ancient Rome

Romans made other contributions to psychiatry, in particular a precursor of some

contemporary practice. They put forward the idea that strong emotions could lead to bodily
ailments, the basis of today’s theory of psychosomatic illness. The Romans also supported humane
treatment of the mentally ill, and in so doing codified into law the principle of insanity as a
mitigation of responsibility for criminal acts, although the criterion for insanity was sharply set as
the defendant had to be found "non compos mentis", a term meaning "not sound of mind".

From the Middle Ages onwards

The Middle Ages, however, witnessed the end of the progressive ideas of the Greeks and
Romans.
 During the 18th century, the French and the British introduced humane treatment of the
clinically insane, though the criteria for diagnosis and placement in an asylum were considerably
looser than today, often including such conditions as speech disorder, speech impediments,
epilepsy, and depression or being pregnant out of wedlock.

Europe's oldest asylum was the precursor of today's Bethlem Royal Hospital in London,
known then as Bedlam, which began admitting the mentally ill in 1403 and is mentioned in
Chaucer's Canterbury Tales. The first American asylum was built in Williamsburg, Virginia, circa
1773. Before the 19th century these hospitals were used to isolate the mentally ill or the socially
ostracized from society rather than cure them or maintain their health. Pictures from this era
portrayed patients bound with rope or chains, often to beds or walls, or restrained in straitjackets.

Insanity is no longer considered a medical diagnosis but is a legal term in the United States,
stemming from its original use in common law.[10] The disorders formerly encompassed by the
term covered a wide range of mental disorders now diagnosed as bipolar disorder, organic brain
syndromes, schizophrenia, and other psychotic disorders.[1]

Insanity defense

In United States criminal law, insanity may serve as an affirmative defense to criminal acts
and thus does not need to negate an element of the prosecution's case such as general or specific
intent. Each U.S. state differs somewhat in its definition of insanity but most follow the guidelines
of the Model Penal Code. All jurisdictions require a sanity evaluation to address the question first
of whether or not the defendant has a mental illness.

Most courts accept a major mental illness such as psychosis but will not accept the
diagnosis of a personality disorder for the purposes of an insanity defense. The second question is
whether the mental illness interfered with the defendant's ability to distinguish right from wrong.
That is, did the defendant know that the alleged behavior was against the law at the time the offense
was committed.

Additionally, some jurisdictions add the question of whether or not the defendant was in
control of their behavior at the time of the offense. For example, if the defendant was compelled
by some aspect of their mental illness to commit the illegal act, the defendant could be evaluated
as not in control of their behavior at the time of the offense.

The forensic mental health specialists submit their evaluations to the court. Since the
question of sanity or insanity is a legal question and not a medical one, the judge and or jury will
make the final decision regarding the defendant's status regarding an insanity defense.

In most jurisdictions within the United States, if the insanity plea is accepted, the defendant
is committed to a psychiatric institution for at least 60 days for further evaluation, and then
reevaluated at least yearly after that.

Insanity is generally no defense in a civil lawsuit. However, in civil cases, the insanity of
the plaintiff can toll the statute of limitations for filing a suit until the plaintiff has recovered from
this condition, or until a statute of repose has run.

Feigned insanity

Feigned insanity is the simulation of mental illness in order to deceive. Amongst other
purposes, insanity is feigned in order to avoid or lessen the consequences of a confrontation or
conviction for an alleged crime. A number of treatises on medical jurisprudence were written
during the nineteenth century, the most famous of which was Isaac Ray in 1838 (fifth edition
1871); others include Ryan (1832), Taylor (1845), Wharton and Stille (1855), Ordronaux (1869),
Meymott (1882). The typical techniques as outlined in these works are the background for Dr. Neil
S. Kaye's widely recognized guidelines that indicate an attempt to feign insanity.

One particularly famous example of someone feigning insanity was the case of Mafia boss
Vincent Gigante, who pretended for years to be suffering from dementia, and was often seen
wandering aimlessly around his neighborhood in his pajamas muttering to himself. However,
testimony from informants and surveillance showed that Gigante was in full control of his faculties
the whole time, and ruled over his Mafia family with an iron fist.

Today feigned insanity is considered malingering. In a 2005 court case, United States v. Binion,
the defendant was prosecuted and convicted for obstruction of justice (adding to his original
sentence) because he feigned insanity in a Competency to Stand Trial evaluation.
 Some of the earliest references to the criminally insane can be found in Roman law, which
by and large advocated leniency, maintaining that madness was a punishment in itself. The issue
of madness and criminal responsibility was being debated as far back as the 13th century with
prominent writers of the time arguing that the 'will to harm' must be evident within a crime and
the lack of such a will among the mad excused them of responsibility.

As soon as society began to engage with the idea that madness negated criminal
responsibility, the study of mental illness within a forensic context was inevitable.

In 1603 Sir Edward Coke maintained that the madman 'did not know what he did', and as
such did not actually display any criminal intent. This was important because form this point
‘insanity’ was judged exclusively in cognitive terms; namely did the accused know that what they
were doing was wrong?

An early example of how this was encapsulated within the legal system is the wild beast
test (1724) which stated that individuals exhibiting actions more like animal reflexes rather than
moral choice were said not to be responsible for the crime they committed.

'Totally deprived of his understanding and memory and doth not know what he is doing,
no more than an infant, than a brute, or a wild beast.'

As a result of a number of high profile cases additional criteria for judging criminal
responsibility came into play e.g. being able to distinguish between good and evil. In time this
criteria became an independent measure of madness and juries had the option to find the accused
not guilty by reason of insanity.

A key historical landmark in the legal relationship between insanity and responsibility can
be traced back to the 20th January 1843 when Daniel M'Naghten shot and killed Edmund
Drummond, the private secretary of British Prime Minister Sir Robert Peel; mistakenly thinking
Drummond was Peel, his intended target.

In a landmark legal ruling M'Naghten was found not guilty of murder on the grounds that his
delusional mental state rendered him incapable of knowing that what he was doing was wrong.
This enduring legal precedent within the insanity defense became known as the 'The M'Naghten
Rules.'
Fact Vs. Fiction

As part of their role within the legal system - in particular assessing criminal responsibility
- a forensic psychologist may be asked to determine whether an accused individual can legitimately
claim insanity as part of their defense.

As with other areas within the remit of the forensic psychologist, the insanity defense is
often misrepresented and over stated in the popular media, which in turn has resulted in a skewed
perception among the general public.

Contrary to public belief that the insanity defense is a common get out of jail card, the
reality is that only a handful of defendants pursue an insanity defense and those that do rarely
succeed. In percentage terms within felony cases, the insanity defense is employed around 1% of
the time and within that 1% it is only successfully employed about a quarter of the time.

It's also worth noting that should a defendant be found not guilty on the basis of insanity,
they are likely to spend more time confined to a mental institution, than a sane individual in jail
who has been convicted of a similar crime.

Also contradicting the notion that the insanity defense is an easily exploitable legal loop
hole are the major provisions of the Insanity-Defense Reform Act of 1984. Signed into law on
October 12, 1984, this was the first comprehensive Federal legislation governing the insanity
defense and the disposition of individuals suffering from a mental disease or defect who are
involved in the criminal justice system. The more significant provisions of the act were that it:

1. Significantly modified the standard for insanity previously applied in the Federal courts.
2. Placed the burden of proof on the defendant to establish the defense by clear and convincing
evidence.
3. Limited the scope of expert testimony on ultimate legal issues.
4. Eliminated the defense of diminished capacity.
5. Created a special verdict of "not guilty only by reason of insanity," which triggers a commitment
proceeding.
6. Provided for Federal commitment of persons who become insane after having been found guilty
or while serving a Federal prison sentence.
(Source US Attorneys Criminal Resource Manual)

Expert Witnesses and the Insanity Defense

Expert testimony is typically proffered in trials where the defendant is raising an insanity
defense. The typical successful insanity defense requires a showing of significant mental illness or
impairment through expert testimony. The role of experts in insanity defense trials is somewhat
unique. There has been substantial controversy about the role of expert psychological testimony
in insanity defense trials, and some have advocated doing away with experts in these cases. The
law places a number of constraints on experts in insanity trials. Psychologists in most instances
testify about a diagnosis for the defendant and the symptoms associated with that diagnosis, and
they give their opinions regarding the defendant’s ability to understand the difference between
right and wrong. However, after the Hinkley case, the Federal Rules of Evidence were amended
to disallow expert mental health testimony on the ultimate issue—whether or not the defendant
was sane or insane at the time of the alleged offense. This decision was left to the trier of the fact.
Limited research has examined the effect of expert testimony in general or of ultimate opinion
testimony on juror decision making. A consistent finding is that the ultimate opinions proffered by
experts do not have a significant effect on decision making, contrary to the concerns underlying
their prohibition.

"The Forensic Psychologist & The Insanity Defense"

` "As part of their role within the legal system - in particular assessing criminal responsibility
- a forensic psychologist may be asked to determine whether an accused individual can legitimately
claim insanity as part of their defense.

As with other areas within the remit of the forensic psychologist, the insanity defense is
often misrepresented and over stated in the popular media, which in turn has resulted in a skewed
perception among the general public.

Contrary to public belief that the insanity defense is in essense a get out of jail card, the
reality is that only a handful of defendants pursue an insanity defense and those that do rarely
succeed. In percentage terms within felony cases, the insanity defense is employed around 1% of
the time and within that 1% it is only successfully employed about a quarter of the time.
 It's also worth noting that should a defendant be found not guility on the basis of insanity,
they are likely to spend more time confined to a mental institution, than a sane individual in jail
who has been convicted of a similar crime.

Further evidence that the insanity defense is hardly a legal loop hole can be seen in the
major provisions of the Insanity Defense Reform Act of 1984. Signed into law on October 12,
1984, this was the first comprehensive Federal legislation governing the insanity defense and the
disposition of individuals suffering from a mental disease or defect who are involved in the
criminal justice system. The more significant provisions of the act were that it:

1. Significantly modified the standard for insanity previously applied in the Federal courts.
2. Placed the burden of proof on the defendant to establish the defense by clear and convincing
evidence.
3. Limited the scope of expert testimony on ultimate legal issues.
4. Eliminated the defense of diminished capacity.
5. Created a special verdict of "not guilty only by reason of insanity," which triggers a commitment
proceeding.
6. Provided for Federal commitment of persons who become insane after having been found guilty
or while serving a Federal prison sentence."

Criminal responsibility and mental illness in Pakistan

In a population of 200 million people in Pakistan, approximately 22 million have a mental

illness, but only about 500 qualified psychiatrists are practising in the country, producing a ratio
of one psychiatrist for 400 000 people. Mental health-care facilities for prisoners, including a
proper follow-up or rehabilitation system, are completely absent in Pakistan.

 Consequently, mental health care for prisoners is worse than for the general population.
  Dictated by traditional customs and religious beliefs, patients with psychiatric disorders in
Pakistan seek diverse traditional methods of treatment, including homeopathy,
naturopathy, Islamic faith healing, and sorcery.
 Mental health care requires greater attention and awareness in Pakistan.
This need for improved knowledge regarding mental health was highlighted when the Pakistan
Supreme Court considered the case of a 50-year-old man with paranoid schizophrenia. He was
symptom-free at the time of the court appearance. Despite a diagnosis of paranoid schizophrenia
with hallucinations, delusions, and ideas of grandiosity by a team of government psychiatrists,
who had treated him for the past 8 years during his incarceration, the prisoner's medical reports
were dismissed by the court. The court declared that schizophrenia is a recoverable disease, and
therefore does not fall within the definition of a permanent mental disorder. The man was
sentenced to death on charges of murder.

This verdict faced a backlash from human rights groups and psychiatrists in Pakistan and was
condemned by the British Pakistani Psychiatrists Association.

 In an appeal to the Supreme Court to reconsider, the Association stated that schizophrenia
is classified as a severe, incurable illness by WHO's International Classification of
Diseases (ICD-10) and the Diagnostic and Statistical Manual (DSM-5) of the American
Psychiatric Association.

This incident raises concerns regarding how legal and medical personnel should work
together to decide how to treat and punish offenders concomitantly. In Pakistan, the approach has
now shifted to becoming more situational, and aims to investigate the relationship, if any, between
the crime and its psychotic basis. It is important to evaluate the frame of mind of the accused at
the time when the crime was committed. “Guilty but mentally ill” has been added to the insanity
plea in the USA, allowing the legal system to monitor admissions to hospital for patients with
mental illness. The key is to balance the rights of patients to be treated with the rights of the public
to be protected.

Assessment of criminals with mental health disorders is a sensitive procedure, requiring

in-depth understanding of the mental illness and the laws accommodating medical diagnoses.
Facilities are needed for those patients deemed to have committed crimes because of their mental
health disorder. Incurable psychiatric diseases such as schizophrenia must be recognised as such
by legal professionals, and allowances must be made to treat people who are sick. Such patients
do not fall into the category of deliberate criminals, but at the same time they pose a risk to public
safety. An alternative to execution or imprisonment could be the establishment of institutions
aimed at housing, treating, and monitoring people with mental health disorders. In addition to the
Mental Health Ordinance 2001, and the Sindh Mental Health Act 2013, Pakistan must look into
revising its laws for dealing with wrongdoers diagnosed with a mental illness.

12 Profound Pros and Cons of the Insanity Defense

Surely, you must have read about or either recalls the story where former US President
Ronald Reagan got shot back in the 1980s, right? Well, the man who attempted his assassination
tried to put forward an insanity defense when he was put on trial for the crime. In case you did not
know, insanity defense is a type of defense where the person who is charged with an offense would
admit that he committed a crime, but would claim that he is not responsible for it due to mental
illness. Simply put, he would be found not guilty by reason of being insane. But given its privileges
and coverage, this way of defense has become one of the hottest legal topics in debates around the
world. To have a good idea about it on our end, let us take a look at its pros and cons.

List of Pros of Insanity Defense

It creates an instant atmosphere of guilt.

For an insanity defense to work, the defense party should admit that the crime did happen, but the
defendant actually did not commit it. So, rather than trying to dispute the facts, the goal is to find
the defendant as being innocent because his mental state. Due to the fact that many societies do
not want to give punishments to people who do not genuinely know what is right from wrong, the
trial’s evaluation would becomes more about an individual’s state of mind, rather than the actual
case facts where harm was caused.

It does not allow death penalty.

One huge advantage of insanity defense is that the accused could avoid penalized with death, even
if he were proven guilty. In the context of crime, the sentence can be very lenient as compared
with an accused who is proven to be guilty, but is not proven insane.
 It can save a life.
If a person really does have mental incapacity, and it will be considered that his condition has
caused him to commit a capital crime, which means the defense could save his life. Put in mind
that a capital crime carries a punishment of eventual death. However, being found not guilty
because of insanity means that a capital punishment is out of the question. It could mean that the
accused would just be housed at a professional mental health treatment center. Though it might
not be jail, still it gets him off the streets.

It charges lenient sentencing.

Simply by the virtue of insanity, a person can get some respite from the court. While he will be
declared medically and criminally insane, he would not be tried under the same circumstances as
an accused individual who is in his right mind. These two reasons are the primary bases why
insanity pleas are used in cases where they are applicable.

It can lead to a no-jail term or possible acquittal.

In some cases, people who are accused of crimes can avoid being imprisoned if proven insane.
Though the chance of acquittal has become slimmer over the years, it is still possible that a person
might get some reprieve. It is likely that he would be sent to a psychiatric facility and may even
be set free after staying there. However, it is not guaranteed that an accused would be entirely
acquitted.

List of Cons of Insanity Defense

It is abolished in some jurisdictions.

Take note that insanity defense is not accepted at all jurisdictions in all courts. Some have
abolished it, so a case might need to be transferred, which is quite unlikely unless a very convincing
reason is there, to a jurisdiction that uses such a provision.

It can lead to increased trial costs.

If a party attempts to push insanity defense, then the trial’s cost will be increased. It is likely that
the defense will hire specialists to evaluate the defendant in order to determine the level of existing
mental illness. For the prosecuting team, they will also want to be involved in the process of
specialist selection. Also, it is recorded that only 25% of insanity defenses were successful, and
they only account for about 1% of the total cases that are handled by the justice system each year.
What does this mean? Majority of people are found capable of standing trial, even if they attempt
to push for an insanity plea.

It can be very difficult to prove.

This is certainly true, as mental illness or a history of it has to be proved by endorsing it to an
expert, given the seriousness or gravity of the crime. Even so, it would be eventually up to the
judge or the jury to accept or reject insanity defense. Also, it might happen that, despite being
proven insane, an accused person may still be proven guilty and given an adequate sentence as per
the law, even death.

It does not guarantee relief.

Often, it is perceived that insanity pleas are a clever ploy. However, it is certainly not. In fact,
being relieved from a jail sentence even if an accused had to stay in a psychiatric facility is not
always a good thing. It is likely that such stay will be more taxing for the accused, and there is
always a chance to get cured and then sentenced as a sane and normal person.

It can lead to rejection.

Because of abuse of insanity defense in the past, judges, juries and prosecutors, these days, have
become more cautious. So, every time it is put forth, it would ring alarm bells, where every person
involved would become overly conscious of all arguments in favor or against the defense party. It
is become more difficult to use insanity defense to prove an accused not guilty or reduce his jail
term.

Pleading insanity

In January 2014, Muhammad Asghar, a 70-year-old British man from Edinburgh, was
convicted of blasphemy and sentenced to death by a court in Rawalpindi. Mr Asghar had initially
been arrested in 2010 after sending letters in which he declared himself a prophet. His UK medical
records report that he was first referred to psychiatric services and treated for depression in 1993.
In 2000, he suffered a stroke, which resulted in left-sided weakness of limbs and facial palsy. He
suffered from epilepsy, depression, hallucinations and persecutory and grandiose delusions. On
February 17, 2010, before travelling to Pakistan, Mr Asghar was sectioned in Scotland under the
Mental Health (Care and Treatment) (Scotland) Act 2003, and taken to Royal Victoria Hospital in
Edinburgh. Shortly afterwards, he was diagnosed with late onset paranoid schizophrenia. Given
the nature of his illness, it is very likely, on the balance of probabilities, that he is still and was
exhibiting the symptoms and signs of his illness at the time of the alleged offence, even if he
continued to be fully medicated.

A government prosecutor in this case is on record as saying that convicted Mr Asghar

claimed and confessed to be a prophet inside the court and even in front of the judge. Mr Asghar’
s lawyers had argued during the trial that he should be granted leniency on account of a history of
mental illness but a medical panel appointed by the state later rejected this argument after
reviewing his case. In this case, the nature and degree of the mental disorder, namely paranoid
schizophrenia, is such that the person’s reason was alienated. It is difficult to translate the
terminology of legal judgments into clinical corollaries but the mental disorder had been such that
it played an overwhelming role in determining the occurrence of the offence. In this case, the
person is suffering from a psychotic illness and there is a direct link between positive psychotic
symptoms (delusions and hallucinations) and the act committed. If evidence had been presented
in this trial, it would provide information contributing to the area of forensic psychiatric assessment
and would address the aspects of mental disorder and circumstances leading up to the event.

An appeal challenges both his conviction and his sentence. The grounds for appeal include
the court’s failure to consider any evidence of his mental health problems. This case is highly
sensitive because of the strong reaction by the religious right to blasphemy cases. It is not my
intention to oppose the blasphemy law — I believe that Allah is one and incomparable, and that
Prophet Mohammad (PBUH) is the last prophet of Allah. However, my professional oath demands
and ethically binds me to help in saving the life of a patient and that the case gets thoroughly
investigated so that an innocent person does not become the victim of a misplaced judicial process.

The findings of the mental evaluation will become evidence in Mohammad Asghar’s trial
and whether he was legally insane at the time of writing letters in which he had claimed to be a
prophet. The High Court is expected to re-examine the medical evidence and decide if the verdict
is not guilty by reason of insanity. Mr Arshad suffers from paranoid schizophrenia and his medical
history and psychiatric report from his consultant psychiatrist, Dr McLennan, confirms the
diagnosis in this case. If defence applied the ‘McNaughton rule’ and proved that Mr Arshad, at the
time of committing the act, was labouring under such a defect of reason — from disease of the
mind as not to know the nature and quality of the act he was committing or, if he did know it, that
he did not know what he was doing was wrong, then rules state that a person cannot be held
responsible for a crime, creating grounds for insanity. Considering that Mr Asghar is still suffering
from mental disorder and is presenting with acute psychotic symptoms, i.e. paranoid delusions of
prophethood at the time of examination, he could be committed to the psychiatric hospital and
detained under the Mental Health Act. If Mr Arshad is found to be insane, he can be released to
go back to Scotland. His consultant psychiatrist, Dr Jane Mclennan, has confirmed that in the
affidavit dated June 10, 2011, which was submitted to the court during the trial, that she would be
happy to have him admitted in her care in the Royal Victoria Hospital. He could theoretically be
released one day if doctors determine his sanity has been restored. However, if the verdict is guilty,
Mr Arshad may be sentenced to death or spend the rest of his life in prison without the possibility
of parole.

The stance finally taken by the American Law Institute on the insanity defence in 1965,
which states that a person is not responsible for criminal conduct if it is the result of mental defect
or illness, is essentially the same as Islamic law. Islamic law states that a crime is not a crime
unless there is the intention of doing it. Thus, an insane person is considered to be lacking intention
because of a disturbed thought process, and so is not liable for the crime committed. Prophet
Mohammad (PBUH) said, “Allah’s commands exclude those who are asleep till he wakes up, and
the young until reaching puberty, and the insane till they become mentally competent.”

The law has important implications for the lives of all citizens, including those who are
mentally ill. The laws governing the treatment of mentally ill people give a clear indication of a
country’s attitude towards such people. The relationship between a society’s attitude and the law
is a dynamic one, and a two-way affair. On February 20, 2001, the Pakistan Mental Health
Ordinance came into effect and the Lunacy Act of 1912 consequently stood repealed. The 2001
ordinance promised to bring about significant changes in the law relating to mentally disordered
persons with respect to their care and treatment, management of their property and other related
matters but it did not include any clause relating to insanity and diminished responsibility. The
Mental Health Ordinance 2001 does not answer the crucial question of the extent of the criminal
and civil liability of people who are mentally ill, which means that the law on this matter has to be
sourced from other sources of criminal and civil law.